Crisis in Zimbabwe health sector deepens

AUDITOR-GENERAL (AG) Mildred Chiri has exposed the rot in the country’s healthcare sector, which has failed to procure ambulances between 2019 and 2020 and faces serious understaffing and equipment shortages.

Zimbabwe is facing a serious health crisis, according to Chiri’s audit report on the 2021 Utilization Accounts, Financial and Revenue Accounts and Fund Accounts.

Her report comes at a time when South Africa is accusing Zimbabweans of overburdening the neighboring country’s health facilities.

In her report, Chiri said the Harare government dental center, the country’s largest referral center, is operating at capacity with insufficient human resources and equipment.

“I found that dental service delivery was negatively impacted as the healthcare facility was operating below capacity. The health facility did not have sufficient human resources, financial resources, infrastructure and equipment,” Chiri said, referring to the dental center.

“During my visit to the healthcare facility, patients were turned away because dental equipment was not available to perform the required dental procedures.”

The facility, which provides oral health services to patients and offers training and internships for dental technicians, therapists and assistants, requires eight dental chairs and eight mobile dental carts, but only has one at a time.

It also requires four autoclaves (sterilizing equipment), four air compressors for dental procedures, and two dental X-rays, but it had none. The dental center also has no water and electricity supply.

An analysis of human resources showed that in 2019 63% of the employees were employed in the positions, but this number dropped to 53% in 2020.

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The health facility offered training for dental therapists and assistants, but the number of students had declined significantly, a situation that could result in the country having no therapists.

“The facility was supposed to train 30 therapists every year, but 15 therapists were trained in 2019 and 10 therapists were trained in 2020… The delivery of services to the citizens has not been effectively provided as only a limited number of patients are cared for. The country could end up without therapists if the number of trainees continues to fall each year,” said Chiri.

The facility’s management claimed that the Ministry of Health hired the Ministry of Finance for financial assistance.

That being said, a public-private partnership between Nyanga District Hospital and Nyaradzo Funeral Assurance Company has not been legalized and remains an oral agreement, Chiri noted.

“Previously, I reported that Karoi District took a long time to submit medical aid application forms to medical aid societies. The hospitals in Marondera, Bindura and Karoi had medical aid application forms for the Premier Service Medical Aid Society and the National Social Security Authority which were rejected and had not been followed up.

“In 2018 I reported that Masvingo and Gweru provincial hospitals did not support creditor balances because they did not keep creditor records. The situation is still the same,” she said.

Chiri uncovered unsupported spend at 11 healthcare facilities visited in 2018, which resulted in $160,295 in spend that was not fully supported by source documents such as requirements, invoices or receipts, and goods receipt notes.

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Nine health care facilities visited in 2018 incurred US$143,154 in expenditures without obtaining competitive bids and subsequent settlement plans.

Also, healthcare facilities did not have service level agreements in cases where goods and services were sourced from a single supplier.

For the year ended December 31, 2020, Headquarters, Harare Dental Center and Government Analyst Laboratory did not maintain complete and correct accounting records in relation to the Health Services Fund.

According to the report, the segregation of duties in accounting was not observed at the Government Analyst Laboratory and the Harare Dental Center during the reporting period.

“The officer responsible for receiving the receipts was the one who did receipts, banking, updating the cash book and preparing bank reconciliations. In addition, the officer in charge of approving requests at the Harare Dental Center was also responsible for certifying and sharing receipts for payments,” Chiri said.

The health sector crisis is likely to escalate further as Zanu-PF lawmakers push for the passage of the Private Voluntary Organizations (PVOs) Amendment Act, which is likely to drive donor funding out of the sector.

Finance Minister Mthuli Ncube gave only 14% of the 2022 state budget to the Health Ministry, leaving donors to fill the gap.

Health experts speaking to NewsDay yesterday said that if non-governmental organizations (NGOs) were banned, the health sector would be paralyzed as the sector gets nearly 85% of its funding from NGOs.

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The president of Zimbabwe’s private medical and dental practice, Johannes Marisa, said Zanu-PF’s remarks were just political banter as Zimbabwe could not survive without NGOs.

“It’s just political rhetoric. There is no country that can run without NGOs, which remain very important because they contribute very significantly to the growth of the health sector. Donors are the ones who also give incentives, especially in the rural areas. We cannot afford to ban these NGOs in a developing country, especially here in Zimbabwe,” Marisa said.

Enock Dongo, President of the Zimbabwe Nurses Association, said: “Let’s put politics aside and be realistic. If we look at our economy in Zimbabwe, there is no way we can sustain the Ministry of Health without the help of donors and NGOs.

“For political reasons it is not fair to talk about the donors in the Department of Health as they are non-political. We have not heard of any donor pushing a political agenda related to the Department of Health. These donors only play a role in social responsibility, they even help in rural areas,” Dongo said.

Health expert Setfree Mafukidze tweeted: “Nurses in Zimbabwe are receiving child support from NGOs because the government cannot afford it. 85% of the Ministry of Health is funded by donors.”

Health Department spokesman Donald Mujiri said: “Donors contribute a lot to the health sector. The Treasury can give you an exact figure on how much they contribute.”

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