Improving national health delivery

Economic Dialogue with President Emmerson. D. Mnangagwa
The recent economic challenges have not spared our health sector. The strain has shown by way of medicines which have either been unavailable, in short supply, or unaffordable.

This adverse situation has obtained in spite of Government efforts to keep stocks of vital, essential and necessary medicines in our clinics and hospitals at an average level of about 54 percent.

A stable health environment is a people’s right and a key social pillar of our Vision 2030.

Vital and essential medicines are what sustain our national primary healthcare system, which we run through clinics and district hospitals.

This level of health care and intervention is our first line of defence when it comes to national health. It should never fail and should be strengthened always.

Our Ministry of Health and Child Care has isolated 19 drugs which must always be in stock and available in clinics and hospitals to underpin our primary healthcare.

In addition, Government ensures adequate stocks for drugs for communicable diseases like HIV/Aids and tuberculosis, and for malaria.

To date, we have registered remarkable success in containing communicable diseases, even becoming a global model on best practices. Vital medicines reach all our clinics and hospitals through distribution channels of NatPharm, our central warehouse for pharmaceuticals and related products.

NatPharm’s supply-runs to community clinics, district and provincial hospitals must always be regular and predictable for an efficient health delivery system.

Our partners have also weighed in to complement Government efforts in delivering health services to our people. We thank them for their support.

My Administration has ensured that we are able to offer free health services in certain critical areas, as well as taking care of the vulnerable. The same collaborative, community-based and focused approach has been demonstrated in containing the recent outbreak of cholera in some parts of our country, principally in urban areas.

Development partners and corporates have played an outstanding role. Today the cholera threat is largely contained; but its harsh scars remain on our Nation, and its painful lessons are there for all to see.

Never again should we be found wanting in building and maintaining infrastructures necessary for delivering safe services to our communities.

They deserve better and should always get the best from us.

The shame of so literate a society succumbing to such a medieval disease should never be suffered again.

The ongoing medium and long-term measures now underway in various towns and cities should forever end the shame.

We have made a decision to make basic health services available and affordable to all our communities. Yet this laudable decision to offer free health services has had a telling impact on national drug supplies.

There is an upsurge in demand for basic health services, all against our limited resources. Our economy, though on a definite rebound, is not yet out of the woods.

The pressure on health services grows stronger as one scales up the ladder of healthcare, beyond the primary level.

Both at secondary and central healthcare levels, drugs generally become relatively less available and more costly.

Equally, donor support begins to decline more and more. Donors have tended to confine their support to primary health care level. Everything else is left to Government.

This is especially so in respect of non-communicable diseases (NCDs). Yet NCDs are increasingly becoming a bigger menace to our people, possibly because of changing lifestyles.

NCDs require expensive medicines for care and treatment. We used to manufacture more than 80 percent of our drugs. Our pharmaceutical industry used to be very strong and competitive, even well-reckoned within the region and beyond.

I am talking of heydays of pharmaceutical manufacturers and enterprises like CAPS, Datlabs, Pharmanova, Varichem and many such drug manufacturers.

We have since lost that capacity and have become a net importer of essential drugs. This we must reverse.

For that reason, our healthcare system is now exposed to external shocks and to the ups and downs of our economy.

We need foreign currency to import medicines. Foreign exchange earnings are a function of our ability to export.

Therein lies the challenge.

At no time has this turbulent link between the state of the economy and the availability of drugs and other pharmaceutical products in the country been so direct and impactful as in the past weeks during which our economy has registered sharp shocks and challenges.

Although we are slowly creeping out of this economic trough, the negative impact this bad patch has had on the healthcare sector is still being felt. The drugs supply situation in the country had deteriorated, with many key drugs either unavailable, unaffordable or in short supply.

In the majority of cases, these drugs which are mostly imported, were now being sold in hard currencies, thus adding an additional burden on the sick. This is unacceptable.

There are things we have to do to check, arrest and reverse these adverse developments, and to stop their recurrence.

Principally, foreign exchange releases to the health sector must be upped initially, and then maintained at levels which avert stock-outs. Our disbursement decisions must rest on an understanding that health is a human need which thus cannot be postponed without endangering human life.

Key facts and figures immediately stand out. Over the years, our importers of essential drugs have accumulated a debt of about US$27 million. Today these importers’ creditworthiness in the eyes of their foreign suppliers is very low. The debt has accumulated largely because of scarce foreign currency for foreign payments.

We thus need a double thrust on this front, namely dealing with the legacy debt in the industry, while meeting current drug needs and stocking for the future.

The figures before me show that recent disbursements by the Reserve Bank of Zimbabwe have largely been swallowed by the legacy debt, with very little going towards fresh orders of pharmaceutical products with which to meet current demand, let alone for restocking.

In the immediate and interim, we must use our national drug store facility, NatPharm, which is the least encumbered, as our vehicle for placing fresh orders for medicines, while we tackle the legacy debt.

Where foreign drug suppliers have local agents who may be incapacitated to import for reasons already cited, some arrangements may have to be reached with NatPharm so we move speedily to plug the import gap.

In other cases, drugs may have to be imported through Government-to-Government arrangements, with the responsible ministry, supported by the ministries of Finance and Economic Development, Foreign Affairs and International Trade, and Transport and Infrastructural Development, moving with speed to secure arrangements, and to move drugs to stabilise the situation in the shortest possible time.

NatPharm requires about US$60 million to stabilise the drug supply situation in the country. This will be made available while we mobilise funds to retire the legacy debt so as to reopen relations with foreign suppliers.

This week we will host the Vice-President of India. India is a key drug supplier to us.

Government hopes to take full advantage of this fraternal visit to explore possibilities on pharmaceutical supplies on the back of government-to-government arrangements.

Likewise, we will engage other governments with supply capacity at good value for money.

Our scope of engagement with friendly governments will go beyond drug imports. We will explore ways to reboot our capacity for the local production of essential drugs as before. Pharmaceutical drug manufacturers led by CAPS have to be resurrected. This means retooling them and twinning them with good equity partners.

I am happy that discussions between CAPS and a prospective partner are at a very advanced stage. Before long we will celebrate a retooled and operational CAPS which should recover its past glory as a key drugs supplier in the region and on the continent.

Similar companies like Varichem, Pharmanova, Datlabs, as well as NatPharm’s proposed manufacturing subsidiary, NatMed, must, likewise, be supported.

There is a huge market for drug manufactures on the continent where only a couple of nations have manufacturing capacity.

Many Zimbabweans are turning to foreign countries for specialised healthcare.

This is very expensive for our Nation.

Zimbabwe’s healthcare is not competitive, relative to similar services in other countries, developing or developed. But the story goes further than affordability.

It is also about sparse skills in the country, and about poorly-equipped health facilities.

Yet what we end up spending on foreign care more than doubles what we need to build these specialist skills, and to equip and stock our specialised hospitals for more advanced interventions.

A few examples illustrate my point:

◆ We only have three heart surgeons in the whole country;

◆ We have seven neuro-surgeons, mostly based in Harare;

◆ We have one diabetologist, even though an estimated three million Zimbabweans suffer from diabetes;

◆ We can’t do vital organ transplants; and

◆ We don’t even have a national organs register.

The story goes on and on.

Yet we have a very healthy base of general practitioners, surgeons and physicians who, with a small fraction of what we spend on medical tourism, we could easily turn into specialist physicians. The time has now come for us to do just that.

As I write, the Ministry of Higher and Tertiary Education, Science and Technology Development has completed a national skills audit. Except this is in very broad, generic terms. I now want each sector, the health sector especially, to derive and develop from this broad audit, sector-specific skills audits which should help with our overall national skills development planning.

Gone are the days where we just receive any scholarships on offer from friendly countries.

We must now spell out areas of skills need which are reckoned in terms of our development vision and priorities, and the numbers we aim for, so we seek scholarships that build national capacities in areas of greatest need.

The health sector must blaze a new trail in this regard.

Much more, the skills strategy must be encompassing. By definition, medical work is collaborative. What this means is that whichever key skill we target must develop alongside supportive skills in related disciplines.

Hard on the heels of this must be a programme of equipping our facilities with modern medical gadgets which those skills require to function.

The old Department of National Scholarships which we are restructuring will be a key vehicle for this broad national skills strategy. Our provincial and central hospitals are needlessly clogged by cases which in fact should be dealt with at lower levels.

Our inability to ensure that institutions at primary level are adequately staffed and provided with core competencies has created this impossible situation where provincial and central hospitals are no longer referrals for complicated cases requiring specialised interventions only.

Poor working facilities and conditions are to blame for this collapse in the national referral system which should serve us well.

Add to this the absence of trauma facilities along our highways where traffic accidents are frequent. Illustratively, any serious traffic accident cases along the Harare-Chirundu Highway will have to be rushed back to Chinhoyi and Harare!

This is quite typical on all our highways. We have lost many lives as a result.

We now need to revisit our whole institutional healthcare chain, both by way of spatial distribution and the deployment of key competencies across these institutions.

There is a lot more which is needed in the health sector than I have been able to cover in this article. I have not, for instance, dealt with the key area to do with national health insurance.

This vital link in the health delivery chain has all but collapsed. Yet it ensures our citizens are assured of care, both during their active lives and later on in life.

Health insurance is a key area for collaborative investment action by both the public and private sector. It requires major re-mapping. What I have done in this instalment is merely broach key points for a conversation which cannot wait any longer if our Vision 2030, by which we aspire to be an upper middle income economy, is to be realised.

Beyond pressure points of the day, we need a broad vision that gets us to the end-state we desire. We have many experienced practitioners in the health sector. Our medical schools are churning out hundreds of bright junior doctors. So, too, are our institutions for training nurses, and allied skills.

All we need is to harness this brain power for far-reaching policy decisions and actions.

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