Minister of Health Dr Henry Madzorera on Question Time

8 February 2011

The Minister of Health and Child Welfare, Dr Henry Madzorera, speaks to SW Radio Africa journalist Lance Guma and answers questions sent in by the listeners.

He is asked to explain his statement that Zimbabwe should export health care workers to other countries and replies to queries about corruption in the delivery of ARV’s, accusations of misuse of money at the National AIDS Council and what his ministry is doing to retain health care workers in the country?

Interview broadcast 02 February 2011

Lance Guma: Hello Zimbabwe and thank you for joining us on Question Time. Our guest today is the Minister of Health and Child Welfare Dr Henry Madzorera. Thank you for joining us.

Henry Madzorera: Thank you Lance.

Guma: OK now we start off with the editor of the NewZimbabwe.Com website, Mduduzi Mathuthu – he asks the first question and says in his own words – why haven’t you been as successful as David Coltart the Minister of Education in rallying international finance to rebuild the health sector?

Madzorera: Thank you for that very good question. Let me start by saying good evening to Zimbabwe. This question assumes that the minister of Education has been more successful in rallying international finance. I don’t know where they get that from or where the statistics come from but what I want to say is that there’s been a lot of support to the health sector, we’ve achieved a lot and there’s been a lot of international support.

I don’t think there is any ministry which is supported more than Health in this government of national unity. It might be that perhaps we have not shouted too much about it but let me just chronicle a few of the achievements we’ve had. You’ll know that on the HIV front we’ve got a Global Fund supporting Zimbabwe to the tune of several hundred million dollars.

We’ve got other programmes, organisations supported by various governments like the American government, the two CIDAS (Canadian and Swedish aid agencies) and , I’m referring here to the ESP (Expanded Support Programme); EGPAF (Elizabeth Glaser Paediatric AIDS Foundation) is doing a lot on the HIV front as well and they get funds from the American government and so this year alone they have received, I can’t accurately the figure but I think it’s around fifty million dollars to do prevention of mother to child transmission and paediatric Aids programmes and we launched this programme last week and it was in the public arena.

Then we go to the issue of infrastructure, rehabilitation – there has been a lot of support from many organisations, for example USAID helped us to rehabilitate infrastructure at our major central hospitals and some provincial hospitals and we are still getting support from other institutions. There’s been a lot of support in the area of drugs – that is why our drugs supply situation; particularly at primary care clinics have been good. In some instances going up to 90% of requirement.

This has come through other donors again who are working through UNICEF to procure what we have called Primary Care Kits. I could go on and on, we’ve got a lot of work and support going on in terms of health information systems and computerisation of the ministry so that data can flow smoothly from the primary care centre to head office.

We’ve had a lot of support on the cholera front; we continue to have support to manage cholera, to get commodities for preparedness sake; though we don’t have an outbreak going at the moment but for continued preparedness. I cannot finish chronicling the amount of assistance we are getting from partners.

On the human resources front, you know that again we have got a retention scheme going. We are the only ministry that has got a retention scheme for its workers so we do give a top up salary to all the health care workers and it has worked very well for us in terms of retaining health care workers, you won’t find that in Education.

Now I want to emphasise something – I don’t really want to compare what is happening in the ministry of Health with what is happening in Education; our problems are different, our needs are different. Education is doing extremely well I must agree right from the start and I want to congratulate Minister Coltart for the work that is happening in his ministry but to assume that not much is happening in Health would be erroneous as well.

Guma: OK, you quickly touched on the staff retention schemes that you have in place and I think that also partly answers the question that we have from Tinomudaishe Chinyoka who says what plans, if any, does the government of national unity have in place to not only retain in the country newly qualified doctors and nurses but also encourage those that have left to come back home?

Madzorera: Thank you – another very important question because human resources for health is the most important ingredient in the provision of health care so I will start with the plans. The plans that we have as a government are to ensure that we remunerate our health care workers to the same level as everywhere else within the SADC region.

In other words, we don’t want anybody to leave Zimbabwe and go to work in South Africa because of the remuneration package only. So that is our target, we want to do better than what is happening elsewhere within SADC. We haven’t reached that yet – it’s going to take us a bit of time.

We are hoping that as we exploit our diamonds in the Chiadzwa region and as other sources of income come into the government, we’ll be able to reach this target but for now we are having to make do with the little government salary that there is, we are having to make do with what the donors are helping us with in terms of the retention scheme which is currently funded by the Global Fund.

We still have a lot of partners interested in helping us retain our health care workers so were gaps arise for example we have got a gap of nearly 20, 25 million dollars in the retention scheme for this year and partners have already started coming in to fill in those gaps and we are extremely grateful for that because they realise it’s really the most important thing within the health delivery system.

We are also improving conditions of service. This year we want to work very hard on the issue of institutional accommodation. We want to make sure that resident doctors stay at hospitals where they’re supposed to work. You can’t have GRMOs for example who stay ten kilometres away from the hospital; they must be resident at the hospital.

We want to provide accommodation to all health care workers as far as possible – that is a major retention initiative. We are talking to all the local authorities; Harare City is the one we started with but we have also spoken to the Bulawayo City fathers and to other councils. We want them to be able to give land for our health workers to be able to build their own houses and that’s part of the retention programme.

If somebody has got a piece of land and starts building, they are likely to stay where they are. We are looking at the issue of motor vehicles for our health care workers. We had a scheme that ran last year and the year before where they could import vehicles duty free – we want to expand this system this year, subject to Treasury of course.

We hope we will have a scheme this year again for health care workers where they can purchase motor vehicles to make them mobile. You know most health care workers have to do night calls as well, we don’t want them hitch hiking at night. Those are some of the, then the last thing that I must mention is improving the conditions of work themselves at work.

The environment in which they work, the tools of the trade so if you’ve got a patient with pneumonia are you, do you have the facilities to do an x-ray and to give them the correct anti-biotics? Those are the tools of the trade I am talking about because it can be very frustrating to work in a system where you can’t really apply your skills to the full because the system is dysfunctional. So that’s what we are doing as a government to retain workers.

Guma: OK now you recently suggested that Zimbabwe should export nurses to other countries. Dr Douglas Gwatidzo who is the chairman of the Zimbabwe Association of Doctors for Human Rights has said it is wrong to export nurses when the health care situation is still dire. Now how do you justify your proposals?

Madzorera: Well thank you for bringing that issue up again because I think it was misunderstood by both the people who wrote the article in the Herald and the people who commented later on. We never said we want to export health care workers tomorrow. Our priority is to ensure that we fill all the posts within the country, fill our establishments that’s number one.

Number two, we have applied to Treasury to actually increase the establishment because this establishment we are working with was done in the ‘80s and the population has since probably doubled and therefore we want to increase the number of health workers.

Number three, we never said we want to export health workers because we can’t pay them. That’s not the motive. The motivation is currently we are training two thousand nurses a year and we are working on improving that to probably three or four thousand nurses a year by increasing capacity within our schools of nursing because I believe we must give everybody who wants training, the training they want.

Even if there is no job for them in Zimbabwe, every Zimbabwean is entitled to a good education and Ministry of Health must do its bit, Ministry of Industry and Commerce must do its bit and so forth to educate Zimbabweans. Then we come to the proposal that we had. The proposal works along the same lines that other countries like Cuba, Indonesia, India and so forth are doing.

You know we have got Cuban doctors in Zimbabwe who came through a bi-lateral government-to-government agreement and they’ve helped us a lot in this country. Zimbabweans are very good at human resource development and we must use that strength also to do government-to-government agreements. Where we have got excess labour we can then export that excess labour.

It gives our people international exposure, it gives us a presence in other countries, it improves and increases our influence internationally and when those people come back, they come back with very valuable additional experience. So what we intend to do is over the next couple of years to start looking into this.

Recently and when I say recently I mean in May of 2010, the WHO at the World Health Assembly adopted the international code of practice on the international recruitment of health personnel and one of the provisions in that code is countries can now go into bi-lateral agreements.

Instead of Zimbabweans just leaving and going to work in the UK willy-nilly without the government benefiting anything, we must look at ways of, health workers will always leave, that’s one thing we must always agree with each other, what we want is for them to leave under the banner of the government, under the protection of their government and to be able to benefit the country.

So that’s what we are looking at, it won’t happen tomorrow, it will probably take a year or two to be able to enter into these memoranda of agreement with various countries. It’s not an emergency and we’ll only export those health care workers whom we want to export.

Guma: Now last year in December you were quoted admitting there is corruption in the delivery of anti-viral medication in Zimbabwe and you vowed to stamp out the practice. From Masvingo comes a question from Noel Mangwende who wants to know how you will deal with this problem?

Madzorera: First of all those were allegations from various NGOs, for example Zimbabwe Lawyers for Human Rights published an article ‘Corruption burns universal access’ and we took that study very seriously. We don’t dismiss the studies that Zimbabweans do; in fact I’d like to encourage all Zimbabweans who know about any corrupt practices going anywhere to report to us so that we are able to follow that through.

So we are working on it, we have set up committees to investigate some of these allegations and those committees are at work right now and we can’t tell you exactly where they are and where they are working but they are working and we will tell the nation the results when they do come out.

Where there is need for disciplinary action, we will not hesitate to discipline rogue workers but my cursory assessment as I go around the facilities is that indeed there may be a few corrupt workers but they are few and we will work at them. I visited Bulawayo recently and at a public meeting I held, there were people who complained about cases of corruption and those will be investigated.

Guma: You spoke recently also about how your ministry is exploring ways of increasing funding for AIDS programmes next year as the number of people, including pregnant women, on ARV’s was increasing. Priscilla in Harare wants to know has there been any improvement in this and is this attributable to the government of national unity?

Madzorera: There’s been a lot of improvement. First of all the National Aids Council budget for 2011 has improved significantly. I think they are expecting to collect something in the region of US$23 million dollars. Now that’s a massive improvement from 2009 where I think they collected something like five million dollars.

So our own tax payers are contributing increasingly more to the fight against HIV and that’s highly commendable it’s an effort of the government of Zimbabwe. Our partners have also come in very nicely.

I mentioned earlier on the increased, proposed increased activity of EGPAF which is Elizabeth Glaser Paediatric AIDS Foundation, they got some funding from the US government and they are going to be doing a lot of work in the prevention of mother to child transmission of HIV and in paediatric Aids which is their core business. Is it attributable to the inclusive government? Yes it is.

A lot of the things that are happening now are due to our improved international relations, improved cooperation with the international community and there are a lot of grants coming; some of them are still in the cooking pot and we can’t exactly talk about them but there’s a lot of interest and activity around health in Zimbabwe.

Guma: Obviously talking about Aids programmes, one can’t miss to talk about the National AIDS Council and some of the stories that have gone on over the past couple of years to do with corruption, misuse of money, people buying cars, furniture – what’s your assessment of developments there?

Madzorera: National AIDS Council is a parastatal, it’s almost government. It’s audited annually and the books are available for inspection by anybody who wants to inspect the books. The board that makes up the board of the National AIDS Council is a multi-sectoral board. It’s not made up of people from the Ministry of Health.

We have all stakeholders – people from the church, people from various NGOs, we even have musicians and other people within the board and the people living with HIV themselves are within the board and they look closely at the use of funds. Every year they have a budget which they send to the minister for approval and the minister approves and they run along with that budget.

Any variations to the budget they report to the minister. I’m very satisfied with the way the National AIDS Council is running but people always speculate. I want to challenge those speculators to actually come and ask us to give them a little window to look into the functioning of the administration of the National Aids Council and I’m sure they will come up with a good report.

Guma: John in Mabvuku wants to ask about the campaign by your ministry to promote male circumcision as part of efforts to fight HIV and Aids. He says in June 2009 you talked about circumcision clinics being set up. Now he wants to know whether that programme has been a success and has it worked to reduce infection rates?

Madzorera: Yes we launched the programme last year in Mutare as the nation will remember. The programme on male circumcision is going on extremely well in Zimbabwe and the roll-out is on going. When it is all finished we want every district to have many centres that offer male circumcision. We are still rolling out the programme, that means setting up the clinics, putting the equipment, training the health workers, ensuring that they’ve got the correct tools to do the male circumcision and so forth and we are still actually looking at newer technologies that will make male circumcision faster and more efficient.

As you know, male circumcision reduces the rate of transmission of HIV to men by 60%; that’s a huge percentage. So the programme is on course but all I want to warn the nation is what we have always warned the nation about – male circumcision is an additional tool in our arsenal in the fight against HIV transmission. It is not in itself 100% foolproof in terms of prevention, so those who get circumcised should still continue to use all the other methods of prevention of HIV transmission that we have always advocated for.

But the programme is being rolled out nicely and if, I think you said John? If John wants to learn more since he lives in Harare, let him go to the Spilhaus Centre at Harare Hospital and he will get very good friendly service there. But I can’t tell you how many centres are already doing it now, it’s an on-going programme and we are rolling it out very fast to all the districts and health centres.

Guma: OK, we’ve got the time for one more question and if you could make the answer just quick since we have about a minute to go – there’s a general feeling if it was not for the refusal of ZANU PF to fully implement the power sharing deal, the coalition government could have achieved a lot more. Do you agree that your ministry for example could have achieved a lot more if it was not for the negative image created by the political squabbles and on-going human rights abuses?

Madzorera: Well it is a known fact that this inclusive arrangement is not very acceptable to many of our partners and it is a known fact that nearly all our partners do not want to work through the arms of government in terms of the aid they are giving so that’s why you hear me talking about the American government giving money to EGPAF this one working through another one, the Crown Agents doing this for this Global Fund and other partners.

It’s because there’s mistrust for this arrangement and I want to agree with the caller, if there was a unitary government made of the MDC, there would be a lot more help coming in and for that matter coming in directly through the government and not through proxies as we see right now.

Guma: Well that’s the Minister of Health and Child Welfare, Dr Henry Madzorera joining us on this edition of Question Time. I hope he has answered all your questions. Dr Madzorera thank you so much for your time.

Madzorera: Thank you very much Lance

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