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Council must do more to contain typhoid: Experts

Failure by Harare City Council to provide basic water and sanitation services to its residents is fuelling the outbreak of water borne diseases such as typhoid and cholera, health experts have said. Water-borne diseases, the experts said, were primitive in this era. As such, the specialists called for the city to venture into private partnerships with developmental partners in order to resuscitate infrastructure which is failing to cope with the growing population.
The sentiments by the experts come after the death toll from typhoid in Harare has since risen to three from December last year.
The deaths have been recorded in Hatcliffe (1) and Mbare (2), while hundreds have been treated.
Parliamentary Portfolio Committee on health member Dr Paul Chimedza said the prevention and control of water-borne diseases depends entirely on the provision of clean water and best sanitation practices.
Dr Chimedza, who is former Deputy Minister of Health and Child Care, said the conditions in Harare were breeding ground for the bacteria as most areas do not have water.
He said even if medical personnel intervened, the outbreaks would be difficult to control.
Community Working Group on Health executive director Mr Itai Rusike said the solution rests on the city in not only consistently supplying clean water, but must be coupled with regular refuse collection, and ensuring that burst pipes are fixed and replaced.
“Typhoid is a primitive disease, which council should not struggle to contain. In Harare, we are not supposed to have alternative sources of water such as boreholes and unprotected wells, but if the need arises, the city should make sure that all the alternative sources are chlorinated,” he said.
Zimbabwe College of Public Health Physicians Dr Vonai Chimhamhiwa echoed similar sentiments saying: “The city’s water supply is highly susceptible to contamination because of the old pipe system that is still in use, hence any pipes that burst, get contaminated and the risk of transmission is very high.”
Ultramed Health medical Aid Society chief executive officer Dr Sydney Mukonoweshuro called for the revival of the city’s infrastructure and spirited campaigns that will educate residents to follow strict hygiene practices.
“The water-borne disease outbreaks must be understood from the acute migration that happened to Harare. The city that had an infrastructure to handle one million people woke up accommodating millions of people. The authorities have tried their best, but it is a problem that will require huge capital investment to expand and resuscitate infrastructure,” he said.
Harare City Council Health Services director Dr Prosper Chonzi said he was in agreement with the health experts that the permanent solution for the outbreaks will be to address all the environmental issues. He said instead of him battling chronic ailments such as HIV and Aids, tuberculosis and others, he was being left to react to diseases, which could be eliminated through the provision of water and sanitation.
On Hatcliffe, Dr Chonzi said the situation had improved as only three people had presented themselves with similar symptoms of typhoid.

Harare Water director Engineer Hosiah Chisango said council had been facing technical challenges in its bid to improve water supplies.
Harare needs at least 1 200 mega-litres to enable every household to have water everyday.
The city’s water department has been failing to cope with water demand over the years, mainly because the original infrastructure was designed to serve a population of 300 000.
The city’s population has since increased to almost 2,5 million without a corresponding expansion of water infrastructure.

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Outcry over typhoid deaths

Outcry over typhoid deaths

HARARE - Zimbabwean doctors yesterday called on the Zimbabwe Human Rights Commission (ZHRC) to ensure government accounts for every death as a result of archaic diseases amid unprecedented public outrage over typhoid deaths.
Zimbabwe’s government was facing scrutiny from the Zimbabwe Association of Doctors for Human Rights (ZADHR) after noting the continued deplorable state of service delivery in Zimbabwe’s cities, towns and Harare in particular, saying the local authorities’ suburbs have become the epitome of failure to prioritise a safe and clean environment as a key tenet of a strong primary healthcare system.
“...we call upon the ZHRC to institute an investigation into the continued outbreaks of these archaic diseases which are preventable and proffer recommendations to both the councils and the government,” ZADHR secretary Evans Masitara told an interface meeting yesterday with the State-run ZHRC, represented by its chairperson, commissioner Elasto Mugwadi.
“We believe these continued outbreaks are a health rights violation and smack of negligence and incompetency on the part of the duty bearers.”
This comes as two children are reported to have lost their lives with total suspected cases of 604, and the outbreak spreading beyond Mbare — the disease’s epicentre — to adjacent suburbs such as Budiriro and Glen View, where many have been sickened by contaminated water and food.
“Residents are daily subjected to unsafe drinking water, burst sewer pipes and uncollected garbage.
“These conditions are conducive for the outbreak of communicable diseases and not only typhoid,” Masitara said.
Another risk is cholera, a bacterial disease that tends to break out amid intense rains in parts of Harare.
“As we all recall, Zimbabwe was attacked by a cholera outbreak in 2008 which saw deaths and over 99 000 reported cases,” Masitara said.
A cholera outbreak that started in August 2008 killed over 4 000 people and left nearly 100 000 ill. The epidemic was officially declared over in July 2009.
2010/11 also had sporadic outbreaks of typhoid in Harare.
“The conditions that favour the outbreaks are the same and this calls us to ask, have we seen nothing and have we heard nothing?” Masitara said.
Typhoid — a bacterial disease spread through poor food hygiene and contaminated water — occasionally breaks out in Zimbabwe’s poorer townships, where water supplies are still basic more than three decades after independence.
Untreated, the disease can lead to complications in the gut and head which can kill up to one in five patients.
Masitara told the ZHRC that NGOs — under the Civil Society Health Emergency Response Coordinating Committee (CSHERCC) — had called for the setup of a commission of inquiry that looks into curbing preventable diseases.
Community Working Group on Health (CWGH) executive director, Itai Rusike, said that as long as the water crisis in Harare was not addressed, residents will continue to be exposed to diseases such as cholera and typhoid.
“The causes of the 2008 outbreak have not been addressed and the main reason for the typhoid outbreak is the unavailability of water. People are resorting to alternative sources of water which are not safe,” Rusike said.
Combined Harare Residents Association (CHRA) chief executive, Mfundo Mlilo, blamed erratic water supplies and poor waste management for the typhoid outbreak.
“..we are concerned about this and one of our resolutions is to engage State actors so that we find a lasting solution.”
“We believe the ZHRC has a role to play in holding the Harare City Council as well as other local authorities to account,” Mlilo said.

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Tragedy feared as senior doctors join strike

Tragedy feared as senior doctors join strike

SENIOR doctors and specialists yesterday joined striking junior doctors, further paralysing services at government hospitals mostly in Harare and Bulawayo.

Public hospitals’ outpatients departments were a sorry sight, as patients were left stranded following the industrial action by doctors.
The situation at the country’s major referral hospitals in Harare and Bulawayo has taken a frightening turn, with obstetrician and gynaecologist registrars also downing tools.
This potentially puts the lives of expecting mothers, especially those requiring surgery, and their unborn babies at risk.
In a statement, the registrars, who are specialist trainees in obstetrics and gynaecology, said they no longer felt it was safe for the patients if they continued in the absence of senior resident medical officers.
“We tried to continue working, but the demands are so exhausting, such that we fear we may end up making fatal errors resulting in unwanted maternal and perinatal morbidity and mortality,” the registrars said.
A2 paediatrics casualty at Parirenyatwa Hospital, which deals with children, was also shut down.
In a notice, one I Ticklay, the acting head of department paediatrics, to Noah Madziva, the clinical director, said the section had been closed in “line with contingency plans”.
“All paediatric patients will be seen and managed in main causality,” the circular read.
A tour of Parirenyatwa Hospital by the NewsDay Weekender crew yesterday revealed the shocking situation, which is most likely going to cost some lives.
Hospital emergency rooms were staffed largely by nurses and interns and waiting rooms packed with patients, many on stretchers.
Hordes of patients sat in the outpatients department in long, winding queues. The serious ones lay on stretchers, with no one to attend to them except for their relatives, who were frantically trying to get them help.
With dejected faces, the patients sat on the wooden benches unsure of when they would get to see a doctor.
“We have been here since 10 in the morning, but it is almost 2pm and we have not been attended to,” one sickly looking man, who was coughing badly, said.
A young man in his early 20s and on a stretcher, struggled to sit up maybe to get some attention, but no one came.
The pain on his face was quite evident and his swollen feet stretched out before him looked horrendous.
“We hear they are on strike or go-slow. We are not sure. All we know is there is no doctor to help us and many of us will go home unattended,” a distraught woman who was struggling to breathe, said.
The stuffy room was filled to capacity as both patients and concerned relatives milled around waiting for absolution that never came.
The situation remained dire, as many patients failed to be attended to, as most hospitals were operating with skeleton staff.
Striking doctors are deadlocked with the government over long-standing grievances which include an announcement by government that it would no longer employ them upon completion of their two-year internship, a situation that would render them jobless.
The doctors are also pressing for the government to raise their on-call allowances and want it to provide them with a duty-free motor vehicle import scheme, among other issues.
The Health ministry frantically tried to avert the disaster by offering to create 250 new posts, but the doctors scoffed at the offer, which has no time frame.
On Wednesday, as a last-ditch attempt the Health ministry sent out a desperate plea to the doctors urging them to return to work.
Hospital officials also tried to rattle the doctors into coming to work by circulating a threatening statement.
However, the doctors would have none of it and carried on with the strike.
“We have noted with utter disappointment the new tactics by various clinical directors at central hospitals, that instead of engaging doctors and try to find solutions to our current demands, they have reverted to threats and victimisation,” Edgar Munatsi, Zimbabwe Hospital Doctors’ Association president said.
Meanwhile, health stakeholders have rallied behind the doctors urging the ministry to urgently address their concerns.
The Community Working Group on Health (CWGH) said the current situation could result in prolonged human suffering and avoidable deaths.
“As CWGH, we strongly believe that the current labour dispute could have been resolved amicably if the government had honoured the promises it made to the medical practitioners last year,” Itai Rusike, CWGH’s director, said.
“It is surprising that the ministry of Health Child Care has now offered to open up 250 new posts, for junior doctors and 2 000 for nurses when it has not fulfilled last year’s promises to the same doctors.”
Meanwhile, the doctors have vowed to press on with the strike until all their concerns have been dealt with in their entirety.”

BY PHYLLIS MBANJE February 18, 2017
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Health levy introduction welcome

Charity Ruzvidzo —
The move by Minister of Finance and Economic Development Patrick Chinamasa to introduce a health levy will go a long way in improving the country’s health sector, experts say.
The health sector, which is largely dependent on donor funding, is set to benefit immensely from this domestic funding initiative. Presenting the 2017 National budget, Minister Chinamasa said it was critical that all economically active individuals contribute towards funding health services.
“It is, thus, proposed to introduce a health fund levy of 5 cents for every dollar of airtime and mobile data, under the theme, ‘Talk-Surf and Save a Life,’” said Chinamasa.
He said this will take effect from January 1, 2017. The Minister of Health and Child Care Dr David Parirenyatwa said the levy would equip the health sector with necessary resources to ease access of services for the public.
“The levy will benefit our health sector. It will be used to purchase drugs and medicine. This will assist in increasing the accessibility drugs of in our hospitals,” he said.
Dr Parirenyatwa said Minister Chinamasa was yet to prescribe how the funds are to be managed.
“The money is going to be ring fenced for health facilities only. This means it will be used to improve our health sector. It is not going to be diverted elsewhere. We are yet to hear from the Minister how the funds will be managed and distributed,” he said.
The minister said the health levy did not entail free medication for all Zimbabweans.
“Groups of people that are supposed to get free medication will still get free medication. The health levy will enable easy access of drugs and purchase of equipment in our health sector. Those that can afford to pay for medication must pay,” he said.
The health fund levy, he further said, was the correct way to go in terms of ensuring an improvement in the health sector.
Community Working Group on Health (CWGH) executive director Itai Rusike also welcomed the introduction of the levy.
“The health levy is a welcome innovative domestic health financing strategy for our public health delivery services,” he said.
“The Government must be applauded for introducing the 5 percent tax on airtime and mobile data to finance the purchase of drugs and equipment.”
The health lobby activist said this was the only way Government could ensure sustainability of current programmes in the event that external partners pull out or reduce their funding commitments to Zimbabwe.
He said the current situation where external partners fund more than 90 percent of the country’s drug requirements was unsustainable.
Rusike urged the Government to ensure transparency in the use of funds collected under the health levy.
“A strong management and accountability of funds is needed so that they are strictly used for the intended purpose. The success of the fund will also see a strong advocacy for other options for domestic funding of the health ministry to be explored further,” he said.
The health lobbyist said more strategies to raise funds needed to be explored to improve the health sector.
“There must be a further increase on cigarettes and alcohol duties or taxes,” he said.
“Adding a new earmarked tax on products with high sugar content, genetically modified foods, earmarking a certain percentage for third party insurance to fund hospital emergencies will also assist.”
Extending tax concessions for private sector contributions to the health system, Rusike said, would also help including making tax concessions to medical aid societies that have invested in areas outside their core business.
Health and Child Care Parliamentary Portfolio committee chairperson Dr Ruth Labode said the introduction of the health levy would assist in curbing the brain drain in the health sector.
“I personally advocated for the implementation of the health levy. It will help our crippled health sector. You find that we have doctors moving to other countries due to working conditions that are not conducive. The health levy will enable us to stop this,” she said.
The legislator said the health levy was likely to raise an estimated $80 million per year.
“We estimate that $80 million will be raised per year from the health levy, that is depending on how many people buy airtime.
“This should surely bring change and development to our health sector,” she said.
Dr Labode urged the Ministry of Health and Child Care to create an autonomous body to handle the funds under the health levy.
This, she said, would ensure the levy was used for its intended purposes. Zimbabwe Association of Doctors for Human Rights (ZADHR) board member Dr Evans Masitara said they supported any move to improve the ailing health sector.
“We appreciate Government’s initiative to introduce a health levy. However, the Minister of Finance should have increased the 2017 budget allocation for the health sector,” he said.
Dr Masitara reiterated the need for transparency if the health levy was to be a success in boosting the health sector.
“The Ministry of Health must put in place mechanisms that ensure funds are not abused. A panel must be set up to monitor the use of the funds. We need to see improvement, the health sector must change for the better,” he said.
Most people cannot afford to purchase drugs due to the financial constraints. In more developed countries like the United States, the health levy has contributed to healthcare access.
This goes towards assisting the poor and vulnerable groups who cannot afford to pay for health care facilities. — Zimpapers Syndication.

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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.