Zambian leaders, including current president Michael Sata, have flocked to South Africa for medical treatment at government expense, prompting a complaint by a leading NGO that “they have no confidence in their own healthcare system”.

This week, a Zambian medical doctor who has immigrated to New Zealand this week blamed the lack of government investment in the state health sector for the skills drain and the worsening crisis in the country’s health services.

Contacted in Christchurch via email, Mwandila Munanga (35), said it was frustrating to have to turn patients away because of a lack of facilities.

“In medical school, and even more when I started working, I would struggle to help suffering patients due to lack of adequate or certain health resources. I always knew that we could do better,” Munanga said.

According to the World Bank, the Zambian infant mortality rate is 86 per 1 000 live births, compared with 6.9 per 1 000 in the United States, while life expectancy is 48.

The organisation said that Sata and his wife Kaseba had been direct beneficiaries of government-funded treatment in South Africa while he was in opposition.

In January last year Sata wrote a letter thanking the incumbent president, Rupiah Banda, for evacuating his wife to South Africa. However, he added the cheeky implied criticism that “health care must become a human right by law, [rather than being] for the privileged few, after 46 years of independence”.

Other top politicians who have benefited include Banda himself, former president Frederick Chiluba, and late local government minister Ben Tetamshimba.

The Mail & Guardian understands that the country’s third president, the late Levy Mwanawasa, broke with tradition by not travelling to South Africa for medical check-ups – instead he flew to England for this purpose during the entire eight years of his presidency.  

Experts say that the health system has suffered under the burden of government austerity measures, designed to tame inflation and tighten fiscal discipline. Some 64% of Zambians live on less than $1 a day.

In 2010 the World Bank reported that the health system suffers from staff vacancies of more than 33%, while 69% of professional posts are unfilled, with “doctors, nurses, midwives, lab technicians in acute shortage”.

Added the bank’s country report: “Patient queues and waiting times are long, averaging 65 minutes. More seriously, the length of time being spent on patient care is being compromised. Facilities are increasingly relying on expatriate staff and volunteer staff.”

It added that “the human resources situation in Zambia is in a state of crisis”.

The ministry of health acknowledges the staff shortages in Zambia’s 2011 National Action Plan, which states that the total number of staff in the health sector is 29 533 – 57% of the approved establishment.

The average patient-to-doctor ratio is about 10 000:1 – about double the World Health Organisation-recommended ratio for doctors and far higher than the recommended ratio of nurses to population 700:1.

Public service sources say treatment junkets abroad by Zambian politicians have cost taxpayers billions of kwacha.

The M&G asked the spokesperson for the Zambian health ministry, Kamoto Mbewe, how much such trips cost the government. Three weeks later he had not responded.

Natalie Jackson, client services manager at Morningside Hospital in Johannesburg, confirmed that many Zambians came to the hospital for specialised treatment. However, she declined to give details.

Treatment at South Africa’s private clinics is not cheap. The Morningside tariff schedule shows, for example, that the rate for a private ward – which Zambian high-ups are known to use – is R3 199,70 per day.

In theory, there is universal access to Zambia’s health system, but in practice access is limited by the underfunding of hospitals and clinics and a shortage of doctors and nurses.

Most health institutions are in a dilapidated state and have no drugs to dispense to patients. In many cases, only across-the-counter painkillers are dispensed, even for serious conditions.

New state hospitals have sprung up, including the newly-built Levy Mwanawasa General Hospital in Lusaka. However, they lack vital equipment and staff.

Relatives of a patient admitted to Levy Mwanawasa Hospital after a miscarriage, for example, were advised to take blood samples to a private hospital for diagnosis.

“We were told to take the (blood) samples to St. John’s Hospital. This is too much for the family; we have no more money left,” said a relative, who asked to remain anonymous. 

In November last year three leading civil society organisations, the Civil Society for Poverty Reduction, Caritas Zambia and the Jesuit Centre for Theological Reflections, urged government to abide by the Abuja Declaration, an African Union instrument, of allocating 15% of the total national budget to the health sector.

“Allocation to the health sector is 9.31% of the total budget,” the organisations said in a petition to the finance ministry on the 2012 budget. “Though this is a significant increment it falls below the Abuja commitment.”

Setting out his reasons for settling in New Zealand, Munanga said:

“Young patients with heart conditions got to me ... they suffer and die so young from something that can be treated if only the resources were readily available.”

He said that the stark contrast between the quality of healthcare in Zambia and New Zealand had reinforced his commitment to make a difference in his home country. In 2009, he teamed up with other doctors in New Zealand through the Mutima (heart) Project to mobilise resources and provide heart operation services to poor Zambians.

“There is no established cardio-thoracic service in Zambia,” he said.

A well-placed government source said the lack of trained medical staff is most severe in rural Zambia, where people may have to travel hundreds of kilometres for a rushed consultation.

“The health sector is one of the most neglected, and I do not see how we can reach the Millennium Development Goals on health by 2015,” the source said.

Sata recently directed the finance minister, Alexander Chikwanda to explore ways of improving the remuneration of doctors as a way of “putting more money in their pockets and improving health”.

The Mail and Guardian Newspaper - SA, March 16 to 22 2012