Catastrophic Health Costs in Zimbabwe Presentation by Nonjabulo Mahlangu Community Working Group on Health (CWGH) ZIMA CONGRESS 2015 19 -23 August Elephant.

Catastrophic Health Costs in Zimbabwe Presentation by Nonjabulo Mahlangu

Community Working Group on Health(CWGH)

ZIMA CONGRESS 2015

19 -23 August Elephant Hills, Victoria Falls

THEME: ETHICS IN MEDICAL PRACTICE

Introduction

"Patients are left to die because they cannot afford tertiary care services. The service providers have withdrawn their services or are demanding cash up front"

Ruth Labode in a press statement in May 2015

Various reasons can be attributed to this but this is a reality that is happening on the ground (Corruption, human resources gap)

The truth of the matter is that patients are dying due to failure to access health care services especially specialized care. The cost is too high and out of reach for most Zimbabweans

Is the government financing the health sector adequately???

BackgroundHEALTH has long been one of the most

important social concerns of Zimbabwean people.

Major gains were achieved in the 1980s through joint and complementary action between the health sector and communities.

However, the combined impact of AIDS, structural adjustment, and real reductions in the health budget and in household incomes, has reversed many of these gains.

The quality of health care has declined, and health workers and their clients have become demoralized.

Background The right to health is enshrined in the

constitution of Zimbabwe implying every citizen has the right to highest-attainable standard of health

However, most Zimbabweans are failing to access health care due to exorbitant charges by doctors and health facilities.

Communities have had to take on more and more responsibility for looking after the ill, by providing home-based care, paying for their health care and dealing with their health problems.

Government Health expenditure

The 2001 and 2010 National Health Accounts show that the government contribution to financing health has drastically reduced, from 39% to 18% respectively.

At the same time, the household contribution increased from 36% in 2001 to 39% in 2010, with external assistance increased from 4.2% in 2001 to 19% in 2010 and private health expenditure increased from 20.8% to 24%.

Health Expenditure 2010 compared with 2001Relatively high and

increasing OOPS36% (2001) 39% (2010)NHA 2010 -

households in higher income quintiles spending more, while the poor households had stopped seeking care from conventional health system.

Government Health Expenditure

Health Budget vs. National Budget

Year (%)

Allocation20139.87%20148.2%20156.3%

Allocation Vs. Expenditure

Implications of Catastrophic Health Costs Health care financing provides the resources

and economic incentives for operating health systems and is a key determinant of health system performance

Inadequate funding of the health system, results in a myriad of challenges in the health delivery system which include exorbitant user fees

Currently, in the absence of substantial government financial support, user fees provide the main income for many health care facilities, enabling them to provide at least the minimum service.

Key issuesStudies have shown that user fees

affect the health seeking behavior of patients as they act as a barrier to access to services

User fees may be charged as registration fees, consultation fees, fees for drugs and medical supplies or charges for any health service rendered, such as outpatient or inpatient care.

All these are considered as barriers to access to services

Key issuesHigh consultation fees and cost of

specialized care make services inaccessible to ordinary citizens.

The renal and cancer patients are the worst affected as costs for treatment are unbearable.

Families are forced to dispose of their assets so as to meet medical costs - How does this affect the family ??? Food security, education????

Key Issues As much as the country has recorded a decrease in

maternal mortality, the rates are still high Unaffordable maternal health services remain a great

challenge. Giving birth in a government or municipal facility costs

between US$3 and US$50 These costs are often prohibitive, leaving some women to

give birth outside the health system. It is estimated that more than 39 per cent of women are

delivering at home

IssuesOf concern are maternal deaths which are

continuously being recorded which can be avoided

A growing trend is the increase in the number of pregnant women in urban centers who are seeking maternal health services in rural areas where such MNCH services are free. ( Some argue that the quality of care is better)

Some cases have been noted in border towns where pregnant women prefer to cross borders to Botswana and South Africa in pursuit of affordable Maternal Health services

IssuesThere has been a decrease in medical aid

membership due to the current environment ( closing of industries, loss of jobs, etc)

Reduction from 600 000 members in 2007 to 400 000 at the end of 2014 Association of Healthcare Funders of Zimbabwe (AHFoZ)

This has a negative effect as citizens may not seek health care or even adhere to treatment due to associated costs

This may result in patients seeking alternatives to medical care - complications or even death

In the private sector most of the doctors are requesting for co- payments or cash up front which is not affordable to most citizens

IssuesMedical tourism is now common

with patients finding it cheaper to travel to India for specialist care considering OOP costs such as cost of blood, surgical sundries and co-payments.

Issues The current environment where there is retrenchment or an

unexpected financial loss presents major challenges in accessing health care

In addition to the immediate significant financial and emotional hardships, there are also psychological and physical health problems

Among those that have been laid off are people with chronic illnesses such as cancer, diabetes, hypertension (HBP) and HIV, and they stand to automatically lose their medical aid cover as they are rendered incapable of paying for monthly subscriptions.

Laid-off workers on anti-retroviral therapy (ART) may not be able to access the quality health services they used to enjoy, a development that may result in serious health complications or even death.

Abrupt loss of income may also compromise adherence to medication

Challenges in the health delivery systemUnderfinancing of the health delivery

systemPublic health facilities are severely

understaffed. Characterized by poor salariesShortages of essential drugsPoor living conditions for health workers

especially in the rural areasLow morale amongst health workersInadequate tools of trade

ConclusionOne of the fundamental principles of Health

financing is that individuals should not be prejudiced in their access to essential health care due to income, place of residence or other factors.

The government through its central role, through the budget allocation offers a critical way in offsetting disparities that arise from people’s different socio-economic status.

For the right to health to be attained, health services should be affordable to all.

ConclusionTherefore, various stakeholders

should advocate for increased allocation of resources to health and the attainment of the Abuja-declaration

Prioritization of health in the National budget

Alternatives to health financing

THANK YOU SIYABONGA