Patients may have to pay more as ministry is allocated only a fifth of what it required

Detention of patients will be the order of the day in 2015 because hospitals will have to recover fees from them to remain open as the Ministry of Finance has allocated the Ministry of Health only a fifth of what it requested.

Movement for Democratic Change legislator Ruth Labode said the government had only allocated US$53.328 million to the Ministry of Health when it requested US$303.023 million, excluding salaries.

“The amount allocated for operations represents only 18% of the Ministry’s requirements. The allocation is 6.8% of the total government allocation and this allocation misses the Abuja Declaration of 15% by 8.2%,”she told Parliament last week.

“Please note that I have discovered that we are all calculating the 15% Abuja Declaration differently. Some people are using a denominator of the current expenditure while others are using the fiscus. So, it will be different depending on where you are coming from. The allocation per capita is $29.23. The ideal recommended by WHO is $60 per capita.”

Labode, who is a medical doctor, said Zimbabwe will therefore have to depend on donor funding for health services but donor funding did not apply to central hospitals.

“As this budget stands, central hospitals are going to heavily depend on user fees. What it means in real life is that you should not be surprised when you hear that wards are closed. As I speak now, Muchinanyemba Hospital in Matabeleland South has been closed because there is no water and there is no money. Then detention of patients will be the order of the day in 2015, because the hospitals have to either remain closed or opened and they charge,” she said.

Labode queried why Zimbabwe could not fund its health services when it had exported diamonds worth US$8 billion. This was enough to fund the entire 2015 budget which stood at US$4.5 billion, she said.

Full contribution:

LABODE: I will give a short analysis of the budget for the Ministry of Health and Child Care. The total budget allocation was $4.5 billion according to the Blue Book and not $4.1 billion according to what the minister told us in Victoria Falls.

The ministry’s bid was US$303.023million (excluding salaries) and the Minister of Finance allocated only US$53.328 million leaving a gap of US$249.695million. The amount allocated for operations represents only 18% of the Ministry’s requirements. The allocation is 6.8% of the total government allocation and this allocation misses the Abuja Declaration of 15% by 8.2%. Please note that I have discovered that we are all calculating the 15% Abuja Declaration differently. Some people are using a denominator of the current expenditure while others are using the fiscus. So, it will be different depending on where you are coming from. The allocation per capita is $29.23. The ideal recommended by WHO is $60 per capita.

Out of this allocation, about 6.5% is going towards administration. Curative Services will get 81%. Though the figure sounds high, it is not high because in the curative services you are including the central hospitals which are big guzzlers and they eat a lot of money. If we then go back to the fact that only $53 million was allocated, that is what this 81% represents. Please note that central hospitals are not eligible for donor funding, so it becomes imperative that we find money for central hospitals. As this budget stands, central hospitals are going to heavily depend on user fees. What it means in real life is that you should not be surprised when you hear that wards are closed. As I speak now, Muchinanyemba Hospital in Matabeleland South has been closed because there is no water and there is no money. Then detention of patients will be the order of the day in 2015, because the hospitals have to either remain closed or opened and they charge.

Then we have preventive services that got 9%. This makes sense because we are expecting our partners and our donors to inject $305 million. This money caters for the District, Rural and all EPI functions that prevent you from coming to institutions. We must actually thank our donors and maybe let me read to you where the funds are coming from. I know that by the end of the year, we will receive around $600 million but this is what has been committed so far. This means that one day when we have to run our health services, the cost of health services in Zimbabwe is $1 billion because if we are receiving $600 million from donors and we still have gaps especially on ART, it means we need at least a billion, which we should be able to raise if we exported about $8 billion worth of diamonds.

The donor support which has been committed so far includes; the Global Fund malaria $10.6 million, the National TB programme $12.6 million, Global Fund HIV $6.5 million, UNICEF for rehabilitation $600 000, EPI $2 million, UNICEF on EPI $3.9 million, WHO $402 million and this figure may increase after their determination which is done in March. UNDP $75 million, Reproductive Health $600 million, UNICEF $48 million, UNICEF $1 million and it comes to about $305 million. I know USAID will come in and pour a lot of money but they have not yet confirmed how much money will come into the system. This is for preventive services.

Now going back to our own allocation, Minister Chinamasa, you have downgraded the Ministry of Health and Child Care to number five in your allocation. Generally, within the SADC and within Africa, the Ministry of Health normally takes either the second or third priority position, but you have put us down to number five. I do not know what that means. The other issue which is of concern with this budget is if you go and look at the onward allocation to provinces, you will notice that the concern of the Committee is that, somehow the formula used does not take into account poverty levels Minister, variables like what distances people walk and the disease burden. We know that provinces like Matabeleland North, people walk between 50 to 75 km to get to health institutions. This means, they will not go to such institutions and they will not be registered. So they will not appear in the system and the hospital will not get money.

Matabeleland North is a very poor province. It has a high prevalence rate of HIV and is malaria endemic. If you go to the distribution, the money is split into the ten provinces equally. Nothing really is happening economically for the poor people to be able to pay for service. It is like a penalty for you to be poor. You must somehow make money so that we give you more money. So I really think, Minister, you need…….

SPEAKER: Order, please address the Chair.

LABODE: I am sorry Sir. I really think Mr. Chair [HON. MEMBER: Inaudible interjection.]- I withdraw Mr. Speaker Sir. I strongly believe Mr. Speaker Sir that we should re-look at our resource allocation formula. There are studies being done sponsored by donors and the Ministry of Health and Child Care, where they are saying, how do we distribute the scarce resource that is there so that we deal with the issues of equity. You find that even when the results are presented, we do not have the courage to say this province needs more than this and we should be able to do this in the future please.

Mr. Speaker Sir, generally this budget is a poor man’s budget. I can see where the Minister of Finance and Economic Development was coming from and we want to thank the donors who help us and who will see us through the year hopefully. I heard the Chairperson for the Budget and Finance Committee saying donors should commit. Donors commit but they commit in their own time. While we are grateful, we should not forget what happened in Malawi where one day, donors woke up in the morning and said, asambeni and left.

As we are being helped, we should be looking for our own long term domestic financing for our own services. We should endeavour to try and get at least up to – we have 25% of the diamonds in this world. So we should be able to raise US$8 billion and our US$4.5 billion budget becomes nothing. I know there is talk of health financing and other issues, we need to harness resources from somewhere to be able to do as much as we can. We always need partners; we agree but let us try and identify domestic funding for our activities. This is what as a Committee we thought was important for this budget. I thank you.

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