Zimbabwe is on the verge of a massive health crisis, as internal documents from the Health and Child Care ministry have revealed that the country cannot stock adequate drugs and is left with only two weeks’ supply due to erratic foreign currency allocations and gross underfunding by Treasury.
According to the ministry’s strategic documents and a presentation made by Health minister Obadiah Moyo that were exclusively obtained by CITE, availability of medicines is at “overall 26% against a target of 60%”.
Both the private and public health sectors are battling stock-outs of critical drugs, the documents showed.
Shortages of drugs, particularly at public hospitals, worsened around September last year after Finance minister Mthuli Ncube announced a cocktail of austerity measures.
Ncube’s interventions, which included a two percent tax on electronic transactions were meant to stem an economic collapse, but instead, they spawned the collapse of the bond note surrogate currency, which has now morphed into Real Time Gross Settlement (RTGS) dollar.
The resultant currency chaos led to acute shortages of medicines, basic commodities and fuel.
Four months later, junior doctors went on a month-long strike protesting against a lack of equipment and medicines at public hospitals.
The government only convinced the doctors to return to work in early January after Moyo made assurances that drugs would be made available, but information obtained by CITE shows that the situation is dire.
“The level of medicines (availability) in both the public and private sector is a serious cause for concern, characterised by stock-outs of certain commodities and less than two weeks cover for others,” reads a presentation by Moyo at the ministry’s strategic retreat early this year.
“Availability of medicines is at overall 26% against a target of 60%, (stocks) of vital (drugs) is 30% against a target of 100% and (stocks of) essential (drugs) is 24% against a target of 80%.”
Moyo also revealed that only 22% of the needed medical sundries were available at public health institutions at any given time against a target of 80%.
“The above availability is heavily influenced by largely donor supported commodities for HIV, TB (tuberculosis), malaria and some reproductive health commodities,” he added.
Despite public pronouncements by Moyo that the Reserve Bank of Zimbabwe (RBZ) would provide foreign currency to the pharmaceutical industry to import essential drugs, the documents reveal that the funding remained at less than 30%.
“Availability of foreign currency is delaying procurements,” Moyo said. “Of the required foreign currency, we only received less than 30%.
“The RBZ had promised a weekly allocation of US$4 million towards the pharmaceutical industry.”
The revelations come amid reports that the government has for the last six months failed to allocate money to the National Pharmaceutical Company (Natpharm) for the procurement of drugs.
Natpharm, which is responsible for the procurement, warehousing and distribution of drugs in the country, has been waiting for funding since September last year.
Suppliers are said to be reluctant to supply the state-owned firm with the critical drugs because of the government’s poor track record in paying debts.
Moyo said the ministry was struggling to use instruments such as letters of credit because of Zimbabwe’s poor creditworthiness and that of banks involved.
Natpharm issued tenders worth $77 million to three companies to buy drugs, but the contracts, which are only valid for five months, are due to expire before the medicines are delivered.
At the height of the drugs crisis late last year, the government said it had set up a US $60 million facility for Natpharm to buy 100 tonnes of medicines from India.
As if the foreign currency shortages were not enough, the Health and Child Care ministry is battling a funding gap of $174.1 million this year.
In his 2019 budget, Ncube allocated the ministry $755,337 million and another $61, 37 million would be funds accrued through retentions.
The government expects to cover the gap through grants and donations from international funders, who according to the ministry documents were yet to make any commitments about funding for this year.
Zimbabwe is reliant on donors for 34% of drugs and commodity funding, the ministry said.
However, donors exclusively fund interventions for diseases such as HIV/Aids, tuberculosis and malaria, creating headaches for authorities in the health sector.
“The gap could be addressed by engaging development partners to consider other conditions besides the main three without creating heaving dependency,” Moyo suggested.
Other proposed solutions included “swaps with partners supporting the ministry” and “seeking financing mechanisms including government to government” agreements.
In 2017 the government introduced a health levy that is being used for procurement of blood stocks and laboratory stocks for hospitals, but it has so far proven inadequate.
The 5% tax on cellphone airtime first unveiled by the then Finance minister Patrick Chinamasa was meant to alleviate the shortage of medical sundries at public health institutions.
Documents in our possession reveal for the first time how the levy has been utilised with most of it going to the procurement of drugs, with $24, 7 million having been spent last year out of the $41 million raised during that period.
The procurement of blood and blood products ($4,8 million), medical equipment ($4,3 million), vaccines ($276 254), dialysis, laboratory consumables and payments to BOC Gases took up the other part of the levy, the documents showed.
A health committee was constituted to manage the fund.
Zimbabwe’s health delivery system, once touted as one of the best in Africa, has been crumbling over the years due to gross underfunding and a serious brain drain.
Doctors and nurses often go on strike while medicines are usually in short supply.
The previous administration led by former president Robert Mugabe froze the appointments of civil servants, including health workers, to cut a public service wage bill that had become unsustainable but Moyo believes it has become an albatross for the health sector.
“It is important that all vacant posts be unfrozen and a framework that allows posts to be filled soon after termination in order to ensure continuity in service provision at all levels,” the minister said in his presentation.
“It is proposed that a total of 3 230 out of the 6 875 vacant posts be unfrozen in 2019.”
The government is also under pressure to recruit staff to man newly established health centres across the country.
These include executive posts for new districts, which are Mbire in Mashonaland Central, Mangwe in Matabeleland South, Mhondoro Ngezi and Sanyati in Mashonaland West.
“These districts are currently operating with staff from other health facilities to the disadvantage of the communities,” one of the ministry documents revealed.
The government is also under pressure to create posts for nurse aides and general hands for 183 new clinics.
“Posts were not created for the nurse aides and general hands making it difficult for the nurses to clean the clinics as well as maintain the grounds over and above their mandate of caring for patients,” the document added.
“Resources were allocated for the construction of Lupane Provincial Hospital in Matabeleland North noting that it is the only province without a provincial hospital.
“Posts will have to be created for the outpatients department, hospital executive, pharmacy, laboratory radiography, administration and finance as well as human resources.”
The majority of Zimbabweans depend on public health institutions because services at private hospitals and surgeries are priced beyond the reach of many.
Health insurance is also a preserve of the few who are formally employed in a country where unemployment hovers above 90%.