The government is still struggling to find a solution to one of the major health crises in Zimbabwe’s history, three months after junior doctors went on strike demanding better pay.
Sapes Trust director Ibbo Mandaza, a former top government official, who was influential when Zimbabwe set up its civil service after independence, believes the strike has exposed a leadership deficit in President Emmerson Mnangagwa’s administration.
Mandaza (IM) was permanent secretary in the Ministry of Manpower and Public Services in the 1980s and was also director of the Manpower Survey that set the parameters for the creation of the civil service after independence.
He told our chief reporter Everson Mushava (EM) in an interview that the government had policies in place to deal with the strike, but was failing to prioritise.
EM: We have doctors striking for more than 80 days and government seems not to have a solution to the crisis described by many as a soft genocide. You have been in government before as permanent secretary in the Manpower and Public Service ministry and before that, as director of the Manpower Survey. In your career as a civil servant, did you face similar situations and how did you deal with them?
IM: Of course, that was the main problem at independence, the fear that white skills would leave and indeed within weeks of independence, we had a strike at Air Zimbabwe.
Fortunately, we had been working with Ethiopian Airlines to have about 107 Zimbabweans trained.
I went to Ethiopia in April and in May 1980, brought back the 107, and brought with them their trainers.
That is how we killed the strike. We knew before independence that we were very weak on skills and our fear was to experience what had happened in Mozambique when the white people departed.
For example, in Mozambique in 1975, 26 000 Portuguese white railmen left the country and grounded the railway system.
From day one of independence, we were busy trying to keep the key areas functional by training and retaining skills.
EM: Were doctors one of your priority skills?
IM: True, health was one of them. For example, the medical school was producing nine doctors a year and after a manpower survey, we raised the number to 110 per year.
I am critically aware of the health sector and this over 80-day strike has made us even more aware of the importance of the doctors.
People are dying. It is a life and death situation.
We must provide resources for them because in turn they are providing for our people in the country.
We cannot lose the 500 doctors and we have precedence on how to retain them.
EM: When you talk of precedence, do you mean doctors once went on strike for such a long time?
IM: Doctors went on strike long after me but we knew at the beginning that since the health sector was critical, we had to provide for it well on time.
From the beginning, we prioritised the health sector but we had precedence in the Air Zimbabwe case I mentioned.
We brought our trainee personnel from Ethiopia and broke the strike and Africanised Air Zimbabwe overnight.
EM: After the Air Zimbabwe rude awakening did you come up with a response mechanism for the health sector?
IM: We realised that medical skills were so important.
Like I indicated, these are people. who come with very high passes from “A” Level and are marketed internationally.
So, we had to design a scheme of retaining them. We had to design a special scheme, a retention scheme on the back of training.
The fiirst thing we did for those who were in training; we introduced the bonding scheme in which those trained had to spend the same number of years under training and working in the country.
They couldn’t leave. We went to Parliament and bonded those under training in every critical field.
So, if you had been trained for five years as a doctor, you will be bonded for five years in the country, but there was a benefit to it.
It means your allowances for training under the Zimbabwe Development Fund would be kept and they got them at the end of bonding.
Many youngsters were able to buy houses at the end of the training.
We provided loans for cars and houses; this is how many of them managed to drive the Mazda 323s then.
For all specialist skills, there had to be retention. You have to attract professionals to stay in the country.
EM: Since we now have this lengthy strike, does it mean the interventions used in the past are no longer in place?
IM: The policies are there. We introduced a skills retention programme to encourage, and incentivise doctors, young lawyers and engineers to stay in the country, and in the public service.
And this scheme was almost equivalent to a double salary, and it worked and I am saying we should go back to the same scheme that worked well.
There is no need to argue, to justify that, it is very clear why it is important. We wanted to keep them.
It is incredible; I remember very clearly this background. The policies are not introduced because of bad leadership.
In our case, in the case of the doctors, in the past 80 days, we have learnt that this is what happens when you abuse those who are so critical to our lives.
Now, let us move off quickly to resolve that through a long term policy intervention such as that we used in the early 80s.
EM: If invited to give advice today, what would you instantly recommend should be done to get the doctors back at work?
IM: A total of 1500 junior and senior doctors, housing on site for juniors and a vehicle loan scheme.
It can’t be too difficult to set up a fund with an initial sizeable injection to allow for a meaningful number to access initially, they can even purchase vehicles for the scheme, for economies of scale, waive duty (nothing new there), for seniors, perhaps access to state/council land for housing.
EM: What do you think is making it difficult for the current government to go back into history and introduce things that once worked?
IM: One, amnesia on the part of government. For example, Misheck Sibanda was my deputy in the Manpower Planning Ministry, he knows and he should know what we did in 1982.
They should go back to the files. Number two, there is leadership deficit from people at the top, especially Health minister Obadiah Moyo.
Instead of being vindictive, he should try to understand the context in which we find ourselves as a country and use precedence in dealing with the problem.
People are dying. Second, there is a leadership deficit in the country.
We have a leadership concerned with power retention than serving the people.
EM: This government came to power thorough a coup and there is suspicion that they are afraid to reward the doctors more than the soldiers because they could be removed from power. What is your comment?
IM: Of course it is true, if you look at the amount of resources in the national budget given to the security sector, almost 30%, accorded to Defence, Home Affairs and Office of the President.
Security, the military security complex, is a priority for this government and this in part accounts for the dislocation in the prioritisation in this country.
The military in this case, however, should know clearly the importance of the health sector. People are dying.
There is no necessary contradiction between providing for the military security complex and providing for the health sector at the same time.
It is completely compatible in my view; there is no conflict at all. It is just leadership unable to rationalise priorities.
Let us work it out, what is required to get the doctors back to work can’t be more than US$2 million.
Less than a million a month, or less than US$500 000, No one is thinking about that.
EM: Last week, telecoms tycoon Strive Masiyiwa tried to get the doctors back at work. What is your view on the assistance he proposed?
IM: Let him contribute to a fund, a special retention scheme, which will help retain the health skilled workers.
In general, about 70% of all of our skilled workforce is outside the country and instead of having piecemeal plans let Masiyiwa, out of all the money he has made out of this country, put back the money in the community through an institutional framework, not this public relations exercise.
The money should be used to widen the resource base as a country and to retain the health workers.
EM: Looking at the doctors’ strike do you the government has proper priorities?
IM: When you look at these monetary policies, I think the key focus is on production.
This country is not so much mechanised as one might want, so the key issue is on manpower.
It is critical in the development of the country. Doctors are a critical sector.
If we have a sick community, these people will not go to work.
Let us try to synchronise these factors and have the right people to do what is right.
We have precedence, let us look at that; let us amend it to suit today’s needs.
We have doctors, they are already trained and we are in the retention mode, it is cheaper than training them.
Government should ask itself the cost of the doctors leaving. If we allow the doctors to leave and replace them with Cuban doctors, it will be more expensive keeping and paying the foreign doctors.
What is our internal rate of return to the investment we made in training the doctors?
It is a social benefit that should curb the amount of forex this government is spending in seeking medical attention outside the country.
It is not only the politicians; we all do it for our relatives, sending people to China, India and South Africa. A healthy and educated population is good for development.
We can even internationalise this retention issue, there are bodies like the Africa Management Services Company; it is about skills development that government can tap in.
Have we made a case to the company, I doubt. African Management Services Company is funded by the United Nations, United Nations Development Programme, World Bank, so there is money available, which can be tapped into outside the budget.
We have to stop being antagonistic and be rational and focus on what is key to our people.
Forget the politics, when your mother is sick, there is no politics about it.
If it was in the United Kingdom, you cannot touch the Health Services Board.
Politicians can rise or fall due to health, which is why even now, health is an electoral issue in Boris Johnson’s camping and in the United States we had the Obamacare.