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Monday, 2 May 2011

Mobile Hospitals—A Gigantic Policy Blunder! (Guest Blog)

A news article which has appeared in the Zambian Watchdog under the title “Each Mobile Hospital to Gobble K450m per Trip on Allowances,” if its content is authentic, is one of the many good reasons why President Rupiah Banda’s decision to buy the controversial mobile hospitals will be recorded in our beloved country’s history as having been a gigantic policy blunder.

In the article, it is revealed that each mobile hospital, which consists of 7 trucks, will require more than 36 personnel per visit of 2 weeks in any given rural area, including medical doctors, nurses, clinicians, laboratory staff, surgeons, pharmacists, and support staff.

And it is estimated that K450 million will be spent in allowances on EACH of the 36 or so mobile hospital personnel over a period of 2 weeks, an amount which does not include expenses on fuel, oil, spare parts, maintenance of the 7 trucks, and so forth, especially after the two-year initial contract with the Chinese supplier of the mobile hospitals. Also, the amount does not include the monthly salaries of the 36 or so mobile hospital personnel expected to serve on EACH of the 9 mobile hospitals.

All these expenditures are in addition to the US$53 million secured from the EX-IM Bank of China to purchase the 9 mobile hospitals from the China National Aero Technology Import and Export Corporation, and which will need to be repaid over a period of 40 years.

Besides, it is irresponsible, wasteful and unwise for President Banda to buy mobile hospitals which are unacceptable for the following reasons:

(a) They are likely to last only a few years, given the poor state of roads in rural areas;
(b) There are a lot of rural communities today where there are no motorable roads;
(c) It will be very difficult to control the potential abuse of the mobile facilities and their contents;
(d) There will be a high potential for cohabitation and/or marriage breakdowns among nurses, doctors and other personnel who will be assigned to work away from their families;
(e) For a healthcare system that is already understaffed, the assignment of well over 324 personnel to the 9 mobile hospitals will lead to greater levels of stress among health personnel at existing hospitals and other permanent healthcare facilities in the country; and
(f) The mobile hospital personnel will inevitably be subjected to deplorable conditions, including the lack of proper lodging, bathing and toilet facilities, and will be disposed to deadly diseases like malaria.

As any genuine development economist would advise, loans, if there is really a pressing need to obtain them, should ideally be used to support the production and/or exportation of tradable goods. However, the US$53 million loan would still have made sense if it was secured to cater for the following:

(a) Provision of free healthcare for all Zambians;
(b) Construction of more permanent healthcare facilities nationwide;
(c) Provision of adequate medicines, medical equipment and ambulances;
(d) Financing of research designed to find cures for HIV/AIDS, cancer, tuberculosis, and other deadly diseases; and/or
(e) Hiring, retention and training of health personnel.

The mobile hospitals are, by and large, ideal for a country that is at war. For Zambia, they are a luxury we can clearly not afford.

No doubt, the procurement of such temporary facilities is going to be the most conspicuous case of misapplication of resources by a Republican president thus far. It is a clear case of misplaced priorities! Sooner or later, the President and/or members of his inner circle will be crossing national borders for medical treatment or check-ups after wasting the US$53 million on mobile hospitals!

And President Banda and the Movement for Multi-party Democracy (MMD) want to continue to rule Zambia beyond 2011 after committing the country to such kinds of loans appropriated on worthless projects!

The US$53 million deal has all the characteristics of an attempt by President Banda to use the mobile hospitals as a campaign tool for the 2011 general elections, designed to woo voters in rural areas. He could win the Republican presidency, but he won’t be there to personally make a contribution to the re-payment of the loan!

And how does one explain the prominence of single-source procurement by the President during the short period he has been in office, if it is not to reap personal or political benefits from the deals involved? What is the use of having a procurement authority and technocrats in government ministries whose function is merely the acquisition of machinery, equipment and services that are prescribed by ministers or State House?

There is a need for Chinese government officials to guard against encouraging President Banda to borrow lavishly from their country’s state companies to finance projects which are conceived without consultation with Parliament and/or the Zambia Public Procurement Authority. They will do well not to participate in such furtive schemes if they are interested in cementing the existing cordial relations between their country and the people of Zambia.

Five more years of an MMD administration is, clearly, the last thing the majority of Zambians will ever wish for; they have suffered enough over the last 19 or so years of MMD reign.

We, therefore, need to put personal, ethnic, religious, and partisan interests aside and give the mandate to Comrade Michael Sata and the Patriotic Front (PF) to form government later this year and hope that they will work to break the socio-economic decay and backwardness which has haunted our beloved country over the last 19 or so years of the MMD administration.

In this regard, I wish to ask all those who teach our children, those who take care of the sick, those who extract and process copper and other minerals, those who provide transport services, those who create goods and services in the private sector, those who sell products in open markets and retail outlets, those who work in the civil service, those who serve orphaned and vulnerable children, and those who are currently unemployed to join and participate actively in this endeavor.

Finally, I wish to advise President Banda to re-assign the mobile hospitals to Zambia National Service (ZNS) camps in the 9 provinces after incorporating the functions of the Disaster Management and Mitigation Unit (DMMU) that is currently vested in the Office of the Vice-President into the functions of the ZNS. They (the mobile hospitals) could be appropriately used during natural and man-made disasters, and during outbreaks of infectious and deadly diseases like cholera.

Henry Kyambalesa
The guest author is the Founder and President of the Agenda for Change (AfC) party.

The Zambian Economist encourages guest contributions from leading Zambian thinkers on matters relevant to national development. The purpose of these notes is to stimulate discussion and ensure logic and impartial critique plays a leading role in shaping public debate. See the special observers page for more information.


  1. Medics hail mobile hospitals
    By Zambia Daily Mail on Wednesday 28 July 2010


    THE Zambia Medical Association (ZMA) has welcomed the signing of a US$ 53 million concessional loan agreement between Zambia and China for the provision of mobile medical services to the rural parts of the country.
    ZMA secretary general Robert Zulu said in response to a press query on Wednesday that the concept of mobile hospitals has been misunderstood by many sectors to mean a physical hospital on wheels.

    “The signing of the agreement between Zambia and China to provide mobile medical services to rural Zambia is welcome. Specialist medical services in Zambia are concentrated to those in urban areas and the Zambians living in rural areas are denied the specialist skills that their counterparts are enjoying,” Dr Zulu said.

    He was concerned that people who manage to reach the hospitals end up getting long appointments and are subsequently discouraged.
    Dr Zulu said the concept of mobile hospitals has been misunderstood by many sectors to mean a physical hospital on wheels.

    “Transportation of a structure like Ndola Central Hospital on wheels is not practical but rather the services that are offered by the same institutions are what we are transporting to districts,” he said.

    Dr Zulu said the various skills and expertise that medical personnel have at the University Teaching Hospital, NCH and Kitwe Central Hospital should not be restricted to health institutions in urban areas.
    “Health is a human right and should be available to every Zambian regardless of where they are living,” he said.

    Dr Zulu said ZMA will look forward to the detailed plan of medical and surgical consumables and the type of specialist services that will be included in the mobile medical services.

    He said ZMA will work with the Ministry of Health in the provision of high standard medical services to all Zambians regardless of where they are living.
    Dr Zulu said the mobile medical services should be tailored to relieve the burden on health delivery system in Zambia

    He said Zambia is already offering mobile specialist medical services to a small extent through organisations like FLYSPEC, Zambia Flying Doctors and Mercyflyers.

  2. Kalumba - Kashikishi16 June 2011 at 08:20

    You guys writing here have no idea how these Mobile Hospitals are helping Zambians stay alive. You all have medical insurance and you are covered where you are. Our people in rural areas have a culture of only going to the doctor when their lives are threatened and they can’t walk. At this point, it makes no sense to expect them to walk or ride 10 km to the nearest hospital or clinic. They eventually die after being treated by herbalists and witch doctors who sucker them out of their last monies. This is our culture; like it or not!

    Mobile hospitals have helped a great deal in reducing this scourge. Thousands of people have been treated and have recovered from simple diseases that, under normal cultural circumstances, could have cost their lives. People in rural Zambia are very excited and are queuing up to be served by these medics who come to your doorstep. Lives are being saved and people are surviving all thanks to US$53 million that you academics decided was a failure before it was even tested.

    So, before you criticize your country from a safe distance with western health care, try first to understand your people, their plight and most of all, their culture. If you can’t do this, then stay away from our politics and economics because you will not agree with what we (the majority) want!

  3. Physicians provide consultations 24 hours a day, 365 days a year

  4. This is a good development for the medical care in the region. It has to be more accessible.


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