Zambia’s health care system is a Sorry Sight

IF you are a patient in Kaputa, Kalabo or Lundazi and have been referred to UTH, your hopes are raised somewhat believing that being at the country’s biggest hospital may just be the answer to your ailment.

But when you get there, you soon discover that UTH is nothing more than a vivid symbol of everything wrong with Zambia’s public healthcare system.

I got to UTH one Sunday afternoon on hearing my uncle had been evacuated there. Then began the chase for this test and that scan.

By 22 hours, we learnt that for a certain type of scan only one machine was working but we needed to book and the nearest we could be attended to was in a month’s time. Even Levy Mwanawasa Hospital was relying on the same machine, we heard.

Did you say there’s only machine working in this whole place, I asked, in disbelief.

Please don’t say that, you will get me fired, she said, in a hushed tone.

My heart sank.

If there is only one machine working at what is – or is supposed to be – the country’s largest health facility, what does that say about the public healthcare system?

A doctor told us this test and that test could only be done at one of those private labs across the road. I have learnt that such referrals are not something doctors make with pride. But what can they do?

I was reminded of the year 2000 when GRZ fired doctors who were on strike not demanding more pay, but equipment to serve their patients better. That was 20 years ago. Equipment is still an issue today.

Call it a business opportunity or a failure of the public healthcare system, those labs outside UTH are serving a need. The traffic there says so. On a trip last month, I noticed that the same private labs have set camp outside Ndola Central Hospital. There’s a message in this.

Count yourself lucky if the pharmacy has the medicine the doctor has prescribed. Chances are you will be back outside UTH, this time with a prescription. This was our case as even the National Health Insurance Management Authority (NHIMA)-designated pharmacies didn’t have the required drugs.

By the way, if you needed to move your patient from one place to another within the hospital, the search for a wheelchair will take you down several hallways. Good luck in finding one.

Nowhere is the gulf between intentions and reality in the provision of health services more visible than in rural areas.

According to the National Health Strategic Plan (2017-2021), GRZ aims to provide health services “to as close to the family as possible.” That means having a health center within a 5 km radius.

Being a regular traveler in rural Zambia, I have lost count of how many times I have given lifts to people (especially mothers with babies on their backs) going to or returning from what they call their nearest health center.

I normally ask them how far the place is. Either out of being too conservative or being used to hardship that it now looks normal, they will say it’s near. But by the time they tell you they have reached, you have covered 15 km. That’s just one way.

After having covered that distance on foot, they were probably attended to by a lone and overworked Clinical Officer who didn’t give much by way of diagnosis or drugs. Paracetamol is all they got for a pain that’s not gone away for months.

The gospel is that the idea of building health posts, district and provincial hospitals was to increase availability of health services and decongest UTH which was enamored with referrals from across the country. But without personnel, equipment and drugs, those new buildings are no more than glossy landmarks.

The lack of personnel, equipment and drugs in public hospitals is a result of misplaced priorities. Nothing else.

In 2014/2015 GRZ decided that building a car park at UTH (which by the way remains incomplete to-date) was more important than ensuring there are enough beds, linen and diagnostic equipment.

Imagine the difference $1 million (the alleged price of one fire tender) would make if it were applied to buying new equipment for UTH. Ambulances (even the overpriced ones) are important. But what’s the point of buying new ambulances that will quickly deliver you to a hospital without equipment and drugs?

Zambia signed the Abuja Declaration of 2001 which enjoins governments to allocate at least 15% of their national budgets to health. In the last few years, the allocation has been declining as follows:

2016 – 8.3%

2017 – 8.9%

2018 – 9.5%

2019 – 9.3%

2020 – 8.8%

2021 – 8.1%

Remember allocations are one thing. Whether the money actually gets disbursed and spent on planned activities is another. If it does get disbursed, factor in corruption and theft and the already measly allocations are reduced even further.

In short, without the donor community, there would be nothing left of Zambia’s public healthcare system.

Continue counting your lucky stars if you can afford private medical care or are privileged to be covered by your employer.

But spare a thought for the thousands of medical staff who are doing their job with the barest minimum of tools, who are frustrated not because they don’t like their work, but by the lack of tools.

Equally spare a thought for the thousands of patients agonising in pain with no solutions in sight, not because medical personnel are incompetent or have boycotted their patients, but because the system is failing them abysmally.

If there are any journalists reporting on health in Zambia, please remember, if a reminder was ever needed, that the state of the public healthcare system does not reside in the lofty statements from Ndeke House on Haile Selassie Avenue or in the spanking new buildings. Availability of personnel, drugs and equipment is a bigger and better barometer.

By Reginald Ntomba