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Crisis in health sector deepens – Newsday

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AUDITOR-GENERAL (AG) Mildred Chiri has exposed the rot in the country’s health sector, where there is serious understaffing and shortages of equipment with no ambulances having been procured between 2019 and 2020.

According to Chiri’s audit report on the appropriation accounts, finance and revenue statements and funds accounts for 2021, Zimbabwe is facing a serious health crisis.

Her report came at a time when South Africa is accusing Zimbabweans of straining the neighbouring country’s healthcare facilities.

In her report, Chiri said the Harare Government Dental Centre, which is the country’s largest referral centre, is operating below capacity with insufficient human resources and equipment.

“I noted that delivery of dental services was negatively affected as the health institution was operating below capacity. The health institution did not have sufficient human resources, financial resources, infrastructure and equipment,” Chiri said, referring to the dental centre.

“During my visit to the health institution, patients were being turned away because of the unavailability of dental equipment to perform the necessary dental procedures.”

The facility, which offers oral health services to patients and provides training and internship to dental technicians, therapists and assistants, requires eight dental chairs and eight dental mobile carts, but it only has one of each.

It also requires four autoclaves (sterilising equipment), four air compressors for dental procedures and two dental X-Rays, but it had none. The dental centre also has no water and power back-up.

An analysis of human resources showed that in 2019, employees in posts were 63% of the establishment but the figure decreased to 53% in 2020.

The health institution was offering training for dental therapists and assistants, but the number of students had significantly declined, a situation that may see the country having no therapists.

“The institution should be training 30 therapists each year, yet in 2019, 15 therapists were trained and in 2020, 10 therapists were trained … Service delivery to the citizens was not being effectively rendered as there is a limited number of patients being assisted. The country may end up with no therapists if annual numbers of trainees continue to decline,” Chiri said.

Management at the institution claimed that the Health ministry was engaging the Finance ministry for financial assistance.

Apart from that, a public private partnership between Nyanga District Hospital and Nyaradzo Funeral Assurance Company was not regularised and remain a verbal agreement, Chiri noted.

“Previously, I reported that Karoi district took a long time to submit medical aid claim forms to medical aid societies. Marondera, Bindura and Karoi hospitals had medical aid claim forms for Premier Service Medical Aid Society and National Social Security Authority that were rejected and had not been followed up.

“In 2018, I reported that Masvingo and Gweru provincial hospitals failed to support creditors’ balances as they did not maintain creditors records. The situation is still the same,” she said.

Chiri exposed unsupported expenditure at 11 health institutions visited in 2018 which incurred expenditure amounting to $160 295 that was not fully supported by source documents such as requisitions, invoices or receipts as well as goods received notes.

Nine health institutions visited in 2018 incurred expenditure amounting to $143 154 without seeking competitive quotations and subsequently compiling comparative schedules.

Also, the health institutions had no service level agreements in cases where acquisition of goods and services was from a sole supplier.

For the financial year ending December 31, 2020, the head office, Harare Dental Centre and Government Analyst Laboratory did not maintain complete and proper accounting records relating to the Health Services Fund.

The report said the segregation of duties in the accounts department was not observed during the period under review at the Government Analyst Laboratory and Harare Dental Centre.

“The officer who was responsible for receiving revenue was the one receipting, banking, updating the cashbook and preparing the bank reconciliations. Furthermore, at Harare Dental Centre, the officer who was responsible for approving requisitions was also responsible for certifying and passing vouchers for payments,” Chiri said.

The crisis in the health sector is likely to escalate further with Zanu PF legislators pushing for enactment of the Private Voluntary Organisations (PVOs) Amendment Bill which will likely chase away donor funding from the sector.

Finance minister Mthuli Ncube allocated only 14% of the 2022 national budget to the Health ministry, leaving donors to fill in the gap.

Health experts who spoke to NewsDay yesterday said the health sector would be crippled if non-governmental organisations (NGOs) were banned as the sector gets almost 85% of its funding from NGOs.

Medical and Dental Private Practitioners of Zimbabwe president Johannes Marisa said Zanu PF’s utterances were just political banter as Zimbabwe could not survive without NGOs.

“That is merely political rhetoric. There is no country that can run without NGOs, which remain very important because they contribute very significantly to the growth of the health sector. Donors are the ones that also give incentives, especially in the rural areas. We cannot afford banning these NGOs in a developing country, especially here in Zimbabwe,” Marisa said.

Zimbabwe Nurses Association president Enock Dongo said: “Let’s put politics aside and let’s be realistic. Looking at our economy in Zimbabwe, there is no way we can sustain the Health ministry without the help of donor funds and NGOs.

“It will not be fair for political reasons to talk about the donors that are in the Health ministry as they are apolitical. We haven’t heard of any donor that is pushing a political agenda as far as the Ministry of Health is concerned. These donors are only playing social responsibility roles, they are even assisting in rural areas,” Dongo said.

Health professional Setfree Mafukidze tweeted: “Nurses in Zimbabwe are paid retention allowances by NGOs because the government cannot afford that. 85% of the Health ministry is donor-funded.”

Health ministry spokesperson Donald Mujiri said: “Donors contribute a lot to the health sector. The Ministry of Finance can give you an accurate figure on how much they contribute.”

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No social media posts, please: Sri Lanka tells government employees amid crisis – Hindustan Times

Published on Sep 28, 2022 12:55 PM IST

Sri Lanka Economic Crisis: In a fresh order to 1.5 million state employees, the Ministry of Public Administration and Management said a long-established ban on speaking to reporters now extends to social media posts.

Sri Lanka Economic Crisis: A Sri Lankan flag is waved by a protester.(AP)

Sri Lanka Economic Crisis: A Sri Lankan flag is waved by a protester.(AP)
AFP |

Sri Lanka ordered civil servants on Wednesday not to express opinions on social media after some officials claimed schoolchildren were fainting from a lack of food due to the country’s dire economic crisis.

In a fresh order to 1.5 million state employees, the Ministry of Public Administration and Management said a long-established ban on speaking to reporters now extends to social media posts.

“Expressing opinions on social media by a public officer… shall constitute an offence that leads to taking disciplinary action,” the order said.

It followed claims from provincial health officials and teachers that dozens of students were fainting in schools because of a lack of food.

Read more: Once bitten, twice shy: How Sri Lanka is limiting its President’s powers

Since late 2021, Sri Lanka’s 22 million people have been suffering the country’s worst-ever economic crisis after the government ran out of dollars to import many essentials.

This triggered huge shortages and unofficial inflation rates second only to Zimbabwe, as well as protests that led to the ouster of president Gotabaya Rajapaksa in July.

Health Minister Keheliya Rambukwella dismissed claims of malnutrition among young children. He accused “politically motivated” public health workers of exaggerating the situation.

However, the World Food Programme said in its latest report that six million Sri Lankans — nearly a third of the island country’s population — are “food insecure and require humanitarian assistance”.

Rajapaksa’s successor Ranil Wickremesinghe has cracked down on anti-government protesters and banned demonstrations in much of the capital.

This month, his government struck a conditional agreement with the International Monetary Fund on a $2.9-billion bailout.

The lifeline is dependent on Colombo reaching a deal with creditors to restructure its external debt mountain of around $51 billion.

Its biggest creditor China has so far not publicly shifted from its offer of issuing more loans instead of taking a cut on outstanding ones.

Get Latest World News along with Latest News from Indiaat Hindustan Times.

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Payout delays constrain Health ministry – Newsday Zimbabwe

LATE disbursement of funds is constraining the Health and Child Care ministry’s operations, it has been revealed.

Health ministry’s acting finance director Lynette Tennis yesterday told the Parliamentary Portfolio Committee on Health during a workshop for legislators monitoring special drawing rights (SDR) projects that very little funds were being disbursed from the 2022 health budget.

The workshop was facilitated by the Southern Africa Parliamentary Support Trust.

“The releases have been too little to make an impact to whatever we have to do as the Ministry of Health to achieve our mandate. The hospitals have not been getting support from the Ministry of Finance and as we move forward we received a circular in August that made it worse saying there is need for due diligence to be taken for all procurement that is being done. We are yet to get responses for whatever we submitted to them,” Tennis said.

“Funds have not been coming to the ministry, releases have been too little for the ministry, and we have not been getting support from Treasury. We managed to get 11% of our capital budget and we always ask when the other is going to come.”

“From August 1 to date we haven’t received any release from the Finance ministry which goes towards the financing of hospitals. However, we had other areas of concern that include medical gas and the blood programme.

“When it comes to the procurement of medicine, we still have challenges because things are not moving and the money is not coming. The Finance ministry is not releasing funds, they cite cash-flow challenges. We appeal to the Parliamentary Portfolio on Health for assistance.”

She said the situation at the country’s hospitals was dire because the ministry last received funds for district hospitals in April.

On research programmes, Tennis said none took place at hospitals due to lack of funding.

Director in the Health and Child Care ministry Frank Chiku said: “At Parirenyatwa Hospital, which is our biggest referral hospital, there was an allocation of $800 million and nothing has been disbursed. Repairs cannot be done; transformers and toilets cannot be repaired. We have been requesting money since February and nothing is coming, there are no funds being released to us, we have not been given any amount.”

Chiku said the Parirenyatwa laundry and incinerator facilities needed to be improved.

“Some district hospitals to date have zero disbursements.  Even from the 2022 budget we did not get the full funds that we were allocated.”

Finance minister Mthuli Ncube allocated $117,7 billion (14,9%) of the $968,2 billion 2022 national budget to the Health ministry.

Zimbabwe received US$961 million SDR funds in August last year. Government said the SDR funds would be deployed towards productive sectors including industry, agriculture, mining, infrastructure investment and roads, among others.

 Follow Harriet on Twitter @harrietchikand1

 

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How to repair trust in health care – POLITICO

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The pandemic may not be to blame for Americans’ lack of faith in medicine.

Confidence in the medical health system fell hard this year: In 2022, only 38 percent of Americans said they trusted the system, down from 44 percent in 2021, according to pollster Gallup. That would seem to confirm the conventional wisdom that U.S. health care took a big hit during the Covid-19 pandemic.

But more than two decades of Gallup data show that trust in health care spiked at the pandemic’s outset and has now returned to the modern norm’s low levels.

That’s not good. The problem is intractable, and the solutions are hard to envision.

But we’ll give it a shot.

NUMBERS GAME

Faith in the health care system spiked in 2020, rising nearly 10 percentage points higher than it was in any year since 2001 in Gallup’s survey as Americans rallied behind medical workers fighting Covid-19.

The return to the recent normal – and low – levels of trust may be less a Covid story and more a reflection of a broader crumbling of confidence in American institutions that includes the media, organized religion and the government.

What can we do about it? 

There are no easy fixes, but some things can be done to restore trust, numerous experts we spoke to said. Here are four of their suggestions:

  • Prioritize improved care for groups experiencing disparate outcomes and establish a dedicated leadership team. Deepening engagement in the community can also help build trust.
  • Help ease financial anxiety by expanding health insurance coverage while increasing price transparency.
  • Digital health technology can provide more touch points for providers to build lasting relationships with patients. 
  • Reforming the for-profit health care model could help remove one reason people suspect providers have an ulterior motive.

Mandy Cohen, North Carolina’s top health official during the Covid-19 pandemic, emphasized using trusted messengers.

“We partnered with many different folks in all walks of life, everything from Richard Petty in NASCAR to Rev. William Barber in the African American faith community,” Cohen said. “We thought about simplifying the message but also who was delivering that message.”

Ideas are aplenty, but implementation is another matter. We’ll keep our eye on Gallup’s poll to see what the future holds.

WELCOME TO FUTURE PULSE

This is where we explore the ideas and innovators shaping health care, and where Carmen, whose hair decided to go gray early, hopes the gray-hair-don’t-care trend is here to stay.

Share news, tips and feedback with Ben at [email protected], Ruth at [email protected] or Carmen at [email protected]

Send tips securely through SecureDrop, Signal, Telegram or WhatsApp.

TECH MAZE

Why your new doctor may not know your medical history:

Seamless access to and sharing of medical records promises huge benefits for patients when they switch doctors or see specialists. But delays in making it mandatory, despite a congressional directive, underscore that it’s not imminent.

The case for it is clear: Patients will gain if they can shop around and know their records will follow them. There’s also less chance a new doctor will make a mistake if they know a patient’s history.

Congress saw the benefits when it mandated data sharing in a 2016 law, the 21st Century Cures Act.

But nearly six years later, a provision barring providers from hoarding patient records isn’t fully rolled out and advocates for doctors and hospitals are lobbying for a further delay.

Why so slow? HHS finalized the information sharing rule on March 9, 2020, just as the world was shutting down to fight Covid-19. It delayed implementation during the pandemic, but the deadline is coming in nine days.

The American Medical Association, the American Hospital Association and other medical industry groups wrote that they want another year in a letter to HHS Secretary Xavier Becerra and National Coordinator for Health IT Micky Tripathi yesterday.

The organizations cited technical challenges. Vendors, they explained, are behind providers because HHS set deadlines that didn’t align for them.

Tripathi cast doubt on any delay in a statement to Future Pulse: “We don’t believe patients or providers can afford to wait any longer.”

WORLD VIEW

BEYOND PANDEMICS IN AFRICA — The recently established World Bank pandemic preparedness fund aims to help low- and middle-income countries — many in Africa — respond to major health crises.

Ahmed Ogwell Ouma, the acting director of the Africa Centres for Disease Control and Prevention, said the goal should be to head them off before they become crises.

Africa needs help building institutions at the ground level to improve health care and respond quickly to disease outbreaks, Ogwell Ouma said.

The focus of the rich world on Covid-19, and the donations it sent to Africa to fight the virus, struck many African public health experts as too prescriptive. They would have preferred more flexibility to use the funding to combat long-standing plagues like HIV.

The UN recently reported that the 1.5 million new HIV infections worldwide last year, a million more than the global goal, was a major setback in the effort to end AIDS by 2030.

A measles outbreak in Zimbabwe, driven by a drop in immunizations during the Covid pandemic, has killed more than 700 children. And Ebola is spreading in Uganda.

A different strategy: To build the institutions he envisions, Ogwell Ouma argues that African governments need to train experts, not only in public health, but also in legal and social issues.

And he would also like to see African governments and businesses expand their own efforts to improve pandemic preparedness and response.

“We need to ensure that we start domestically before you go out,” he said. When governments set priorities at home, it’s easy to channel international funds to those instead of being imposed by donors based on their interests, he said.

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