HEALTH POLICY

Ministry of Health working document Draft 1

The Government of Zimbabwe Ministry of Health and Human Welfare (Child welfare) will be composed of several departments overseen by the Minister of Health and the Deputy.

 

1- DEPARTMENT of COMMUNITY HEALTH and EDUCATION (DCHE)

 

Mission statement,Working principles,Core functions and Goals of the Department of Community Health and education.

Mission statement of the DCHE

The mission of the DCHE is to work in partnership with the community to ensure the optimal health and well being of all people through a dynamic and responsive process respecting the diversity of the community and challenging us to provide for present and future generations.

Working principles of the DCHE

1. Based on Science and Evidence
2. Driven by Social Justice
3. Focused on Prevention
4. Centered on the Community

Core Functions of the CDHE

1. Assessment: The regular collection, analysis and sharing of information about health conditions, risks and resources in a community
2. Policy Development: The development of local and nationwide health policies using information gathered from assessment activities. Policy development incorporates information sharing, citizen participation, and involvement in policy and decision making.
3. Assurance: Focuses on maintaining the capacity of public health to respond to critical situations such as disease outbreaks and environmental hazards, as well as the delivery of health care to persons who otherwise would not have any.

Goals of the DCHE

The goals of our nation’s public health system is to prevent disease and disability, promote healthy lifestyles, and prevent and mitigate the results of both unintentional and intentional public health threats, including biological, chemical, and nuclear terrorism as well as natural disasters. These goals are facilitated through implementation of the following ten essential public health services.

• Monitor health status to identify community health problems.
• Diagnose and investigate health problems and health hazards in the community.
• Inform, educate, and empower people about health issues.
• Mobilize community partnerships to identify and solve health problems.
• Develop policies and plans that support individual and community health efforts.
• Enforce laws and regulations that protect health and ensure safety.
• Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
• Assure a competent public health and personal health care workforce.
• Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
• Research for new insights and innovative solutions to health problems.

Public health infrastructure

The governmental public health infrastructure provides the backbone necessary to carry out the ten essential public health services. Three areas are vital to a strong public health system: public health workforce; information, data, and communication systems; and organizational and systems capacity. Public health infrastructure is comprised of a complex network of people, systems, and organizations working in all levels of government and in the private sector. As such, the strength of the public health system depends on sustained, consistent investment and cooperation among all levels of government.

Public health workforce
An adequate and well-trained workforce is necessary for carrying out the essential public health services. Currently, this is critical due to the increasing retirement rate of public health officials and workers and insufficient education incentives. Government will support coordination between the DCHE and THE PRIVATE SECTOR to develop mechanisms to recruit and retain individuals to the field, including a government loan repayment or scholarship program that supports master of public health graduates who choose to work in local, and central government public health agencies.

Physicians and public health professionals in the Diaspora

The ministry of health will offer incentives for public health professionals, primary care physicians, specialist physicians, nurses and physio and occupational therapists, scientists and researchers for returning either part time or full time to Zimbabwe to render service in the field of medicine, science and health. Specifics of these incentives and the full policy will be detailed in the working document.

Public health surveillance

Government will support the need for tracking both human health and environmental indicators using epidemiologic methods. Epidemiological surveillance is defined by the WHO  as “the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in assessment, planning, implementation, and evaluation of human health and environment.” Applying epidemiological methods when gathering data ensures a critical examination of the data, and incorporates information not only on health outcomes, but also on the environmental hazards and exposures to which these outcomes may be related.  Tracking conditions in the environment and the public health status of populations provides an opportunity to compare this information through time and across geographic areas.

Public health laboratories

Public health laboratories provide the basic and confirmatory laboratory testing data and consulting information for a vast number of public health programs. This includes confirmatory testing during disease outbreaks for known diseases and/or new emerging conditions affecting human health. Participation in acute disease laboratory testing and public health epidemiology processes; verification of therapeutic or vaccination compliance for disease intervention and prevention programs; monitoring of the environment for harmful contaminants; testing and consulting on potential biological or chemical threats in preparedness planning and response; toxicology testing in support of both human health and law enforcement; and congenital disease detection and referral for immediate medical intervention in newborn screening programs. Public health laboratories rely on a competent and technically trained workforce; availability of state of the art scientific equipment; and up-to-date facilities. Government will use existing laboratory infrastructure in district and government hospitals in order to achieve a high level quality of testing and accounting procedures.

Department of Community Health and Education is subdivided into different offices as follows:

1-Office of Infectious Diseases

This office has a director and deputy who will oversee these program areas:

• HIV and STD Program
• Nosocomial Infections and Hospital Health Program (NIHHP)
• Diarrheal and Enteric Disease Program (DEDP)
•  Malaria and Parasitic Disease Program (MPDP)
• Respiratory Infections Program (RIP)

Each of these Programs will have a Chief Program Officer (CPO) under whom there will be program coordinators.

Each program will have a surveillance system to monitor infectious disease outbreaks and early epidemics such as cholera or malaria.

Each program will have a preventive section dealing with education and health promotion testing and screening services.

Each program will have a research and development section, which will liaise directly with the medical schools and the Public health programs therein.

2- Office of Maternal and Child Health

This office has a director and deputy who oversee these program areas:

• Prenatal care/antenatal education program (PCP)
• Childhood immunization Program (CHIP)
• Pediatric health and wellness Program (PHWP)
• Adolescent health and wellness Program (AHWP)
• Domestic Violence Counseling Program (DVCP)

Each of these Programs will have a Chief Program Officer (CPO) under whom there will be program  coordinators.
Each program will have a surveillance system to monitor the statistics and data on immunizations.

There will also be a system to ensure that all children are up to date with their mandatory immunizations in order to prevent outbreaks of measles mumps and rubella.

A system will be in place to keep track of child abuse and domestic violence cases which will be referred to law enforcement authorities as deemed necessary.

Each program will have a research and development section, which will liaise directly with the medical schools and the Public health programs therein.

3-Office of Chronic Diseases

There will be a director and deputy to oversee the programs in this office. The programs are:

• Diabetes program (DP)
• Cardiovascular disease program (CDP)
• Rheumatoid arthritis and arthritis program (RAAP)
• Obesity and nutrition program (ONP)
• Oncology and cancer program ( OCP)

Each of these Programs will have a Chief Program Officer (CPO) under whom there will be program coordinators.

Education on prevention of chronic diseases is very important. Emphasis should be on healthy lifestyle good well balanced nutrition and the importance of an annual physical evaluation by a primary care physician.

Each program will have a research and development section, which will liaise directly with the medical schools and the Public health programs therein.

4- Office of Geriatric Care and Welfare

This office has a director and deputy who will oversee these program areas:

This office deals with the welfare of the elderly, from their medicinal nutritional and physical therapy needs to their domestic and social set ups.

This office will liaise directly on research and development, with the medical schools and Public health programs therein.

5-Office of Occupational Health and Welfare

This office has a director and a deputy. There will be field officers who are answerable to the deputy director.

The office will be involved in ensuring that companies and organizations are compliant with occupational health laws and worker’s compensation guidelines.

This office is also responsible for the inspection of workplaces in order to ensure the safety and wellbeing of workers.

This office sets out the guidelines for a safe working environment and ensures that companies get the right certifications required to operate certain hazardous machinery or equipment.

6- Office of Environmental Health

This office deals with health hazards in the environment, such as the

•  dumping of toxic waste and chemicals into water reservoirs or landfills,
• The presence of radioactive chemicals in the environment
• Presence of carcinogenic chemicals in homes and environment
• Inspection of homes for lead based paints (cause disease in children)
• Inspection of homes for asbestos roofing (causes lung cancer)
• Control of environments which breed zoonotic hosts for diseases such as malaria, trypanomiasis (sleeping sickness), schistosomiasis (bilharzias) and other vector borne diseases.

7-Office of Mental Health Services

This office will have a director and a deputy director to oversee the programs. There will be program officers to oversee each program area.

This office will be divided into the following programs:

• Pediatric Mental Health Program
• Adolescent Mental Health Program
• Adult Mental Health Program

Each of these programs will have an education and training component for the specific gage groups. The pediatric and adolescent mental health programs will be responsible for providing mental health and counseling services to schools. These programs will also be responsible for evaluating mental health services provided by private practioners, NGOs and any in house counselors in schools, and other institutions.

An initiative of this office is the provision of counseling and mental health support to victims of torture and abuse during turbulent times in Zimbabwe dating back as far as the war of liberation (pre 1980) and Gukurahundi massacres in Matebeleland (1982) and the torture victims during election periods.

Another initiative is the rehabilitation of youths who were part of ZANU-PF militia training camps, whose mental state needs to be assessed and to restore them to functioning as useful members of society.

This office will liaise directly on research and development, with the medical schools and Public health programs therein. Direct collaboration will also take place with the schools of social work, prison services and mental health facilities in the country.

Each of these offices has a specific mission under the overarching mission of the department of community health. Each department also has a specific set of goals and objectives and a strategic plan setting out 3 year, 6 year and 9 year plans of action (POAs).

 

2- DEPARTMENT of PRIMARY CARE and REFFERAL SERVICES (DPCRS)

 

Mission Statement: The Department of Primary Care and Referral Services is committed to making affordable and accessible health care a right for all Zimbabweans regardless of socio economic status. Accessibility of primary care physicians for examinations, diagnoses and prescriptions is our top most priority.

Working Principles of the DPCRS

• Evidence based diagnosis and treatment of disease
• Focused on treatment and cure of disease
• Centered on individual medical assessment and provision of up to date, effective treatment.

Core Functions of the DPCRS

• Delivery of primary health care, drugs and other treatments to Urban and Rural populations in Zimbabwe.
• Oversight of and collaboration with private insurance companies to ensure affordable healthcare coverage for all.
• Maintaining medical infrastructure and quality assurance standards both in the government and private sectors of the health care delivery system.

This department is further divided into the following offices:

1-Office of Rural Physicians and nurses and physical therapists

Government will provide access to quality, affordable health care which is an important building block of rural development. Rural Zimbabwe poses unique challenges to the traditional economic models of health care delivery, which includes centralised hospital centers and employer-sponsored health insurance. Local district and provincial hospitals and the central government must work in partnership to develop innovative solutions to improve the quality, affordability, and access to health care and health insurance in rural communities across this nation. In moving forward with this important initiative, the government recognizes that a one-size-fits-all strategy for health care in rural areas will not meet the unique needs of individual communities. Therefore, district, provincial, mission hospitals and central government should work collaboratively on identifying issues and proposing solutions to improve access to quality health care in rural areas.

Key in this office will be:

Adequate numbers of trained internal medicine physicians to administer primary care and who will issue referrals to specialist physicians as needed.

Adequate numbers of trained nurses and nursing assistants who will perform duties at hospitals, at station clinics and carry out home visits for the elderly, the incapacitated and pregnant women.

Adequate numbers of trained physical therapists to serve at provincial and district hospitals as well as to perform home visits for the elderly and the incapacitated.

This office will ensure the proper and timely administration and documentation of immunizations and immunization coverage in the rural areas. It will also ensure that patients have basic medical coverage for basic medical check-ups and for emergency ambulatory care.

 

2-Office of Urban Physicians and Clinics and physical therapists

This office is responsible for the certification of urban physicians both in the government and private sectors.

This office is also responsible for the oversight of private practice physicians, private hospitals and clinics, private physio therapy practitioners, private insurance companies and private practice nurses and physicians working in NGOs.

This office will conduct due diligence on all foreign physicians and researchers coming into Zimbabwe to practice medicine or to carry out clinical research.

This office will work closely with the Institutional Review Board (IRB) for research and ethics.

This office will enforce compliance with the surveillance system for reportable diseases, a list of which will be made available nationwide to all physicians and medical practices in the private and government sectors.

 

3- Office of health coverage for primary care and preventive services

This office will partner with private insurance entities to purchase health insurance for those who cannot afford it. A government run insurance company will be set up under which eligible elderly, pregnant women, orphans and orphanages, widows without sustainable income will be covered for basic medical treatment, mandatory testing and screening and preventive services.

These are the basic two departments and the working paper will detail  each of the specific areas of service and what they entail.

The paper will then describe the role of the ministry of health, collaborations with other sectors of government and sources of funding for proposed activities. The issue of health professionals in the Diaspora will be given some attention, including incentives for a return to Zimbabwe for service.

 

N.B A 60 page or so strategic health policy plan available to us will be used as a working document