/ 20 September 2013

Parirenyatwa has another go at it

Bouncing back: David Parirenyatwa says he has big plans for the ­country’s health sector.
Bouncing back: David Parirenyatwa says he has big plans for the ­country’s health sector.

Most will remember David Parirenyatwa as the minister who presided over the worst cholera outbreak in the country's history, in which more than 4 000 people died.

That was during the height of the 2008 economic collapse.

The ­government declared a national emergency, paving the way for international humanitarian organisations to send aid.

Now, after a five-year absence from government, the not-so-new minister of health is back in office, and this time said he had "big plans" for the country's health sector.

In 2008, Parirenyatwa left his ministry not only facing a cholera epidemic but also a collapsed health sector characterised by a massive exodus of health professionals, shortages of drugs and medicines, broken life-saving equipment and the closure of hospitals.

Perhaps as an indictment for everything that had gone wrong, Parirenyatwa was left out of the inclusive Cabinet.

Reopening closed hospitals
He was replaced by the Movement for Democratic Change's Henry Madzorera, under whose tenure — like many social sectors of the economy — saw some measure of improvement, including the reopening of closed hospitals.

These successes in the health sector are largely attributed to the increased support from the treasury and increased international partnerships.

It is estimated that international partners invested more than $600-million in the health sector in the past five years.

The Mail & Guardian sat down with Parirenyatwa, who said that what happened in 2008 was in the past and, right now, he was the right man for the job.

When asked whether his ministry was planning to regulate the operations of medical societies amid recent concerns about their alleged lack of transparency, their inability to make timeous payouts to healthcare providers, as well as contributions that are ­perceived to be exorbitant, Parirenyatwa said that asking his ministry to oversee medical aid companies would be too huge a responsibility.

But, he said, the government is keen to facilitate the formation of an independent regulatory authority to monitor the operations of the medical societies and the private sector.

Anything right?
I asked whether the inclusive government had done anything right in his ministry.

He acknowledged that progress had been made, particularly in maintaining the decline of HIV prevalence rates and improving morale among health workers to deliver.

This was something he said he would maintain. "It is important to support what has been happening. We want to see what we give back to the patients. This involves looking at all the spheres, from drug supply, patient care, professionalism that is given by the medical staff and alertness to communicable and noncommunicable diseases."

An issue of concern was the low level of staff at most health institutions.

About 2 000 newly trained nurses are ­failing to secure employment in ­government hospitals because the ministry of finance froze the ­hiring and replacement of nurses, citing financial troubles related to the country's high wage bill for civil servants.

This has meant that the few health staff who were available were seriously overworked.

Problem of staffing
Parirenyatwa said addressing the problem of staffing issues would be a major focus of his administration.

"Clearly we must have an unfreezing of posts. The establishment has not changed in the health delivery system since 1980 and we believe that it's high time to expand our establishment and engage more people."

When asked about the promise of free healthcare that the old government had made, Parirenyatwa said he would continue with efforts to relieve the burden of the cost to the most vulnerable groups in society. He did not specify where funds would come from.

"Everybody must pay or be paid for, so it's a question of who pays for who," he said.

"I believe that we must look very kindly at children under five, ­pregnant women and people over the age of 65. These are very ­vulnerable groups. Our maternal mortality rate in this country is extremely high, so we must give pregnant women ­priority and user fees should not be a hindrance to giving them adequate care.

"We will look at a situation where we have cross-subsidies: those who can pay must pay and those who can't pay, for whatever reasons, the state must look after them."

No faith in local health facilities
President Robert Mugabe appears to have no faith in local health ­facilities — he often flies out to Hong Kong and Singapore for even minor medical treatment.

Equipment for specialised treatment such as dialysis and radiotherapy in government ­hospitals is almost constantly broken, or in some instances has become obsolete.

Parirenyatwa said his ministry has already "begun a compendium of what kind of machinery is required per institution".

Another concern is that there are not enough machines available, so hundreds of people who need specialised treatment must wait for months to get it.

"I have already met with all the central hospital chief executive officers and provincial medical directors from the provinces so that they [can] tell us what is missing in their institutions. We will use these lists to mobilise resources. It is my hope that the media can help us in our mobilisation efforts by publicising our needs when the right time comes."

Health issues such as diabetes, obesity, hypertension and cancer are becoming endemic in Zimbabwe, Parirenyatwa said, and they too are a priority for his ministry.

"We are going to be very rigorous in dealing with these noncommunicable diseases, which are caused by lifestyle issues such as heavy drinking and smoking and poor diets."

Perhaps it's too early to tell whether Parirenyatwa should be given a ­second chance, but looking at the government's history of not delivering services in key areas, many Zimbabweans will certainly not be holding their breath.