By Given Mutinta
A little while ago I visited my home village Makomba west of Pemba in Southern Province. On my second night at the village around 22 hours my aunt started to have birth pangs and I was asked to drive her to the clinic. At the clinic we found a family with a nine year old girl bitten by a snake and she was lying unconscious on the veranda of the clinic. I approached the parents of the little girl and asked them why the clinic was not open for the girl to be attended to. I was told that they were waiting for the Clinical Officer (CO). An hour before we arrived at the clinic the family of the little girl asked the guard at the clinic to call the CO from his house a kilometre away from the clinic. I sat in the car as we waited for the CO to come. As we were waiting the little girl passed on and people started wailing. When the guard heard people crying at the clinic he came back running. I went to him to ask where the CO was and just to be told that he was sick and admitted in Monze Mission Hospital. I could not hold my fury and so I went closer to the guard and asked him why he took so long. The guard told me that after checking on the CO he went to light his cigarette at a nearby home. I excoriated the guard for not treating the matter with urgency. I was really incensed!
If we knew there and then that the CO was sick I would have driven my aunt and the little girl to another clinic. I was also befuddled to learn that a population of more than 1, 900 was being served by one health worker. Anyway, I drove to another clinic 15 kilometres away on a wrecked road.
No matter how skilful one is at negotiating pot holes such an effort on this gravel road could not make a difference. Before we could get to the clinic my aunt gave birth to a baby boy. When we got to the clinic she could not be admitted because there was no free bed space. I had no choice but to drive her to another clinic 11 kilometres away where she was admitted. Barely one hour elapsed I was told that she passed on due to excessive bleeding during and after delivery. Three hours later I was informed that the baby as well passed on because he inhaled some fatal delivery fluids. I was hopping mad and awfully angry with the entire health system. In less than ten hours three people died because of poor or lack of health service delivery.
I said to myself if the guard had not gone away for a long time and we had a second health worker at the clinic in my village the three lives would have been saved. If the road was not dilapidated and there was a free bed space at the second clinic two lives would have been saved.
It is unfortunate that at this time and age our people especially in rural areas are dying because of poor or lack health service delivery.
Why is that we do not have enough health workers to serve our people especially in rural areas when almost every private hospital I have visited here in Durban has more than two Zambian health workers? These are the health workers who are supposed to be serving their brothers and sisters in Zambia. Why is that we do not have enough health workers for our people especially in rural areas? Why is that public health workers continue to move to the private sector or abroad when their services are desperately needed in our country? What has gone wrong with our public health system, and for how long will the crisis for the shortage of health workers be part of our public health system? We need to stop this mass murder of our people due to poor or lack of health service delivery.
One of the critical issues the Patriotic Front (PF) government should address is the plight of health workers. Dr. Joseph Kasonde Minister of Health (MoH) should deal with the problem of the movement of health workers to the private sector and abroad. This crisis must be addressed as an integral part of strengthening the public health system. Are health workers migrating in response to difficult circumstances such as poor work premises or limited training opportunities or poor salaries or lack of opportunities for career advancement? Whatever the case, what deliberate and pragmatic measures have we put in place to address this sombre situation?
To lessen attrition from the public health sector workforce and the negative effects of the shortage of health workers, we need to address the causes of public health workers’ dissatisfaction and to identify both financial and non-financial factors that influence their choices to migrate.
Maintaining an adequate health workforce requires a sustained effort in workforce planning, development and financing. We need ground-breaking strategies to retain and motivate health workers in the public health sector.
Concerted efforts should be made to source and regularly deliver quality, low cost in-service training opportunities for public health workers not only for doctors, which will encourage the notion that their careers are in good hands.
The poor or lack of health service delivery in our country highlights the importance of considering a broad range of financial and non-financial incentives that may be packaged to attract health workers and to encourage them to stay in the public health sector and work in rural areas.
Incentive strategies should be comprehensive and include long-term political commitment from the PF government. We need sustained effort at all levels that will involve key stakeholders and health workers themselves in developing the strategy, formulating policy and implementing initiatives.
The PF government should expand or build institutions to train more health workers. The MoH should robustly and frequently monitor and evaluate health systems, strengthen supervision and perform management systems that link health worker performance to supportive supervision and appraisal especially in rural areas.
Dr. Kasonde and his team should transform the MoH to be able to adapt and adjust the incentives to the changing needs and desires of our health workforce.
It is high time we had a public health system able to save and sustain our people’s lives especially in rural areas.