On Vote 14 – Ministry of Health and Child Care – $462 086 163 000:
HON. WATSON: Thank you Hon. Chairman for this opportunity to debate the allocation to the Ministry of Health. I would like to point out to the Minister that as we are debating here, there is a huge crisis at Ingutsheni Hospital in Bulawayo. They were left budgetless, foodless for the patients they have an outbreak of pellagra. Pellagra is a disease which equally makes you mentally unstable. So patients who are really mentally unstable are now likely to be worse.
The very fact that this budget allocation has gone in mere terms down, from USD1.1 billion equivalent to USD730 million equivalent is likely to mean that long before the mid of next year, when you can come to this House for a Supplementary Budget, patients in Government institutions would have no choice but to be there, given their mental condition, many will be starving yet again. The fact that the per capita spending has declined from USD71.66 down to USD48.78 is an indication of absolute understaffing in the health sector and that it will be left in a more dire position than it has been this year, which is being bad enough.
I seriously believe that having read the Health Committee report, you may have decided prior to this debate on each Vote to actually relook at the Health Vote, because at Abuja they said 15% of nothing is nothing. Per capita spending in USD terms is ultimately what counts. We are well below the World Health Recommended figure and we are likely to find our health institutions severely incapacitated and severely underfunded. I thank you.
(v)HON. NDIWENI: Thank you Hon. Chairman for giving me the opportunity to talk about the Ministry of Health Vote. The Ministry of Health Vote, the problem that we are facing is that of disbursing money. There is very late disbursement and the state of the health sector at the moment is not pleasing at all, mainly due to lack of disbursement of money.
Mr. Chairman, I want to draw your attention to places like Parirenyatwa Hospital, this previous year, 2022, have had zero disbursement on their capital budget. What that means is even if there is a bulb that blows out – I think you remember at one stage there was a ceiling they were showing that was falling apart at Parirenyatwa Hospital. The truth is there was no money, zero was released for capital budget at that central hospital.
So we plead with the Minister that whilst the money cannot be enough but the little that had been budgeted for should be released timeously because we look at our ordinary people; the only interface they have with Government is hospitals, the health sector. So if you do not put anything to the health sector, the only interface that our people have got with Government, will be deplorable. People are not going to be happy with the Government because this is the only time they meet the Government. This is the only time when they are ill that they feel that the Government should do something about them. I plead with the Minister that please, we know that this year, the amount allocated to Health is even less than last year in terms of the Abuja Declaration, that 15% allocation of the total budget should be reserved for health. We know it but if you give it 2% or 10%, then release that money timeously.
Look at the brain drain that is happening in the health sector. Some Municipal clinics here in Harare are closing because there are no nurses, why, because there is no money to pay the health workers. So I plead with the Minister that let us not play around with the Health budget. Of all the budgets that we have, let us release whatever money is allocated to the Health Ministry timeously and save our people. I thank you Hon. Chair.
HON. GONESE: Thank you very much Hon. Chair. I rise to make a contribution on this very critical Vote. I am cognisant of the fact that the resource envelope is already stretched. I am alive to the fact that there are so many competing interests but I rise on a matter of principle. I really want to say that as a nation, we have made some progress in terms of achieving the target which we as a nation willingly and voluntarily acceded to when we signed the Abuja Declaration.
I am concerned that we are retrogressive because I believe that at one time we had gone to 13% but when you look at the current allocation, it is not even that. It is around 9%, which I think is a step backwards. I would like to get clarity from the Hon. Minister of Finance as to why we are moving forward and then we move backwards. Having acknowledged that some adjustments have already been made, I submit the importance that the Health Vote is to our nation. If we do not have enough medication and facilities at our hospitals and people dying all the time and we have our health workers not satisfied with their working conditions, we will continue losing lives that could have been saved. I therefore request that notwithstanding the difficulties and the challenges that we have, that we seriously reconsider this particular Vote. I urge the Hon. Minister to increase it. I would have loved it to get to the 15% of the Budget and I think that would be the position that we should strive to have. In the event that we are not able to achieve it this year, we must take steps to ensure that at the next Budget, we get there. For now, I would submit that let us get at least to 14% so that as a nation, we are seen to be serious. It is not just about the target. It is also about the impact, effects and the consequences of not increasing this Budget. It is for these reasons that my contribution is that, please Hon. Minister, let us increase this particular Vote, ideally to where it should be which is 15% of the Budget. I so submit Mr. Chair.
THE TEMPORARY CHAIRPERSON (HON. M. KHUMALO): May I remind Hon. Members not to debate. Please bring new ideas, do not debate.
HON. MADZIMURE: Thank you Hon. Chair. I have got two issues. The first one has to do with motor cycles that were supplied by the World Health Organisation (WHO). It is now four years after these motor cycles were donated and to date, they are not working. So, we have got 100 motor cycles that are lying idle that were donated some four years ago. The reason is simple. They are saying they do not have money to train health workers who are supposed to use those motor cycles. If you divide the 100 motor cycles by 10, it means each province will have 10 motor cycles for the health workers. This will make a big difference. In other countries, for those people who are diabetic, HIV positive, high blood pressure, they supply medicines using motor cycles. We have got 10 motor cycles lying idle because the staff that is supposed to use them cannot be trained.
The second one Hon. Chair has to do with a hospital in Matobo. When we were doing consultations, it was submitted that the hospital was actually condemned and if you visit the hospital, it is in a sorry state. You do not have accommodation for the pregnant women. Even those who will be in the wards waiting to deliver may be shifted when rains come because the roofs are leaking. So, there must be a line that deals with that particular hospital because that is the only hospital that they have. As a result, you find people crossing into Botswana or South Africa to deliver. It is an issue that needs to be dealt with. Thank you Mr. Chair.
(v)*HON. CHIDAKWA: Thank you Hon. Chair for giving me this opportunity to add my views. The Vote for the Ministry of Health should be increased so that hospitals are capacitated. If you go to major hospitals like Parirenyatwa, the service that you receive immediately is BP and temperature checks but it takes time for patients to get assisted. This is due to the fact that there will be few doctors and the doctors do not have the necessary tools to use. Food that is being served to patients is not good due to lack of funding. Hon. Chair, some hospitals do not have medical equipment to do Xray and scan. The other cause for shortages of drugs is failure by the Ministry of Finance to disburse the allocated funds to the sector. Let us increase the budget allocation to this Ministry. I request that funds should be disbursed timeously in order to avert the health challenges that we are facing as a country. For a nation to progress, its people should be in good health. I thank you Hon. Chair. I thank you.
HON. CHINYANGANYA: Thank you Mr. Chairman, I would like to speak on the Ministry of Health’s budget. The Health Ministry is one of the critical ministries that we have because it concerns the lives of people and as such, it deserves to be allocated a budget that will be able to cater for the purchase of medicines and the hospital infrastructure as well. If you look at it right now, most patients in border towns are going across the borders to access health care. Victoria Falls, they are going to Zambia; in Beitbridge they are going to South Africa and in Mutare they are going to Mozambique.
We used to be one of the most advanced and most equipped countries when it comes to healthcare. Right now, our health system is in the intensive care unit. So we kindly ask the Minister of Health to increase the budget so that our people can have proper healthcare facilities. As we speak, the situation at Parirenyatwa, Chitungwiza Hospital is dire. At Kadoma General Hospital, there is no medication and there is no critical medical equipment. The Minister can increase sim tax to fund the Ministry of Health budget, and I think that will go a long way in trying to serve our people. I thank you.
THE TEMPORARY CHAIRPERSON: Hon. Members, may I remind you that you seem to be repeating what has been said already by other Hon. Members. Can we move forward?
HON. I. NYONI: Thank you Mr. Chairman I will try not to repeat what has been highlighted. My contribution on the Health budget is, I am looking at the National Blood Transfusion Service. We know that blood plays a major part, particularly in the festive season where we are expecting to have a number of accidents on the roads. Blood plays a major part in the maternity ward in various hospitals. I will give an example in the Southern region; we have UBH, Mpilo Hospital and other hospitals in the region.
At the moment these various blood transfusion stocks are very low and the reason is that they are not paid on time by the relevant Ministry because of inadequate funding. It is very important that adequate funds are allocated to the Ministry of Health so that you are able to meet funding on this particular important part of health, which is blood and that is life.
Currently, we are facing inadequate blood supplies because the National Blood Transfusion Services are not able to fund their services on a daily basis. Therefore, my clarion request to the Minister is to ensure that there is timeous release of funds. There must be an increase in the allocation to ensure that the National Blood Transfusion Services are well catered for. I thank you.
THE TEMPORARY CHAIRPERSON: Hon. Members, I repeat again may you summarize your suggestions. I will end up not giving other people time to debate.
*HON. T. ZHOU: Thank you very much Mr. Chairman. If the Ministry of Health is awarded an additional budget, I am pleading with the Minister that disbursements must be done on time. I will give an example whereby you allocated an amount amounting to 250 million to Mberengwa District Hospital. All the processes were done but on disbursements, that fund was not disbursed. They had planned to build the OPD Department but they did not manage to build it, they have only managed to put up a foundation only this year.
In next year’s budget there will be no allocation to that effect. We just promise people but we do not disburse the money. I am pleading with the Minister that all projects must be completed and for this year’s uncompleted projects they must be carried forward to next year’s budget. I thank you.
(V) *HON. NYABANI: Thank you Hon. Chair. Where I come from in Rushinga, we value the well-being of people. The Hon. Minister must allocate more funds to Health because there is no medication in Rushinga clinics. The clinics do not have vehicles like ambulances and other vehicles. Rushinga is near the border and there are a lot of diseases like malaria and so on. People travel long distances to go to the clinics. Rushinga must be given more money so that they do not have to travel long distances to access medication.
My son was not well and I tried to take him to hospital but by the time I got to the hospital at around 6p.m. it was closed. A lot of hospitals and clinics must be solar powered so that even if they work late they will not have any difficulties and people will be helped.
Mr. Speaker, in Rushinga even if people are involved in car accidents and I once helped accident victims by taking them to the hospital, they were only given cards because there was no medication; they were expected to buy their own medicines. My plea is that people be helped when it concerns health issues. People in rural areas are suffering, they do not have money. If only we had companies in this country that manufacture medicines instead of importing from other countries. This will ensure that we have enough supply of drugs for our hospitals so that our people can be treated using these drugs. I thank you Hon. Chairman for giving me this opportunity to make my contribution.
*HON. TEKESHE: Thank you Hon. Chairman. I want to emphasise on the points made by the previous speaker, Hon. Nyabane. The main issue is that our rural hospitals do not have drugs, even drips and people have to buy for themselves. These people in rural areas do not have the money to buy drugs. If they visit the hospital and they are given a prescription, the next thing is that they go straight home without the required medication.
So I appeal to the Minister. The funds that have been allocated to the health sector are too little. The health sector should be given more funds so that hospitals are well equipped and they have enough drugs and even ambulances. In the rural areas, there are no ambulances to ferry the sick to hospitals. If there is an accident, people die because there are no ambulances. Well wishers end up ferrying the injured to the hospital.
Nurses used to be searched when exiting hospitals but that is no longer being done because there is nothing for them to steal. If this Bill passes in this House, please allocate enough funds to buy drugs and medication. Members of Parliament are now taking it upon themselves to buying medication for some of the less fortunate people in their constituencies. Thank you Hon. Chair.
THE TEMPORARY CHAIRPERSON: Hon. Members, there is vehicle AFX1475 which is blocking other vehicles.
(v)HON. BRIG. GEN (RTD.) MAYIHLOME: Thank you Hon. Chair. My contributions are very few. The first one Hon. Chairman is about district centres that do not have hospitals or rural health centres. May the Ministry also consider these places that have been identified and presented in the citizens’ budget as not having adequate rural health centres?, Esigodhini was identified together with Shamva five years ago that it was the worst hospital in the country but no allocations have been made in the past three years.
Secondly, the issue about cost recovery in hospitals – it is my proposal for domestic resource mobilisation. We are saying instead of giving the wrong perception that we are offering free medical services, people find that there is nothing. It is better if people were charged at least for paying subsidised rates and then they find that x-ray machines, scans and diagnostic equipment are working. You go to renal clinics, you find that the renal clinics at Parirenyatwa out of the 17 that were operational, only three are operational now because the equipment is just degraded and run down and we are saying these non communicable diseases, you have to address them because these are very expensive and very real problems that people face. Renal patients have not much else to do besides living through that dialysis. So if only the Minister can consider equipping Harare, Parirenyatwa, Mpilo and UBH hospitals with renal equipment at least 10 for all of those hospitals.
Finally, the issue of Ingutsheni Hospital – honestly those people are sick enough already to be at that place. For them now to go without food, I think really as a society, as a nation that cares, we do not seem to be taking Ingutsheni Hospital very seriously. We are seeing letters flying all over the place. They are begging for food. Why are they begging for food when we are saying everyone else in the country has sufficient food? Where is the Ministry of Health and Child Care, where is the Ministry of Public Service, Labour and Social Welfare and where is the Ministry of Finance and Economic Development? Ingutsheni Hospital is circulating letters asking citizens to subsidise it on food. It is not fair. Let us have a budget that addresses the immediate plight of people who are sick. Everybody one day will fall sick. I thank you Mr. Chairman.
(v)HON. S. NDLOVU: Thank you Mr. Chairman. I also want to add my voice on this Health budget. What I have seen in hospitals is women who are giving birth cannot be operated unless and until they buy things that are supposed to be used during the operation like injections to put someone to sleep and even gloves for the doctors. There is absolutely nothing in hospitals. So I am saying as a woman myself, the women are doing a service to the nation by giving birth to Zimbabweans and truly speaking, they must be looked after especially in time of giving birth.
Most of our women are from the rural areas and they do not have the money to buy these things for them to have an operation because the hospitals are not equipped enough and the disbursement of funds are not even adequate. From what was given to our hospitals, they cannot even buy things like gloves and paracetamol and we are talking of a woman who is giving birth to a child who belongs to the nation. So I am saying can the Minister look into this matter to add more funds to the health sector, to disburse the funds timeously and to disburse everything that has been allocated to the Ministry.
Sometime this year, what was allocated to hospitals was not disbursed, not even half of it. So how do we expect hospitals to run if they do not get the allocation that has been budgeted for them? Can the Minister look into this issue? Again not women giving birth only, everybody who goes for an operation must buy whatever is needed for that person to go through an operation. Also the machines in hospitals are not working. Private doctors are bound to make more money because the doctor will say well, the machine is not working in hospital but you can go to this clinic in town and you will get assistance.
Why should we go that far? Why can we not equip our hospitals with machines that are working and what are we saying to the district hospitals that do not even have these machines? They are supposed to be transferred to bigger hospitals like Parirenyatwa, Mpilo and UBH, but also in these big hospitals, these machines are not working. So as a Government which is saying we do not want to leave anyone behind, I think we are doing the opposite; we are leaving a lot of people behind. As it is, people no longer go to hospitals because they do not have confidence in these hospitals anymore. Can the Minister look into this seriously?. I propose that the monies must be disbursed by the first quarter of 2023 so that ministries including the Ministry of Health and Child Care can start buying things that are needed for the hospitals. Thank you.
(v)*HON. MANGORA: I want to add my voice to the Health budget. My request to the Minister of Finance and Economic Development is that he should add a lot of funds to cater for diseases like cervical cancer that are detected often too late because of unavailability of facilities at primary healthcare level. By the time one needs that medication, it becomes too expensive especially in private hospitals. We need to have such facilities in public hospitals so that people can be treated earlier. If you are supposed to go for chemotherapy, not so many people can afford that especially people who earn low salaries. For hospitals that cater for mental health hospitals, we need to have a lot of funds allocated there because sometimes they end up becoming violent and some of them escape because of hunger. There is need for a lot of funds to be allocated so that they get enough. I do not have much to say but just to say funds must be availed to those hospitals that cater for mental health as well as for the procurement of ambulances. I saw patients especially paralysed ones failing to get into an ambulance because they were not user friendly, so we need funds to be allocated for that. I thank you.
THE TEMPORARY CHAIRPERSON (HON. MAVETERA): Hon. Members, I am closing this debate, all of you are repeating the same things. We are closing this debate. Can I have the last one.
(v)HON. TOFFA: Thank you Hon. Speaker. Without having to repeat what others have said, I would like to add the fact that in rural areas – [HON. NDUNA: Inaudible interjection.] –
THE TEMPORARY CHAIRPERSON: Order, Hon. Nduna, order please!
(v)HON. TOFFA: There is no medication, they have got no X-rays and I will give a typical example of Filabusi where we were attended to and we were to share a cube of tablet. Hon. Speaker, I would also like to talk about Ingustheni Hospital, just to add and I know it has been spoken about. It is important because it looks like as a country, we do not look at mental health as something important. I think we need to take that very seriously. I would like to make a recommendation; as we have done public hearings and moved around, I have noticed that at most hospitals, there are broken down cars. I would urge the Minister of Finance to have all these broken down vehicles collected and sold. You can actually raise money for the Ministry of Health instead of letting the cars rot at the hospitals and all the other Government departments. Thank you Hon. Chair.
THE MINISTER OF FINANCE AND ECONOMIC DEVELOPMENT (HON. PROF. M. NCUBE): Thank you Hon. Chairperson for the comments from the various Hon. Members, which I really appreciate. Let me start off from the comments by Hon. Watson; she has left the House. Basically, the Health sector budget is actually split into two; the first part is what we appropriate from the Consolidated Revenue Fund and this amounts to about ZWL470 billion; that is what we are debating. Then we have an additional ZWL232 billion from development partners. They support Health directly and they are very clear about that; they run various programmes. The total that is going to the Health sector is ZWL702 billion. That is what we should be looking at. If we look at the draw-down in terms of budget utilisation for the Health sector, up to now it is 65%. Also, there is the donor funding that is also being drawn-down in parallel as well.
The issue about this sector is not so much that of using adequate funding, but it is about the speed of disbursement and it is a push and pull issue. If we look at other ministries such as Transport, they have actually run out of budget; Agriculture has also run out of budget. They are high expenders and they real push for their budget release. We feel that perhaps we could improve the absorptive rate so that they can get their funding faster. At the same time, you have competition between donor funding and also domestic funding where you are quite aware that in some sub-sectors, officials prefer to work with donor funding because they are getting hard US dollars for that. We have all those challenges as well.
Hon. Chair, also there is something else, I do not know whether you have noticed that we have got private hospitals mushrooming everywhere, every other corner of Harare, there is some private hospital coming up – I am dramatising. It is quite clear that this is a growth sector. If you go to those private hospitals, you will find that there is adequate medicine and there is equipment and quality personnel. Also we have found that some of the drugs that we buy for public hospitals disappear very quickly and how come these private hospitals always have medicine, what is going on? I think there are a lot of issues that I think we need to deal with within the sector including perhaps finding a way for the public sector and the private sector to work together on a public-private-partnership. Maybe we need to find a way to subsidise our citizens for them to access the private hospitals. Really at the end of the day, it looks like access is the issue but there are quite a lot of private hospitals around us.
Hon. Chairperson, I want to mention something else – some colleagues – and here I am not going to be specific mentioning the issue of cancer. In the last year’s budget, we have created a fund for non-communicable diseases where we have taxes from sugar drinks and should be ring fenced to deal with subsidising drugs for cancer, hypertension, diabetics, UNCDs; so this needs to be operationalised. In addition to that, I am going back to the resources again. We have been borrowing to also support the Health sector. Some of you have seen the clinics that have been built through the MNS arrangement, the one in Harare South and the one in Cowdry Park is as good as done now. The one in Mataga in Zvishavane has started and then we move on to Chimanimani, I heard Hon. Mayihlome mentioning Filabusi- we are eying Filabusi to build again a polyclinic there. We will build about 30 of these polyclinics around the country and that is based on our borrowing activities, not even from the budget but borrowing to support the sector.
The way we see it, we feel that the sector in terms of resources that have been allocated, there is adequate resources but the issue is draw-down, competition between donors and Government funding. We also need to find a way for the public and private sectors to work together so that they can improve on access to our public citizens.
Therefore Hon. Chairman, I do not think there is room to maneuver here; let us just work on disbursement so that the Ministry can also receive funds as fast as other ministries such as Agriculture, Transport, Office of the President and Cabinet and so forth. I thank you.
HON. P. D. SIBANDA: Hon. Minister, how do you reconcile the issue of you indicating that for part of your Health budget, you are relying on development partners at a time that this country is pushing a Bill that is literally going to restrict the operations of development partners through the PVO Amendment Bill –[HON. MEMBERS: Inaudible interjections.] –
HON. TOFFA: Thank you Hon. Chair – [HON. P. D. SIBANDA: Inaudible interjection.] –
THE TEMPORARY CHAIRPERSON: Order! Hon. Sibanda, that is unparliamentary.
HON. P. D. SIBANDA: Is the Minister’s conduct Parliamentary; he sits there as an arbiter, be independent, do not be sided in your opinions. Is his conduct parliamentary – that is nonsense!
THE TEMPORARY CHAIPERSON: Order, order! Hon. Sibanda, may you withdraw that word.
HON. P. D. SIBANDA: Listen Hon. Chair, how does he interfere and say the Hon. Minister should not answer when I did not direct the question to him? Okay, I withdraw nonsense.
HON. TOFFA: Thank you Hon. Chair. My point of clarification is that whenever the Minister responds or even when he responded today with regards to the timeous disbursement of funds, particularly to the Ministry of Health and Child Care, he says it is a draw-down and the Ministry’s fault but as a Minister of Finance and we are always asking the Minister about this issue, what mechanisms have you put in place to correct this? What is it that you are going to do to make sure that the Ministry of Health gets the funding on time? If they are not drawing down, the people in Zimbabwe and in the hospitals in particular, are not getting medication and are not being capacitated and yet you say the funding is there sitting in the coffers waiting to be used. What is it that you are going to do to remedy this mischief?
HON. PROF. M. NCUBE: Thank very much Hon. Chair. I really thank Hon. Toffa for asking for mechanisms that we should put in place to improve the disbursement. I am glad she asked that. What we have done with the Ministry of Agriculture and the Ministry of Transport is to set up coordination process where the technical teams meet every week to track progress on disbursements and programmes. It has worked very well for those two ministries, so again I would suggest that we follow a similar approach because it has worked. It is not yet in place but we will put that in place and in some occasions the Ministers also get involved. So for example for Transport and Agriculture, some of the meetings I attend with Hon. Masuku and Hon. Mhona. So the same thing will apply to Health – that is what I propose Hon. Chair, I think it will work going forward.
Vote 14 put and agreed to.
