Malaria scourge: Community education vital cog to save lives

By Nhau Mangirazi, Newsday

Sadness engulfed Rosina Mujakachi after visiting her pregnant sister battling a malaria attack at Karoi District Hospital two weeks ago.

Her sister was among the over 30 people from the surrounding outlying Hurungwe villages receiving treatment for malaria at the hospital.

It is reported that at least five people died this month at the medical institution when malaria cases peaked in the rural communities, including a malaria hotspot, Kazangarare in Hurungwe North constituency.

Mujakachi said her sister, who is from the Kazangarare area, was diagnosed with malaria. Nyama resettlement is also another malaria hotspot that claimed a local headman last week, according to sources.

Mujakachi was grateful that her sister was being treated.


CWGH Executive Director Itai Rusike

“My concern is on communities which get free mosquito nets regularly but ignore proper use of the nets,” said Mujakachi, adding that most villagers appeared to be reckless about their health.

Hurungwe district medical officer, Munyaradzi Chidaushe, confirmed a malaria outbreak in the area.

“We are calling for precautionary measures from everyone. People must seek medical attention urgently so that we can curb malaria. They must use mosquito nets regularly,” Chidaushe said.

Local transmission in the community has been reduced to very low levels among most outlying rural communities within Mashonaland West province, in three districts, including Chegutu, Mhondoro Ngezi and Zvimba.

Other districts like Kariba, Sanyati, Makonde and Hurungwe are in the control phase where the malaria disease burden is significantly high.

Ironically, last week, Kariba district recorded a surge in malaria cases that reached a peak of 87 cases in one week.

Mosquito illustration

Kariba district medical officer Godwin Muza told stakeholders that the cases were in both urban and rural communities.

Of these 30% are from Msampakaruma rural, with Nyamhunga in Kariba town pegged at 24%.

Kanyati and Kasvisva are at 10% apiece while Gache Gache stands at 8%.

Mahombekombe and Siakobvu have 6% of the cases each.

On April 25, Zimbabwe joined the rest of the world to celebrate World Malaria Day amid renewed calls for community education to support malaria eradication.

Women Action Group director Edna Masiiwa commended Zimbabwe for making positive strides in combating malaria through donor support.

“Fortunately, Zimbabwe has sound policies on malaria with full-fledged personnel at the ministerial level covering all communities with the support of grassroots community health workers. Some donors, including the Global Fund, are pushing the country’s agenda of malaria eradication. We hope it further helps the country to reinvest and reimagine its focus on the malaria thrust,” she said.

Masiiwa, however, noted that the health sector faces challenges of worker flight.

“Retention of some workers in health sector remains a challenge, but we hope and trust that it will be corrected sooner rather than later,” she added.

She bemoaned abuse of mosquito nets in some communities.

“As a country, we must continue with community education to help those mostly affected in remote areas understand the positive gains of using mosquito nets donated freely for their well-being. It’s a challenge that the country faces and needs a holistic health approach to overcome,” Masiiwa, a women’s rights advocate, noted.


Mrs Masiiwa

Community Working Group on Health executive director, Itai Rusike, admitted that malaria remains a national health challenge.

“The burden is particularly devastating for pregnant women and young children,” Rusike said.

He added that sustained funding was critical to keep prevention and treatment efforts on track.

“If mosquito nets and preventive medicines for pregnant women are unavailable, lives will be lost. When the supply of test kits and first-line treatments is disrupted, malaria cases and deaths spiral. Investing in the fight against malaria not only saves lives but also boosts productivity, creates economic opportunities, strengthens national health security and makes the country safer for everyone,” Rusike said.

“Now is not the time to pause the fight. It’s the time to give everything or risk a surge in malaria cases, growing resistance and the spread of the disease across districts including to non-malaria areas. If left unchecked, malaria will become much harder and more expensive to control, thereby putting millions of lives and decades of progress at risk.”

Rusike, a health advocate, said the country must act decisively to end malaria as a public health threat and build a healthier, safer, more prosperous future for all.

“Everyone must help in the eradication fight,” he said.

Mashonaland West provincial health promotion officer, George Kambondo, said World Malaria Day was a reminder for continued efforts to eliminate malaria and ensure a healthier future for all.

“Let’s work together to raise awareness, support research and advocate for better healthcare systems. Zimbabwe joins other countries in the world to commemorate Malaria Day. Let’s fight malaria. Together, we can make a difference and save lives,” he said.

Kambondo added that there was a need for combined efforts.

“Let’s remember that every life lost to malaria is one too many. By investing in prevention, diagnosis and treatment, we can save lives and build stronger, healthier communities,” he said.

According to government, Manicaland province is the most affected province, contributing 40,7% of malaria cases and 38,8% of deaths in the country, followed by Mashonaland Central, which contributed 28,2% of cases and 24% of deaths.

“Children under 5 years of age account for 14% of the cases. Nationally, there were 36 423 malaria cases with 85 deaths recorded,” the statement by the Health and Child Care ministry said.

On a positive note, Africa stands at the forefront of a revolutionary shift in global health, driven by artificial intelligence (AI) and data science, according to a report released in early April.

The landscape presents an unprecedented view into the potential to improve AI governance in Africa to reduce the risk and stop the perpetuation of inequity.

Titled Governance of Artificial Intelligence for Global Health in Africa, the report was sponsored by Science for Africa Foundation after a culmination of a year-long effort involving convenings across Africa’s five regions, policy analysis and extensive surveys to identify policy gaps and opportunities in AI and data science for global health.

This year’s theme is Malaria ends with us, reinvest, reimagine and reignite, calling for renewed investment, innovation and commitment at all levels of the malaria eradication community to accelerate progress towards ending the disease.

Globally, there were 597 000 malaria deaths in 2023, with 263 million new cases of malaria in the same year.

According to the World Health Organisation (WHO), 95% of malaria cases are in the African region.

The global community recommitted to eradicating malaria in the late 1990s and, as a result, an estimated 2,2 billion cases and 12,7 million deaths have been prevented over more than two decades.

WHO noted that after years of a steady decline, progress has stalled.

“Further progress and decades of hard-won gains are in jeopardy.

Extreme weather events, conflict, humanitarian emergencies and economic stresses are disrupting malaria control efforts in many endemic countries, leaving tens of millions of people with limited access to the services they need to prevent, detect and treat the disease,” WHO said.

It added that without prompt treatment, malaria can rapidly escalate to a severe illness and death.

“It’s time to recommit to ending malaria. We have the knowledge, life-saving tools and targeted prevention, testing and treatment methods to defeat this disease.

We must reinvest in proven interventions, reimagine our strategies to overcome current obstacles and reignite our collective efforts together with countries and communities to accelerate progress towards ending malaria,” WHO said. – Newsday

Childhood on the Brink in Zimbabwe’s Midlands

By Gamuchirai Masiyiwa,


Eneles Zhou cooks outside her home. Zhou, a mother of five, has dedicated her life to caring for her children with sickle cell disease.

ZVISHAVANE, ZIMBABWE — Morning light slants through the window as Eneles Zhou inspects two of her children. They’re wrapped in blankets. Despite March’s typically warm days, in this home in the Midlands province, Zhou’s children struggle with temperatures their bodies cannot regulate.

A mother of five, Zhou quickly coaxes flames to life and prepares porridge, timing it with the children’s medication schedule — folic acid to boost red blood cells, then hydroxyurea to prevent any complications. Over the years, this routine has become familiar.

When her firstborn was diagnosed with sickle cell anemia, a hereditary disease, at 7 years old, Zhou had never heard of it. Doctors told her that 1 in 4 children might inherit it, and with two symptom-free, she clung to hope.

But by 2021, tests had confirmed that three of her children carry a severe form of the disease. Two others have a milder version.

Zimbabwe’s widespread failure to screen newborns means many families only discover the condition after irreversible damage has begun. Without early detection, children often suffer severe complications or die, even before the age of 5, says Dr. Patience Kuona, a pediatric hematologist who’s spearheading a sickle cell research initiative.

In 2024, Zimbabwe launched its first pilot screening program, testing 550 newborns and revealing that the sickle cell trait affects between 3% and 12% of the population. The data is not yet published, says Kuona, the lead researcher.

Still, the pilot — part of ongoing research by the Sickle Hemoglobinopathy Research in Zimbabwe and Zambia — marks only the beginning of a much longer journey for those with the disease.

Specialized care, especially for families outside major cities, remains a mirage. Essential medicines — folic acid, penicillin, hydroxyurea — are often unavailable in public health facilities. Advanced treatments such as bone marrow transplants and gene therapy are not available due to resource constraints. Specialized sickle cell disease clinics exist in five central hospitals, with limited provincial access.

“Pain relief is there, but opioids are scarce in lower-level hospitals,” Kuona says.


Eneles Zhou high-fives her daughter, Partner Sibanda, at Gresham Primary School. Despite frequent absences due to her sickle cell disease, Partner excels academically.

Sickle cell disease, the world’s most common inherited blood disorder, warps healthy cells into crescents. The sickle cells break down easily, leading to anemia. They can also clog small blood vessels, causing excruciating pain and organ damage.

Globally, 7.74 million people bear this genetic burden. Over half a million children were born with the disease in 2021. While Zimbabwe’s 12% prevalence rate appears modest compared to hot spots like Nigeria, Uganda and Democratic Republic of Congo, where rates soar to between 20% and 45%, the country’s fragile health care infrastructure magnifies suffering, turning what should be a manageable condition into a daily battle for survival.

Zhou’s case is especially challenging. Her five affected children are different ages — one adolescent, two teenagers and two preschoolers — and the complications worsen as children grow, with higher risks of infections, kidney problems, blood clots and stroke.

Zhou’s eldest, Panashe Sibanda, 20, has endured the worst. Despite six daily medications, he is constantly in pain. He struggles to sustain friendships. He can’t join gatherings because pathogens infect him too easily. A simple cold triggers what he calls a “pain crisis,” which no over-the-counter painkiller can relieve.

For 1 in 3 people with sickle cell disease, pain is a near-daily companion. More than half grapple with pain most days.

“I’ve survived 61 near-death experiences since I was 13,” Sibanda says.

The disease burdens families financially through frequent hospitalizations and work loss. Zhou’s husband’s irregular carpentry work barely sustains them. Zhou doesn’t work outside her home; her children’s disease requires full-time care.

During her children’s playtime, Zhou remains alert. These aren’t carefree moments of childhood abandon; they’re carefully monitored sessions within the confines of their immaculate home. One dust mote could trigger an infection.

“I am always nervous,” she says. “Always anxious.”


Eneles Zhou walks her daughter, Partner Sibanda, to school. Zhou’s daily routines are shaped by her children’s medical needs, including monitoring school attendance.

Photos Credit: Gamu Masiyiwa
This article was first published in the Global Press Journal (GPJ)

Revitalizing PHC4UHC by 2030 and rebuilding a fragile health system from the bottom up

… Addressing Zimbabwe’s Health System Demise and Brain Drain

By Itai Rusike

This article was first published in the Medicus Mundi Switzerland (MMS) Bulletin, #172 March 2025

The health and social services must function optimally for a country to realize social cohesion, economic growth, and be in tandem with the global health and security agenda. The current situation of investing in education and professional training and then “donating” the young and able-bodied products to already established, functional health systems located in wealthy countries is a luxury that poor economies like Zimbabwe cannot afford. The remaining few health workers remain frustrated and incapacitated to deliver effective care resulting in the subdued population health status currently obtaining in Zimbabwe.


CHWs in Zimbabwe participating at the National Health Financing Dialogue – @Itai Rusike

The development and transition of the health system in Zimbabwe over the decades

Zimbabwe has documented a number of transitions in its healthcare delivery system. In the pre-colonial era and before introduction of conventional medicine, traditional and spiritual methods of diagnosis and treatments were complemented by diets and taboos that supported the health across the life course. There were specific foods and medicinal plants for the pregnant women, newborns, young children, adolescents, young adults and the elderly. Various medicine men and women and the older uncles and aunts would oversee these, but there were no formally trained health professionals.

The colonial era came with introduction of western medicine but was limited mostly to the urban, mining and agricultural areas, and left the rural areas to continue their various traditional medical practices to address ailments. This saw the introduction of formal training of the natives in health especially nursing, environmental health to complement those introduced by the settlers. The first African Zimbabwean doctor was Samuel Parirenyatwa.

At its Independence in 1980, and just two years after the Alma Ata Declaration the government premised its health delivery system on the concept and philosophy of Primary Health Care (PHC) (WHO, UNICEF, 1978); greatly expanding the reach of conventional medicine to the rest of the country in terms of more health institutions and a defined healthcare workforce for the public health system, to be followed by a health workforce “establishment”. This was after the realization that the majority of the population resided in the rural areas and yet health care was centralized in the few urban centers. A number of policy pronouncements guided the process of ensuring the goal of “health for all by 2000”; including the white paper on health of 1981, “Planning for Equity in Health” of 1985, and the accompanying decentralization saw much improvement in the population access to affordable and quality health care.

In the 1997-2007 national health strategy, 85% of the population had access to a health facility within 10Km. The public health system catered for about 80% of the population through central government, local government, church and NGO run institutions. The life expectancy, maternal, child and general mortality in the population greatly reduced while health status and other favorable indicators improved leading to the country attaining notable health and welfare standards.

At its Independence in 1980, and just two years after the Alma Ata Declaration the government premised its health delivery system on the concept and philosophy of Primary Health Care (PHC).

Current situation

A number of challenges have almost reversed this progress and development of Zimbabwe’s health sector of which have been decades of socio-economic and political challenges that impacted negatively on health and related social services. These have been compounded by weaknesses within the system characterized by rigidity within the governance and management levels and resultant failures to adapt to the changes. The health workforce bear the brunt of these systemic weaknesses and failures and so after the demise of almost all the health system building blocks trained and experienced staff have been leaving in large numbers to join the private sector, neighboring countries and the diaspora. The major complaints have been poor remuneration, limited access to tools of the trade, as the health institutions continue to have stock outs of medicines and major supplies.

The weak governance systems also mean that there is no organized systems to adequately plan for and deploy the few trained personnel to benefit their populations, nor benefit the country when they emigrate to other countries.

The country and health system failed to adequately adopt to major transitions and have left healthcare workers with little or no support in terms of capacitation to cope, protection from infections within institutions and during public health crises, nor financial cover to make their work and contribution worthwhile. Among the transitions have been the structural adjustment programs, (ESAP) of the mid 1980’s, the HIV pandemic of the early 1990’s, and now the socioeconomic and political situation since the turn of the millennium. There have also been demographic, epidemiological and technological transitions in line with population increases, disease trends and this combination of major changes required a corresponding governance and management structure that responds with timely and effective policy and legislative responses that ensure sustainable service delivery with the health workforce at the center- being a services sector.

However the decentralization of early 1990’s was not followed by devolution and healthcare worker issues have continued to be centralized, fueling frustration and health worker exodus and thus almost emptying the institutions of their health workforce.

Despite progressive increases in budgetary allocations towards the 15% allocation for health, (Abuja, 2001), the fiscal disbursements have been inadequate to keep the system afloat. The 15% mark has never been attained, with Government spending on health care as a percentage of total public expenditure increasing only from 10.6% in 2022 to 11.2% in 2023.

This poor financing for health has been another sore issue for the health workers as they interface with clients they cannot adequately serve. The majority of clients seen in the public sector remain without comprehensive care except for a few selected diseases and conditions which receive vertical funding (HIV/Aids, TB, Malaria, maternal and child conditions). Despite the recent moves to integration Health Communitiy Workers (HCWs) get frustrated rendering inadequate service and have therefore been moving to more resourced jurisdictions.

This situation means that universal access to health remains beyond reach, until and unless the complex health situation is effectively addressed. The recent developments of wars, climate crises and the major shifts in the donor landscape well before the earlier warning of the 2030 deadline requires urgent action on the part of government and the health ministry.

The majority of clients seen in the public sector remain without comprehensive care except for a few selected diseases and conditions which receive vertical funding (HIV/Aids, TB, Malaria, maternal and child conditions).

Causes of the global health care workforce shortages

A number of factors are responsible for the current situation including the demographic and epidemic transitions. The inadequate health workforce in developed countries cannot cope with the combined complexities of chronic diseases compounded by ageing populations. Meanwhile in developing countries it’s the opposite in that the epidemiological transition has not been effectively addressed as they remain with a huge burden of infections, emerging and re-emerging diseases, unchecked chronic/noncommunicable diseases which include injuries, mental health conditions and substance abuse.

The demographics are characteristically young populations but with limited access to education and training opportunities due to weak health, education and other social systems. The weak governance systems also mean that there is no organized system to adequately plan for and deploy the few trained personnel to benefit their populations, nor benefit the country when they emigrate to other countries. The case in point being that of the expatriates deployed to Zimbabwe during the post-independence era and in recent times, the Cuban health, education etc brigades whose deployment is regulated by their state, and follows signed agreements with the receiving countries. The World Health Organization (WHO) Global code on recruitment of health care workers has not been heeded, neither is it enforceable in the member states as is the framework convention on tobacco control, (FCTC) and the international health regulations, (IHR, 2005, 20012), both of which are binding.

The current situation of investing in education and professional training and then “donating” the young and able-bodied products to already established, functional health systems located in wealthy countries is a luxury that poor economies like Zimbabwe cannot afford.

Social and economic consequences of a shortage of HCWs for countries with weaker health systems
In Zimbabwe, the past two decades have been characterized by massive outward migration of health, education, social and other professionals due to the protracted social political and economic demise. This state of affairs has greatly impacted on government’s functionality with the high levels of corruption taking resources away from where they are needed most. The results have been telling in the multi system collapse including public health infrastructure and services.

As a result, the major determinants of health have become severely neglected, causing outbreaks and adding a considerable burden of preventable diseases and conditions. For a largely unemployed population, the paradox is the huge out of pocket expenditure for preventable ailments while the collapsed system cannot serve the clients. The result has been adverse health indicators across the population with considerable premature, avoidable and excess mortality.

How do HCWs experience the effects of staff shortage?

Healthcare workers are supposed to work as teams and seldom in isolation. At central, city and provincial hospitals there used to be multidisciplinary teams of 2-4 consultants per firm, with registrars, senior and junior residents, then the nursing team, physiotherapists, nutritionist etc., but currently there may just be one doctor -and few nurses. The workload becomes unmanageable and each shift is taxing as oftentimes one cadre has to carry out the tasks of 3 or 4 others, with no one to discuss the patient condition, treatment options nor debrief.

This has resulted in burnout of the few cadres whose recognition and remuneration has not increased significantly despite the increased demand on them. The patients and their relatives often accuse them of blocking services and pilfering medicines and supplies for their benefit when in fact it’s the nationwide corruption that has stripped the system and caused the neglect. At the districts and remote clinics often one nurse has to oversee a whole unit and this compromises patient care, accurate documentation and patient follow up. There is little time for continuous professional development as most of the time the staff is overwhelmed and working solo.

The patients and their relatives often accuse them of blocking services and pilfering medicines and supplies for their benefit when in fact it’s the nationwide corruption that has stripped the system and caused the neglect.

How effective is the WHO Global Code of Practice on international recruitment of HCWs?

For countries like Zimbabwe the global and even the WHO Afro regional office pronouncements on preventing or minimizing health worker migration have been ineffective. There has to be some acknowledgment to the sending country to compensate for its investment in the professional and this to be ring-fenced to further enable training and or improving the working environment of those who remain in-country. Deliberate efforts must be made to invest in addressing the demise of the health systems that have bled too many healthcare workers by the major receiving and wealthy nations.

There has to be some acknowledgment to the sending country to compensate for its investment in the professional and this to be ring-fenced to further enable training and or improving the working environment of those who remain in-country.

What are the potential solutions to address HCWs crisis/shortage long term?

– Address the work environment by re-investing and revitalizing the health delivery system across the WHO’s six building blocks of a health delivery system, and in tandem with a revitalized primary health care for universal health access (PHC4UHC, CWGH, PHCPI, 2022).
– Implement the health financing reform in line with the dwindling donor support and the critical need for a robust local financing architecture.
– Improve the governance and management of the healthcare workforce and ensure that well trained health professionals are in charge and make decisions rather than the corruptly appointed management.

The latter have been competing with and further frustrating the healthcare workers and yet remain without a sound understanding of the system and its complexities. Given the extent of the demise and the high turnover of staff over a protracted period, there may be need to bring in some of the old guard, (retired but not tired) to hand hold and mentor the young inexperienced staff. This can help restore the dignity of the profession, improve confidence, service delivery and patient outcomes.

The government must also ensure implementation of the Constitutional provisions for health and its determinants, enforce the public health act and enforce mandates across all sectors that hold key determinants of health in order to effectively prevent disease and promote health. The result will be more manageable workloads for the reduced staff. Furthermore, there has to be strategies that address the huge and unchecked burden of non-communicable diseases, injuries and mass trauma casualties, mental health, substance abuse and climate induced health issues that have not yet received attention but are over-loading the limited health workforce.

Itai Rusike is the Executive Director, Community Working Group on Health (CWGH) – Zimbabwe. Itai is a Public Health Activist with more than 20 years’ experience organising involvement of communities in health actions in Zimbabwe. He is a member and chairperson of various health related committees, along with being the Vice-President of Medicus Mundi International Network.

For the full bulletin, follow link : https://www.medicusmundi.ch/en/advocacy/publications/mms-bulletin/health-workforce-shortage-are-there-potential/kapitel-1/addressing-zimbabwe%E2%80%99s-health-system-demise

CWGH: Driving stronger advocacy and accountability for better health outcomes

• In Zimbabwe, the Community Working Group on Health rallied voices to shape a powerful domestic health financing position paper. Previously, budget decisions were exclusive to government officials, leaving out community perspectives. This advocacy secured an increase in health spending from 10.6% to 11.2% from 2022 to 2023, demonstrating the power of community-driven change.

Read more: https://www.globalfinancingfacility.org/partnership/csos-youth

Part of the team that makes it happen