The deaths of several African ministers due to COVID-19 have sparked a conversation about the need to strengthen local health care facilities that were largely neglected before the pandemic.
So far in 2021, South Africa, Eswatini, Zimbabwe, and Malawi have all lost cabinet ministers to the pandemic. These high-profile deaths have led to concerns that health care systems may be overwhelmed due to a second wave of the coronavirus and the possible spread of a new, more transmissible COVID-19 variant that was first detected in South Africa and has now been found in six other African countries: Botswana, Comoros, Ghana, Kenya, Mozambique, and Zambia.
Politicians in these countries often bypass local health systems and seek care elsewhere. In 2019, former Zimbabwe President Robert Mugabe died in Singapore after receiving treatment in the city-state for several months. In the same year, current Zimbabwe Vice President Constantino Chiwenga spent four months in China receiving medical treatment for an unknown illness.
But COVID-19 has closed borders and made travel impossible, meaning even those in positions of relative privilege have had to rely on the overtaxed health systems in their own countries.
Fungisai Dube, executive director at Citizens Health Watch — a local organization in Zimbabwe that monitors health care delivery in public and private hospitals — said that the health care system in the country was “ill-equipped” to deal with the pandemic because of lack of investment.
“The spread of COVID-19 — even amongst the political elites, such as Cabinet ministers, army generals, and captains of industry — reminds us that nobody is safe until everyone is safe.”— Itai Rusike, executive director, Community Working Group on Health
“The death of the ministers, for me, is noteworthy because ordinarily they could have gotten health care elsewhere. … But this time, they had to go to the facilities that they have neglected for years, and they wanted those facilities to perform miracles, which was not possible,” she said. “We have tended to label local health facilities as more for the poor, for those that can't go to India, that can't go to South Africa or China or some other countries.”
Dube added that Zimbabwe is failing to cope with its COVID-19 caseload and that the system has crumbled. “All along, we thought it was collapsing, we thought it was a gradual disintegration towards the end. But actually when the second wave hit, we literally collapsed,” she said.
“[If] you are a health worker ... and [Foreign] Minister Sibusiso Moyo comes there [to the hospital] sick, you run like a headless chicken trying to make sure — but you have nothing to use, you have nothing at your disposal. Eventually the minister will die,” Dube said.
Moyo died in a local hospital on Jan. 20 after contracting COVID-19.
Itai Rusike, executive director at Zimbabwe’s Community Working Group on Health, said that “the spread of COVID-19 — even amongst the political elites, such as Cabinet ministers, army generals, and captains of industry — reminds us that nobody is safe until everyone is safe.”
He added that there are hard lessons for political leaders to learn from COVID-19 on the importance of prioritizing domestic health financing and having functioning public health delivery services, especially now that they cannot travel outside the country for medical treatment due to pandemic travel restrictions.
“Health services in Zimbabwe are underfunded with perennial strike actions by nurses and doctors, shortages of essential medicines, poorly equipped hospitals, shortages of PPE [personal protective equipment], and generally low staff morale,” Rusike said.
Dube agreed, adding that Zimbabwe has not prioritized local health investment over the years, since those in government often don’t use their own country’s system. “There hasn’t been any political will … to try and develop our facilities to world-class standards,” she said.
George Jobe, executive director at Malawi Health Equity Network, said a similar story has played out in Malawi.
Prior to COVID-19, the country’s public health facilities were experiencing challenges such as almost 50% vacancy rates, as well as inadequate ambulances, ventilators, and PPE, he said. But the pandemic exacerbated the lack of resources.
Now that everyone has been forced to rely upon local public health facilities due to airport closures, Jobe is hoping there will be a realization that “the country's health services need to be better resourced so that referrals to other countries should greatly be minimized.”
Figures from UNICEF show that both Malawi and Zimbabwe have consistently failed to meet the target set out under the 2001 Abuja Declaration, which saw African Union countries pledging to allocate at least 15% of their annual budgets to the health sector.
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Over the last few years, Zimbabwe has gradually increased its budget allocation to health from 7% in 2019 to 10% in 2020 and 12.74% in 2021 — but still failed to meet this target. In Malawi, though health remains the third-largest sector in terms of budget allocations — with 9.4% of the total budget in the 2019-2020 financial year — it has also consistently failed to meet the target.
However, the Malawian government appears to have taken heed of the need for more investment. In January, after the deaths of two Cabinet ministers, Malawian President Lazarus Chakwera declared a state of emergency over COVID-19 and pledged to increase funding and recruit additional medical personnel.
“Our medical facilities are terribly understaffed, and our medical personnel are outnumbered,” he said.
Marion Pechayre, head of mission for Médecins Sans Frontières in Malawi, said she has also noticed a rapid increase in resources at the two biggest hospitals in Malawi.
“The Ministry of Health has stepped up quite well in the past two weeks, because they have recruited more than 1,300 staff and they had some 150 oxygen concentrators which they distributed throughout the country,” she said.
Though Dube said she hopes officials in Zimbabwe will do the same, she is doubtful that this will be the case. “I am still convinced that even after this, if [the government] are to do something, they will develop a state of the art for themselves,” she said, “not for me and you.”
Update, Feb. 15, 2021: This article has been updated to clarify that prior to COVID-19 Malawi’s public health facilities had a vacancy rate of almost 50% and that MSF has noticed increased resources in the two biggest hospitals in Malawi.