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Health activists fret over second line ARVs

THE Community Working Group on Health (CWGH) has urged Government to prioritise the procurement of second line antiretrovirals whose availability has been affected by shortages of foreign currency.
In a statement, CWGH executive director Mr Itai Rusike said if the situation is not addressed urgently, the country will end up losing some of the gains achieved over the years.
The shortages will definitely compromise the health of about 35 percent of the estimated one million people on second line treatment as they will default on taking their medication.
“Limited availability of ARVs impedes patient initiation, adherence and poses a major barrier to the fight against HIV/Aids,” said Mr Rusike.
The shortage of second line ARVs come at a time when the World Health Organisation (WHO) has warned of drug resistant HIV as an emerging threat in developing countries.
Nac board chairperson Dr Everisto Marowa recently said while resources have been set aside for the procurement of ARVs and other related products, the actual procurement has been adversely affected by foreign currency shortages.

@thamamoe        December 14, 2017 Local News     Thandeka Moyo, Health Reporter
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‘Matapi flats should be destroyed’…David Parirenyatwa

Pressure is piling on Harare City Council to decisively deal with the perennial typhoid outbreaks with Health minister David Parirenyatwa calling for the demolition of Mbare’s Matapi hostels.

This follows an outbreak of typhoid in the highly-congested hostels early this week with 21 cases detected so far.

Parirenyatwa said he was shocked at the filth and poor services in the area.

“There is uncollected garbage, overflowing raw sewage and no running water. This is a conducive environment for diseases like typhoid to thrive,” he said during a tour of the hostels on Thursday.

Parirenyatwa said the hostels should be demolished as they were now inhabitable.

“Yes, we will treat and put measures to deal with the cases, but if situations like this persists, we will not win this war,” he said.

The Community Working Group on Health (CWGH) challenged the city to urgently address the key drivers of typhoid in order to permanently stop future recurrence.

“The situation on the ground indicates that while infrastructure is present, it is old, poorly functioning and poor availability of safe water leads to sourcing of water from less protected, informal sources,” said CWGH director Itai Rusike.

He said it was surprising that council was planning to introduce a typhoid vaccine in a bid to prevent future infections without adequately addressing the key drivers of the disease.

“It has been noted that the recurrent outbreaks of typhoid in Harare are being caused by erratic supply of clean water, supply of contaminated drinking water, burst sewer pipes and poor hygiene,” Rusike said.

He said the typhoid vaccination should only complement service provision and should not be taken as the main intervention strategy in the fight against the outbreak.

The Combined Harare Residents’ Association (CHRA) also implored Harare City Council to address the major drivers of typhoid and prevent needless loss of lives in the capital.

“CHRA is concerned that typhoid continues to spread across Harare mainly as a result of acute water shortages, poor sanitation, raw sewage spillages and uncollected garbage,” the residents’ group said.

“Of major concern is the fact that Harare City Council has apparently failed to prioritise service delivery with $10 million out of the $12 million collected monthly going towards obscene salaries for council staff. Service delivery has largely suffered due to the fact that council is allocating most of its financial resources to overpaid salaries.”

CHRA said as a result of council’s failure to prioritise service delivery, residents had been exposed to diseases such as typhoid and cholera.

“This unfortunate development comes at a time Harare City Council has proposed an increase in water tariffs, a development that is likely to worsen the already dire situation for residents especially given the current economic environment,” CHRA said.

The Community Water Alliance also argued the problem was linked to the quality of water the council is supplying to residents.

But council insisted the fresh typhoid outbreak reported in Mbare early this week was not linked to the city’s erratic water supplies but a direct result of unhygienic conditions in the suburb.

“The outbreak has nothing to do with chemicals, if anything our coverage of water delivery has improved. Typhoid is all about hygiene,” council spokesman Michael Chideme said, adding there was no need for residents to panic as the local authority had stocked adequate water treatment chemicals.

"It is professionally unacceptable that the situation was allowed to deteriorate to these levels when the country has the Ministry of Health and Child Care (MoHCC) and the National AIDS Council (NAC), institutions that jointly superintends over the procurement and distribution of the
living-saving drugs. Both institutions must have raised the red flag well before the situation reaches this crisis point if proper monitoring procedures were in place.

"The major constraint to procurement in 2017 has also been the availability of foreign currency to procure ARVs. Foreign currency supplies from the Reserve Bank of Zimbabwe can lag behind for as much as 4-5 months," said Rusike.

Meanhwile, Rusike added that there was need to advocate for more immediate policy attention to be given to significant obstacles in drug access, including foreign currency supplies to Natpharm, timely payment to Natpharm of debts, adequacy of trained pharmacists in government service, improved management of drugs with an information system that provides timely information on drug availability, improved equity in the distribution of available drugs with greater support of drug supplies to primary care level.

"There are a number of factors affecting drug availability. It appears that at primary care level the level and quality of staffing, expertise and resources is currently too low to provide for the basic requirements of a drug procurement and management system. Higher levels of the health system are also not adequately supporting quality and supply in this level of care.

"Resource constraints and foreign currency shortages have also limited supplies at higher levels. There are also shortages due to losses from supplies that have been obtained. This occur when drugs expire or are stolen."

Government spending on health had declined in real terms and is currently concentrated in hospitals, particularly at central level. There is disproportionately high expenditure on staff and health infrastructure as compared to other recurrent inputs such as pharmaceuticals and maintenance, resulting in the general shortage of medical consumables. The shortage of foreign currency has undermined efforts to maintain a supply of affordable ARVs.

There is evidence that drug access has fallen in recent years, and that drug availability is falling, most sharply at the clinic services that form the frontline of the health care system with the community. This represents an unfair cost burden on poor communities, but also opens the way
for the growth of private unregulated drug markets.

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Allocate foreign currency towards ARV procurement – CWGH

THE Community Working Group on Heath (CWGH), has called on government to prioritise allocation of foreign currency towards the procurement of Anti Retro Viral medicines ARVs amid revelations of massive ARV stock outs at public health centres and pharmacies.

CWGH Executive director Itai Josh Rusike said it was disheartening that Zimbabwe which over the years made tremendous gains in reducing HIV/AIDS related deaths through multi-sectoral efforts, is now experiencing a serious shortage of Abacavir – a second line ARV drug to the extent that people taking that drug are only being given a week's supply instead of the usual three months' provision.

"As an organization whose primary focus is the enjoyment of quality equitable health services, the CWGH would like to urge the government to quickly avail foreign currency for the procurement of ARVs to save thousands of lives that are under threat. The shortages will definitely compromise the health of the 35% of the estimated one million people on second line treatment as they will default on taking their medication.

"Limited availability of ARVs impedes patient initiation, adherence and poses a major barrier to win against the HIV response as a country. It should be emphasised that optimal adherence is essential to ensure individual treatment access and limit viral resistance. Treatment for HIV/AIDS is threatened when ARV drugs are not available, undermining treatment compliance.

The weekly supply of the drugs will force people to commute regularly to their usual collection points thereby incurring heavy out-of-pocket costs, a situation most people will not afford under the current harsh economic situation. Some will fail to collect their drugs leading to defaulting due to prohibitive costs," said Rusike.

He added that even once drugs reach facilities, there are many other barriers to access which include transport charges and fees to use facilities, and the costs of lost work time.

"When drugs are not available in facilities community members may be forced to buy them from private suppliers. The cost of medications have increased significantly and medical care costs have been the highest rising element of the Consumer Price Index for some time. If the current situation is not addressed urgently, the country will end up losing some of the gains recorded over the past years.

It is important that the government secures access to ARVs for the realization of the 90-90-90 objectives; that is to initiate 90% of diagnosed patients and obtain viral suppressing in 90% of those on ART. What is most disturbing is that the shortages of ARVs comes at a time the World Health Organisation (WHO) has warned of a drug resistant HIV as an emerging threat in developing countries."

Meanwhile, drug interruption has been cited for increased cases of this new strain. According to the WHO, rational drug use implies that "patients receive medications appropriate to their clinical needs, in doses that meet their own requirements, for an adequate period of time, and at the lowest cost to them and their community".

"It is professionally unacceptable that the situation was allowed to deteriorate to these levels when the country has the Ministry of Health and Child Care (MoHCC) and the National AIDS Council (NAC), institutions that jointly superintends over the procurement and distribution of the
living-saving drugs. Both institutions must have raised the red flag well before the situation reaches this crisis point if proper monitoring procedures were in place.

"The major constraint to procurement in 2017 has also been the availability of foreign currency to procure ARVs. Foreign currency supplies from the Reserve Bank of Zimbabwe can lag behind for as much as 4-5 months," said Rusike.

Meanhwile, Rusike added that there was need to advocate for more immediate policy attention to be given to significant obstacles in drug access, including foreign currency supplies to Natpharm, timely payment to Natpharm of debts, adequacy of trained pharmacists in government service, improved management of drugs with an information system that provides timely information on drug availability, improved equity in the distribution of available drugs with greater support of drug supplies to primary care level.

"There are a number of factors affecting drug availability. It appears that at primary care level the level and quality of staffing, expertise and resources is currently too low to provide for the basic requirements of a drug procurement and management system. Higher levels of the health system are also not adequately supporting quality and supply in this level of care.

"Resource constraints and foreign currency shortages have also limited supplies at higher levels. There are also shortages due to losses from supplies that have been obtained. This occur when drugs expire or are stolen."

Government spending on health had declined in real terms and is currently concentrated in hospitals, particularly at central level. There is disproportionately high expenditure on staff and health infrastructure as compared to other recurrent inputs such as pharmaceuticals and maintenance, resulting in the general shortage of medical consumables. The shortage of foreign currency has undermined efforts to maintain a supply of affordable ARVs.

There is evidence that drug access has fallen in recent years, and that drug availability is falling, most sharply at the clinic services that form the frontline of the health care system with the community. This represents an unfair cost burden on poor communities, but also opens the way
for the growth of private unregulated drug markets.

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Zim’s public health spending lowest in Sadc

GOVERNMENT spending towards health this year averaged a measly $21 per person, a figure that is lower than $24 per person in 2016, the Community Working Group on Health (CWGH) has said.
BY VENERANDA LANGA
In its contribution to the 2018 National Budget consultations, CWGH said the per capita allocation towards health is one of the lowest in the Southern African Development Community (Sadc) region whose average spending on health per person is $146.
“The per capita allocation stands at $21 down from $24 in 2016 and this implies that the government will spend an average of $21 per person on healthcare in 2017,” CWGH executive director, Itai Rusike said.
“The per capita health allocation is lower than the Sadc average of $146 and per capita health allocation in South Africa is $650, Zambia $90, and Angola $200,” he said.
Rusike said the CWGH is also worried about the total budget allocation to health, which has remained lower than the prescribed 15% of the total budget by the Abuja Declaration and the Sadc target of at least 11,3% of the total budget.
“Countries such as Malawi, Rwanda, Madagascar, Togo and Zambia have managed to reach the Abuja Declaration target, according to the World Health Organisation (WHO), and as of 2015, Rwanda spent at least 23% of its budget on healthcare.”
The CWGH said Zimbabwe has however, made significant gains in the area of HIV prevalence, child and maternal mortality, which have significantly dropped.
Rusike, however, railed against the government’s over-dependence on external donor funding for the health sector at 24,9%, although the bulk of health financing is from employers who contribute 28,4% and government at 21,4%.
“The high dependency on external financing is unreliable, unpredictable, unsustainable and highly dependent on the political environment; raising concerns on the sustainability of health financing institutions and the vulnerability of government’s budget should external funds be withdrawn.”
Other problems noted in the health sector include poor infrastructure and ill-equipped hospitals, as well as a worrying ratio of patients to health personnel which stood at 12,7 health workers to 10 000 patients in 2011 (WHO statistics).
The country is also said to be relying heavily on imports for drugs, equipment and other hospital consumables, while some health institutions have inadequate equipment to carry out diagnosis.
The CWGH said the government must broaden the tax base in order to fund health, by for example introducing tobacco tax, or raising taxes on sugar-sweetened beverages to fight non-communicable diseases and even introduce a wealth tax.

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Parliament To Boycott 2018 Budget Unless It Meets Abuja Target

The Parliamentary Portfolio committee on Health says it will not entertain a flimsy allocation of funds to the health sector in the forthcoming 2018 budget presentation unless the 15% Abuja target is met.
This was said by Matabeleland North senator Sibusisiwe Budha-Masara at the Pre-budget review workshop organized by the Community Working Group on Health (CWGH) held on Wednesday in Harare.
“I think as a country, this is something that I would want Zimbabweans to consider even though there is little time for you to put your input into this budget. But I think this is the opportunity for us to say whatever we feel the budget must look like because a healthy nation in terms of economic development we need healthy manpower and it is our right that we must receive quality health as citizens of this country,” she said.
She added that health must be prioritized in this year’s budget allocation.
“I think we need to lobby and talk to relevant organisations who can assist us that this budget this time around must pay priority to health,” said the Senator.
Zimbabwe is a signatory to the Abuja Declaration of 2001 in which African Union countries pledged to allocate at least 15 percent of their annual budgets to improving the health sector. Since then, the country is yet to meet the target. In the 2017 budget, the health sector only got 7 percent.
She declared that should the budget miss the Abuja declaration on allocating 15 percent of the National Budget, it risks not seeing the light of day.
“If it does not meet the 15 percent Abuja Declaration, I think we have got all the power to deny it that it cannot be passed as long as health in Zimbabwe is not a priority,” she said.
Binga North MP Prince Dubeko Sibanda sharing his experience in Uganda learnt that if a budget ignores the plight of the marginalized it doesn’t get Parliamentary approval to be passed.
“One thing I took in Uganda, they have got a law which says unless the budget meets certain criteria or takes care of people that are generally marginalized that budget should not be passed. Its part and parcel of their law. Its never passed,” the parliamentarian said.
With just three weeks before the 2018 Budget is announced by the new Finance and Economic development minister Dr Ignatious Chombo, the parliamentary portfolio committee, NGOs expect the treasury to meet the Abuja declaration which states that 15 percent of the National budget should be dedicated to Health to show commitment of ensuring a healthy and productive nation.
Presenting the 2017 national budget year, the then Finance and Economic Development Minister Patrick Chinamasa announced that $281,9 million will be channeled towards the sector inclusive of remuneration for the public health care personnel ($223 million), operations and maintenance ($29,6 million), as well as capital expenditure that has been pegged at $29,5 million.

 

October 11, 2017October 11, 2017 NewsRoom By Kudakwashe Pembere
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Harare Now an Ancient City…As Harare Tops In Typhoid Cases – Health Times

THE city of Harare now resembles an ancient town as it lacks the characteristics and requisites of a modern day city due to poor planning and recurrent diarrheal diseases like Typhoid and Cholera which were most prominent during ancient times.
Typhoid was first discovered in 1880 in New York City but is also believed to have existed around 430 BC in Greece where it almost wiped out a whole army.
Briefing a Community Working Group on Health (CWGH) Public Dialogue meeting on Recurrent Outbreak of Typhoid and Diarrheal Diseases, Director for Epidemiology and Disease Control in the Ministry of Health, Dr Portia Manangazira said Harare is now a serious health hazard due to increased activities which are fertile breeding ground for ancient diseases like Typhoid and Cholera.
“What is an urban area, it is defined, but when you go to Hopley Farm and Hatcliff you wonder whether its urban or rural. This is where we get it wrong, we want to be urban but we are not that urban. Urban areas come with its stipulations and unfortunately we are failing to them in Zimbabwe. We have to start by regulated urbanisation first, and we are already talking 30, 50 years ago just making a proper urban setting and then the state that now lead you to a healthy city.
“If you go to a city in Europe today, you would think you are in a forest, they are well wooded with trees and open spaces, but what are we doing with our cities here, we put houses and then the houses are not serviced there is no sewage, there is no waste management systems, so we have gone back to the Victorian type of a city and yet we still want to be associated with modern times,” said Dr Manangazira.
She added that Zimbabwean cities are demoting health rather than promoting and called on local authorities to fix the mess and restore the City to its former Sunshine City status. She also said water in the city should only from tapes and not boreholes and wells.

A borehole with an installed Chlorinator
A borehole with an installed Chlorinator

Harare has seen an uncontrollable sprouting of overpopulated illegal residential areas like Hopely, Calledonia (though it was recently regularised) Epworth and others. The areas lack in basic health, water and sanitation facilities as most residents uses bushes as toilets and get water from unprotected holes and boreholes.
According to city health experts, most boreholes in Harare in particular Hatcliff are contaminated and residents should use best water treatment methods like chlorinating or boiling water before use. Hatcliff recently had more than 13 inl-ine boreholes Chlorinators installed in a bid to reduce the spread of Typhoid through drinking water.
A borehole with an installed Chlorinator
Meanwhile, Dr Issac Phiri also from the department of Epidemiology in the ministry of health said Harare has recoded highest Typhoid cases since it was first reported in 2009.
“From January, we had an increase in cases of Typhoid in Harare, specifically in Mbare where over 1 405 as we speak and 78 of them were laboratory confirmed. Unfortunately, three deaths were recorded and this could be an underestimation.
“By district, Harare, has contributed a majority, over 80 percent of the cases were reported in Harare. Over 1 2018 have been reported in Harare. Mashonalnd Central, 200 cases, Mash West, 30 cases and these have been conformed to be Typhoid. All deaths were recorded in Harare.”

September 29, 2017 NewsRoom By Michael Gwarisa
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Improving emergency care vital

Improving emergency care vital

I. Rusike, E. Sharara, C. Chimhete and T. Munouya
In front of us in one of our rural districts is a road accident with injured passengers including children.They are distressed – the local public hospital has no ambulance and they are trying to find enough money to assure the private ambulance service that they will be able to pay the fee before they will send the ambulance.
The fee is more than they can afford, but if they don’t find someone to pay and get people to care quickly the injured people could have complications or suffer avoidable deaths.
This is not the only problem people who have emergencies face. Ambulances can take long to respond. Many ambulances do not have basic equipment or adequately trained staff to take care of patients during transit, also complicating their recovery or risking fatalities in transit.
Emergency departments are under resourced, without adequate equipment and staff to cope with the critically ill patients coming to them, including patients who have delayed seeking care until they have an acute emergency.
In some countries in our region, a critical shortage of doctors and other skilled health workers has affected the quality of the response to emergencies. Yet in others, like South Africa and Uganda, ambulances are better equipped and staffed, and people arriving at emergency facilities find doctors and nurses on stand-by and ready to receive patients and give them prompt care.
This situation is compounded by conditions that increase the risk of traumatic injury. For example, the state of our roads in Zimbabwe raises concern, especially when they are further damaged by heavy rains and other climate disasters.
Poor roads not only raise the risk of accidents, but also mean that ambulances cannot easily access patients in need. During the rainy season, rural roads become impassable, making access for emergency services even more difficult.
While communities assist with emergencies where they can, local transport operators sometimes take advantage of poor conditions to overcharge desperate patients in need of acute care, including pregnant women, carers of sick children and elderly people.
In the absence of adequate investment in roads and services, poor people pay the price. Allocating funds to improve road systems will prevent accidents and also make it easier for ambulances to reach emergencies.
Yet in 2017, of the $15 million that the Harare City Council said it needed to improve the road network, it received only US$1,2 million from the Zimbabwe National Road Administration (Zinara).
The situation may be worse when air rescue emergency services are needed, as a key component of an effective emergency care system. Air rescue emergency services are more scarce healthcare resource, and as in Zimbabwe, the only public service for this may be the Air Force.
There are private services for those who can afford the costs of private insurance or providers, but these are unaffordable for the majority, and thus only used by a minority of people.
In the common discussions on universal health coverage and emergency responses, it is important that we at minimum ensure availability, accessibility and affordability of effective and good quality emergency medical services for everyone in the public.
Good quality emergency medical services provide an immediate response to a variety of illnesses and injuries and the treatment and transportation of people in health situations that may be life threatening.
They should provide universal quality care to all those who need it at the time they need it to save their lives, prevent suffering or disability. Although the current situation varies from country to country in the region, for many this is not yet delivered.
The situation contradicts the fact that in Zimbabwe, as for seven other countries of the region, according to EQUINET policy brief 27, the constitution guarantees citizens the right to health care, including emergency medical services. Section 76 (3) of Zimbabwe’s Constitution states this as, “No person may be refused emergency medical treatment in any health care institution.”
Of course no service would refuse care, but a situation of inadequate investment in affordable, accessible and good quality emergency services, including ambulances can be understood to be a form of denial, or refusal.
The Zimbabwe Constitution makes this clear in stating that the state must take reasonable legislative and other measures, within the limits of the resources available to it, to achieve the progressive realisation of this right.
While public emergency services offered by state-owned health institutions, the Air Force, the police and Fire Brigade are weak and poorly resourced, people’s rights are violated and they are exposed to high payments for private services, or worse still disability or death.
It is evident that this is a core duty of the state and must be adequately funded. When public emergency care services are not adequately funded, staffed or provided, it leads to a growth of commercial and privatised services.
While this is a private sector response to demand, and can help to minimise morbidity and mortality if of good quality and properly regulated and monitored, it is not appropriate to rely on the private sector for this service, and leads to inequities in access to care. The driving force of private provision is maximising profits and not the needs of the most disadvantaged members of society.
A trend towards privatisation of emergency medical services thus has highest burdens for the poorest, adding to the stresses in often tough economic environments of accessing services and meeting medical bills.
A 2016 study by the Zimbabwe Coalition on Debt and Development on a public-private partnership in one major central hospital in Zimbabwe found that residents faced challenges in realising their right to health care, due to the high cost of services, unfair treatment of those who cannot pay, “ . . . deepening inequality between the haves and have-nots” and report of corruption in the demand by staff for differing levels of cash payments.
They attributed this violation of rights to health care to the “private vendor profit motive” and diminished public control.
Beyond improving public funding of emergency care services, we can
also take advantage of technology advances. For example, health facilities have used mobile phones to alert ambulance services and to support those attending to patients while waiting for an ambulance or medical personnel, improving the possibility of improved outcomes for patients.
A “Dial-a-Doc” initiative by one mobile operator in Zimbabwe works with enlisted services of medical practitioners at a call centre to respond to phone-in requests for information and help from the public. A similar service is available in South Africa, Zambia and Malawi. At the same time, we cannot keep relying on the health services to manage growing risks in the environments we live and work in.
Death and disability from traumatic injuries from road traffic accidents on poor roads, from climate disasters and other accidents, and acute health crises in pregnancy, for children and others, and due to unsafe working conditions are largely preventable and should not be filling our health services.
We need to have a commitment from all sectors that play a role to identify and reduce their role in traumatic injury and illness.
As economies improve they should show marked reductions in such trauma, but even under challenging economic conditions, adequate, affordable and accessible public emergency care

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Chronicle scribe scoops health reporter award

Chronicle reporter Thandeka Moyo (left) receives a certificate and a trophy from Mr Douglas Moyo, the Bulawayo National Aids Council officer (right), while Mr Nobert Dube of the Community Working Group on Health (CWGH) looks on during the CWGH Health reporting journalists awards at a Bulawayo hotel on Friday. Thandeka won the best CWGH health reporter award

Cynthia Dube, Chronicle Reporter
THE Chronicle’s award winning journalist Thandeka Moyo last Friday scooped the 2017 Maternal, Child and Sexual Reproductive Health Rights Award.
Moyo, The Chronicle’s health reporter was named the winner of the inaugural award courtesy of the Community Working Group on Health (CWGH).
She was awarded for a series of stories on maternal health she produced, including a story about a woman who died while giving birth at Mpilo Central Hospital due to negligence.
For her ninth journalism award, Moyo walked away with a certificate, a trophy and cash.
Freelance reporter Jermaine Ndlovu was the first runner-up.
Anastasia Ndlovu and Pamenus Tuso, also freelance reporters were second runner-ups. Addressing guests who attended the presentation ceremony in Bulawayo, CWGH board member Mr Norbert Dube urged journalists to continue reporting on health issues affecting Zimbabweans in order to force authorities to act.
“We value and appreciate your leading role in promoting quality health coverage in Zimbabwe.
“I would like to urge you to continue informing, educating and raising awareness on various issues affecting communities in the country such as bilharzia, intestinal worms, elephantiasis, leprosy and blinding trachoma and other common diseases,” said Mr Dube.
He said media houses should engage health organisations to improve their health reportage.
Veteran journalist who was one of the adjudicators Tapfuma Machakaire said accuracy, truthfulness, fairness and balance had earned the winners the awards.
“We were also looking at the originality of the story and multi-sourcing which is very important if the story is to be informative,” said Machakaire.
He said the judges also assessed the story’s impact on society.
CWGH director Mr Itai Rusike said he was happy that unlike in the olden days, health issues were making it as news.
“It will take efforts by the Government, the private sector and the media to ensure our health sector is revived.
“We also want to appreciate media houses represented here for their effort in spreading health messages,” said Mr Rusike.