By Dr David Okello
Recently Zimbabwe hosted the 67th Session of the WHO Regional Committee for Africa in majestic Victoria Falls. It was an uplifting experience to see all health leaders from governments in the continent and partners united.
The leaders placed health of the people at the centre of development endeavours not just in words, but showed that they care. Opening the Session and welcoming delegates, the President of Zimbabwe, His Excellency R.G. Mugabe stated, “Let us therefore push health to take its deserved prominence on our agendas in our sub-regional groups, at the African Union level and indeed on the global stage”.
President Mugabe also noted that Africa is disproportionately represented on the global disease burden for communicable and non-communicable diseases. “We must ask ourselves why this is so and more importantly, what can we do to arrest and reverse these trends.”
In this vein, let me highlight the thrust of current health development efforts. Achieving Universal Health Coverage (UHC) has become a dominant policy preoccupation within the global health community.
The concept of equity remains central to UHC, as it is embedded in the overarching principle of the Sustainable Development Goals (SDGs) “leave no one behind”. But achieving equity calls for innovation, and population tailored approaches; and in general UHC is not cheap. Therefore, investing in research to identify contextually feasible options and a path to UHC should remain a matter of critical concern to all of us.
In Zimbabwe, the impact of economic challenges on the health sector is quite familiar to us all. No doubt, we need to interrogate the impact of the changing environment and how to adapt to it. In this regard, there is a need to consider how the health system can withstand and be resilient in the face of an economic challenge, while still striving to expand access to services and ensuring readiness to respond to public health threats.
Considering the fiscal constraint, due attention should be given to building resilience at the district health systems level. As we all know, previous efforts on strengthening district health systems are yet to provide convincing and sustainable results. More work and evidence is therefore needed on what works best at that level.
Another crucial issue in Zimbabwe is the role of the private sector in provision of healthcare services; and how we should fully exploit their potential in moving towards UHC. In a resilient health system, private health care provision will coexist with public health services. But private health care services must be regulated to also provide training, monitoring, supervision and technical support; and should enable public sector workers to earn a living through a structured part-time arrangement.
Efforts must be made to enforce standards and quality of care in the private healthcare sector, however. For instance, we must find ways of ensuring that treatment guidelines for conditions of public health concerns (e.g. guidelines for TB, HIV/AIDS, STIs, and Malaria treatments) are made available and adhered to in the private healthcare sector. Presently, these guidelines are mainly enforced in the public sector.
Health research, in this regard, is critical to facilitate practical solutions to ensure strong national health systems for the delivery of health care within the overall goal of achieving UHC and the SDGs. Despite its importance though, priority is not given to health research and data, which results in low investment. As such, research must be considered a priority and must be locally driven, relevant and appropriate for the national and local circumstances.
Considering the above, what then can be considered as policy options and priorities for Zimbabwe?
During economic contractions, recurrent expenditures (paying for salaries, medicines and basic maintenance) often take precedence over capital investments. However, Government and partners in the health sector could still find ways to maximise resources and reduce costs – particularly to ensure that the policy positions and national health strategy that are already in place are fully implemented. Therefore, going forward, the following priority actions should be explored:
First, efforts must be made to keep expanding the fiscal space for health. Crises often present unexpected windows of opportunity to access extra resources for health, reform health systems, adopt unusually bold actions and take on ingrained special interests for the greater good. The pending introduction of Social Health Insurance schemes should be implemented in phases to ensure the programs are resilient to economic shocks. The insurance schemes will reduce out-of-pocket financing, particularly for vulnerable populations by eliminating user fees.
Second, Global health security remains topical issue given what we have learnt from the Ebola Virus Disease (EVD) outbreaks in West Africa. Clearly, diseases have no borders. For that reason, there is need to build global health security. We need to strengthen public health programs and surveillance mechanisms against communicable diseases to avoid disease outbreaks and possible epidemics. Related to this is the emerging problem of antimicrobial resistance (AMR) which will have costly implications for service delivery. We need to make all efforts to combat AMR.
Third, due attention must be given to the increasing burden of non-communicable diseases; including cancers, diabetes mellitus, road traffic injuries and mental health. To this extent, we should conduct surveys on NCDS to better understand the burden of the disease, the role of risk factors and pollution of the environment. We should also mobilise adequate domestic resources to address the emerging NCDs epidemic.
Fourth, the health sector in Zimbabwe must endeavour to take advantage of the spread of recent technological advances such as mobile telephones and finance, to create opportunities for the introduction of more cost-effective health interventions such as telemedicine, strengthening monitoring and surveillance.
In the quest for solutions to the challenges in the health sector and as we forge ahead towards Universal Health Coverage, the actors in the sector should also actively engage other sectors as solutions to some of the challenges may be found readily in those sectors.
*Dr David Okello is the Representative of the World Health Organisation in Zimbabwe