Harare Students and Junior Doctors Workshop Report ZADHR News 6 Human Resources for Health: A Rights’ Based Approach The workshop was held on the 29 August 2009 at Bronte Hotel in Harare and attended by 50 junior doctors and medical students. A summary of the presentations and recommendations made by participants follow below: Health Systems and Right to Health Approach: A Framework for Thinking: Primrose Matambanadzo. The World Health Organisation defines health systems as “all institutions, people and actions whose primary intent is to promote, restore or maintain health.” Human resources for health (HRH) are a key element of the health system and are frontline witnesses of the progress in achievement of the right to health. For enjoyment of the right to health - enjoyment of facilities and conditions that are necessary for good health – it is necessary to have an effective and integrated health system with human resources for health of adequate number and skill. Examining Factors Aggravating the Degraded State of our Health System and their impact on Human Resources for Health: Dr Nemache Mawere A racially biased health system that was overly dependent on Mission Hospitals to serve the bulk of the population was inherited at independence. A primary health care approach was adopted in the mid 80s which yielded results with a good referral system in place, increased community participation and lowering of indicators. Allocation of resources for health was reduced during the years of ESAP and in the mid to late 1990s further pressuring a health system struggling to cope with the added disease burden of HIV/AIDS. This period was also fraught with frequent strikes by health workers which were met with a harsh response and dismissals by the government. Brain drain, especially of nurses sharply increased in the late 1990s, with further massive exodus of health professionals in the early 2000s. The departure of teaching staff from the Medical School impacted the quality of medical education. This was mirrored by an increase in intakes in a bid to replace lost human resources with newly trained cadres. During the last decade strikes by health workers became even more frequent. The situation came to a head at the end of 2008 when hospitals were forced to close as was the University of Zimbabwe’s Medical School. Zimbabwe’s Medical Training: Challenges and opportunities: Perspective of the lecturer: Prof. Chidzonga (Dean of the College of Health Sciences) Currently the intake into medical school is around 200 students per year for facilities that can accommodate only 60 – 80 students. This is mainly an attempt to address the shortage of doctors in the country. Laboratory space is too small for the number of students and clinical teaching is minimal. Furthermore, there is no transport for students thus consuming some of their time travelling on public transport. Vacancy rate of up to 100% has been seen in some departments within the institutions. Salaries for lecturers are quite low thus low morale among lecturers. Upon graduation more than 90% of the trained doctors leave the country and this further worsens the situation of depleted human resources for health in the country. Zimbabwe’s Medical Training: Challenges and opportunities Perspective of the cadre: Dr. Chizhande (President, Hospital Doctors Association) The medical training has been marred by brain drain and collapse of the health system. Final year students at the medical school complain that some of their lecturers fail them unjustifiably. There is little mentorship for the junior doctors and conditions of service are quite poor and the remuneration is pathetic. Grievances are not addressed in a timely manner contributing to frequent strikes. Punitive measures such as bonding should be avoided with the focus on improving conditions of service to retain staff. Human Resources for Health: Strategies for Retention and Development: Mr. Sande Director (Condition of Service and Industrial Relations –Health Services Board) The following remedies have been embarked on to retain and develop Zimbabwe’s human resources for health: • Lobbying for 15% of the national budget to be allocated to health • Limiting bureaucracy by resuscitating of Health Management Boards and decentralising of decision making to enhance efficiency; • Providing accommodation (institutional accommodation and an affordable housing scheme); • Providing transport (affordable transport for, car loan schemes and duty free certificates for health professionals); • Defining career pathways after training • Dialoguing with health professionals in and outside the country Recommendations • The Dean should facilitate the resuscitation of the medical students association, which was banned some time ago, as a channel for students to air their grievances. • The Dean should investigate allegations that some lecturers who are failing final year students unjustifiably. • There is need to standardize final year examinations as is the case with Part 3 exams. • Housemanship should be standardized to levels comparable to those in the SADC region. • Bodies representing health professionals should speak with one voice in raising concerns with the functioning of the health system. • Grievances by health professionals should be resolved amicably without fear of losing employment. • Strategies should be put in place to encourage specialisation as there are a few specialists in the country at the moment. • The HSB should focus on improving working conditions for health personnel to retain them instead of taking punitive measures such as an unnecessarily long bonding period. 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