A few weeks ago senior doctors wrote to the government, threatening to down their tools today (29 July) if their many demands were not met. Among their grievances was a demand that they be given adequate protective equipment (PPE) in the face of rising numbers of patients with the coronavirus. The lack of PPE has seen many health care workers testing positive. The doctors also demanded that their be paid in USD dollars.

While the government has sought to explain away some of these grievances the demand to be paid in USD dollars was rejected outright. The government claimed that there were not going back to re-dolarisation which they called a tried and failed concept. It’s not clear what the government means by this as a lot of economists blame the government’s avarice for the failure of dollarisation. Below is a full text of the letter to senior doctors:

The Executive, Senior Hospital Doctors Association

Attention: Dr S Nyaguse – Chiurunge
Ref: Ministry of Health and Child Care P 0 Box CY1122 Causeway HARARE
Reference is made to your letter dated 14 July 2020 addressed to the Acting Honourable Minister with regards to the above and a meeting held on the 27th of July 2020 to discuss the issues raised in your letter.

Below is the detailed response of the issues which you raised: 1. Personal Protective Equipment (PPE); It is noted that the demand for PPE is continuing to rise in sync with the rising number of Covid-19 cases. The procurement and distribution of PPE is a continuous process and not an event as the consumption rate is very high. PPE is the biggest cost driver in the prevention and containment of COVID-19. While efforts are in progress to expand local production of some of the items which will reduce pressure on resources required to import other products that are not produced locally, the Ministry is currently working with NatPharm to procure additional PPE and expeditiously distribute it to all stations. The latest PPE stock status shows that we have just over a month’s supply of PPE at the current usage rate.

As at 28 July 2020, a total of 253 health workers including student nurses had tested positive for COVID-19. The Pharmacy Directorate is finalizing the quantification of PPE requirements for submission to the Resource Mobilization Committee of the Ad-hoc Inter-Ministerial Task Force on COVID-19.
Please find attached the stock status as at 27 July 2020.

2. COVID-19 Testing of hospital inpatients Testing continues to be a challenge. Health Workers are struggling to provide services to clients without COVID-19 tests being carried out in the face of inadequate PPE. There has been an increase in poor outcomes in all departments as clients go unattended as a result of limited testing capacity. The Ministry has since written to all public and private institutions directing them to set up patients under investigation units (PUI Units) to facilitate timely attendance to patients seeking care.

Whilst COVID-19 testing has been decentralized, challenges continue to be faced on availability of some consumables such as Gene X-pert cartridges which are scarce on the international market. Donations of PCR testing kits were also received but our testing capacity is limited by the shortage of viral transport media VTM and swabs among other items which include boosting human resources. In that reign the Ministry is planning to recruit laboratory trained staff.

3. Medicines, medical sundries and medical equipment The availability of drugs, medical products and equipment is a direct function of the availability of forex, as over 90% of medicines are imported. Collectively we have not demonstrated capacity to produce our own drugs and equipment locally the high import bill for medicines and medical products. Covid-19 derailed the procurement processes that were in progress as resources had to be diverted to the pandemic. The new Ministry realigned staff is hitting the ground running to:

a. Establish requirements and priorities;

b. Establish the available resources both in local and forex; and

c. Initiate the procurement processes and follow up on existing commitments.

4. Payment of salaries in USD The Health Service Board with the guidance of the Acting Hon Minister have made submissions to Treasury to review Health Worker Packages. However, the Government is not in a position to pay salaries in USD. Full US dollarization of the economy is a tried, tested and failed concept. By February 2018 the country was dry of the US Dollar with citizens sleeping at the banks to withdraw their deposits to no avail. Foreigners also descended on Zimbabwe in search of the easily accessible US Dollars in addition to locals also externalizing their US Dollar reserves. There is absolutely nothing to stop that from happening again. Doing the same thing over and over again expecting a different result is Albert Einstein’s definition of insanity. We have to be innovative and explore other ways of resolving these challenges.

a. The US Dollars is American currency printed by the Federal Reserve and is not printed for free for other countries; b. Other countries can only access the USD through international trade of goods and services;

c. The USD reserves generated by the Zimbabwean economy are not adequate to sustain import obligations such as fuel, food because of droughts and natural disasters, electrical power following droughts resulting in reduced generation, medicines and medical products aggravated by Covid-19, industrial and agricultural machinery just to mention a few. Diverting the limited USD forex to paying salaries is suicidal for the economy and social services provision.

d. Printing the ZWL$ without consideration to the economic fundamentals is inflationary and Zimbabweans are experiencing the horrors of a second wave of hyperinflation.

A measured approach in improving salaries and buying power of the currency is recommended as evidenced by some of the efforts which include the under listed: i) The Government reviewed salaries by 5o% and paid a USD 75 denominated civil services Nostro card to Health Workers. ii) A request for an upward review of the COVID-19 Risk Allowances was submitted to Treasury. (The Health Workers had requested for 400, 500 and 600 USD equivalent.) iii) Use of arbitration to address sticky salary issues.
5. Payment of Clinical Allowances The payment of allowances to University of Zimbabwe Consultants was approved in principle. To this end, the Parirenyatwa Group of Hospitals has been processing payments pegged at an agreed RTGS3,50o per consultant per month. Payments for March 2020 were made on the 3. of April 2020, whilst payments for April 2020 were made on the 3rd of June 2020 with payments for May and June having been processed on the 17th of July 2020.
Whilst noting the payments, concern was raised on having Parirenyatwa meet the bill noting that the revenues inflows have declined since the onset of COVID-19.

6. Other emerging issues

a. Donor funded allowances from the Health Development Fund The HDF has set aside a budget of USD2 million to cover all Health Workers. Guided by presence at work this might cover only up to two months. The Ministry has however opted for this amount to be used for procurement of PPE.
b. Dual employment for University of Zimbabwe Consultants Concern raised by UZ-CHS over inconsistencies on the dual employment is noted. This issue has since been brought to the attention of the Honorable Minister and will be addressed as part of the ongoing restructuring of the public health sector.
It is hoped that the above responses answer the questions raised in your correspondence and we pray that you will reconsider your intention of withdrawing services with effect from after duty on the 29th of July 2020.


Dr G. Mhlanga
Cc Hon Acting Minister of Health and Child Care: Prof. dr. A Murwira Hon Deputy Minister of Health and Child Care: Dr J Mangwiro Executive Director, Health Service Board: Ms R R Kaseke

Whither too

It’s not clear how the senior doctors will do in response to this letter.