3-mob.com 
Doctors have handed in to the Minister of Health and Child Care Dr Obadiah Moyo, nine grievances and suggested solutions to the crisis in the country.
A strike has become a possibility after various challenges exacerbated by the current mayhem in the country.
We publish the communication in full below. Doctors will meet the minister later on Monday to discuss them.
The Zimbabwe Hospital Doctors Association (ZHDA), its members and the National Executive Committee have long-standing grievances that affect service delivery to our patients, and have resulted in the deterioration of quality of health care nationwide. These have been previously raised, but have recently been compounded by the prevailing economic conditions. It is our duty therefore to present these issues advocating on behalf of our patients, our members and the entire health sector.
This document contains a detailed list of government doctors’ grievances as well as suggested solutions as of the 9th of October 2018. These were summarized in a letter written to the Health Service Board Chairperson on the same day, copied to the Minister of Health and Child Care, and the Minister of Finance and Economic Development for their urgent attention. The grievances and suggested solutions, in no particular order of importance, are as follows:
1. Unavailability of resources (Drugs and Equipment) – this grievance was raised in several communications since February this year. We were assured that USD 22mil had been allocated to procure drugs and equipment, and that in July supplies would improve. What is on the ground is contrary to this, and patients have to buy medication from private pharmacies, which also have run out of stock and/or are demanding US dollars.
Suggested solution: – we implore the government to prioritize the health sector in allocating foreign currency, and to seek aid from its international partners. It may be prudent to declare a state of emergency in our sector.
2. Staffing and establishment – it is common knowledge that our hospitals are understaffed, especially concerning clinical staff i.e doctors, nurses, pharmacists, radiographers and lab technicians. This grievance was raised in February this year, and the establishment was said to be being reviewed but to no avail.
Suggested solution: – we implore the government to unfreeze critical posts and increase the current establishment and staffing levels. If the personnel are not available, an overtime or locum allowance should be payable to those doing more work than they are warranted to do.
3. Remuneration – we note that after the announcement of the fiscal and monetary policies, prices of basic commodities have increased remarkably and shortages have started. Also, the sellers prefer foreign currency and some are not accepting RTGS currency. In addition to that, the Collective Bargaining Agreement 2 of March 2018 states that our salaries are paid in US dollars. As of this month, our members were paid in RTGS and cannot access basic goods and commodities, let alone travel to work.
Suggested solution: – we implore the government to pay salaries in US dollars as previously agreed. Furthermore, we request non-monetary incentives such as fuel to be available to our members and the civil service at government prescribed rates. Most hospitals have fuel tanks.
4. Health Service Bipartite Negotiating Panel – according to Statutory Instrument III of 2006, the panel consists of a government side and a workers’ side. The workers side is selected by workers. Earlier this year, the then Minister of Health and Child Care violated this regulation and prescribed representatives for workers without prior consultation from Apex. This has led to doctors having no representation in that forum.
Suggested solution: – we implore the ministry to review this, rescind it, and consult Apex so that we reconstitute the HSBNP lawfully and start negotiating with immediate effect.
5. Working hours – in February, we raised that the government had not prescribed working hours for middle level and senior doctors. In this time of shortage of staff, this has led to some doctors being overworked without compensation. The last time we checked (in July this year), we were informed that the Director of Curative Services was working on this, but to date there has been no official communication.
Suggested solution: – Middle level doctors should work for not more than 10 calls per month, each lasting no longer than 8 hours and any extra to be paid as locum. One cannot be expected to do a continuous 36 hour shift as this compromises quality of care
6. Reference systems and Casualty – in some central hospitals, junior doctors are the first point of contact with the patient. This affects quality of care because junior doctors should work under supervision. Whilst we understand that this may be due to short staffing, it is our role to protect patients at all costs and ensure quality of care.
Suggested solution: – Casualty should be manned by SHOs/HMOs in that specialty. If their hours are beyond prescribed working hours, they should be compensated as locum.
6. Reference systems and Casualty – in some central hospitals, junior doctors are the first point of contact with the patient. This affects quality of care because junior doctors should work under supervision. Whilst we understand that this may be due to short staffing, it is our role to protect patients at all costs and ensure quality of care.
Suggested solution: – Casualty should be manned by SHOs/HMOs in that specialty. If their hours are beyond prescribed working hours, they should be compensated as locum.
7. Health Service Board vs. Health Service Commission – in the 20th century, an enquiry into Zimbabwe’s Health Sector and how to improve it was made. A repeat enquiry was made also in the 21st century. The findings of both enquiries concluded that our health sector requires a Health Service Commission, but instead a Health Service Board was put in place. This board is not independent in both policy and finances.
Suggested solution: – we implore government to dissolve HSB and setup a Health Service Commission that runs independently.
8. Health Insurance – we note with concern that most medical aid societies have branched into providing medical care for their clients. Examples include PSMAS and PSMI, CIMAS and CMAS clinics, and CELLMED. This brings about conflict of interest and ultimately poor patient care. Furthermore, the returns to government hospitals are minimal if any.
Suggested solution: – we implore government to have a comprehensive National Health Insurance for every citizens, to ensure access to health for all. Furthermore, may the government put in place laws prohibiting insurers from being service providers.
9. Hospital Administration and Policies – we often hear of hospital policies that we have never seen documented anywhere. Also most members feel that the incumbent administrators are not health-oriented, as evidenced by their lack of a medical background and the haphazard running of hospitals (e.g procurement of drugs being done by general hands). In addition to that, there is always a blame game between government and administrators in terms of funding or finances.
Suggested solution: – review all administrators especially in central hospitals. Appoint medical personnel into managerial posts (CEO, Operations etc). We also implore the government to change from decentralization of funds to devolution. Let each hospital run its own operations, remitting nothing to anyone.
We hope these grievances will be looked into with the urgency they deserve, and solutions quickly put in place. Members are agitated and frustrated by working under deplorable conditions.
ZHDA NATIONAL EXECUTIVE
Comments
Loading…