Dr. Simon Nyadundu, Provincial Medical Director of Midlands Province, Zimbabwe
“I feel it is hugely important to strengthen the knowledge and skills of local health workers and District Medical Teams on governance.”
Dr. Simon Nyadundu (48) comes across as a man of calm deliberation and resolve. “When I see something that really needs to be done or changed, I throw everything into it, convince others and get it going.”
As a young boy in rural Nyanga he dreamt of becoming a chemical engineer. Then, at age 16, he met with a serious accident and got burned on the leg. “This was my first serious encounter with the Zimbabwean health system. I had to wait, saw the long queues and vividly remember how I thought: this has to change, these queues need to go.”
“I decided to study medicine, started in the capital Harare, became a government medical officer, did trauma-management, and later also some clinical orthopedic practice in Mutare and private practice.”
As a member of the United Methodist Church (UMC) during the protracted financial crisis of Zimbabwe in 2008-2009 Dr. Simon was also involved in some of the church’s international programmes. For instance, in partnerships with the Norwegians, he assisted on the UMC health boards and engaged in oversight on grants that would come in. He participated in the Japanese JICA programs on health systems strengthening. His seniors saw his talent for management and very soon Nyadundu found himself first steward government medical officer and then director of the Mutare Provincial Hospital, in Manicaland Province, a managerial job, which in Zimbabwe holds the same esteem as being a Provincial Medical Director.
“When the medical delivery system in Zimbabwe hit rock-bottom during the crisis of 2008-2009, it was very clear to me that things had to change more fundamentally. The situation in provinces was dire. The going got really tough. Many facilities were in trouble or abandoned.
“We had cholera outbreaks. During those, the International Red Cross came in to assist the Province. They were thinking of setting up a mega tent-camp nearby and flying in all kinds of materials. I got involved and intimated to the leaders that for half the cost of all those external inputs, they could use existing infrastructure at my hospital, repair existing materials etc.
“I told them this would save them half their budget, they accepted. This got me further involved in the resuscitation and rehabilitation of our hospitals after the crisis and we got assistance from the Red Cross Society.
“Through these various experiences, health systems management increasingly drew my attention. This is why from 2011-2012, I studied public health at the University of Zimbabwe. It was the point at which I had come to realize that you cannot go very far in health, if the management side of things is not sorted out. If there is no managerial autonomy, and everything is centrally tied up, nothing moves.
“At that point, I was asked to become acting Provincial Medical Director in Manicaland. When we got a Provincial Medical Director, I took up the Provincial Epidemiology and disease post, which was a salary-and-status ‘drop’, but I felt I had to take this step to enable me to step into new ground. By then, the diversity of health systems work had really grabbed me, and the blinkers of merely doing clinical work had fallen off.
“For me the Province is the true unit of action in our country’s health system. That is where you really see how things are in practice, and where service delivery, communities and management meet.
“I feel it is hugely important to strengthen the knowledge and skills of local health workers and District Medical Teams on governance. Most health workers and local administrators do ‘governance by default’. They need to know much more about health finance, human resource management etc.
“This is not only because that boosts people’s technical skills. More importantly, it resets a balance. It can render local health people more in charge, and less easily trampled upon. I have noted that there is still a substantial information and knowledge gap.
“Decisions are often taken elsewhere, not built on a real sense of what can be done in a given location. Local health workers and administrators may not admit this, but many may feel regularly that they are the only ones not knowing. This can make people shy or reluctant to voice their convictions.”
“Personally, I get frustrated by not knowing something, but even more by the non-application of known principles and good practices which are known to work.
“So, if a governance collaborative would step into this arena and assist in the sharing of real-life stories and practices, this could be tremendous local
empowerment, even in cases where leaders may resist change.
Dr. Simon speaks in the aftermath of Zimbabwe changing its president and government. The country hovers between hope and fear. Dr. Simon, however, is clear about his personal philosophy of change.
“One needs to try and be committed. You cannot say something has failed if you have not tried at least a few times, in a few spots, have not implemented the full recommended packages and given it your 100%.”