Hardly three months after junior doctors agreed to end their strike and begrudgingly returned to work, consultants (senior doctors) at Parirenyatwa Group of Hospitals have decided to scale down their services and only attend to dire emergencies. We can call this a partial strike for lack of a better term, seeing that the doctors will sometimes go to work, but, only to attend to very serious emergency conditions.

Limited resources

This is not the first time professionals in the health sector have complained of lack of proper resources. Nurses and junior doctors have raised the alarm several times before. Last year, junior doctors’ representatives had to be taken to Natpharm as government attempted to prove that drugs and consumables had been procured. History is repeating itself as senior doctors are crying foul over the exact same problem. “…the situation with regards to medical consumables and equipment is now even worse than it was in December 2018… We are now forced with immediate effect to further scale down the services which we are offering, to deal with dire emergencies only until the situation normalises. The currently available resources might not be able to sustain the emergency service provision beyond the end of the month,” said the senior doctors in a letter to their Group Chief Executive Officer. “As consultants, our hearts bleed because of what is prevailing and feel that if we continue pretending we can offer full services we would be complicit in the deaths of our patients,” the letter went on. It looks like their request to meet the Minister of Health and Child Care has quickly been attended to as a meeting is currently believed to be on the cards.

Budgeting problems

From the onset, the healthcare sector seems to have been allocated inadequate funds in the 2019 budget and we are already feeling those effects. Permanent Secretary in the Ministry of Health and Child Care Dr Gerald Gwinji revealed that their ministry needs at least $1.387 billion annually in order to work optimally. Government only allocated $694.5 million in their 2019 budget. Speaking to the Parliamentary Portfolio Committee on Health and Child Care, Dr Gwinji lamented the over-reliance on donor funding. Currently donors are funding more than 50% of our health needs and that funding is mainly in HIV/AIDS. If the lack of adequate funding from government continues, the donors will get the impression that we are not serious about our health needs as a country. In any case, donor funding is not always guaranteed. It depends on the goodwill of those granting it. We have seen the United States of America cutting down on aid since President Trump took office. This goes to remind us that we have no say on how much donor funding we want and will get.

Misplaced priorities?

It is fair to say that our roads have been in need of major repairs for a long time now and government is showing a lot of zeal in dealing with this problem. Recently, they announced that $1 billion would be spent on roads rehabilitation. Yes, a reliable road network is a key ingredient in economic growth as it improves mobility. However, spending $1 billion on roads at a time when hospitals do not have essential drugs and consumables is both ill-timed and misplaced. Considering that some of this money is coming from the recently introduced 2% tax on electronic transfers, we expect money to come in every day. If we were to use just half of this $1 billion to procure consumables and drugs for hospitals, we will get rid of half our problem. Moreover, we know that the foreign currency that government retains from exporters is used to fund essential needs. Surely, healthcare is one of them. Funds should be directed towards that.

According to the latest World Health Organisation (WHO) data for 2018, our life expectancy is 61.4 years and we are ranked a poor 162 in the world. Although we are improving, we are still a long way to go. However, a look at the major causes of death tells a story. Our top causes of death are mainly health related. These include HIV/AIDS, pneumonia, coronary heart diseases, stroke and the like. This tells us that we need to pay greater attention to our healthcare in order to reduce the mortality rates and improve our life expectancy. Road traffic accidents are cited as another cause of many deaths in the country but we need to prioritise and fund strategically. We cannot use up all the money on roads at the expense of healthcare.

Abuja Declaration and MDGs

Signed more than a decade ago, the Abuja Declaration targets that nations should allocate at least 15% of their total budget to healthcare. This is a test we continue to fail dismally. Our 2019 allocation to health translates to 8.6%. The Sub Saharan average is 11.2%. Even using that measure, we are still below average. In fact, we have been for a while. In 2015 we were at 6.57% then went to 7.46% in 2016, 6.88% in 2017 and 5.84% in 2018. Rwanda is already around 24% There are other success stories but, we are not one of them. Because of this, we cannot claim to be doing well in the progress towards attainment of the Millennium Development Goals (MDGs). We continue to grapple with HIV/AIDS, child mortality, malaria and other diseases. Last year, Cholera outbreaks reminded us just how fragile and underfunded our health sector is. We ended up relying on donations again.

So, here we are. Our healthcare professionals are going on strike not because they want more money, but because their employer is failing to support their employees with adequate tools with which to do their work.