Why is Zimbabwe’s health sector crumbling?

In mid-March Zimbabwe’s public sector doctors stopped working – the second time in three months – citing a critical shortage of drugs, equipment and consumables in hospitals, a development that they said not only reduced them to the sordid role of merely certifying deaths, but made them complicit in patients’ mortality if they were to continue pretending that all was well. 

“As consultants, our hearts bleed because of what is prevailing [in the country’s hospitals] and feel that if we continue pretending we can offer full services, we would be complicit in the deaths of our patients,” the country's senior doctors said in a statement announcing the start of their industrial action.

The disgruntled doctors worked at the country’s five referral hospitals. They said they would only attend to emergency cases, citing poor and inadequate medical supplies. In January, junior doctors went on a 40-day strike over similar concerns. It was the senior doctors who persuaded them to return to work and to allow the government breathing space to fulfil its promises. 

The promises included an improvement of the doctors’ monthly salaries from $100 (RTGS$329) as well as improve the supply of hospital consumables in addition to replacing obsolete equipment, some of which is more than 40 years old. The government promised to put $25 million towards the urgent needs of the health sector, but did not bother to meet its side of the bargain, forcing the senior doctors to take up the issue themselves.

At a meeting to address their concerns, the senior doctors gave harrowing stories of the dire situation in the country’s hospitals —  from having to clean deep wounds on burnt victims – including children – without first putting them on any pain-killers, to how bandages are washed so that they can be re-used, and to how patients suffer nosocomial infections inside the hospitals where there are no sterilisers, disinfectants and detergents, let alone protective clothing for medical staff who move from one bed to another in the crowded hospitals. 

“There is no urgency, there is no priority, people are not listening to us,” said a tearful Dr Azza Mashumba, the head of the Paediatric division at the Parirenyatwa Group of Hospitals at a meeting in mid-March called by Health Minister Obadiah Moyo to avert the strike. “I have written a million lists, I have knocked on a thousand doors, I come to work and I do my very best, but my outputs are stillbirths, my outputs are disabled babies.” 

Such were the harrowing accounts given by the doctors, who described how people are dying from treatable diseases at government hospitals owing to the shortage of basic medical equipment, medicines and other accessories.

“We start them [patients] on chemotherapy and in two weeks, the syringes are finished. We interrupt treatment, then we restart and it doesn’t work. What have we done for them? There is no urgency; I am here because I am desperate. I have tried, we have tried, but I feel we are not being heard. We need to move … we are not working,” Mashumba said.

Dr Faith Muchemwa, a plastic and reconstructive surgeon in the burns unit at the same main referral hospital, narrated how nurses are forced to wash used bandages with their bare hands so that they can be re-used, putting their health and those of the patients at grave risk.

“At the burns unit, there are no basic sundries and medicines. We have no bandages; they wash bandages and hang them in the bathroom and reuse. Obviously, they are not sterile. We have seen so many infections in the burns unit,” said Muchemwa.

“The health personnel have no protective gear to prevent cross infections. This is despite the fact that we are dealing with open wounds and pus. Patients are dying more than ever because we are operating once every two weeks,” a despondent Muchemwa added.

The senior doctors highlighted that the persistent shortage of basic essential drugs, equipment and sundries – one of the major grievances that had culminated in the junior doctors’ strike – remained unaddressed. 

“As consultants who were and are concerned with return to normalcy, we stepped in and persuaded the junior doctors to return to work in good faith that our parent ministry would improve the supply of the basic consumables,” the doctors said in their statement. “However, the situation with regards to medical consumables and equipment is now even worse than it was in December 2018.” 

This, the doctors said, has continued to severely compromise the safety and working conditions of medical staff as well as “compromised patient care, putting patients’ health and lives at risk at the very institution which is supposed to restore health and life.” 

With 98 percent of medical drugs coming from donors, the health sector is not a priority for the government, which regularly spends generously on presidential junkets and other luxuries while threatening the unhappy health sector professionals. 

Just like in the days of former president Robert Mugabe, the leaders themselves seek medical treatments abroad as the facilities at home are hopeless. Zimbabwe has only three doctors for every 20,000 of its citizens.

The government always blames all the country’s woes on the targeted sanctions that the United States of America and other Western countries have imposed on Zimbabwe’s leaders for nearly two decades as a way of forcing them to improve their human rights record. 

“This [videos of weeping doctors that have gone viral on the social media] has been useful for the world to know that we are working under tough conditions as a result of the sanctions imposed on our country by the United States through ZIDERA [Zimbabwe Democracy and Economic Recovery Act],” Moyo, the health minister, told the state-run Herald newspaper.

“I wish that video could also reach the United States President Donald Trump so that he can be able to see the catastrophe which the sanctions have caused on the generality of Zimbabweans,” he added. 

The minister himself, a long-time sidekick of former president Mugabe, has had difficulties endearing himself to development partners having failed to shrug off charges of being an academic and medical impostor, after being exposed as having masqueraded as a medical doctor for decades when he is a mere laboratory technician.

However shortly after the senior doctors joined the junior doctors in highlighting the dire situation in the public hospitals, Moyo summarily dismissed Dr Thomas Zigora and Dr Nyasha Masuka, the chief executive officers of Parirenyatwa Group of Hospitals and Harare Central Hospital respectively, on flimsy charges of being late to a meeting with him. It was believed the dismissal of the heads of the country’s two major referral hospitals is part of a purge against senior medical personnel that have been questioning Moyo’s suitability to turn around the country’s health sector given his background of fake qualifications.

In early May, Hospital Doctors Association of Zimbabwe (HDAZ) Spokesperson Dr Mxolisi Ngwenya revealed that none of the government’s promises – including a salary hike – had been fulfilled, so the junior doctors could be back on strike again any day from now.

“Nothing has changed,” Ngwenya told TRT World. “We called off the strike to give the government a chance to fulfill its promises, unto now, our salaries remain unchanged, drug supply remain critical and equipment is still dilapidated. It is clear that government was not negotiating in good faith.” 

The planned strike would be the third inside five months as doctors desperately seek to force the government to make it possible for them to provide service to patients.

Nurses are working for three days a week as the government cannot afford to pay them, while thousands others have been trained but remain unemployed as the government has frozen recruitment of public sector workers in an attempt to manage its wage bill. The public sector is bloated, mostly from ruling ZANU-PF party officials, war veterans and their children that make the bulk of the ghost workers that continue to strain the state coffers.

A 2011 comprehensive payroll and skills audit done by Ernst & Young on behalf of the ministry of Public Service revealed that there were over 75,000 ghost workers on the government payroll.

Meanwhile a group of citizens, led by journalist and filmmaker Hopewell Chin’ono has started a Save Our Hospitals Zimbabwe initiative to mobilise resources to bring some level of normalcy to the country’s hospitals. The initiative involves mobilising all types of resources from Zimbabweans based both at home and abroad.