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THE public health system has been rehabilitated and largely restored during the Second Republic with not just the basic health services in place, but some of the most advanced and surgical procedures, for example open heart surgery, now done.

There might be queuing, simply because so much can now be done at reasonable cost, and waiting lists for several procedures are not short, again because these can now be done in Zimbabwe and done in Government hospitals. 

But generally, the major difference between the public and private sectors is the degree of comfort for patients, with no large wards in private hospitals and fancier menus, rather than in the services that can be offered.

The already gazetted Health Services Amendment Bill is about to go through its Parliamentary processes of investigation and debate plus, almost certainly these days, some final polishing as legislators bring in improvements to what the technical medical staff in the public sector have already had drafted.

Among the measures proposed is a better link between the public and private health sectors.

These include a mandatory acceptance by private hospitals, laboratories and other services of public patients where this is the only realistic option. But regulations by the Minister of Health and Child Care will lay down the precise procedures and payment protocols, so they cannot be abused or manipulated and will not overwhelm the private sector. 

Basically the draft sees these as brief one-off referrals for certain laboratory and similar tests in exceptional cases, rather than as a routine matter. This exceptionalism is possible because of the major upgrade in the public sector and from other links laid out in the draft Bill. 

These seem to be there to cope in circumstances where the private facility is much closer than the public facility when there are life-threatening requirements.

In other words, the links between the sectors are not designed to be routine.

However, it has become apparent that there are some in both sectors who see referrals of public work to the private sector to be not just routine but unapproved and a way of making sure that some private facilities that may be struggling for customers can get this from public patients who have been wrongly and needlessly referred, and are expected to pay in full, and upfront, whatever fee the private facility demands.

One of the seven councils under the Health Professions Authority, the Medical and Clinical Scientists Practitioners Council, has unearthed a scam that sees some doctors and some nurses in public health facilities referring patients needing laboratory tests to a group of private laboratories, who even have bike messengers standing by outside the public facility to move the samples over.

The scam appears to have been unearthed during a broader investigation in private laboratories, which exploded in number during the Covid-19 alerts and with some of these new laboratories offering services whose quality needs upgrading and who have difficulty getting private referrals. It is also well-known that fees charged by private laboratories can vary immensely, with some charging several times the price that solid laboratories with plenty of referrals and often linked to a medical aid fund are charging. 

Presumably the respectable private labs are the laboratories that would be authorised in an emergency by the appropriate officer in a public hospital. Competition in the private sector is inevitable, but it appears to have got out of hand in some laboratory work.

The laboratory council is still investigating, so was not making any direct allegations in its initial warning, but it appears likely from the sort of underhand processes that have been uncovered that the Government medical staff directing patients to use private laboratories are getting a cut of the work they generate. 

These doctors and nurses are not just suggesting that a patient should look at a private laboratory, but recommend a specific laboratory without giving the patient the practical option of shopping around.

The fixing up of the public health system included not just equipping laboratories in that system but ensuring they had the required consumables, the chemicals and other test materials, that are needed. 

That was part of the clean out at NatPharm, and the determined effort to make sure that the essential medicines and other consumables were available as a matter of course. The national budget for health has not only been increased, but the crackdown on corruption and other horrors has along with the solid Second Republic efforts made development partners more open to assisting. 

When they know what they help out with is being properly used then they are more willing to help. The investigation needs to tackle both ends, the staff who press patients and the laboratories willing to be involved. 

The laboratory council has asked the public to contact it when this sort of scam is pulled and we hope people, or at least their relatives, will come forward so that the evidence will pile up and appropriate action can be taken, probably as part of the general clean up of the Wild West edge of the private sector.

At the same time the sort of procedures that are likely to be introduced once the Medical Services Amendment Bill becomes law can be tried out and refined at a more local level, so that when a private laboratory is needed there has been a proper selection process that offers the patient the best value for money and someone responsible is certain that there is no chance of a Government laboratory being able to do the work in that place and in time.