Online Reporter
There has been a continuous and very effective upgrade of the entire public health network under the Second Republic involving building more clinics and hospitals, increasing staff and ensuring that the doctors and nurses are ever better qualified and have more skills, making sure equipment and other requirements are in place, and ensuring that medicines and medical supplies are adequately stocked.
It has not been an instant process, but progress has been continuous for more than six years across the full ambit of the public sector, which a large majority of Zimbabweans rely on and which is now moving into the lead for certain critical services.
The expansion of the basic primary health network tends to grab the headlines, since it has seen that significant expansion, especially in rural areas.
Rural district councils and central Government have been the source of devolution funds and equipment as they cooperate to make real the commitment to ensuring everyone is within 5km of a health centre.
There are still gaps, and some now oddly enough in cities where the expansion of residential areas has not been matched by the commissioning of new health and educational facilities, despite the considerably higher levels of city financing compared to most rural areas.
But the list of the new clinics, super-clinics and hospitals is growing and almost every week now we hear of a new facility being commissioned as work that started a year or two ago reaches its conclusion.
At the same time, more and better equipment is being moved into the public hospitals and clinics, and the logistical systems to ensure medical consumables and medicines are readily available where they are needed are now largely working.
We have moved beyond the stage where patients’ families had to provide so much.
Of course, none of this would mean much unless the whole public health system was adequately staffed at all levels, from nurse aids and community health workers all the way up to specialised nursing teams and qualified and experienced specialist physicians and surgeons, which means the brain drain has to at least be slowed right down and, hopefully, some of those who have gained experience outside the country have come home.
A sign of the upgrade at the top-end has been the 41 successful heart operations at Parirenyatwa Group of Hospitals this year, just six months after such surgery resumed with the first heart operation for some years done in the middle of last year.
This required reassembling and rebuilding a specialist team and making sure it had the back-up it needed. Such a team is not just a casual assembling of staff, but needs to be in place and to gain experience as a team to be effective.
The next stage, planned for next year, is to increase the number of heart operations to between 100 and 150. This will require some upgrade of facilities, with the hospital now looking at a 10-bed cardiothoracic intensive care unit and high dependency unit, as well as other back up.
At present heart surgery patients recover in the general intensive care unit which limits numbers that can be operated on.
The cardiothoracic unit needs to move above 100 operations a year to ensure that the team maintains its very level of skills, and as it moves into this range it can also start the teaching work that must be done if specialist staff are prepared to take over as time goes on, and in any case Zimbabwe must need more than one such unit if all patients who need surgery are to be operated on.
We still see a fair number of Zimbabweans travelling outside the country, principally South Africa and India, for heart surgery, which explains why there is a waiting list of only six months for the sole Zimbabwean unit.
But as people become confident that their own doctors and nurses can do the work, and the hospitals are properly equipped, then obviously a high proportion of those needing such surgery will elect to have it done at home at considerably lower cost.
We have seen some other high-end surgery, such as the separation of conjoined twins, as well as what can now be seen to be routine emergency surgery, with that helicopter ambulance service making sure that patients now arrive on time for this high-end surgery to be most effective, another of the upgrades.
President Mnangagwa has been pushing the upgrade process, wanting a decent and efficient public health system that can be accessed by all Zimbabweans.
The private health sector has made a significant contribution to health, but its range is limited to those with adequate financial resources, either to afford the services or to at least pay the high monthly premiums needed in the health insurance and medical aid schemes that give full access to such private care.
A sign of most developed countries, and now more and more developing countries, is that public sector can handle just about everything, and private health care is mostly concerned with private hospital rooms and nicer food, rather than making sure essential services are in place.
Funding is getting better. Next year the health budget moves to 13 percent of all Government spending, just below the African target of 15 percent and so putting Zimbabwe very high on the list.
As the economy keeps growing, and so tax revenue automatically increases, ever more resources become available and so the public health sector becomes ever better.
But we have already, under the Second Republic, moved a long way along the path for a complete and functioning high level public health system, one that reaches the people and then can treat almost every ailment that the people reached may suffer from.
