Chiwenga should act on health licence fees

REGULATORY authorities are some of the major cost drivers of health service delivery in our country.

With health financing mainly out-of-pocket, achieving universal health coverage (UHC) becomes a pipe dream.

Health service providers are left with no option except to increase their tariffs in the face of strangulating fees that are charged by regulatory authorities.

Municipalities and councils are squeezing the little juice left in the medical practitioners through charging unjustified fees in the form of operating licences.

There are many issues which I think the Health and Child Care ministry should consider in its endeavour to deliver health, if we are to achieve UHC.

The viability of health delivery service depends on the 2007 World Health Organisation building blocks which include health workforce, financing, medicines, governance, service delivery and information systems.

The public health delivery system is facing insurmountable problems, a majority of which revolves around the issues of human resources and medicines.

Patriotic medical practitioners at least deserve some respect in this country. Nevertheless, some see their clinics and surgeries as opportunities to economic stardom.

The Health ministry should know that the operating environment is not very friendly to medical practitioners. The toxicity is at its worst at the beginning of the year when numerous licence fees are demanded.

City councils smile to the banks as they collect licence fees. A snap look at some of the fees charged show that Marondera Municipality requires about US$800 in permit fees, Victoria Falls (US$1 145), Harare (US$640), Chitungwiza (US$632), Ruwa (US$1 000), Norton charges $290 000 per quarter and Kadoma charges $390 000 for surgeries.

I salute lawyers who stood firm against councils that wanted to peg licence fees for their practices. Yes, lawyers argued that their operations were governed by the Law Society of Zimbabwe and they were not applying for shop licences.

Medical practitioners are accountable to the Health Professions Authority of Zimbabwe and their operations should not be interfered with by councils as long as they pay their monthly rates.

Why are permit fees pegged without consulting relevant stakeholders? Why are the charges so punitive yet medical services are regarded as very critical needs? Bulawayo City Council has done very well in terms of charges and it should be applauded for attracting investment in the health sector.

The behaviour of some of our councils is detrimental to the entrepreneurial spirit that President Emmerson Mnangagwa always preaches about.

I believe the Health ministry has an obligation to develop its members in the country. The medical aid industry has been dominated by powerful societies that have muscled out and outcompeted smaller players.

The threat of entrants seems to have died down, given the application and registration fees for newcomers which are US$500 and US$15 000, respectively.

Raising such amounts to start a medical aid society (MAS) is a mountain to climb, especially at this juncture when there is a serious liquidity crisis in the country.

This amount is a deterrent for starters and is only there to sap all the energy from prospective participants. Only 10% of Zimbabweans are medically insured, leaving about 14,6 million people without medical aid.

Many informal workers are not on medical aid and it would be good to attract more players in the medical aid industry in a bid to reduce costs.

We have many players who appear in the medical field and demand very big pieces of the cake, which I think is not fair considering that health service delivery should be affordable.

Many private practitioners have been hounded out of business in the country because of unfair practices.

MASes are pushing many practitioners out of business by merely failing to pay their dues. The Health ministry is the regulator and licences are generated from the head office. There is now a perennial problem of non-payment, but the same MASes are given their operating licences despite their incessant failures.

How do we expect low health service charges when the service providers are not paid for the services they render?

Does Health minister Constantino Chiwenga know that civil servants are struggling to get medical attention because the Premier Service Medical Aid Society has not been honouring claims for a long time?

Radiographers and radiologists were recently moaning about the exorbitant licensing fees charged by the Radiation Protection Authority of Zimbabwe (RPAZ).

How on earth could regulation fees for Computed Tomography, Magnetic Resonance Imaging and X-rays be close to US$4 000? A general practitioner who runs an X-ray and ultrasound scan is expected to pay US$1 200 as licensing fees to RPAZ.

How can the prices of basic medical investigations go down when such amounts are required by officials who are merely sitting in their offices? The end result is high costs of medical care and it will be a hearculean task to achieve UHC.

I believe government should be in the know that we are being charged exorbitant fees.

Medical practitioners have not known peace with councils demanding exorbitant charges that are not warranted.

One wonders who is behind all these measures that strangle the few remaining and patriotic health practitioners in the country.

It is my hope that all such contentious issues be addressed by central government through the Health and Child Care ministry.

Central government should consider the plight of its workers and all those who are in the health sector. Monitoring health regulatory bodies is one step in correcting the mess that is prevailing today.

We expect the parent ministry to act when we raise such complaints as key stakeholders in health service delivery in Zimbabwe. No to corruption!

    Johannes Marisa is president of the Medical and Dental Private Practitioners Association of Zimbabwe. He writes here in his personal capacity.