Why social protection is a key element of the National Budgeting process

10 Dec, 2019 - 15:12 0 Views
Why social protection is a key element of the National Budgeting process

eBusiness Weekly

Tawanda Musarurwa

The colossal Parirenyatwa General Hospital in Harare is the largest medical centre in the country, with an excess of 5 000 beds and 12 theatres in the main hospital complex.

And as well as its general medical and surgical sections, Parirenyatwa includes Mbuya Nehanda, a maternity section; Sekuru Kaguvi, which specialises in eye treatment; and an annex for psychiatric patients and several specialist paediatric wards.

So it is easy to imagine how shocked and out-right disturbed I was when happened to pass through this mega health facility a couple of weeks ago, to find it near empty – one or two securities guards and general hands were milling about, and maybe one or two nurses minding the occasional private ward.

Parirenyatwa, a public hospital is usually crowded as the majority – most of whom cannot afford to be on medical aid – flock there. A last ditch option to save their lives in a moment of extreme need.

But it was empty – a ‘white elephant’ almost. But the question I could get out of my head is: where are all those sick, vulnerable ones?

And at the end of November, the Minister of Health and Child Welfare Dr Obadiah Moyo told a cabinet meeting on the issue of the strike by Public Hospital Doctors and Harare City Council Nurses.

Dr Moyo said the doctors’ strike has now gone beyond 84 days, with the doctors continuing to cite incapacitation. As such, health service provision at most central hospitals remains “constrained.”

He said:

“On the situation at Harare City Council clinics, 99 out of the expected 179 nurses turned up for duty as of 25th November, 2019. The recent opening of the Edith Opperman Clinic in Mbare has since eased the challenge of home-based deliveries.  Pertaining to disciplinary hearings for striking doctors, 508 disciplinary cases on doctors that have not been coming to work have so far been heard, out of which 498 doctors were found guilty.

“It will be recalled that from the previous report, 435 doctors had been discharged, and since then an additional 13 doctors have been found guilty and discharged, bringing the cumulative total of doctors discharged to 448.”

All this points to a significantly underfunded health system.

The Zimbabwean Government still – and appropriately so – has got significant elements of a governing system in which the national government plays a key role in the protection and promotion of the economic and social well-being of its citizens.

This means Government still provides critical goods and services that individuals cannot provide individually for themselves.

And from a more expansive perspective, Government can function to cushion its ‘vulnerable’ citizens such as the old, youth, the sick, the disabled and the unemployment.

And one of the main ways in which Government achieves such a role is through the National Budget, which is basically the key instrument through which a government collect resources from the economy, and allocates or uses those resources responsively, efficiently and effectively.

Outlining his broad masterplan in September 2018, Zimbabwe’s Finance and Economic Development Minister Mthuli Ncube highlighted the following:

“The budgetary framework should also be anchored on policy-based budgeting, where the budget is prepared with due regard to government policy and service delivery objectives,” said the Finance Minister.

“This also underpins a “value for money” objective, where policy achievements are weighed against the financial resources deployed, seeking to achieve efficiency and high impact.”

However, in some respects, Professor Ncube’s 2020 National Budget – announced early last month – did not live up to some ‘service delivery objectives’ expectations.

For example, one service delivery area that is absolutely critical and requires a ‘welfare’ approach to managing is the country’s public health sector.

But it’s one sector that has been constantly underfunded over the years.

Zimbabwe is party to the Abuja Declarations (2001), a pledge made by members of the African Union in which member nations pledged to increase their health budget to at least 15 percent of the state’s annual budget; it also requested Western donor countries to increase their support.

But here we focus on the former aspect.

In announcing the 2020 National Budget, Finance Minister Ncube in November, he said the health sector was being allocated ZW$6,5 billion for the upcoming year out of the total ZW$63,6 billion.

“To consolidate our achievements in healthcare, I am allocating $6,5 billion to the sector. This will cater for health infrastructure, personnel welfare, medicines, drugs, and sundries, among other essential hospital equipment and necessities,” said the Finance Minister at the time.

“The Abuja Target remains an elusive target for the country as Government expenditure on health is still less than 15 percent, (Abuja target) over the period 2012-2019.”

The ZW$6,5 billion does not meet the Abuja Declaration target of 15 percent of the annual budget.

And there are concerns whether this level of funding is even remotely adequate, particularly in a situation where public health centres have long faced challenges ranging from shortages of medicines, consumables and essential medical equipment.

The country’s public hospitals have also been affected by overcrowding, poor diets for patients, inadequate infrastructure and, of late, an ongoing industrial action by doctors.

Observers say the ZW$6,5 billion (which translates to around US$406 million when calculated at the official foreign currency interbank current rate of 1:16) is far from adequate, in view of the objectives that Government itself has set for the public funds.

“There is clearly a funding gap within the country’s health system. Although the African Union’s member states pledged in 2001 to allocate at least 15 percent of their budget to the health sector each year, most countries on the continent are seriously lagging behind,” said one private health practitioner who chose to speak on anonymity, “and in my view, the best strategy to reduce this gap is for the Government to look outside beyond the fiscus to find additional sources of finance for health systems.”

“In my view, then, we should be tapping into both multilateral and bilateral as well as private capital to better finance a functional public healthcare system.”

In respect of the 2020 National Budget, Government said it will give priority to the construction of health infrastructure, including renovating both urban and rural health facilities, even as it will try and leverage on public-private partnerships.

Government also said it will ensure that the National Budget prioritises procurement of vaccines and kits for immunisation, while recruiting more doctors and nurses.

In addition, it was expressed through the budget that additional health care would be given to households where it is difficult to earn more money, for instance, the households of persons with disabilities, the chronically ill, the elderly and child headed households, who will receive assisted health care under the Assisted Medical Treatment Orders (AMTO) facility and cash transfers among other social protection benefits.

It’s ambitious, but can it be implemented with limited resources?

In an earlier paper titled ‘Meeting the Healthcare Challenge in Zimbabwe’, the World Bank suggested that to prevent further deterioration in the public health sector, the government must give priority to reducing the budget deficit and restructuring debt service.

“Until this has been accomplished,” the World Bank said, “maximizing efficiency and redistributing available funding can do much to achieve greater balance and effectiveness in service provision.”

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