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Public health is constantly fighting to gain attention and resources

Dr David Okello Special Correspondent
I feel deeply honoured to be invited to give a keynote address at this prestigious Zimbabwe Annual Medical Research Day. I am told that this event also doubles as the Dr Steven Chandiwana Memorial Lecture. From the onset, I should mention that I have two confessions to make:

My first confession is that – having spent the last five years in this country, this event will also mark the beginning of the end of my public engagements in the country. I appreciate the hospitality and friendship found abundant during my tenure of office here in this beautiful country. I am at a loss for words to explain my profound gratitude.

My second confession is that: Mr Christopher Samkange, Director, Institute of Continuing Health Education, asked me to focus my speech on: i). How research can be used to strengthen health systems in a generic manner; ii) Observed causes of “fragility” in the Zimbabwe health delivery system and how they can be mitigated; iii) The resilience of the Zimbabwe health delivery system and how this can be used to enhance performance of the system in the critical times ahead; and iv) Opportunities that exist to improve and optimise the performance of the Zimbabwe health delivery system in the short to medium term.

I may not be able to cover all this massive assignment within the time allocated. Suffice to mention, however, that the central theme of my speech is “Challenges in the Healthcare Sector Present Opportunities for Innovations”.

As we all know, Zimbabwe hosted the 67th Session of the WHO Regional Committee for Africa at Victoria Falls from 28th August to 1st September 2017. It was an uplifting experience to see all health leaders from Government and partners united here. The leaders placed health of the people at the centre of development endeavours not just in words, but showed that they care.

For example, His Excellency, the President of Zimbabwe, Cde R.G. Mugabe, stated: “Let us therefore push health to take its deserved prominence on our agendas in our sub-regional groups, at the African Union level and indeed on the global stage.” President Mugabe also noted that Africa is disproportionately represented on the global disease burden for communicable and non-communicable diseases. “We must ask ourselves why this is so and more importantly, what can we do to arrest and reverse these trends.”

This brings me to talk about the immediate encounters we face here in Zimbabwe. Public health is constantly fighting to gain attention and resources. Many of the mechanisms and infrastructures that safeguard public health on a daily basis go unnoticed until something dramatic goes wrong.

The need to invest in health may come into view only when the food or water supply is contaminated, or when the stocks of essential medicines procured through support from partners suddenly run out, and/or when surveillance misses the start of a major outbreak. Although the consequences of such failures are costly and disruptive, public health still struggles to persuade Government to invest in basic infrastructures and services – before something catastrophic happens.

At the same time, we know that in this part of the world, lifestyle changes join demographic trends to cause a dramatic rise in non-communicable diseases (NCDs). The new burden of NCDs comes at a time when the country is still struggling to bring infectious diseases under control. Fortunately, NCDs are largely caused by a small number of shared risk factors, including: improper diet, inadequate physical activity, tobacco use, and excessive alcohol consumption.

Here, I would like to appeal to the researchers to find feasible ways of confronting the risk factors to NCDs. We must pressurise industries to stop marketing dangerous products to our children. In addition, action is needed to protect the population against harmful practices such as drug abuse and other unhealthy life styles; and to provide them with reliable, trustworthy information and advice.

Furthermore, may I make mention of another matter of grave concern. What can we realistically do in response to the carnage we are facing on the roads? Road traffic accidents have reached totally unacceptable levels. We know that these accidents are largely preventable if different relevant initiatives are implemented conscientiously. The risk factors are mainly behavioural – including non-compliance with road traffic regulations and harmful use of alcohol, among others.

It is also about time we paid attention and got better understanding on who actually is injured on the roads; and what is the impact of the injuries on families and communities. This remains an area of much needed research, to examine the full knock on consequences of road injuries. We should not limit our concerns just on medical treatment and rehabilitation of victims of RTAs.

There is a need to consider how the health system can withstand and be resilient in the face of an economic slowdown, while still striving to expand access to services and ensuring readiness to respond to public health threats. By resilient, I mean health actors, institutions and populations being able to absorb shocks and maintain core functions and good health when a crisis hits, and draw from the lessons learnt during the crisis, to reorganise and remain viable.

Resilience also implies an ability to draw on personal resources to face adverse circumstances, ensure effective prioritisation and protect core functions. In my opinion, we should pay particular attention to building resilience at the district health systems level. As we all know, previous efforts on strengthening district health systems are yet to provide convincing and sustainable results. More work and evidence is therefore needed on what works best at that level.

Another crucial issue here in Zimbabwe is the role of the private sector in provision of healthcare services; and how we should fully exploit their potential in moving towards UHC. In a resilient health system, private health care provision will coexist with public health services. But private health care services must be regulated to also provide training, monitoring, supervision and technical support; and should perhaps enable public sector workers earn a living through a structured part-time arrangement. Of course, they should be well regulated either by professional associations or by Government.

The important role of research cannot be over-emphasised. We are all aware that the African region has a high burden of both communicable and non-communicable diseases. These are further complicated by demographic, economic, social, security and environmental changes that directly or indirectly impact on the health of the population.

Strong national health systems are needed to deliver health care interventions to achieve UHC and the SDGs. Health research is critical to help find practical solutions to these challenges in the healthcare setting. Despite its importance though, priority is not given to health research and data, which results in low investment.

We also realise that most of the research efforts in our country are externally driven, and may not always be tailored to provide answers to local needs. Consequently, several structures for local health research systems are either non-existent or weak. In my view, research must be locally driven, relevant and appropriate for our circumstances. But funding for such efforts remains a major bottleneck.

During my stay in this country I met great people with vast talent across all professional disciplines. While it is true that the health sector still faces major challenges, there have been good efforts in Zimbabwe to resolve some of the challenges, and we are making progress.

• Dr David Okello is the outgoing WHO Representative to Zimbabwe