FULL THREAD: Reasons Why The Health Services Board Should Be Disbanded

The Zimbabwe Association of Doctors for Human Rights (ZADHR) secretary, Dr Norman Matara argues that the Health Services Board (HSB) should be disbanded.

In his International Workers Day statement posted on Twitter, Dr Matara said the HSB should be replaced with a Health Service Commission whose board members, who will be non-executive, will be appointed through an open, competitive process. Below is the statement:

As today is International Workers Day, this thread is about the Health Services Board (HSB) and its passive or active role in the perennial health worker industrial actions and poor remuneration of health professionals in Zimbabwe. The HSB is the big elephant in the room.

… The Health Services Board became operational on June 1, 2005, through Statutory Instrument 88B of 2005 under the Health Services Act (Chapter 15:16 No. 28/2004). All health workers in the public sector were then moved from the Public Service Commission to the HSB.

The mission of the HSB reads: Guided by World Class Standards, seeks 2provide an Efficient, Effective &Responsive Health Service Delivery System through Well-Motivated, Trained &Dedicated staff. Values:Professionalism, Accessibility,Transparency,Integrity, Innovation & Equity.

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The government mandated HSB with making appointments, grading, fixing conditions of service for health workers, investigating complaints made by health workers, supervising and monitoring hospital management boards and assisting in mobilising resources for the sector.

Instead, this bloated board has just served individual interests. Giving themselves hefty allowances, buying top of the range cars for HSB executives, leaving health workers earning less than an equivalent of 150USD per month with no meaningful attempt to improve conditions of service.

The recurrence of industrial actions in the health sector points to an absolute failure in the HSB conceptual framework as well as the inability or unwillingness of the Minister of Health & the HSB office bearers to properly and fully discharge their duties as set in the Health Services Act.

Major weaknesses in the Health Services Act include that the Minister of Health and Child Care is empowered to appoint office bearers of the HSB; direct policy decisions; recognise or revoke representation of health worker associations, and appoint hospital management boards.

The HSB, therefore, lacks independence as its office bearers are appointed, and beholden to the Minister of Health and Child Care.

This lack of autonomy of the HSB from the Ministry severely compromises the quality of decisions that the HSB makes and has a negative impact on the calibre of the health services bipartite negotiating panel as loyalty to the minister can be rewarded by appointment of health workers’ representatives with obscure constituencies and self motives.

The HSB bipartite negotiating panel has had some representatives of health workers (HWs) who have been reappointed by the minister since 2008 and whose mandate from their respective associations is highly questionable.

The board does not have the capacity to make independent decisions that have a bearing on the welfare of HWs. Any decisions that result in increased resources required from the Consolidated Revenue Fund must be approved by the Ministry of Finance.

The requirement renders any negotiations between the HSB and HWs meaningless as they do not have any specific fiscal allocations that address HWs welfare.

Any financial agreement between HWs and the HSB will need to undergo a long, bureaucratic and I’ll define the process of seeking Treasury agreement from the Ministry of Finance.

SOLUTION: Disband the HSB and pave way for a Health Service Commission. The new HSC must have non-executive board members who are appointed through an open, competitive process supervised by Parliament and involving the Minister of Health and Child Care in an advisory role.

The minister of health must have NO role in deciding which HWs association are present in the bipartite negotiating forum. This will ensure the appointment of genuine HWs who offer constructive criticism and communicate the true level of motivation or despair of HWs.

The proposed HSC must have clearly defined and fixed tenure, retirement age commensurate with the public service regulations and should adopt a results-based monitoring framework to guide appointments and reappointments.

The current situation with the HSB has seen recycling of old board members who are well past retirement age with executive appointment benefits and packages, a waste of taxpayers money.

Though the HSB was established with good intentions, results on the ground have shown that it has dismally failed its mandate. HWs strikes continue to be the order of the day. It has become a useless board only good in chowing taxpayer money and should be disbanded asap…