Scale up 2020 health budget, govt urged

BY VENERANDA LANGA/NUNURAI JENA

GOVERNMENT has been urged to craft innovative and sustainable healthcare financing policies and protect the poor and vulnerable groups through implementing a comprehensive national health financial strategy.

Community Working Group on Health (CWGH) executive director Itai Rusike said this in his 2020 CWGH national health strategy budget paper.

Rusike noted that Zimbabwe’s health sector was grossly underfunded compared to neighbouring countries in the Sadc region to the extent that government in 2019 spent US$41 per capita (per person) on health, which is grossly inadequate.

“Government spends a relatively small share of its gross domestic product (GDP) on health care and the lower levels of per capita health expenditure indicate that health expenditure in the country is insufficient to guarantee adequate access and quality of healthcare,” Rusike said.

“Per capita health allocation stands at about US$41 in 2019 up from US$31 in 2018, while per capita health spending is US$650 in South Africa, US$90 in Zambia and US$200 in Angola, and the inadequate public financing of health has resulted in an overreliance on out-of-pocket and external financing, which is highly unsustainable,” he said.

With the prolonged strike of medical doctors at Zimbabwe’s health institutions, poor people are the worst affected because they can not access medical treatment from private institutions.

Rusike said what made the country’s health situation worse was the fact that most of the health financing was donor sourced, which is unsustainable.

“Development partners are expected to complement the 2019 budget appropriations. The Global Fund, for instance, is expected to provide US$75 million. The high dependency on external financing is unreliable, unpredictable, unsustainable and highly dependent on the political environment, raising concerns on the sustainability of health financing and the vulnerability of government’s budget should external funding be withdrawn,” CWGH director said.

Rusike said the main sources of health financing in Zimbabwe are employers (28,4%), followed by households (25%), external financing (24,9%) and government at the lowest at (21,4%).

“There is an over-reliance on out-of-pocket and external financing. Out-of-pocket payments by households have driven many households deeper into poverty. The high dependency on external financing is unreliable, unpredictable, unsustainable and highly dependent on the political environment, raising concerns on the sustainability of health financing institutions and the vulnerability of government’s budget should external funding be withdrawn,” he said.

Rusike said donor funding was dwindling owing to global economic constraints, and, therefore, government must respect the Abuja Treaty requirements that health should get at least 15% of the National Budget.

He said high out-of-pocket spending in health has turned many households poor.“The free user-fee policy for pregnant women, under-fives and those aged 65 years and above has not been backed by resources and has resulted in over-crowding at the tertiary institutions. Moreover, the blanket cover does not look at ability to pay,” he said.

Rusike adjudged the health situation in the country as currently in a critical situation due to macroeconomic instability.“Public health sector allocation stood at 8,9% in 2019. Employment costs, however, constitute 66% of the total health budget. The Abuja 15% target remains an elusive target for the country. The sub-Saharan African average is 13%. As of 2015, Rwanda was spending at least 23% of its budget on health care,” he said.

On shortages of health personnel, Rusike said high drop-out rates in public sector health care posts have resulted in vacancy rates of over 50% for doctors, midwives, laboratory and environmental health staff, exacerbated by the fact that Zimbabwe’s nurses’ establishment was last reviewed in 1983 yet the population has increased significantly.

Meanwhile, acting general treasurer of Zimbabwe Hospitals Doctors’ Association Peter Mungofa said most doctors were now considering job opportunities in other countries as government has failed to meet their demands.

“Nothing has changed despite President (Emmerson) Mnangagwa’s chilling threats. What has changed is that doctors are enquiring about going to work outside the country and our fear is that very few doctors will remain in the country,” Mungofa said.

Mungofa said they were shocked by Mnangagwa’s threats when they thought he was going to resolve the issue of salaries and doctors’ conditions of service.