Zimbabwe’s public health sector is remarkably good considering all the demands that are made upon it but the administrative and management weaknesses, highlighted in a report by the Parliamentary Portfolio Committee on Health and Child Care, must be addressed urgently and should incorporate more best practices from around the world and the private sector.
We stress that the professionals running the sector have a firm grip of the purely professional matters. The huge gains made in the 1980s have largely been maintained. If an epidemic hit Zimbabwe we are confident that those in charge of public health would know what to do.
Professional standards are high and continual training plus encouragement for health professionals to upgrade their qualifications indicate that they will remain high.
Financially the very serious problems have been partially alleviated by some sensible policies along with a modest injection of foreign aid, with the health sector at least appearing to be largely free of the dirty sanctions hitting Zimbabwe. And the fact that external agencies are prepared to give aid strongly suggests that they believe the aid is being, in general, properly used.
The Parliamentary committee, however, has done some hard digging into the management and administration of the public health sector and has found many weaknesses.
These tend to be weaknesses which hit, or have hit, many other health systems around the world.
The debates on public health in most developed countries centre on the need for greater efficiency, better use of the huge sums spent, and very often quite radical changes to how public health is run.
Private systems, in Zimbabwe and in other countries, have faced similar problems and a lot of good practices have been developed that can, and often should, be adopted for public systems.
There are two different sorts of work for those who run health systems, hospitals and the like.
First there are the medical decisions. No one wants to see bureaucrats or anyone besides health professionals making decisions on how patients should be treated, on how diseases are to be fought, and generally making pure medical decisions.
But there is the other side, the need to create and maintain sound management, the need to create logistical chains, the need, in general, to ensure that the health professionals have a smoothly run and well run system to operate in and that every dollar collected for health services is effectively used.
In fact a whole new profession of medical administrators has arisen, some being health professionals retrained as administrators but others coming from other backgrounds.
These new professionals do not make medical decisions, but they provide the support and services those who do most definitely need and, critically, are found in the top echelons of health services working side-by-side with the top ranks of the medical professionals.
The portfolio committee’s report should be studied in this light.
The Minister and his top professional advisors should not be too proud to acknowledge where other talents or other skills are required and should seek ideas from those who have them.
No one, we again stress, wants to change the policy of having medical professionals running the ministry and the public health sector.
But we must also ensure that they are properly supported.