By Takura Zhangazha*
Medical doctors at government hospitals last week announced
that they would embark on an indefinite strike on Monday 27 October. This, after their demands for a review of
their salaries and working conditions have not received what they consider an appropriate
response from the Ministry of Health and Child Welfare.
This is however not the only immediate challenge facing our
health delivery system. Medical Aid Societies
under the umbrella Association of Health Funders of Zimbabwe (AHFOZ) are also having their own differences with the same
ministry and private hospitals over payment rates that they remit for their
clients.
The main reason this latter development has raised a lot of
dust is because it is the private hospitals that have the best treatment facilities
and therefore attract the most patients who are willing or will eventually pay their
hospital bills. They are also at the heart
of our booming medical industrial complex whose primary motive is profit before
all else.
Both developments point to a health services provision system
that is in its own intensive care unit. Except
perhaps that the experts and policy makers attending to it may be ill equipped to
deal with it. Or their intentions may
not be as ethical as one would expect.
In the first instance, the responsible ministry has tended
to have an approach of seeking to sweep things under the carpet. This is largely due to its inept responses to
the state medical doctors demands through to its lack of a long term
sustainable reform of the public health sector to make it affordable and accessible
to the majority poor.
Instead government has sought largely to inconsistently commercialise
public health while at the same time relying on donor funding to keep it afloat.
This has meant strenuous conditions for medical personnel in
state hospitals and in the long run, compromised health service delivery for
low income earning patients. As with the
private hospitals, personal money is the key to full treatment of the sick. One may get admitted but there is no guarantee of proper treatment unless you or your family have money to pay for
drugs or specialist services.
This is why the state doctors strike must be taken seriously
and resolved with urgency. It is
symptomatic of the ‘it will fix itself’ approach government has to health
services provision.
And this is an attitude that has perhaps been learnt more
from the private hospitals and AFHOZ. As
with state hospitals but with much more evident disdain for human life, it is
the money that matters. Hence the
private clinics are the loudest in condemning the medical aid companies for not
fulfilling payments of their clients.
The bigger question that emerges is that of the extent to which
it is a profit matrix that appears to be falling apart. Where the issue at hand is not so much the
negative impact this has on the provision of health services even to those on
medical aid, but keeping the profit margins high. This is particularly so for the medical aid
societies (companies) who have been reported in the media as giving their executives
ridiculously high and disproportionate salaries. All of which is done with alarming impunity
and arrogance.
Because private health services provision has a literally permanent
market due to the dilapidated nature of state hospitals, these disputes between
the medical aid societies and the private hospitals can only be deemed as one
of fighting over larger pieces of the cake.
As opposed to seeking to work to improve the quality of service, its
affordability (even for profit) and accessibility to many.
So we have a dangerous cyclical health crisis characterised by
doctors/nurses strikes, state inefficiency and disregard of citizens’ right to
health and the profit motive of competitive but without innovation private health
players.
What is therefore urgent is an overhaul of the health
service provision system in the country to put the patient at the heart of the
process as opposed to just profit. This
would include structural changes to public health administration such as
ensuring an integrated local health delivery system with a central one, departing
from hotchpotch commercialisation of state hospitals and ensuring a broader
engagement framework with medical professionals in the employ of the state on
their working conditions.
Furthermore there is need to place a cap on the profit
motive of private health services players and introduce a broader ethical regime
that values human life more than it does the business aspects. This is particularly so for medical aid
societies and their relationship with both state and private hospitals.
Above all else, government must tackle its complicity in the
existent medical industrial complex with greater fortitude.
The standards of service at state hospitals
is what has led to flourishing of private services that rely on the ineptitude
of the former to make a profit and have the arrogance to turn poor patients
away. And even further arrogance to be involved in a
public spat about medial aid society remittances to private hospitals and
doctors.
The state is therefore the primary reason why there are
problems in health service delivery. Its scant attention to the structural challenges
of the health delivery sector only to emerge in pretence at putting out fires
that were not only foreseen but evidently cyclical are compromising the Zimbabweans’
right to health and therefore life.
*Takura Zhangazha writes in his personal capacity
(takura-zhangazha.blogspot.com)
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