Zimbabwe: Have the lessons been learned? The signs aren’t good

Public reaction to President Emmerson Mnangagwa’s tweet announcing the death of Lands and Agriculture minister Perrance Shiri on July 29 summarised the polarised nature of the Zimbabwean society, while also serving as a barometer of the effectiveness of government policies in the fight against the Covid-19 pandemic.

Although Mnangagwa did not immediately reveal the cause of death, word had already gone around that Shiri – a powerful former head of the air force and the former commander of the infamous 5th Brigade which is estimated to have killed about 20,000 civilians in the Gukurahundi massacre in the Matabeleland and Midlands regions in the early 1980s – had succumbed to the Covid-19 pandemic.

On July 31, Mnangagwa confirmed Shiri had indeed died of Covid-19, after bizarrely visiting his family brandishing test results. Meanwhile, some family members questioned the claim, and told the media that they suspected that Shiri had been poisoned. Shiri’s death shook the corridors of power and resulted in several ministers and high-ranking government officials going into self-isolation after coming into contact with him.

Shiri – a powerful former head of the air force and the former commander of the infamous 5th Brigade which is estimated to have killed about 20,000 civilians in the Gukurahundi massacre in the Matabeleland and Midlands regions in the early 1980s – succumbed to the Covid-19 pandemic.

While the president praised the departed minister, Zimbabweans responded by criticising government corruption and reported looting Covid-19 funds and demanding working hospitals. A response from @libyPatendero read: “Build hospitals (rather) than promoting corruption through Command Agriculture. Covid-19 is the greatest equaliser.”

Command Agriculture is a support scheme for farmers introduced by government and was overseen by then vice president, Mnangagwa, who chaired the Cabinet Committee on Food and Nutrition. It was introduced at the beginning of the 2016-17 farming season to ensure food security. Joseph Made was the agriculture minister at the time.

Under the controversial programme implemented through Sakunda Holdings owned by Mnangagwa’s advisor Kuda Tagwirei, beneficiary farmers, among them ministers and senior government officials, army commanders and judges received farming inputs and implements. In 2018, Sakunda Holdings failed to properly account for close to $3 billion, according to Auditor-General Mildred Chiri’s audit report for that year, subsequently corroborated by Lands and Agriculture ministry senior officials in parliament.

Shiri’s death shook the corridors of power and resulted in several ministers and high-ranking government officials going into self-isolation after coming into contact with him.

Responding to the president’s tweet, other Zimbabweans openly celebrated the minister’s death, citing the role he played in the Gukurahundi massacres; Shiri has been as “one of the key architects of the Gukurahundi mass executions in the early 1980s”. Other respondents said Shiri was a typical example of the country’s powerful political and military elite, which had subjected Zimbabweans to all sorts of human rights violations.

The state of decay of the country’s health care system has certainly been exposed by the Covid-19 pandemic – and with it, another glaring inequality. It is common knowledge that the members of the ruling elite hardly ever use local hospitals. In an emergency they might use an expensive private hospital, but only until they can fly out to a better-equipped foreign hospital.

When former President Robert Mugabe died on 6 September last year, he was in Singapore, where he had been treated periodically for over a decade. Mnangagwa was treated in South Africa after a poisoning scare in 2017, while Vice President Constantino Chiwenga is a frequent visitor to China, where he has been receiving treatment since last year. Chiwenga has also been treated in South Africa and India.

While the president praised the departed minister, Zimbabweans responded by criticising government corruption and reported looting Covid-19 funds and demanding working hospitals.

Other cabinet ministers and high ranking Zanu PF officials have shown a similar preference for costly overseas treatment. Co-Vice President Kembo Mohadi and Defence Minister Oppah Muchinguri were treated in South Africa after being caught in a bomb blast in 2018. Mohadi also visited South Africa several times last year for treatment. Indeed, at one time, both Zimbabawe’s vice presidents were hospitalised in the neighbouring country at the same time.

Popular opinion regarding Chiri’s death reflects the views expressed in the responses to the president’s tweet.  “Covid-19 knows no elite or poor person. This pandemic is a killer, [and] it should remind the likes of Mnangagwa that they are mortal,” said Miriam Muchongwe (33) a vendor resident in Mbare, a high density suburb in Harare.

She was happy, she said, that limits on international travel meant that powerful people could not easily fly out of the country for treatment. “I may sound like a callous person, but I hope the pandemic hits those at the top hard. Zimbabweans are not stupid. They demand that the government should invest tax-payers’ money in hospitals and other social needs, instead of funding their luxurious lifestyles.”

Responding to the president’s tweet, other Zimbabweans openly celebrated the minister’s death, citing the role he played in the Gukurahundi massacres.

Zimbabweans have expressed their disappointment on various platforms – health care, industry and trade unions, among others – at the containment measures adopted by government to stop the spread of the pandemic since the first case was reported on 20 March.

Zimbabwe Association of Doctors for Human Rights secretary general Norman Matara told me that Covid-19 had brought many lessons with it. “Basically, as a country we were not prepared for Covid-19. Pandemics and natural disasters don’t give warnings, so it is important for countries to have strong systemic building blocks for health systems.”

Zimbabwe has been shown to be weak in all six system components as recommended by the World Health Organisation, Matara said: leadership and governance, service delivery, health system financing, health workforce, medical products, vaccines and technologies and health information systems.

“Covid-19 knows no elite or poor person. This pandemic is a killer, [and] it should remind the likes of Mnangagwa that they are mortal” – Miriam Muchongwe

“As a result, the positive policy steps taken by the government to contain the pandemic, such as introducing a national lockdown, equipping hospitals and isolation centres, decentralising Covid-19 treatment and so on, failed. You can’t neglect hospitals for decades and then attempt to equip them in six weeks. When the pandemic struck, Wilkins Isolation Hospital didn’t have plug points, or a single ventilator.”

Although Covid-19 treatment had been decentralised, most provincial hospitals lacked resources such as beds, ventilators and even personnel, including ICU nurses and anaesthesiologists, while some districts were unable to transfer patients due to a lack of ambulances. The same lack of resources has seen the government failing to roll out Covid-19 tests, with many Covid-19 deaths being discovered only during routine post mortems.

One vital lesson from the pandemic, Matara said, was that the Zimbabwean government should adhere to the Abuja Declaration, in which African leaders committed to allocate 15% of their annual budgets to improving the health sector.

Zimbabwe has been shown to be weak in all six system components as recommended by the World Health Organisation.

In an effort to stem the spread of the virus, government declared a 21-day total lockdown on 30 March, which was extended by two weeks before being gradually eased. Meanwhile, according to the official figures, Covid-19 cases are on the rise. As of 18 August there were some 5,378, with 141 deaths reported and 4,105 recoveries.

However, it is not clear how accurate these figures are. No comparative statistics for Zimbabwe are available. Across Africa, though, the total number of Covid-19 cases is much higher than official numbers suggest, according to the International Rescue Committee. The lack of data may be “due to a variety of factors – such as testing capacity, health infrastructure devastated by conflict, and stigma,” the organisation says.

The rapidly rising numbers raise the question of the effectiveness of the lockdown. Around the world, the primary aim of lockdowns has been to prevent health care systems from being overwhelmed by cases of Covid-19. But Zimbabwe’s severely neglected health care system broke down very soon anyway. So, as Zimbabwe Congress of Trade Union (ZCTU) secretary general Japhet Moyo told me, the lockdown was pointless.

As of 18 August there were some 5,378, with 141 deaths reported and 4,105 recoveries.

The government also failed to provide effective social safety nets for citizens. Most people in the country are dependent on the informal sector for a living, and they were forced to continue informal trading activities despite lockdown regulations. There was also a lack of any effective public transport, as well as a shortage of staple foods such as mealie-meal, with the result that there were often long queues at bus terminuses and shopping centres. Crammed minibus taxis and long queues are concentrations of people, and the very opposite of physical distancing, which increases contagion risk. So it’s likely that enforcing the pointless lockdown has increased the infection rate.

Moreover, while the government had introduced a taskforce, chaired by Mohadi, to fight the pandemic, it had erred by not including a range of stakeholders, among them labour and business, in the taskforce’s deliberations, Moyo said. “It’s very unfortunate that our government does not believe in dialogue or inclusivity. On many occasions business and labour were caught by surprise by some Covid-19 measures and announcements. Consultations could have seen us all pulling together in the national interest. Going forward, the government must learn to consult.”

On 1 May, Mnangagwa announced a ZW$18 billion ($430 million at the time) Economic Rescue and Stimulus Package, “designed to scale-up production in all sectors of the economy in response to the adverse effects of Covid-19.” The amount would see ZW$6.1 billion going to stimulate agricultural production, ZW$3 billion to cover capital and operational expenses for the manufacturing sector, a ZW$1 billion credit support facility for the mining sector, ZW$500 million to support the tourism and hospitality industry and ZW$1 billion for the procurement of Covid-19 testing kits, PPEs and the purchase of drugs.

Across Africa, the total number of Covid-19 cases is much higher than official numbers suggest, according to the International Rescue Committee.

The ZCTU had asked information on disbursements during a Tripartite Negotiating Forum meeting involving government, labour and business on 14 July, Moyo said. However, they were told that the plan “remained an intention”.

In any case former finance minister Tendai Biti has said that the plan did not set aside enough money to save Zimbabwe’s ailing industries. At least $1 billion would be needed, he told the Zimbabwe Independent in mid-June. CZI President Henry Ruzvidzo concurred, describing the stimulus as “a modest amount given the challenges faced by industry” to the Zimbabwe Independent in the same article.

As noted in previous blogs in this series, even before the Covid-19 outbreak, Zimbabwe’s economy was hamstrung by a number of problems, among them a debilitating liquidity crunch, acute fuel and foreign currency shortages, currency volatility and low capacity utilisation as well as runaway inflation. Covid-19 has worsened the plight of Zimbabwe’s ailing industries while stretching its ill-equipped medical facilities and exposing the weakness in the health sector.

Even before the Covid-19 outbreak, Zimbabwe’s economy was hamstrung by a number of problems, among them a debilitating liquidity crunch, acute fuel and foreign currency shortages, currency volatility and low capacity utilisation as well as runaway inflation.

As Zimbabwe Association of Doctors for Human Rights’ Matara noted, major crises such as the Covid-19 pandemic seldom announce themselves, allowing time to plan. As we have seen around the world, the major difference between countries that have weathered the pandemic relatively well and those that haven’t has been the presence or absence of strong, capable institutions – in leadership, health care and research, among other areas.

It was clear from the beginning that decades of under-investment in health care would leave Zimbabwe totally unprepared for the pandemic. And as it turned out, public health care facilities at all levels were completely unable to cope.

Now other major crises are looming, with climate change at the top of the list. Some of my fellow blog writers in this series have mentioned the looming impact of climate change on Africa’s environments. Africa in Fact’s recent edition on the environment (July 2020), to which I contributed, looks at this in a number of African countries.

The warnings are clear. Also for Zimbabwe. Indeed, climate change is one crisis that is actually announcing itself. Much remains unpredictable, but we know quite a lot about its causes and likely impacts. Time will tell, though, if the message of the pandemic is loud and clear to Mnangagwa and his administration.

 

We’d love to hear from you! Join The Wicked Conversation by leaving your comments below, or send your letter to the editor to richard@gga.org.

 

Owen Gagare is the assistant editor of the Zimbabwe Independent, a weekly newspaper, covering business, politics and investigative stories. He has previously worked for NewsDay and the Chronicle. Owen has also written for the Mail and Guardian and has a passion for investigative and in-depth stories as well as human rights and governance issues. He is based in Harare, Zimbabwe.

Repression in Zimbabwe exposes South Africa’s weakness

President Emmerson Mnangagwa of Zimbabwe and President Cyril Ramaphosa of South Africa in 2018. PHOTO GCIS

Roger Southall, University of the Witwatersrand

South African president Cyril Ramaphosa’s despatch of envoys to Zimbabwe in a bid to defuse the latest crisis, in which the government has engaged in a vicious crackdown on opponents, journalists and the freedoms of speech, association and protest, has been widely welcomed.

Such has been the brutality of the latest assault on human rights by President Emmerson Mnangagwa’s regime that something had to be done. And, as the big brother neighbour next door, South Africa is the obvious actor to do it.

It may be guaranteed that Ramaphosa’s envoys – Sydney Mufamadi, a former government minister turned academic, and Baleka Mbete, a former deputy president of South Africa, former speaker of the National Assembly and former chairperson of the African National Congress (ANC) – were sent off to Harare with a very limited brief. They were accompanied by Advocate Ngoako Ramatlhodi and diplomat Ndumiso Ntshinge.

The mission quickly ran into trouble. The envoys returned to South Africa without meeting members of the opposition.

Observers and activists are rightly sceptical about how much will come out of it. The best that is seriously hoped for is that South African diplomacy will bring about immediate relief. This would include: the release of journalists, opposition figures and civil society activists from jail; promises to withdraw the military from the streets; perhaps even some jogging of the Mnangagwa government to meet with its opponents and to make some trifling concessions.

After all, the pattern is now well established: crisis, intervention, promises by the Zanu-PF regime to behave, and then relapse after a decent interval to the sort of behaviour that prompted the latest crisis in the first place.

But in a previous era, South Africa once made Zimbabwe’s dependence count.

South Africa has done it once

Back in 1976, apartheid South Africa’s Prime Minister John B. Vorster fell in with US plans to bring about a settlement in then Rhodesia, and hence relieve international pressure on his own government, by withdrawing military and economic support and closing the border between the two countries.

Ian Smith had little choice but to comply. Today, no one, not even the most starry-eyed hopefuls among the ranks of the opposition and civil society in Zimbabwe, believe that Ramaphosa’s South Africa will be prepared to wield such a big stick. The time is long past that Pretoria’s admonitions of bad behaviour are backed by a credible threat of sanction and punishment.

So, why is it that Vorster could bring about real change, twisting Smith’s arm to engage in negotiations with his liberation movement opponents that eventually led to a settlement and a transition to majority rule, and ANC governments – from the time of Nelson Mandela onwards – have been so toothless?

If we want an answer, we need to look at three fundamental differences between 1976 and now.

First, Vorster was propelled into pressuring Smith by the US, which was eager to halt the perceived advance of communism by bringing about a settlement in Rhodesia which was acceptable to the West. In turn, Vorster thought that by complying with US pressure, his regime would earn Washington’s backing as an anti-communist redoubt. Today there is no equivalent spur to act. It is unlikely that US president Donald Trump could point to Zimbabwe on a map.

Britain, the European Union and other far-off international actors all decry the human rights abuses in Zimbabwe. But they have largely given up on exerting influence, save to extend vitally needed humanitarian aid (and thank God for that). Zimbabwe has retreated into irrelevance, except as a case study as a failed state. They are not likely to reenter the arena and throw good money and effort at the Zimbabwean problem until they are convinced that something significant, some serious political change for the good, is likely to happen.

Second, South African intervention today is constrained by liberation movement solidarity. They may have their differences and arguments, but Zanu-PF and the ANC, which governs South Africa, remain bound together by the conviction that they are the embodiments of the logic of history.




Read more:
How liberators turn into oppressors: a study of southern African states


As the leading liberators of their respective countries, they believe they represent the true interests of the people. If the people say otherwise in an election, this can only be because they have been duped or bought. It cannot be allowed that history should be put into reverse.

Former South African president Thabo Mbeki played a crucial role in forging a coalition government between Zanu-PF and the opposition Movement for Democratic Change (MDC) after the latter effectively won the parliamentary election in 2008. But South Africa held back from endorsing reliable indications that MDC leader Morgan Tsvangirai had also won the presidential election against Robert Mugabe.

As a result, Tsvangirai was forced into a runoff presidential contest, supposedly because he had won less than 50% of the poll. The rest is history.

Zanu-PF struck back with a truly vicious campaign against the MDC, Tsvangirai withdrew from the contest, and Mugabe remained as president, controlling the levers of power. The ANC looked on, held its nose, and scuttled home to Pretoria saying the uneasy coalition it left behind was a job well done.

Third, successive Zanu-PF governments have become increasingly militarised. Mnangagwa may have put his military uniform aside, but it is the military which now calls the shots. It ultimately decides who will front for its power. There have been numerous statements by top ranking generals that they will never accept a government other than one formed by Zanu-PF. The African Union and Southern African Development Community have both outlawed coups, but everyone knows that the Mnangagwa government is a military government in all but name.

Lamentably inadequate

So, it is all very well to call for a transitional government, one which would see Zanu-PF engaging with the opposition parties and civil society and promising a return to constitutional rule and the holding of a genuinely democratic election. But we have been there before.

The fundamental issue is how Zimbabwe’s military can be removed from power, and how Zimbabwean politics can be demilitarised. Without the military behind it, Zanu-PF would be revealed as a paper tiger, and would meet with a heavy defeat in a genuinely free and fair election.

According to Ibbo Mandaza, the veteran activist and analyst in Harare, what Zimbabwe needs is the establishment of a transitional authority tasked with returning the country to constitutional government and enabling an economic recovery. Nice idea, but a pipe dream.

No one in their right mind believes that a Ramaphosa government, whose own credibility is increasingly threadbare because of its bungled response to the coronavirus epidemic, its corruption and its economic incompetence, has the stomach to bring this about. We can expect fine words and promises and raised hopes, but lamentably little action until the next crisis comes around, when the charade will start all over again.

Any relief, any improvement on the present situation will be welcomed warmly in Zimbabwe. But no one in Harare – whether in government, opposition or civil society – will really believe that Ramaphosa’s increasingly ramshackle government will be prepared to tackle the issue that really matters: removing the military from power.The Conversation

Roger Southall, Professor of Sociology, University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Democratic space narrowing in Zimbabwe

Good Governance Africa Executive Director interviewed on South African satellite channel Newzroom Afrika on the situation in Zimbabwe (13 August 2020)

GGA SADC Executive Director Chris Maroleng says there is no doubt that the situation in ZImbabwe has taken a terrible turn for the worse. The democratic space has narrowed significantly and room to manoeuvre for civil society has become less and less.

Watch the interview in the video below.

Zimbabwe’s ill-equipped health infrastructure

Despite Zimbabwe’s crumbling public health infrastructure, former health minister Obadiah Moyo told journalists in Harare on 2 May, 18 days before the country recorded its first Covid-19 case, that the southern African nation was ready to handle the global pandemic. He assured the nation that Zimbabwe had drawn valuable lessons from previous cholera outbreaks and had put in place solid mechanisms to deal with the disease.

The claim that Zimbabwe is ready to deal with the coronavirus has become a government mantra at a time when the pandemic is proving a challenge and stretching resources in better equipped countries such as China, the United States, Spain and Italy, among others. However, health professionals, including Dr Norman Matara, secretary general of the Zimbabwe Association of Doctors for Human Rights (ZADHR), have consistently challenged the claim, saying that the country’s decrepit healthcare system is not ready for the challenge.

He assured the nation that Zimbabwe had drawn valuable lessons from previous cholera outbreaks and had put in place solid mechanisms to deal with the disease.

An investigation by the Zimbabwe Independent published on 6 March revealed the country’s health facilities were woefully equipped. The report revealed that Zimbabwe’s main isolation hospital, Wilkins in Harare, did not have adequate personal protective equipment (PPE) for staff and was relying on space suits, gloves, gumboots and N95 respirators acquired when Zimbabwe was preparing to fight an ebola outbreak in 2014.

In a ministerial statement delivered to parliament in February, Moyo also said the country would use anti-retroviral drugs (ARVs), particularly kaletra, to reduce the impact of Covid-19. While there is preliminary evidence that the drug is effective with some coronaviruses, there is no evidence that it is effective against Covid-19, according to an April report by the Centre for Evidence-Based Medicine. At any rate, the treatment was found to be out of stock.

An investigation by the Zimbabwe Independent published on 6 March revealed the country’s health facilities were woefully equipped.

It did not take too long for the government to be further exposed. On 7 July Moyo was himself dismissed from office, for “conduct inappropriate for a government minister”. Moyo was arrested on 19 June in relation to charges he facilitated the awarding of a $60 million tender for the provision of PPE outside procurement regulations and he was sacked on 7 July. Zimbabweans may wonder if this is not another example of the “catch-and-release” approach that has seen high-profile individuals arrested and released.

The government’s failure to establish adequate public health care measures was demonstrated by its handling of one of the first cases of Covid-19 to be reported in Zimbabwe, that of journalist Zororo Makamba, the son of a prominent businessman and a former high ranking Zanu PF official.

It did not take too long for the government to be further exposed.

Makamba was hospitalised at Wilkins Hospital after testing positive on 21 March. At the time, the institution did not have a ventilator, power adaptors or an intensive care unit. Staff at the hospital did not have adequate PPE, resulting in him being neglected. Zororo died on 23 March, two days after being admitted to hospital, according to a Makamba family statement. The Makamba family released a hard-hitting statement to the Daily News blaming government for the death. The statement was released by Zororo’s brother Tawanda.

“At the end before he died, he kept telling us that he was alone and scared and the staff were refusing to help him to a point where he got up and tried to walk out and they were trying to restrain him. So, this is how my young brother ended up dying. I want people to know that the government is lying [that it is prepared],” Tawanda Makamba said.

Zimbabwe’s main isolation hospital did not have a ventilator, power adaptors or an intensive care unit.

In his statement, Tawanda Makamba said Wilkins did not even have water. “If you come here to be treated for corona there is absolutely no treatment you will get, you will die … People need to know that the government is ill-prepared. It is not ready to deal with the virus.”

The Chinese embassy in Zimbabwe moved swiftly to mobilise the Chinese business community to construct an ICU. The embassy also donated critical equipment, while a local company drilled two boreholes to ensure the hospital had a water supply. Another company installed a solar system to equip the hospital.

“If you come here to be treated for corona there is absolutely no treatment you will get, you will die”.

On March 17, President Emmerson Mnangagwa banned public gatherings of more than 100 people. The ban included weddings, church gatherings, sporting events and national celebrations. Mnangagwa also declared the pandemic a national disaster, to enable government to mobilise resources. On 19 March, he launched a $26 million Covid-19 plan and established an inter-ministerial Covid-19 taskforce to tackle the pandemic.

The government, which had taken a laid-back approach to fighting the pandemic was somewhat jolted by Zororo’s death and the outcry that followed. A day after his death, the cabinet put on hold all other business to discuss ways and measures of tackling Covid-19, in what the state-controlled Herald newspaper uncharacteristically called “a rare show of high-level seriousness by government”.

Cabinet also activated the 11-member inter-ministerial taskforce to deal with the pandemic, chaired by Vice President Kembo Mohadi. The taskforce was mandated with monitoring the situation and managing the response to the Covid-19 outbreak as well as identifying gaps for corrective action.

The government, which had taken a laid-back approach to fighting the pandemic was somewhat jolted by Zororo’s death and the outcry that followed.

On 27 March, Mnangagwa announced a 21-day national lockdown with effect from 30 March, as a principal measure to contain the pandemic. Most businesses were closed although essential service providers as well as producers and retailers of essential goods remained open. Public transport for essential workers was restricted to services provided by the Zimbabwe United Passenger Company (Zupco) and the Public Service Commission.

Mnangagwa also announced that additional treatment and isolation units and facilities would be established to ensure hospitals were not overwhelmed. Covid-19 testing, which was only being done in Harare, would be decentralised to provinces to expedite testing diagnostic services.

Although the lockdown has probably contributed to slowing down the spread of the virus, health experts and ordinary Zimbabweans believe failure to provide basic commodities, social safety nets, PPE for health personnel and ensure mass testing has meant that the measure was not effective. A mealie-meal shortage during the lockdown resulted in large crowds at shopping centres when the commodity was available. In many cases, the police and the military were called in to disperse or control them.

A mealie-meal shortage during the lockdown resulted in large crowds at shopping centres when the commodity was available.

Crucially, the lockdown period was not accompanied by massive testing and tracing of contacts because of a shortage of test kits. To aggravate the situation, the government failed to provide health personnel with PPEs, exposing them to the virus.

On 5 April, Zimbabwe’s doctors took government to court to compel it to provide them and other frontline medical practitioners such as nurses and pharmacists with PPEs. They also demanded that government adequately equip public hospitals to protect them from the deadly pandemic.

In the application, filed by ZADHR, the doctors said government had not put in place measures to ensure the screening and testing of personnel driving public transport ferrying authorised people to and from work. In addition, government had failed to screen and test public servants and security services working during the lockdown.

The government failed to provide health personnel with PPEs, exposing them to the virus.

On April 14, the High Court ordered government to protect frontline health practitioners and equip public hospitals with medication to stem the epidemic. By the time of writing, the government had however failed to adequately provide PPE, prompting nurses to embark on industrial action demanding protection and better remuneration at the beginning of July. At present, nurses earn between ZW$4, 000 and ZW$5, 000 ($40-$50 on the blackmarket). Most doctors take home between $80 and $100.

The banning of commuter omnibuses, which is still in force, has meant that transport company Zupco is unable to transport commuters because it has too few buses. Other commuter omnibuses, independent of Zupco, were stopped from operating as a Covid-19 containment measure. Commuters have to spend lengthy periods at crowded terminuses and pickup points, risking contracting the virus.

“On some days I spend up to five hours queuing for a bus. There is absolutely no social distancing at the terminus or in the buses. I’m sure that the virus is spreading rapidly because of these crowds at bus terminuses,” said Tichaona Muzeza of Granary in Harare.

“On some days I spend up to five hours queuing for a bus.”

Muzeza works in a retail outlet in Harare’s central busines district, which operates between 8am and 4.30pm. “On many occasions I have been late to work because of transport, but the major problem is trying to get home. Most of the time I get home between 8 and 9pm because of transport problems,” Muzeza said. Although he wears a mask all the time in public, Muzeza feels that commuting has put him at a high risk of getting Covid-19.

A Zimbabwe Human Rights NGO Forum Covid-19 lockdown report released on 1 June – day 64 of the lockdown – also said terminuses were hotspots of likely infection. According to the report, the Passengers Association of Zimbabwe (PAZ) had observed that commuters were now forced to rely on open trucks for transportation to work. On 1 June, at most bus terminuses, ZUPCO was not sanitising passengers, for example, the forum said.

After initially encouraging returning residents and visitors to self-quarantine, the government later imposed a 21-day mandatory quarantine for all arrivals, given the high number of positive cases among returnees. However, large numbers of people are escaping from quarantine centres amid reports that the government was failing to provide adequate food. Some of the quarantine facilities, which include schools, colleges and vocational training centres, do not have basic amenities such as running water.

Some of the quarantine facilities do not have basic amenities such as running water.

Quarantined residents have also been complaining about delayed testing and lack of social distancing, which exposes them to the virus, according to the NGO Forum’s report. The Covid-19 regulations relating to mandatory quarantine require returnees to be tested on day one, day eight and day 21, the forum said, but returnees sent to Chinhoyi Training Centre complained that they had spent more than 14 days in quarantine without being tested. In other places, those in quarantine were sharing buckets and crowded bath facilities, not observing social distancing during meals and had not been tested.

National police spokesman Paul Nyathi on 10 July revealed that 222 people had escaped from quarantine centres.

Covid-19 cases in Zimbabwe surpassed the 1,000 mark on 13 July after 49 people tested positive, bringing the total to 1,034. On 16 July, confirmed cases rose to 1,362 after 273 new infections, of which 260 were local transmissions. The virus had claimed three lives, bringing the death toll to 23. It is, however, likely that the true extent of the Covid-19 problem is unknown, because of limited testing. By 16 July, only 97,508 people had been tested countrywide.

National police spokesman Paul Nyathi on 10 July revealed that 222 people had escaped from quarantine centres.

Zimbabweans fear the worst, given a sharp rise in local transmissions, which are not being effectively traced. Worryingly, some cases are only detected during routine post-mortems. With an ineffective government, decayed public health infrastructure and weak public transport system, Zimbabwe’s pandemic is likely to spiral out of control.

 

We’d love to hear from you! Join The Wicked Conversation by leaving your comments below, or send your letter to the editor to richard@gga.org.

 

Owen Gagare is the assistant editor of the Zimbabwe Independent, a weekly newspaper, covering business, politics and investigative stories. He has previously worked for NewsDay and the Chronicle. Owen has also written for the Mail and Guardian and has a passion for investigative and in-depth stories as well as human rights and governance issues. He is based in Harare, Zimbabwe.

SOUTH AFRICA: A prescription for good governance in health

When then Health Minister Aaron Motsoaledi used a state hospital in 2013, the event was unusual enough to make headlines. Until then, it would have been unheard of for a senior politician to use a public hospital.

The fact that it was so unusual is due to the duality of South Africa’s health system – with high quality private care for those who can afford it and a straining public sector for those who cannot. According to Section 27, a public interest law centre, only 17 in 100 people in the country have private medical insurance. Private sector healthcare is 4,2% of gross domestic product (GDP), while public sector healthcare is 4,4% of GDP.

Until then, it would have been unheard of for a senior politician to use a public hospital.

The South African Constitution asserts that everyone has a right to access healthcare. That commitment is about to be tested. As the current health minister, Dr Zweli Mkhize, warned in early July: “The storm that we have consistently warned South Africans about is now arriving.”

By then, South Africa had the most confirmed Covid-19 cases in Africa, with more than two million South Africans tested and almost 300,000 infections. The pandemic has not discriminated. Infections have been registered from the country’s provincial premiers down to the unemployed. It is the access to services that remains unequal. 

The South African Constitution asserts that everyone has a right to access healthcare. That commitment is about to be tested.

Covid-19 has severely tested our health systems and, some would say, they have all been found wanting. Few would disagree that the status quo is unacceptable – but government’s proposed solution does not have universal appeal. In an address to the nation on 12 July, 2020, President Cyril Ramaphosa said the government was committed to “laying the foundation” for a National Health Insurance (NHI) fund, which would enable “all people to have access to the quality healthcare they need regardless of their ability to pay”.

It might have been the moment for government to build confidence in its ability to produce a system built on principles of universality and social solidarity. The reality was very different. Despite a lockdown since 23 March, as the president was speaking, South Africa still had insufficient high- and intensive-care beds and nurses.

“The storm that we have consistently warned South Africans about is now arriving.” – Dr Zweli Mkhize.

For many, it was a stark reminder of what would happen if government was allowed to push ahead with the NHI. For others, it merely reflected an already overstretched health system that can barely cope and the very reason for why major change is necessary.

The coronavirus arrived soon after South Africans across the country were given an opportunity to have their say on what they wanted from the proposed NHI. When government officials travelled across the country, they heard the same complaints: frequent stockouts, dilapidated healthcare facilities and a general lack of resources. Covid19 has amplified these shortfalls.

Covid-19 has severely tested our health systems and, some would say, they have all been found wanting.

Health in South Africa should not be seen as the responsibility of one ministerial function, the ministry of health. Ultimately, a citizen’s health relies on other government ministries as well, particularly infrastructure, water and sanitation – and, of course, the Treasury.

The proposed NHI is essentially a financing system that aims to ensure that all South Africans have access to essential healthcare regardless of their income.

But South Africans are only too familiar with the huge gap between policy and implementation. Covid-19 has laid bare the failings – and interconnectedness – of our for-profit private health sector and a human rights-based public sector.

The proposed NHI is essentially a financing system that aims to ensure that all South Africans have access to essential healthcare regardless of their income.

Ramaphosa is not alone in pushing an NHI agenda during the pandemic. “The realisation of the National Health Insurance has been a road hampered by opposition, and a fundamentally flawed system that is being protected by those that benefited from it,” the Mkhize told a University of Western Cape 60th celebration in June.

The annual budgets of the private and public sectors were similar, said Mkhize, but the private sector served 16%, while the public sector served 84% of the population. “With such inequality, the public healthcare system has suffered in the sheer weight of the burden while the private sector was characterised by over-servicing in the face of rising and escalating healthcare costs.”

South Africans are only too familiar with the huge gap between policy and implementation.

No one disputes that this is unacceptable. Even the Competition Commission’s Health Market Inquiry recommendations, published in November last year, highlighted the gross inequity in healthcare. The NHI’s very essence is redistributive. It is to many the dramatic overhaul our health system needs.

The proposal has received some academic support. Professor Diane McIntyre, in a 2019 paper, argues that while there is room for improvement in the current NHI Bill, it does provide the basis for moving to a universal healthcare system. Under the proposed system, healthcare will be funded with a single pool of tax money to benefit everyone, while medical aids will only provide complementary coverage for services not covered.

But will this improve the country’s health services? For the majority of those unable to access the most basic of services, possibly. But, as McIntyre notes, South Africans lack trust in the government’s ability to manage such a large-scale undertaking and have legitimate concerns about the government’s track record as regards governance. A decade of misuse of public funds, weak governance and a general impunity from charges of corruption has not engendered much faith in the government.

Travel to the Eastern Cape province of South Africa and the impact of the failure to deliver is laid bare. A BBC investigation into health delivery in the province – which had over 50,000 confirmed infections and more than 700 deaths in early July – showed a system on the brink of collapse.

The pandemic has certainly not caused the fault lines in our health system, but it has exposed them. Despite having had more than 100 days of lockdown to prepare for the pandemic’s peak, South Africa still does not have enough beds for the expected rise in the number of serious cases needing hospital treatment. And the impact on healthcare workers has been high. By early July, 377 doctors, 2,473 nurses and 1,971 other health professionals, including community health workers, had been infected, according to Mkhize.

A BBC investigation into health delivery in the province showed a system on the brink of collapse.

Some provinces, such as Gauteng, are already running out of beds in both private and public hospitals. Gauteng’s Health MEC Bandile Masuku said his department expected a shortage of at least 800 beds by the end of July. Given this, and the concerns noted above, the pandemic might be an opportunity to test public-private health sector partnerships. Reports that provinces are signing service level agreements (SLAs) with private hospitals and health practitioners to provide intensive care unit beds point to much needed cooperation.

The negotiations around the proposed public/private partnership have been complex: private-sector doctors were concerned about payment levels and questions of legal indemnity; the health ministry and private sector organisations had to agree common structures and tariffs; and separate agreements had to be negotiated between private sector healthcare organisations and provincial administrations. Given the delays these discussions have caused, the country’s lack of preparation for the peak of the virus may not be entirely the fault of officials. However, their missteps also undermine trust that government has the capacity to implement the NHI.

Some provinces, such as Gauteng, are already running out of beds in both private and public hospitals.

It is not all bad news. As Steve Reid, a medical academic at the University of Cape Town argues, “the COVID-19 pandemic is shedding light on how best to go about building the NHI – and what to avoid”. On the positive side, South Africa has considerable technical expertise and capacity in governance, in health economics, in health systems, in information systems and in community participation in healthcare. However, he warns that the “acute crisis” of the pandemic has also seen the government acting through a top-down, centralised command structure.

“This is not how effective systems based on primary healthcare are built. In the absence of a design approach with clear cycles of learning and feedback of evidence from the ground up, the risk is that the whole NHI system will fail to be implemented,” he writes. “There are many examples of the ‘implementation gap’ between well-intentioned policy and actual practice in South Africa.”

“The COVID-19 pandemic is shedding light on how best to go about building the NHI – and what to avoid” – Steve Reid, medical academic at the University of Cape Town.

How the South African government manages the health response to the Covid-19 pandemic will influence levels of public trust in its ability to deliver the NHI. So, too, will its commitment to good governance in its handling of the crisis.

The best paragraph of the article. Is there some way we can give it prominence, or ask SP to highlight it when they dice it up for web publication? RJ: Yes agreed, Sue, could we make this a pullquote?

 

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Paula Fray is a leading media trainer and coach who works across Africa and the Middle East. The former regional director for Inter Press Service Africa, she is the CEO of the pan-African communications company frayintermedia, which has worked to improve the quality of journalism in Africa since 2005.