Kun på grund af penge fra udlandet er Zimbabwes sundhedssystem ikke kollapset. Landets økonomiske kurver peger nedad og på trods af voldsomme nedskæringer kæmper det offentlige med at finde penge til at betale sine ansatte.
HARARE, 11 August 2014 (IRIN): Zimbabwe’s deepening economic crisis is severely affecting the government’s ability to fund public health delivery and restricting poor people’s access to health care, economists, government officials and health experts agree.
The economy had shown signs of modest improvement under the government of national unity (GNU) between 2009 and 2013, when President Robert Mugabe and his long-ruling ZANU-PF party shared power with the opposition Movement for Democratic Change (MDC). But industry has been performing poorly and company closures have picked up since ZANU-PF won general elections in July 2013.
“It is not surprising that people’s right to health has been compromised by the state of the economy,” John Robertson, an independent economist based in Harare, told IRIN. “Health services are suffering a funding deficit because of the current economic crisis, which has worsened in the post-GNU period.”
As more people have been pushed into joblessness or working in the informal economy, the country’s tax base has dwindled and government is struggling to collect sufficient revenue to pay for public programmes and civil servants’ salaries, said Robertson.
Ruth Labode, a medical doctor who heads the parliamentary committee on health and is a member of parliament for the MDC, said that not only had government allocated too little to health in its 2014 national budget, but it was failing to fund that budget.
Cabinet allocated the health sector US$330 million (down from $407 in 2013), which amounted to 8 percent of the 2014 budget, while public hospitals were given $25 million for operations even though, by January of this year, they owed various suppliers $33 million.
Heavy dependence on donor funding
Labode told IRIN that by the end of July the government had disbursed less than 20 percent of the budget money allocated to public health. She explained that the public health sector was receiving most of its funding from the donor community under the Health Transition Fund (HTF), a $435 million multi-donor pooled fund established in 2011 and set to expire in 2015.
The fund, which is managed by the UN Children’s Fund (UNICEF) Zimbabwe with donations from several European Union countries and UN agencies, aims to improve maternal and child health and nutrition, as well as ensuring the provision of essential medicines, vaccines and basic medical equipment.
From 2003 to date, Zimbabwe has also received more than $707 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Last year, the Fund approved a $555 million grant to fight the three diseases between 2014 and 2016.
“Without the donor community, our public health system would have virtually collapsed given that it is funding the majority of our health programmes,” said Labode.
She noted that the HTF pays for the purchase of 98 percent of the currently available drugs, while the remaining 2 percent are paid for by a levy on taxpayers managed by the National AIDS Council (NAC).
She added: “What we are getting from the donors has helped avert a big disaster in public health, but it is important to note that it still remains inadequate. There is no way donations can adequately cover a whole country’s needs.”
“Patients are left to die because they cannot afford tertiary care services. The service providers have withdrawn their services or are demanding cash up front”
In a press statement in May, Labode said the government’s inability to adequately fund public health had forced hospitals to deny the poor access to health care: “Patients are left to die because they cannot afford tertiary care services. The service providers have withdrawn their services or are demanding cash up front.”
She said health service delivery had also been crippled by corruption such as theft of drugs and equipment from hospitals, and the flouting of tender processes by hospital officials for personal gain. In addition, she said, “the migration of trained labour has hit this sector more than any other.”
Shortage of nurses
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