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Harare water quality frightens residents

Harare water quality frightens residents

HARARE - While attention has been turned towards the spreading waterborne diseases, residents in Harare are now raising concerns over the quality of water being supplied by the Harare City Council (HCC).
While health services director Prosper Chonzi claims the city’s water is safe to drink, its appearance seems to suggest otherwise.
The water being pumped by council has a cloudy and sometimes yellowish brown colour, with algae-like residue accumulating at the bottom of containers after it has been rested.
At times the water is completely muddy and cannot be consumed by residents for obvious reasons.
“Harare tap water is very safe to drink because it meets all the World Health Organisation standards. The only issue may be that it does not meet the smell and sight sense standards but it is very safe,” Chonzi said.
Community Working Group on Health executive director Itai Rusike said environmental conditions are some of the underlying problems that Harare faces.
Rusike added that perennial water shortages plus limited water chemicals mean Harare households are vulnerable to unhealthy environments.
He said because of the unreliable and prolonged water cuts residents are vulnerable to unsafe alternatives.
“The situation on the ground indicates that while infrastructures are present, they are old, poorly functioning and poor availability of safe water leads to sourcing of water from less protected, informal sources. Advice to boil water is difficult to follow during water and power cuts,” he said.
The CWGH director added that women are more susceptible to contracting diseases from unsafe water due to their gendered roles.
In 2015, heavy metals such as lead, mercury, toxic levels of iron and phosphates were traced in the waste water that eventually flows to Morton Jaffray Waterworks for purification.
HCC waste water manager Simon Muserere said chemicals such as phosphates in the water are commonly caused by soaps and detergents used daily.
He said if a phosphate ban is implemented, the city can reduce the quantity that is discharged into the water.
“If that ban is not there, countries like South Africa which have these bans can just dump their high phosphate products in Zimbabwe.
“So when we bath, do our laundry and go about other cleaning activities, those phosphates end up at the treatment plant,” he said.
According to WHO, lead in the body is distributed to the brain, liver, kidney and bones.
WHO advises that no levels of lead exposure are considered safe, however, poisoning by the metal is preventable.
It is stored in the teeth and bones where it accumulates over time. Human exposure is usually assessed through the measurement of lead in blood.
Mercury poisoning disrupts any tissue it comes in contact with and can cause shock, cardiovascular collapse, acute renal failure and severe gastrointestinal damage.
In order to curb cases of water pollution and illegal trade effluent, HCC has drafted the Water Pollution and Trade Effluent Control by-law which regulates water pollution and effluent discharge into the environment.
The by-law has come at a time when the city is battling a lot of environmental, health and food security challenges due to pollution and effluent discharge.
According to the acting chamber secretary Charles Kandemiiri the by-law would make it a condition for all persons involved in the production or manufacture of goods resulting in effluent discharge to install pre-treatment facilities at their premises.
He said it was about time that council took a robust stance in the regulation to avoid water pollution in Harare.
“This will ensure that trade effluent is treated before discharge into the municipal sewer. It will also prohibit the discharge of trade effluent at undesignated points.
“The by-law also ensures that trade effluent and hazardous substances dumped into the sewer system should comply with council’s chemical standards,” he said.

Helen Kadirire  •  16 January 2017
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Floods to worsen Zimbabwe’s health woes

FLOODED rivers and homes, collapsing infrastructure, uncollected garbage, rotting vegetables at vegetable markets, clogged storm water drains and traffic jams caused by flooded streets have all become talking points on social media as Zimbabweans try to laugh off their otherwise appalling conditions.
The incessant rains, some of the heaviest the country has seen in recent times — though a welcome relief after two consecutive seasons of erratic rainfall — have triggered heavy flooding countrywide and has given the largely jobless population something to yap about on social media.
But, many are probably oblivious to the grave health dangers the incessant rains are posing.
For instance Harare’s Mbare, one of the country’s oldest suburbs, has become an eyesore with muddy streets skirted by pools of sewerage outflows testifying why indeed the overcrowded residential area became the epicentre of the current typhoid outbreak.
The floods have increased the potential for other waterborne diseases such as cholera and hepatitis A; while the stagnant pools of water countrywide will propagate vector borne diseases such as malaria, bilharzias and yellow fever.
Other health risks, which can be caused by flooding, include drowning, hypothermia, electrocutions and respiratory infections such as pneumonia and asthma.
The Southern African Development Community Regional Early Warning Bulletin for the 2016/17 highlights that the normal to above normal rainfall condition may induce surface water stagnation and flooding that may cause physical havoc in many countries with many people getting ill (morbidity) and many more dying (mortality).
Flooding due to too much stagnating water, according to the bulletin, increases the chances of water borne diseases such as cholera and other diarrhoeal illnesses.
“There is also the increase of rodent-borne diseases such as plague. Vector-borne diseases such as malaria, dengue fever, and others have also increased in times of floods. Malaria increases maternal and child health morbidity and mortality. There has been a noticeable increase particularly in our region of rift valley fever, bacterial meningitis and yellow fever,” reads the bulletin in part.
Lack of sanitation and hygiene due to floods has been identified as the immediate cause of illness and mortality.
Zimbabwe Association of Doctors for Human Rights (ZADHR) secretary general, Evans Masitara, said the incessant rains in the New Year have complicated matters for the country, which is currently grappling with the typhoid outbreak.
The outbreak of typhoid could get out of control because of the country’s shambolic emergency response mechanisms.
“Our health sector has been suffering a steady decline over the years due to poor management and lack of adequate resources…The typhoid outbreak is not under control and is actually spreading to other towns and cities with cases being reported in Marondera, Mutare and Masvingo,” said Masitara.
Given poor service delivery, especially in Harare where garbage goes for months without being collected, the country is sitting on a health time bomb which could explode soon, leading to unnecessary loss of lives.
Apart from the heaps of uncollected garbage, Harare is also grappling with erratic water supplies, burst sewer pipes and poor drainage due to haphazard construction of houses on wetlands.
“Meanwhile, the blame game continues as departments shift responsibility for the crisis, and then we have some wise politicians who lack common sense, blaming all this on the poor vendors,” Masitara said.
Without the capacity to deal with the looming disaster, the health sector is overwhelmed, chiefly because of human, financial and material resource constraints.
This is being compounded by low salaries, poor working conditions as well as dilapidated infrastructure.
The population of Zimbabwe continues to expand while the healthcare delivery infrastructure deteriorates.
Government has over the years failed to comply with the Abuja Declaration concerning healthcare funding with the last National Budget allocation for health representing a measly six percent of the total budget.
“The issue is not really a resources issue, but that of misplaced priorities. A week ago it was reported that Atracurium, a drug used for anaesthesia in life saving operations, was running out because the Reserve Bank of Zimbabwe was not making payments to suppliers on time. This just shows how skewed our leaders priorities are. How can they choose to ignore the fact that health is a basic human right, provided for in our constitution?” Masitara added.
The country’s poor living environments have affected a wide range of health outcomes leading to recurrent epidemics such typhoid.
ZADHR has thrust the entire blame for the country’s recurrent disease outbreaks on the Ministry of Health and Child Care which it says has not instituted proper systems to prevent disease recurrences and avoidable loss of lives.
In the absence of a proactive Health Ministry, Community Working Group on health executive director, Itai Rusike, believes the health burden for local authorities has been especially unbearable given the fact that most of the council are broke, having very little capacity to address the challenges they are facing due to the failure by the residents to pay their bills.
“The local authorities face a lot of interference from an equally struggling central government incapable of bailing them out due to a tight fiscal space,” said Rusike.

newsdesk@fingaz.co.zw

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Zimbabwe Battles New Typhoid Outreak

Credits: Voice of America

by Sebastian Mhofu

HARARE, ZIMBABWE — An outbreak of typhoid in Zimbabwe’s capital has killed two people and is affecting dozens more, raising fears that the southern African country’s water and sanitation problems are far from over.

Officials say that so far, 126 cases of typhoid have been confirmed in Harare since the start of the rainy season in Zimbabwe about two months ago. There are more than 1,000 other suspected cases nationwide.

But Dr. Prosper Chonzi, who heads the Harare health department, said there was no need to panic.

“What we are doing is to educate the public on awareness issues to do with typhoid — what it is, how it is spread, how to avoid getting it,” Chonzi said. “We are also discouraging people from consuming food from undesignated premises.”

Harare city crews, he added, were clearing blocked sewer pipes in Mbare township and trying to ensure supplies of fresh water in affected areas.

Problems persist

However, a visit to those and other parts of Harare on Wednesday told a different story. Faucets were dry, sewer water could be seen flowing, and some people were using water from open sources like lakes and rivers.

Itai Rusike, executive director of the Community Working Group on Health, said President Robert Mugabe’s government did not learn much from the 2008-09 rainy season, when an outbreak of cholera killed more than 4,000 people in Zimbabwe.

“The fundamental health issues that were supposed to have been attended to from the earlier crisis have not been attended to,” Rusike said. “Authorities are taking advantage of the outdated Public Health Act that we are using, enacted in 1924. Public health trends have changed [since then]. This is why you find that it is easier for the city of Harare to pollute our water bodies and pay the fine, [a] very small fine.”

The pollution he referred to is raw sewer water discharging into rivers, which some people rely on for daily use. Those using the contaminated river can easily contract waterborne diseases such as typhoid and cholera.

Typhoid, an infectious bacterial fever, can be treated with antibiotics, but it still kills more than 220,000 people worldwide each year, according to an estimate from 2014 reported by the World Health Organization.

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Poor adherence to ART on rise

THE country’s fight against HIV is facing new challenges due to reports of misuse and mismanagement of anti-retroviral therapy as reflected by the ballooning cases of second-line treatment countrywide.The National Aids Council (NAC) 2015 report reveals that people on second line treatment are 15 337, an increase from the 13 036 recorded in 2014.Poor adherence to ART has been shown to be a major determinant of disease progression, mortality and health care costs.
While high adherence levels can be achieved in both resource-rich and resource-limited settings following initiation of ART, long-term adherence remains a challenge regardless of available resources.
Some people living with HIV stop taking their medication due to a number of reasons, among them fear of disclosure, stigma and discrimination whilst others listen to prophets who claim to cure the virus.
NAC communications director, Ms Medelina Dube, said non-disclosure to children living with HIV was also fuelling treatment failure.
“Defaulting is particularly rampant amongst young people born with HIV. This is because most parents or guardians do not tell them why they have to take medicines every day and they don’t even know they are living positively,” Ms Dube explained.
“Some are told that they have to take medicines because they have heart or kidney ailments. So when they don’t feel sick they don’t take medicines, thereby defaulting.”
Zimbabwe National Network of People Living with HIV (ZNNP+) executive director, Mr Dagobert Mureriwa, concurs that treatment failure is expensive.
“As a country, we have failed to put in place robust adherence and counselling services to monitor treatment failure. It’s cheaper for a country to have people in one treatment line,” he said.
“Yes, people respond to ARVs differently but due to the fact that 80 percent of our health sector is donor-funded, it becomes unsustainable to have treatment failures.”
Treatment failure is detected when one goes for viral load testing and is found to have more than 1 000 copies per mil. A decreasing CD4 count is also a sign of treatment failure as well as deterioration of one’s health.
Mashonaland East recorded 1 377 cases of second line ART patients, Mashonaland Central 477, Matabeleland North 455, Masvingo 1 448, Harare 3 684, Matabeleland South 645, Mashonaland West 1 430, Manicaland 2 155, Bulawayo 2 187 and Midlands 1 479.
People taking anti-retroviral drugs have been urged to adhere to their treatment requirements so that they do not develop resistance thereby incurring huge health care costs.
The director of the Aids and TB unit in the Ministry of Health and Child Care, Dr Owen Mugurungi, said HIV treatment success is hinged on sticking to specific times of taking the ARVs and on a daily basis without fail.
“Adherence is critical in suppressing the virus and the level of drug concentration should be maintained so that treatment becomes effective,” said Dr Mugurungi.
“If one defaults on treatment for whatever reason, the virus mutates and becomes resistant to drugs being taken. It then becomes expensive to move a patient from the first line of treatment to the second line.”
Currently in Zimbabwe most people are still on the first line of treatment, which is way cheaper and readily available in most public institutions.
Zimbabwe introduced ARV therapy in 2004. The country adopted the WHO treatment guidelines recommending patients begin treatment at a CD4 count of 500, compared to the 350 count in earlier treatment guidelines.
Pregnant women and infants living with HIV are being initiated on treatment regardless of their CD4 count. As such, trends show an increase of people living with HIV.
The number has risen to 1 412 790 in 2015 from 1 356 010 in 2011.
Regimens used for second line treatment include either a combination of tenofovir, lamuvidine, atazanavir/ritonavir or zidovudine, lamuvidine, atazanavir/ritonavir or abavacir, lamuvidine, atazanavir/ritonavir.
NAC used $9,7 million to procure tenofovir, lamivudine and efavirenz and $2 475 970 to buy atazanavir/ritonavir in 2015.
Treatment failures are attributed to lack of drug adherence and drug resistance.
“The treatment gap is being widened because second line treatment is more expensive than the first line. It is more desirable to have as few people on second line as possible,” added Ms Dube.
“NAC through its advocacy programmes has been reaching out to people across Zimbabwe, encouraging them to adhere to treatment. People are encouraged to take their medicines correctly and consistently as prescribed by health personnel.
“People are also encouraged to start treatment early before they fall sick. This means people should get tested for HIV as frequently as possible.”
The University of Zimbabwe Clinical Research Centre (UZCRC) had eight patients on third line ARVs as of September 2012 with an anticipation of not more than 100 people on third line in the country.
An increasing number of patients will eventually need third line medicines which are used when patients stop responding to first and second line treatment regimens.
A medical practitioner who agreed to speak on condition of anonymity said HIV treatment is a sad trend.
“Though it may seem like a small number to some but the fact is it is increasing and the country needs to be prepared to tackle the problem head-on,” said the medical practitioner.
“For those failing on second line the options are severely limited requiring rigorous trials by the health practitioner to determine which of the remaining drugs can be used.”
Third line ARVs include darunavir, raltegavir, etravirine and ritonavir.
Community Working Group on Health (CWGH) director, Mr Itai Rusike, said the ballooning cases of second line treatment could further widen the treatment gap.
“Second line treatment is expensive and the possibility of having a sizeable number on third line is condemning those in need of such treatment to death because they may never access treatment after this,” he said.
However, third line drugs are either unaffordable or unavailable in many developing countries.
“Drug resistance may spread to other related drugs thus limiting future treatment options,” added Dr Mugurungi.

SUNDAY MAIL REPORTER SEPTEMBER 18, 2016 Shamiso Yikoniko

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Eradicating Aids through self-testing

Eradicating Aids through self-testing

Vivian Mugarisi recently in Durban, South Africa

As the world gear up the response to HIV/Aids, self-testing appears to be of great importance in achieving the 90-90-90- target. The 90-90-90 is an ambitious target to help eradicate Aids. But other long standing barriers to accessing comprehensive HIV testing remain significant, especially in Africa.There are still people who worry about HIV-related stigma, those who do not see the need to know their status for one reason or the other and those who are afraid of dying of Aids-related diseases so they would rather not know.

While self-testing could actually be the key for the Zimbabwe to achieve the first 90, which seeks to ensure that all persons living with HIV know their status, lack of linkage to care, counselling and the ability of individuals to test themselves accurately and interpret results remain a major challenge in the successful implementation of home service testing.

But the introduction of this HIV self-service looks imminent.

In an interview on the side lines of the 21st International AIDS Conference in Durban, Aids and TB Unit director Dr Owen Mugurungi said the pilot project which was demonstrated in Mazowe in March was a way of evidence gathering to present to the World Health Organisation for guidance.

He said for the country to secure funding for the project from various donors, there should be guidelines on how to carry out self-testing.

“The unfortunate thing is that when countries that have resource constraints like Zimbabwe go to our partners and ask for some money for self-testing, they will then say there is no guidance for it.

“So what we are doing now is to get evidence for WHO to be able to give normative guidance so if the evidence is good WHO would then come up with guidelines then we can go back to our partners and say give us money for self-test,” he said.

Dr Mugurungi said the country will embark on the programme despite resource challenges in preparation for a full-blown project once resources are secured.

“We, however, feel that with our own limited resources, we should not let the idea or capacity or ability to self-test fade before WHO give us guidance or before donors give us money to do that,” added Dr Mugurungi.

Mr Itai Rusike, the director of the Community Working Group on Health, said information on HIV should be availed such that individuals understand what it means to be positive. He also said there was need to ensure that disclosure issues are addressed and counselling is offered right up to the family level. “I think it is helpful as long as the community understand what it is doing,” he said.

“My worry is the event that someone conducts the test, fails to interpret the results and is nowhere near a clinic for psycho-social support, they may commit suicide.

“Counselling services should then be available at all levels, disclosure issues need to be addressed and we also need to consider gender issues, action after tests, stigma in community, the accuracy of tests, availability of confirmatory tests and so on,” said Mr Rusike.

Gutu South legislator, who is a member of the Parliamentary Portfolio Committee on Health, Dr Paul Chimedza said the country has been ready for a long time and more people now have the knowledge on HIV/Aids related issues compared to decades ago.

“I think Zimbabwe has been ready for a long time it’s just that we have been hesitating to move into this, we need people to have access to testing themselves.

“I know people talk about committing suicide and this and that but we have had diseases that are worse than HIV. “We have had cancers that can kill with no cure but people have been told they have cancer but they survived,” he said.

Dr Chimedza also said self-testing is one way to close the testing gap as nearly 45 percent of the people who should know their status are still in the dark.

Despite the loopholes that need urgent addressing before rolling out home-testing programmes, manufacturers of the rapid self-test kits said it was high time developing countries embrace the low- cost kits to meet the 2020 target.

Premier Medical Corporation Limited president Nilesh Mehta said developing countries can start using these kits as they are very affordable compared to previous testing methods, among them the oral self-testing approach.

“We understand that some of the African countries cannot afford expensive test kits so we produce the highest quality product at a low price,” Mr Mehta said.

One self-testing kit is going for 75 cents which is four times lower than the oral test which costs at least $3 per kit.

The high temperature stable test kits comes with everything one would need to do the test and the product has already been used in South Africa, Ethiopia and Ghana; with South Africa getting at least 40 million kits a year.

Diagnostic Laboratory Suppliers managing director Mr Edgar Chandiwana said various stakeholders should come together to support Government in ensuring that links to counselling are put in place for comprehensive approach to offering HIV testing, treatment and support.

He said telecommunication companies must provide toll free numbers for the public to connect with health care providers at any given time.

“It’s in our best interest to move towards the 90-90-90 and it can only be possible if we can get to have more people knowing their status,” said Mr Chandiwana.

Added Mr Chandiwana: “Though issues of counselling are paramount, we need to keep on moving.

“In our current situation in Zimbabwe, it is an issue that the ministry is looking at closely and with the current infrastructure, someone should be able to call, toll free, and information should be readily available in pharmacies and supermarkets.”

“We need mobile communication companies to come on board to make this a success as they could help bridge the gap of the missing link to counselling services through toll free services,” he said.

He argued that while developing countries are lagging behind in terms of technology, there is need to take a bold move and roll out self-test to achieve the UNAIDS target to end Aids by 2030.

According to the World Health Organisation, self-testing is not new as it is already in use in Australia, France, Britain and the United States.

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Call for health sector funding review

Call for health sector funding review

HEALTH and Child Care Minister David Parirenyatwa has called for treasury to increase funding of the health care system as shortages of resources are compromising service delivery and affecting the health care quality.

The statement comes at a time when Harare’s biggest referral hospital, Harare Central Hospital, is facing an acute drug shortage that has forced it to suspend elective surgeries.

“We need to be able to finance our health system. We cannot be judged as a nation that cannot put money into our health care system.

“Inadequate government funds have negatively affected health service delivery. A country is judged by how it looks after the health of its people,” said Minister Parirenyatwa.

Minister Parirenyatwa who has been touring the country’s health institutions to appreciate the challenges faced by the hospitals recently reiterated that the country’s hospitals were facing a myriad of challenges due to underfunding citing the shortage of drugs as the major challenge.

He said the country’s hospitals were facing shortage of drugs, health personnel, equipment and inadequate infrastructure following an assessment of the country’s major hospitals.

The Community Working Group on Health has also reiterated that the Government should consider increasing health funding in its 2017 budget.

The lobby group director, Itai Rusike called the Government to move beyond tokenism and increase its commitment to funding services that are currently being funded by donors.

“Government has continued to collaborate with its external partners for the funding and sustenance of selected programmes with external funding being channelled off-budget to reduce fiduciary risks.

“However, external funding has somehow become fungible and has in most cases replaced government funding instead of complementing it,” argued Rusike.

“We are also concerned with the high level of donor dependency on medicines and maternal health programmes. Medicines requirements and RMNCH programmes remain some of the most externally dependent programmes exposing them to arbitrary cuts and funding withdrawals.”

Rusike said this donor dependency and not prioritising health funding had plunged Harare central hospital into a crisis that has forced it to suspend elective surgeries due to an acute shortage of drugs which has seen the hospital even running out of basic pain killers.

As the hospital’s crisis worsens, chronically ill patients who get their monthly supplies from this hospital have not been spared.

The health sector has over the years relied on donor funding with over 90 percent of medicines coming from donors, a situation that has mostly affected the poor who mainly rely on these public health institutions.

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Increase funding to health for attainment of Universal Health Coverage

Increase funding to health for attainment of Universal Health Coverage

Government must allocate more funding to the health sector in the 2017 National Budget to ensure that the country achieves universal health coverage (UHC) that continues to elude the majority of Zimbabweans.
For years, inadequate funding for health care has meant that the country has been unable to realise its full potential for providing sufficient and quality services to people. With increased funding to health, Zimbabwe would be able to deal with the current disease burden, address human resources shortages, access to medicines and build more facilities to reduce the distance patients travel to seek health services.
The country needs to progressively move towards meeting the Abuja target of not only allocating 15 percent of the National Budget to health, but actually spending that allocated amount on the sector. It has been noted that in the past years, the Government would allocate funds to health, but would disburse much less to the sector to make any meaningful impact.
Fifteen years after African governments committed themselves to the Abuja Declaration in 2001, only six countries have been able to meet the target. These are Liberia, Madagascar, Malawi, Rwanda Togo and Zambia.
Rwanda, which was involved in a devastating civil war for several years, already spends at least 23,7 percent of its national budget on health care, a percentage that is three times more than what Zimbabwe allocated to healthcare in 2015.
Presently the Zimbabwe Government, which relies heavily on donor funding, has cited a shrinking fiscal space for failing to meet the Abuja target. It is therefore advisable for the country to seek innovative domestic ways of funding the health sector as relying on foreign funds is a national security risk should the donors withdraw support for any reason.
With a narrow revenue generation base, the Government must consider the introduction of “sin taxes” on commodities such as tobacco and alcohol not only as measure of raising funds, but a way of reducing the consumption of harmful products.
It should be emphasised that reaching Sustainable Development Goals (SDGs) requires a sustained momentum in funding the country’s health care system. The current resources nexus shows that the tertiary and central level health facilities attract more funding than the lower levels as a result of the intensity of their services.
While there has been some improvement in Maternal, Neonatal and Child Health (MNCH) indicators, infant, U5s and maternal rates remain a cause of concern as the current rates are too high compared to regional rates. The Government is far from achieving its target of 326 deaths per 100 000 live births by 2020 although maternal mortality declined from 960 live births in 2010 to 651 in 2015.
It should also be noted that poorer households continue to endure disproportionate losses in infant, child and mortality as compared to the richer households so more funding should go towards primary level care.
The current ratio of over 70 percent funding for curative services and less than 10 percent funding for preventive services will not see the country moving towards reducing further the rates of maternal and child mortality.
Lower levels of care handle more patients than the tertiary and central level facilities and it is therefore prudent that a significantly larger share of the budget should go to the district level. The idea of building district hospitals in areas such as Harare, Bulawayo, Wedza and other parts of the country to alleviate the burden of patients at the central level remains a critical requirement. This must be supported by increasing or reviving health grants to urban councils to lower their user fee charges to more affordable levels.
A huge number of patients in the country are still enduring unbearable long distances to access primary health care facilities. The Government therefore needs to increase funding for outreach services so that communities in remote areas and newly resettled areas can also have access to care.
It is also important to resuscitate community support structures such as ward health teams and ward development committees as well as remunerating community health workers well especially village health workers.
There is evidence which shows that socio-economic and geographic inequalities and inequities are hampering access to health services especially for non-communicable diseases (NCDs) such as cancer services.
The State should come up with a clear position on treatment of NCDs. It is important that the State decentralises services and subsidises their treatment costs to lessen the burden on the poor who are the majority.
The creation of a national health insurance (NHI), a process which started in 1991, remains a noble idea but it would be more appropriate if the management of this body is given to the National Aids Council (NAC) given their experience in managing the Aids Levy.
However, there is still need for more inclusive consultations with stakeholders to come up with a comprehensive Bill. Health insurance is currently dominated by a well-established but poorly regulated private sector, serving only 10 percent of the country’s population and is under threat due to increased job losses.
The cost of blood products has become expensive and inaccessible to many. A bottleneck analysis that was carried out by the MoHCC shows that 60 percent of secondary facilities were found to have no blood in their stocks.
Some facilities could not stock blood because of unavailability of fridges, electricity and general poor infrastructure. There is therefore need for the Government to consider other alternatives such as solar refrigerators for storing blood products.
Surveys on human resources and infrastructure have identified huge gaps in terms of human resources and health care technology availability. There is therefore a need to move towards ensuring that agreed normal levels and types of human resources are available and financed at the district level as well as ensure that the minimum healthcare technology is found at the district level.
For example, only 47 percent of facilities in the whole country have TB diagnostic testing equipment while 44 percent of facilities have functional glucometers and strips for diabetes testing and screening.
It is also important to review the staff establishment to reflect the current environment. Zimbabwe is still using a staff establishment of 1983 when the country’s population was 7.5 million but that has since doubled and the disease burden has also increased.
Therefore, there is urgent need to review the staff establishment in order to reduce work overload and burnout health workers.
With the current staffing scenario, the Ministry of Health and Child Care must be exempted from the proposed staff rationalisation which is being spearheaded by the Ministry of Finance and Economic Development to reduce the Government’s unsustainable wage bill.
The health ministry is understaffed and desperately needing to fill in critical staff posts for it to enable to provide basic health care services. For example, 23 percent of all provincial and central hospitals do not have a dentist, most district hospitals do not have four doctors as required in the current establishment system while some are manned by pharmacy technicians instead of degreed pharmacists.
Itai Rusike is the Executive Director of Community Working Group on Health.

September 27, 2016 Features, Opinion & Analysis
Itai Rusike Correspondent
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Health experts warn over SDG targets achievement failure

Health experts warn over SDG targets achievement failure

September 26, 2016

HEALTH experts have warned that Zimbabwe might fail to achieve its health sustainable development goal (SDG) targets as long as funding for the health sector remains below 15% of the national budget.

by VENERANDA LANGA

Itai Rusike, executive director of Community Working Group on Health (CWGH), said there was need to increase the health sector budget next year to deal with the disease burden, access to health facilities by all, address health sector human resource challenges, and deal with the issue of access to medicines by all.
In the 2016 National Budget, Finance minister Patrick Chinamasa allocated only $370,79 million to the Ministry of Health and Child Care, representing 8,3% of the total budget, a far cry from the 15% allocation recommended by the Abuja Declaration on Health.
“Given the current fiscal constraints, government should prioritise and focus on cost-effective health programmes and interventions,” Rusike said.
“Reaching the SDG targets requires a sustained momentum in financing our health care systems, and while progress has been made in improving our health indicators, there is need to sustain the momentum in funding of health care systems.”
Employment costs in the Health ministry were said to be consuming the bulk of its budgetary allocation, leaving little funds for operational costs and capital projects. The result was said to be over-reliance on donors to fund different health programmes such as HIV and Aids, maternal and child health.
“External funding has, somehow, become fungible and has, in most cases, replaced government funding instead of complementing it,” Rusike said.
According to a Unicef 2016 health and child care budget brief, off budget support to the Health ministry by development partners was projected to be approximately $400m, an amount which even exceeded government’s national budget allocation to health.
Most of the donor dependence in the health sector was said to be on medicines.
CWGH expressed disappointment over maladministration at some hospitals, where, in the past, the Auditor-General’s reports indicated expiry of medicines at some health centres, while some hospitals experienced shortages.
“NatPharm should be capacitated so that it can be able to provide regular, affordable and timely supply of essential drugs.”
CWGH also suggested medicinal support should be extended to the elderly and vulnerable groups suffering from chronic illnesses such as diabetes and hypertension as they cannot afford buying medicines that were usually available only at pharmacies.

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Myriad of problems compound Harare Central Hospital’s woes

OPPOSITION parties and health stakeholders have reacted angrily to the deteriorating standards of healthcare in the country, with some calling for a complete overhaul of the entire ministry presiding over the decay.

BY PHYLLIS MBANJE
a-nurse-seen-vaccinating-a-child-to-prevent-rubella-measles

Harare Central Hospital relies on on revenue from paying patients, but 40% of patients constitute the elderly and toddlers who are treated for free

The health crisis in Zimbabwe is deepening and taking on a frightening plunge, with shocking reports that the country’s largest referral hospital, Harare Central, has run out of critical and basic drugs.

So serious is the situation that last weekend, the hospital had to shut down most surgeries except in cases of emergency and those involving maternal cases.

 

But this is not the first time that the hospital, built in 1941 and catering for more than 1 500 deliveries and handling 6 000 causalities per month, has raised the red flag.

The hospital is now struggling to offer quality services. The leaking roofs, peeling floors and cracked walls that become a breeding ground of agents that cause infections, are exposing hundreds of patients to more diseases.

This week, there was outrage over the suspension of surgeries at the hospital, which handles over 60% of all referrals countrywide.

Harare Central Hospital, which is literally falling to pieces with massive leakages from pipes within the walls, is in a dire position.

“This (suspension) is a symptom of a Zanu PF government that is overstretched, unaccountable and overwhelmingly failing the suffering citizens of Zimbabwe,” MDC spokesperson, Kurauone Chihwayi said.

The party further emphasised that the suspension of surgeries at the hospital, due to lack of drugs, is a reflection of the sorry state of public hospitals countrywide and a glaring consequence of the misplaced priorities of government.

“We view this latest disaster as a death sentence to citizens desperately in need of medical attention, who unlike the First Family and Zanu PF chefs, cannot afford the privilege of seeking treatment in Singapore, India, South Africa or private hospitals locally,” Chihwayi said.

MDC accused the government of sustaining “President Robert Mugabe’s merry-go-round trips around the world, which gobble up millions of dollars” while the health sector literally shuts down.

“It is clear that government’s only concern now is Mugabe’s happiness and not the well-being of its suffering millions,” Chihwayi said.

The People’s Democratic Party (PDP) secretary for health and child welfare, Sibongile Mgijima, said the deplorable state of public healthcare in Zimbabwe shows how the government has abandoned its priorities.

“Public healthcare is now in the intensive care unit due to serious shortages of basic medical services and medicine such as aspirin and antibiotics,” she said.

Two years ago, during a tour of the hospital, Harare Hospital’s chief executive officer, Peggy Zvavamwe admitted that the situation was dire, with quotations to repair a single ward requiring over $30 000.

“Our financial situation is dire and if we do not get relief soon, the quality of services will be compromised,” she said.

The hospital’s clinical director, George Vera, who was part of the tour, however, said their precarious situation was compounded by the fact that 40% of their patients were those over 65 years and the under-fives, who do not pay for services rendered.

Since then, nothing much has changed and the situation is now critical.

“We rely mostly on revenue from paying patients, but our situation is that 40% constitute the elderly and the under-five, whom we treat for free,” he said. “The referral system does not exist, we now receive people from everywhere and these are coming to die here.”

Health and Child Care minister David Parirenyatwa recently urged Zimbabwe to swallow its pride, in the face of dwindling resources for the public health delivery system and engage donors, among them the United States, in order to mobilise funds for the sector.

Parirenyatwa said, although the government had reversed the near collapse of public health delivery system, the country had not yet met its set goals and targets.

Community Working Group on Health (CWGH) director, Itai Rusike said, for poor Zimbabweans, public health investments have an impact in reducing household spending through provision of accessible, equitable and affordable disease prevention, health care and consequent reduction in losses of time and costs of consumption due to ill health.

“There is need to progressively move towards meeting the Abuja target of not only allocating 15% of the national budget to health, but actual spending of 15% of all government expenditures,” he said.

In a position paper on budget allocations for the health sector, CWGH said domestic funding remained skewed towards employment costs leaving little funds for operations costs, and capital programmes.

“As a solution, there should be a shift to performance based financing and needs based budgeting system, which will likely result in the narrowing of the gaps between the have and the have-nots,” Rusike said.

Close to 90% of hospitals and clinics in the country are operating without essential medicines in stock, while 80% of the posts for midwives remain vacant in the public sector, and over 3 000 nurses do not have jobs.

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Curse of living with disability

Curse of living with disability

HARARE - Shunned because of the physical deformities they were either born with or acquired later in life, people with disabilities are often forgotten and ridiculed.
Loreen Chikoto was born with dwarfism, a genetic defect that makes her smaller than the average person.
When she started dating, people found it odd and when she got pregnant the comments and taunts were even worse.
“Often, I would hear people saying ‘ndiani akashinga kurara nekamunhu aka, haanzwewo tsitsi here? (who was courageous enough to sleep with such a person, do they not have any mercy for her?). Unbeknown to them is that I am married and was simply doing what most married people do,” she said.
According to Section 22 of the Constitution, the State, all institutions and government agencies must recognise the rights of persons with disabilities and must afford them the respect and dignity they deserve.
Section 83 also mandates the State to ensure that people with disabilities realise their full mental and physical potential through provision of State funded education, access to medical treatment and protection from abuse.
In September 2013, Zimbabwe ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).
Among some of the provisions of the Convention is the right to access justice, freedom from exploitation violence and abuse and protecting the integrity of the person.
Recently, government through the ministries of Social Welfare, Justice, and Women Affairs held consultations to align the Disabled Persons Act to the Constitution.
The exercise was aimed at mainstreaming disability issues as an integral part of the relevant strategies of sustainable development.
During the outreach programmes, some of the persons with disabilities complained that they are judged when seeking medical treatment for sexually transmitted diseases(STIs).
They said they are frowned upon and asked how they contracted the STIs when they visit clinics or hospitals.
Others explained how children with disabilities are deprived of education and often end up dropping out of school.
“Some parents with physically challenged children hide them from society, deprive them of education and infringe on their rights to associate with others,” said one woman.
Senator Anna Shiri told the Daily News on Sunday that there was a serious need for extensive advocacy on the rights and needs of people with disabilities.
She said very few people know how to handle or approach people with disabilities, prompting society to shun or ignore them in key decision areas.
Shiri said issues to do with people with disabilities are no longer a welfare issue but a human rights concern as such people do not require handouts anymore but need to be economically empowered to take care of themselves.
The senator said employment issues are very important as people with disabilities are not seriously considered for employment regardless of their qualifications.
“There is very little awareness on issues concerning people with disabilities. People think they will be a burden when they employ them despite being able to perform the tasks. In Senate, there are only two people representing people living with disabilities while in the Lower House there is none.
“People with disabilities find it very hard to get jobs because of the attitude society has,” she said.
Shiri added that people with disabilities often face the challenge of being wrongly diagnosed because of poor communication between the patient and doctor or nurse.
She said there are no information pamphlets in braille which can be used by the visually impaired or sign language interpretation often leaving these people in the dark on health related matters.
“Many public facilities are not friendly to people living with disabilities. Hospitals, schools and even churches are not accessible to people with disabilities.
“Toilets meant for these people are not one size fits all. Just because it can fit a wheelchair does not mean it was done properly.
“Different disabilities require different adjustments hence the need for specialist architects to build proper structures that can accommodate all.”
“There is need to mainstream disabilities because the Sustainable Development Goals clearly state that no one should be left behind.
“All developmental concerns should include people with disabilities. In 2015, only one disabled person in the whole country benefitted from the revolving loan fund and that is deplorable,” she said.
Shiri said people with disabilities are being abused everyday but their cases are not reported because society does not respect them as human beings.
She said people with disabilities should be self-represented and not have others assume what challenges they face.
The senator, representing people living with disabilities, said only if the UNCRPD is domesticated will the rights of persons with disabilities be upheld and respected.
“The entire legal process is traumatising to a person with a disability. For example, reporting a case can be a task for someone using sign language because a police officer does not understand sign language and when it finally goes to court, interpreters are not readily available,” Shiri said.
She said the National Disability Board members were not part of the government consultation process making it flawed.
Executive director for Community Working Group Itai Rusike said it is unfortunate that people living with disabilities still continue to experience shame, stigma and discrimination.
Rusike said as people living with disabilities constitute 10 percent of the population, the resource allocation to the sector does not reflect their growing need to be fully supported.
He added that people with disabilities are also sexual beings like able bodied people and must have access to information and resources to make informed choices on their sexual and reproductive health.
“The Sexual and Reproductive Health Rights (SRHR) of persons with disabilities are often overlooked by the communities and service providers yet they have the same needs for SRHR services as everyone else.”
“People with disabilities actually have greater needs for SRHR education and care due to their vulnerability to abuse, yet the country has not done enough to popularise and translate policy documents including IEC materials into the relevant materials understood by people living with various forms of disabilities,” he said.
Rusike also said the training curriculum for health personnel needs to have a human rights approach for people living with disabilities and must also include basic training in sign language, braille and provision of disability-friendly facilities in all our health centres.

Helen Kadirire • 18 September 2016