The Rather Big Matter of the State Medical Doctors Strike and our Profit Driven Medical Industrial Complex

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)

‘Resistance is Futile?’ Zimbabwe’s New Age of Tokenism.

By Takura Zhangazha*

The 'extractive' approach of the Zimbabwean government towards its citizens has never been more glaring. From the increases in toll gates, through to the further taxation of vendors and continued eviction of new farmers for grand projects and the default privatisation of education or health services at all levels,  it is evident that the state is in no way people centered. 

It is functioning like a big corporation that looks at its citizens and their economic placement more as cannon fodder for not only economic experiments ala carte the state capitalist models imported from China but also in order to reign in potential political dissent or a desperately needed new political consciousness.

The unstated intention is to develop a system of indisputable permanence of not only the ruling party’s reign in power but also making allegiance to it the only way one can either have an economic livelihood or at least political protection.

Put simply, the intention is to make peaceful resistance and active objection futile or at least token.  Whether it be from opposition political parties (who in their current state are too disorganised to win any foreseeable general election.) Or with civil society where it seeks to enhance human rights which are increasingly appearing to only be granted not in terms of democratic principle but by arrogant government benevolence.

This also extends to private businesses that have to contend with dealing with a state patronage system to acquire tenders or even stay afloat.  Where government has been in crises it has sought funding on the basis of extending either operating licenses or threatening to cancel them if businesses refuse to comply. 

So even if a company sought to function on the basis of transparency and the law, it would however need to consider its profit motive as a priority and therefore find it easier to comply with whatever demands government puts to it. 

The media is also no longer spared, particularly after the formation of the Information and Media Panel of Inquiry (IMPI).  It is navigating a difficult terrain in relation to seeking reform but only at the benevolence of government. 

To this extent the media has had its ‘fourth estate’  and ‘best public interest’ role undermined by its new found proximity to the Ministry of Media, Information and Broadcasting Services.  Unlike previous years, it is no longer just the state media, but also the private print and radio media that has now also sought, especially in terms of its own business interests, expansion via multi-media ownership. 

While the quantitative expansion of the media in Zimbabwe is welcome and long overdue,  its lack of a qualitative dimension leaves a sour taste in the mouth over media independence and credibility. A development that makes democratic principles that should govern our society compromised.

As it is, the combination of our government’s state capitalism economic model (ZimAsset), its patronage system with business, occasional benevolence toward civil society and editorial interference with the media, one can discern a revived systematic intention to make dissension futile or token.   Especially if the dissent challenges the structural frameworks of the current system as determined by Zanu Pf. 

In order to stem this new approach to socio-political and economic developments in Zimbabwe, there is need for citizens, civil society organisations, the media and opposition political parties to return to the democratic principle source. 

This would entail a shift from ‘incrementalism’ (the new constitution) and short term opportunism (reacting to crisis e.g house demolitions, extended taxation) to longer term principle based planning and civic engagement to stem the impunity with which government is functioning. It also means providing organic and therefore alternative frameworks to existent government policies which feed into a holistic social democratic assessment of our country’s challenges going forward. 

In all of this, we would need to get over the politics of entertainment, even if most of our celebrities are political leaders. There is more to our existence as a country that transcends pending but predictable political party congresses, succession debates and character assassinations based on no more than malice.

While we are permitted to enjoy and entertain ourselves as to the factionalism in most political parties and the evidently overdue succession process to President Mugabe, we should be wary of losing sight of the real issues negatively affecting a majority of the population.  Where we do so, we contribute to the establishment of a hegemonic permanence in similar fashion to Angola, where whatever bad thing the ruling party does, it appears, resistance is either futile or token. 

*Takura Zhangazha writes here in his personal capacity (takura-zhangazha.blogspot.com) 

Vanavevhu's Community Based Approach to Youth Empowerment in Bulawayo

 Visiting Bulawayo is always an enriching but very real experience.  I have done so at least three times this year for work related reasons.  In between the workshops and the meetings one always gets a chance to chat with old or new friends about what is going on in the City of Kings and its environs.

By way of serious discussions of socio-economic and political issues affecting it with  civil society activists, journalists and entrepreneurial groups that are working hard to improve the livelihoods of the residents of Bulawayo, one can come to terms with our second city's realities.  

One such organisation I came across is called Vanavevhu. It also uses the acronym, V2 for their entrepreneurial division.

Founded by a colleague Elizabeth Mhangami, in 2010 its mission is essentially to assist orphaned and vulnerable youth in Bulawayo to be able to learn not only life skills but also pursue self reliance through organic farming,  cottage industries as viable small businesses. 

In this regard, it undertakes not only training of young persons in organic farming, beekeeping  and scented candle production  but also how to market and sell the end products of their hard work.  All of these products are made on site at their operations site in Douglasdale, 12 kilometers outside of Bulawayo.  

Not only for sustainability and nourishment but also in order to give the young members a conducive environment for them to complete their formal education while at the same time learning  life-skills (sexual and reproductive health, life choices), household management, financial savings and entrepreneurship/marketing. 

The most salient feature about this organisation is not so much its charitable appeal but the model that it seeks to utilise to empower these youths both socially and economically. 

It is essentially a community based and driven approach of identifying youth headed households that require empowerment not only by way of social support  but also by providing an alternative life learning framework for the youths that are involved. 

Because it is not a handout organisation, rules of engagement are established with the direct participation of the young persons.  These include how to support each other in times of crisis, how to be transparent in accounting for work done and how to be good marketers of products to local industry and residents. 

The key catchphrases in these activities are community support, self-reliance,  and entrepreneurship of the youth.  No loans are given.  Everyone works for their upkeep and that of the organisation.  Financial and production matters are handled in an open and transparent manner while socio-psychological support for the participants are provided for by the able staff at the institution. 

It is a holistic approach to dealing with the challenges that young people in Zimbabwe, particularly those that are socially and economically vulnerable face.  The values of building an enabling community environment combined with an entrepreneurial spirit help the participants to view their life challenges with optimism and perhaps above all, a  plan of empowerment. This is because on average the students at Vanavevhu come in for three years and have to leave for greener pastures in order to allow others a chance at learning. 

My visit therefore, brief though it was,  helped me come to terms with a different model for youth empowerment.  It is one that is based on community goodwill and concern for the future of Zimbabwe's young citizens in a difficult and exclusionary economic environment.  Not by way of giving direct aid or politicisation and abandoning them but by also assuming responsibility for their future as self reliant citizens.  Especially where it is done with an intention to assist them to undertake economic activities that directly benefit them with a strong element of social responsibility to not only each other but also the society in which they live.

This is a model that central government, local authorities and the corporate world would do well to examine seriously with an intention of supporting.  While it cannot compete with bigger agro-businesses in horticulture, it can help young people learn leadership, entrepreneurship, self reliance and community responsibilities as is the case at Vanavevhu. 

It may not be only to assist orphans and vulnerable children but also to assist those that are unemployed develop a new appreciation of what is possible to achieve even in dire economic circumstances and sometimes with limited skills.  

*Takura Zhangazha writes here in his personal capacity (takura-zhangazha.blogspot.com)