'2020 marks death of public health system'

In the midst of severe economic unrest, the Zimbabwean healthcare system has been disintegrating and coming apart at the seams over the years and 2020 took it a notch higher with the advent of COVID-19.

As the curtain comes down on 2020, health stakeholders and workers reflected on the sector in the face of COVID-19 as well as the inherent challenges. Many said the year marked the death of the public health system.

Enock Dongo (Zimbabwe Nurses Association)
"We were the hardest hit as frontline workers. Nurses are the first port of call and that means increased exposure. When COVID-19 cases started being recorded in Zimbabwe, we had no clue as nurses about the novel disease. We were blank.  We had just read about it but lacked the appropriate knowledge to manage cases. A few trainings were done but many were not trained. We estimate that only a quarter received the training.

"Then there was the issue of personal protective equipment (PPEs). That was a huge challenge and a catalyst to industrial action by nurses because we were not protected. We had no gloves, gowns, basic drugs and no ventilators. Basically there were no resources to manage the cases. Patients with symptoms presented at health facilities were expecting us nurses to heal them but we were struggling. But gradually with time we started to close the gaps but to date the bulk of nurses have not been trained formally.

"Nurses were infected and we lost some in the line of duty. Now coming on the issue of salaries — that too was a big headache. 2020 was the worst in terms of poor remuneration. Government did not recognise that as frontliners we needed to be remunerated well. While everyone else stayed home under lockdown, nurses were expected to report for duty. This is despite the glaring challenges of transport. Only a handful of Zimbabwe United Passenger Company buses were on the road. Then most food outlets were closed and nurses had no access to decent food. Hospital canteens were also closed.

"So, when the new Health minister, Vice-President Constantino Chiwenga was appointed, we were anticipating positive change, but we were disappointed.  Since his appointment in August he has not met with us for dialogue. This has been a very hard year for nurses."

Itai Rusike (director Community Working Group on Health)
"The year 2020 has been unusual with so many disruptions - some challenges were COVID-19 related, while others were as a result of our own policy inconsistencies, inefficiencies and corruption.  COVID-19 negatively affected the running of almost all primary care services - with a number of urban clinics closed or offering limited services. Rural health centres remained open, but with limited access by communities as a result of restricted movements. Hospital care  remained severely constrained as a result of COVID-19 restricted access, but also largely as a result of the  lack of medication, hospital sundries and PPEs, labour withdrawals due to perpetual strikes by health personnel for improved wages and supply of PPEs.

"The year 2020 also saw the restructuring of Health and Child Care ministry that has caused a lot of anxiety, lack of job security, low morale and panic among senior health personnel."

Johannes Marisa (medical practitioner and NewsDay columnist)
"The COVID-19 fight involved health workforce and respective leadership. The strike by nurses went for almost 6 months while public hospitals were grounded. We should not forget that the dreaded COVID-19 was the main reason why PPEs were demanded by health workers. It was embarrassing that the Health ministry, directly or indirectly, was involved in the corruption saga around the procurement of PPEs. This was exactly the same time nurses and doctors were disgruntled about working conditions taking cognisance of the unavailability of PPEs.

"The public health measures introduced by government were of great importance as we managed to contain the spread of the virus. However, many are now complacent, which will be catastrophic considering the emergence of a new strain of coronavirus in SA, 501.V2.
Prevention is better than cure."

Fungisayi Dube (trustee Citizens Health Watch)
"The coronavirus pandemic has further incapacitated our healthcare system. 2020 marked the death of our public health system. We witnessed a further increase in maternal mortality and in July, there was an unprecedented number of stillbirths at Harare Hospital.

"Our health personnel have been on a perennial strike with no clarity on when their grievances will be ultimately resolved. The coronavirus has been with us for more than 9 months since the first case was confirmed, yet our institutions remain ill-equipped.

"COVID-19 has disrupted our sexual health rights responses, systems and provision of sexual and reproductive health services, leading to an increase in unplanned pregnancies, and maternal and infant mortality among other health challenges.

"Sadly, we still do not have an effective strategy and system that is in tandem with the new normal. 2020 has turned us back to archaic systems for handling maternal health cases.  Home births are the order of the day. Backyard abortions are on the rise. Unwanted teenage pregnancies have risen exponentially."

Shingai Nyaguse (Senior Hospital Doctors Association)
"At the beginning of the pandemic, a combination of lack of training and inadequate PPEs led to institutions and healthcare workers (HCWs) responding with fear to COVID-19 patients, which caused poor outcomes in some cases. As people learned along the way, things improved. As HCWs, wearing a mask and proper hand hygiene are now second nature.

"There was also a big impact on non-COVID-19 patients because of travel restrictions, reduced incomes, the cost of COVID-19 tests, and staff shortages as many HCWs had to self-isolate.

"The working environment remains difficult but COVID-19 will probably be with us for a while.  It is scary but we have to adapt."

Gladys Hlatshwayo (political analyst)
"The state of our hospitals is deplorable. Health personnel are not motivated, hospitals are not adequately resourced and have no basic equipment and drugs and mortality rates are going up. Zanu-PF has consistently failed to provide accessible quality healthcare for the citizens over the past 40 years that it has been managing the affairs of the State. We have entrusted our public policy to a bunch of looters who do not only loot resources meant for health schemes, but also rely on healthcare systems of other countries at the expense of the suffering citizens.  The fact that the Health minister frequently flies out to foreign capitals to access healthcare is a serious indictment on government's commitment to creating a robust healthcare insurance. Zimbabwe is in need of new stewards because the current leadership is not only corrupt but glaringly vacuous."

Alexander Rusero (political analyst)
"The health sector in Zimbabwe is a basic yardstick to measure whether we are a failed, a collapsed or a weak State. The core operation of the government of the day, democratic or non-democratic remains one of delivering essentialities of life to the people it presides over and one of the critical ingredients in that respect is health. That Zimbabwe is a failed State is out of question. For a government that does not panic when nurses and doctors are on strike, that does not care or even show an iota of concern, it resembles a failed State. In respect of health and other governance architecture, Zimbabwe remains a failed State. Talks of stability and recovery coming from top bureaucrats remain stuck in elitism and a kleptocratic crop far detached from the masses. For people who can't trust even locally produced drugs or institutions that they preside over to tell us of recovery is an insult to the national conscience.