The Division is located at Rowan Martin Building (RMB).
Functions of The Division
- Refurbishing the existing infrastructure, equipment and furniture at all the hospital and clinics.
- Revamping the Communication Infrastructure Network.
- Developing an efficient transport and logistics system.
- Developing an efficient network of clinics/hospitals and complete unfinished projects.
- Developing sustainable health options.
- Ensuring efficient and effective Human Resource for Health.
- Effectively decentralising service provision to the districts.
- Strengthening health service planning management and leadership.
The city has a well developed hospitals and clinics infrastructure. Inadequate capital investment in infrastructure development over the years resulted in most clinics and hospital buildings being in a serious state of disrepair characterised by serious plumbing problems, non functional toilets, poor water supply due to worn out pipes, non functional geysers, sewerage blockages, roof leaks, ceiling boards falling off, gutters and fascia boards falling apart, floor and wall tiles peeling off.
Development of Hospitals Infrastructure
The city has invested substantially in the upgrading of infrastructure at both Beatrice Road Infectious Diseases Hospital and Wilkins Infectious Diseases hospitals. Major outstanding works involve:
- The complete refurbishment of the wards.
- Replacement of the elevator at Beatrice Road.
- Construction of covered walk ways to link the wards and support sections at Beatrice Road.
- Construction of a bulk storeroom at Beatrice Road pharmacy.
- Construction of staff canteen at Wilkins and completion of the one at Beatrice Road.
Wilkins Hospital Uncompleted Wards
More than ten years ago the city started the upgrading of hospital bed capacity at Wilkins through the construction of a three storey ward at Wilkins. Unfortunately the City ran out of funds when the building was 70% complete. The city seeks partners to complete the wards.
Development of Clinic Infrastructure
The department has a wide network of clinics covering the whole city. This network grew over years through construction of new clinics, renovation of old buildings acquisition of residential properties. Council has been able to construct well designed clinics in the high density areas, but in the low and medium density suburbs, the clinics are still improvised structures, usually residential houses, providing a limited range of services, mainly Family Health Services.
There is need to upgrade most of the Family Health Services to satellite clinics, construct maternity clinics in the low density suburbs and the Central Business District, construct a new clinic in the Hopley area and to refurbish all the existing
Communication, Technology and Health Information
Efficient delivery of Health services depend a lot on a reliable communication system. The fixed telephone service at 80% of the clinics is non functional. Communication with both hospitals and with Head Office is a nightmare due to aged switchboards which are broken down most of the time. The department has few computer hardware especially at Head Office and at a few clinics. Most of the computers at head office are networked and we still need to encourage more communication at Head Office.
However the computers in the clinics and hospitals are not networked. The city needs to network al l the computers at the clinics if we have to realize the full value of computerization. Health Information in all our units is currently predominately paper based. The office that consolidates the health information at Head Office is computerised. Computerization and networking of computers in all clinics and hospitals will enhance the accuracy, timeliness and the utilization of health information .
There is also need to establish health information clerks at district level. Even with full computerization, the clinics will continue to generate a lot of paper and to minimize incidences of stock outs of printed stationary, it is prudent to avail photocopiers and duplicating machines to all the poly clinics.
Transport and Logistics
The department relies on an aged fleet of three vehicles for the logistical support to its network of clinics. The department needs to move, on a daily basis, drugs, vaccines, laboratory specimen, linen, dry stores, clinic waste and this poses serious challenges to the health delivery system’s logistics. The department relies on a sister department, the Department of Engineering Services for all repairs to its vehicles. Council’s automotive workshops are currently facing serious capacity problems and are they are not providing value for money service to council departments. The department needs to replace its aged fleet. We also believe there are opportunities to maximize transport management efficiencies especially with regard to the efficient allocation of the vehicles to where they are needed the most.
Furniture and Equipment
The department has not been able to replace old furniture and medical equipment in the last ten years. Most of the furniture, that includes chairs, benches, desks, beds are in a total state of disrepair. The medical equipment, that is, autoclaves, suction machines and diagnostic equipment has gone past its economic lifespan and is now a danger to both patients and staff.
Laundry and Linen Services
The department operates a central laundry system at Beatrice Road Hospital that receives dirty linen and supplies clean linen to the rest of the hospitals and clinics. However most of the laundry equipment, that includes roller irons, tumbler dryers, spin dryers is more that twenty years old and is constantly breaking down, resulting in delays in the supply of clean linen. The laundry itself was not purpose built and laundry staff rightfully complain of lack of change room facilities.
Catering, Domestic Services, Mortuary and Security
The kitchens at the two Infectious diseases hospitals are in a state of disrepair and have become too small for the population served. The pots, stoves and geysers in the kitchens need replacement. The department is unable to provide meals to maternity mothers at the twelve polyclinics and this forces the clinics to discharge the mothers at least a day or two after delivery. We believe this compromises the health of the child and the mother. There is need to construct kitchens at the twelve Poly clinics.
The mortuaries at the two hospitals are in a fairly reasonable state. However there i s need for the planned replacement o f the cold rooms within the next five years to avoid disasters a few years from now. There is also need to modernise the body washing facilities and the reception areas and chapels need major refurbishment. All the city clinics are guarded by Municipal police and by private security. The security situation at most clinics has been compromised by broken down fences and durawall, non functional security lights, lack of electric bells at the gates, lack of guardrooms and the
absence of home guard safes at some clinics.
Health Services in the city are funded predominately from rate payers contribution. The contribution of user fees is currently less that five percent and given the circumstances of our clientele we do not expect user fees to exceed eight percent without compromising the accessibility of our services. The department has received representation, especially from partners, to scrap most of the user fees. The department is of the view that this is premature until a viable and sustainable health funding alternative is available. The department also believe that the lack of constistency in user fees policy, in the short to medium term, causes more harm in terms of confusing the clients. The department, in consultation with the City Treasurer, is in the process of studying the possibility of introducing a health levy to either replace or complement the user fees. The justification for a levy is that public health, especially preventive health, is a public good. The obvious advantage of a levy is that residents will pay in advance for their health care costs and it introduces cross subsidies that are an important factor in taking care of the more vulnerable members of the community.
The department has received consider able budgetary support in the form of drugs, medical sundries, linen, stationery and equipment from partners. Most of these partners came to the rescue because there was a crisis in the country. It is not sustainable for any system to rely on partners for recurrent budgetary support. Central Government has reneged on its funding obligations to the city and the health grant support has been decreasing over the years until it came to zero in 2009, The city provides a public health service to all Harare residents and more than 60% of the people accessing services are unable to pay and are therefore treated free of any charge. Approximately the same number of patients also do not pay rates. It is not financially sustainable for the few rate payers to carry this funding burden. The Ministry of Health and the Department of Social Welfare (in respect to free patients) have an obligation to financially support the city health services.
Health Services Planning and Management
The Department needs to build and develop an organization that is able to implement this strategic plan. It needs to inculcate a planning culture that permeates every facet of the department. Planning should be a programmed activity at all levels of the department and we should ensure that the DHEs and DHTs meet at least quarterly to plan and re-plan and these plans should be consolidated quarterly at the combined DHT meetings.
Organisational Development and Leadership
A lot of time and expertise was invested in the crafting of this strategic plan. It is a well documented fact that most strategic plans never arise from the drawers after the last strategic planning session. What guarantees does the department have that this will be different. Organizations are the software or the operating systems that make plans like this possible – We therefore ought to have the right organizational software and this entails the following:
- Ensuring that the plan is led from the top and implemented from the bottom. There is need for a strong and visionary leadership.
- Ensure that the department moves at the speed of the thought of the leadership. What is resolved by management should be implemented – managers at the various level should take charge.
- There is need to develop the relevant management expertise at all levels of the department. There is need to identify the managerial competencies required by the different managers and to implement Personal Development Plans that are individual specific.
- The department will implement a performance management system that ensures that all efforts are aligned to the department’s strategy and objectives.
- The department will resuscitate the City Health organizational culture founded on the typical hospital or operating theatre culture – where each employee has a specific role and where everyone always does what he/she has to do properly at the right time and with surgical precision.
- All employees should be taken on board and the department should implement strategies that ensure that the all employees feel that their contribution is valuable in the attainment of the department’s vision and mission.