EDITORIAL COMMENT: Universal health coverage an achievable goal

THE seriousness with which the Second Republic is taking universal health care, and the major efforts made in the last five years, were highlighted by President Mnangagwa during two health meetings at the 78th United Nations General Assembly.

While being careful to be bluntly honest about the problems that still remain, he was also able to record the progress on the ever-increasing access to health care across the country, and the major successes now being scored in the battle against tuberculosis after its resurgence in the 1990s and 2000s, a battle largely being won because of the increasing easy access to health care.

Much of the success comes from building up the infrastructure for health care, both in facilities and in staffing, under the present strategy to ensure that practical and accessible universal healthcare is available, everywhere, by 2030.

A lot has already been done, but we still have too many people, especially in rural areas, having to travel long distances and not having someone down the road who can give practical advice. But we are getting there.

The primary clinic network is growing again, largely led by district rural councils who put new clinics and upgraded clinics high on their lists of work that is being done as devolution funds flow into their accounts.

Most of these councils, when setting the priorities and then making sure they get the maximum for their dollars, are using community involvement as a test and as support.

Communities that really need a new clinic have been working together to collect sand and stone and making bricks. This impresses most rural district councils and local MPs, both as measuring the seriousness of the need and of the willingness of the community to help meet that need.

These new clinics being frequently commissioned are obviously not there as a convenience, but because there is a serious need.

There is a need for more urban councils to build up their clinic networks from what the colonialists built before independence.

Cities and towns have grown considerably since 1980, and while some municipal authorities have noticed and done something, others just fold their hands. District, provincial and referral hospitals are conveniently in urban areas, but overcrowded out-patients departments are hardly the ideal solution.

Admittedly there is more private health care in urban areas, but a lot of people cannot afford even the cheaper doctors and clinics, let alone the fancier establishments which the rich patronise and whose fees produce huge shortfalls on most medical aid schemes.

So a lot of urban people only get medical attention when they are very ill, rather than catching common ailments in their early stages when treatment is easier, simpler and cheaper. Since urban areas also get devolution funds they should be doing better.

While the primary health network is being built up, the Government hospital network is being upgraded and maintenance and equipment problems sorted out.

This was already in progress in the early stages of the Second Republic, but the Covid-19 pandemic accelerated what was being done, and brought in not only more budget but also more support from other sectors.

At the same time, the Government is pressing ahead with a new concept in larger clinics, a sort of mini-hospital, with some in-patient care and more services.

Already four are complete and work continues to add to these vital bridges between the primary network and the district hospitals.

At the other end of the scale there is now a concentrated drive to build up the village health workers who, with modern communications, can do so much more and can help get sick people to professional care or can help set people’s minds at rest.

They are also critical in getting children lined up for vaccinations and in getting people in their village to take prevailing infections and illnesses seriously.

Zimbabwe does get some assistance from development partners in the health sector, but most of those able and willing to help like to see a strong effort by the countries they support, along with zero tolerance for corruption and the like.

In other words, quite rightly, they like to see every dollar they use to back up success giving the greatest results, and quite rightly too. So the support Zimbabwe and Zimbabweans give helps make others more willing to chip in.

The success against TB is a result of a wide range of health programmes. It was one of the infections that became more prevalent during the height of the HIV wave of infection and the lowering of immune systems, and some were even reluctant to seek treatment since whatever the cause of their infection they felt others would suspect HIV. But if TB is around more healthy people will get it.

But the growing success of the battle against HIV obviously has its effects. We have already met the 90-90-90 targets and are approaching the 95-95-95 target.

That would mean 95 percent of people infected with HIV have been tested and know their status, 95 percent of those found positive are on ART tablets, and 95 percent of those have seen their viral load almost totally suppressed.

But even with 95-95-95, that still means 15 percent of those infected can infect others, and so we need to maintain precautions and keep up the pressure for lower risk behaviour.

Admittedly with ARTs lifespans can become “normal”, but we would still be smarter to have zero infection rates, and then just maintain the ART programme into the earlier years of the next century until the last infected person dies in extreme old age.

Malaria is still with us, and with warmer winters more mosquitoes will be breeding so we need to have fewer sources of the malaria parasite for them to carry.

If everyone with malaria was treated promptly the infection would die out, even with mosquitoes flying around, since there would be no source. This is how vaccinations work as well. If there is no measles around then no one can catch measles.

President Mnangagwa also brought up the non-communicable diseases: high blood pressure, diabetes, heart problems and the like, along with cancers. Many of these could be tested for when there is a good village-based health care.

At the very least measuring blood pressure regularly would cost nothing once the simple apparatus had been bought and someone trained to use it.

And treatment for that is very cheap and simple, partly diet and partly popping a pill a two. Others would need the growing network of community clinics within a short walking distance to do the tests.

A lot of universal health coverage means what it says, having the facility nearby and having the ambulance to take you to a major hospital if local centres cannot handle the treatment. The Government is also buying ambulances as well as building up the network and building up the hospitals.

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