HEALTH experts have expressed concern over the resurgence in cholera cases, which they blame on poor sanitation and a lack of long-term planning for water supplies in urban areas.
Community Working Group on Health (CWGH) executive director Itai Rusike said cholera will continue to wreak havoc until there is a long-term plan on water sanitation and hygiene intervention.
“Prolonged water cuts in most urban areas are leading to use of unsafe alternatives such as unprotected shallow wells and faecal matter-contaminated boreholes. Local government earmarks revenue for waste collection, this should not be reallocated to other spending. Residents should be brought into monitoring waste dumping. Residents and businesses can provide initial support with clean-up campaigns but routine waste collection, water treatment services and more reliable provisioning need to be improved as a public health priority,” Rusike said.
“The mainstay of prevention of cholera is the provision of safe water, adequate sanitation, good personal hygiene, case management, surveillance and community mobilisation. Cholera vaccination may be used to complement primary measures,” he said.
Cholera, a diarrheal infectious disease continues to cause high morbidity and mortality in Zimbabwe.
Without treatment, death can occur within hours.
Health policy specialist Tinashe Mundawarara said more investment is needed to deal with cholera.
“Investments are needed to detect, prevent, control and monitor cholera. This is further compounded by the fact that cholera is now a protracted epidemic in this country. I am not sure if government has a cost-effective strategy for border screening given that it is resource intensive,” he said.
The country is currently experiencing a new wave of cholera infections, which emanated from Chegutu and has spread across the country, bringing to 17 new cholera hotspots.
Previously, there were only four hotspots.
The new cholera hotspots are Buhera, Chegutu, Chikomba, Chimanimani, Chipinge, Chitungwiza, Chiredzi, Harare, Gokwe North, Marondera, Mazowe, Shamva, Mutare, Murehwa, Mwenezi, Seke and Wedza.
Health expert Josephat Chiripanyanga said: “We encourage people to follow guidelines for cholera prevention so as to ensure that we limit the occurrence of cholera as much as possible. There is a need to practise proper waste (human included) disposal especially in the rural areas to reduce or prevent it from spreading. We all know the adverse effects of cholera and the country has had two serious outbreaks with devastating outcomes. It will be equally bad if we lag behind on prevention.”
As of Thursday last week, there were a cumulative 382 suspected cholera cases, two laboratory-confirmed deaths, five suspected cholera deaths and 71 laboratory-confirmed cases reported.
Health experts have warned that if no action is taken, the cholera outbreak could lead to more fatalities.
ZIMBABWE is experiencing a rise in non-communicable diseases with hypertension now top of the list.
The country joins the rest of the world in commemorating World Health Day.
It will be held under the theme ‘‘Health for All’’.
The theme resonates well with the growing global call for Universal Health Coverage (UHC), which seeks to ensure that people have access to the healthcare they need, without suffering financial hardships.
The Community Working Group on Health (CWGH) has called on the Government to ensure that health services are available, accessible and affordable to every citizen of Zimbabwe.
In a statement, CWGH executive director, Itai Rusike, said the country was experiencing a rise in non-communicable diseases (NCDs).
“Rapid, unplanned, unregulated urbanisation and changes in lifestyles as people migrate from rural to urban areas are causing an increase in the risk factors that cause NCDs and conditions such as injuries, disabilities and substance abuse.
“The prevalence of hypertension is estimated at about 30 percent of the total population, which is higher than HIV, tuberculosis and diabetes.
“Addressing the burden of non-communicable diseases constitutes an integral part of achieving good health and well-being.”
Rusike said targets had been set to reduce premature mortality from non-communicable diseases through prevention and treatment by one-third by 2030.
“The country also suffers a high burden of cancer with the cervical cancer burden being within the top five in the world. “Treatment costs for all cancers remain very high, inconsistent and unaffordable for most people.”
health experts have urged government to ensure citizens have access to clean potable water to stop the spread of waterborne diseases such as cholera.
The country has witnessed a number of cholera cases with suspected cases in 10 provinces numbering 267, while 209 recoveries and two deaths were recorded. Cabinet on Tuesday approved a budget of US$24 168 353 for cholera preparedness and response plan.
Community Working Group on Health executive director Itai Rusike said to effectively deal with cholera, government should deal with fundamental public health issues like access to water.
“The current cholera outbreak is occurring in the context of frequent water and power cuts, and a breakdown of rubbish collection. Advice to boil water is difficult to follow during water and power cuts. The situation on the ground indicates that while water and sanitation infrastructure exists, these are old and malfunctioning and tariff structures are needed to protect poor households’ access,” Rusike said.
He said unsafe environments continued to be a health threat, particularly for poor households and should be more focused on high-density suburbs and rural areas, where significant gaps remain in terms of access to safe water and sanitation.
Medical and Dental Private Practitioners Association of Zimbabwe president Johannes Marisa said while government’s US$24 million pledge towards fighting cholera was welcome, water and sanitation issues should be prioritised.
“It’s needless to fight symptoms when the predisposing factors are dominant, water and sanitation should be robust and up to standard if we are going to contain cholera. Monitoring and surveillance is also important, as well as education on cholera and its symptoms.”
The persisting and recurrent outbreaks of cholera gives a poor reflection of the health and development status of the country.
Water and sanitation are essential for good health outcomes and sustainable development.
Inadequate access to water and sanitation infrastructure is a major source of health challenges and disease outbreaks such as cholera.
Poor and Inadequate water and sanitation is a leading cause of poverty, morbidity and mortality in a number of countries, while providing water and sanitation in schools is key to keeping girls and children in school.
The reduced availability of safe drinking water impacts negatively particularly on girls as they are forced to walk long distances to fetch water in some cases from unprotected sources often affecting their ability to go to school.
A cholera outbreak in late 2008 reflected this decline in living conditions and affected around 100,000 people.
Interruption of water supplies, overcrowding of sanitation facilities and difficulties with urban waterborne sanitation during periods of water cuts means that urban households are very vulnerable to unhealthy environments.
Urban Local Authorities are currently facing a range of problems that are limiting the daily supply of water such as the shortages of water chemicals as household rates are currently being charged in local currency whilst payment of water chemicals to suppliers is done in US Dollars.
The aging and unrepaired sewer systems; waste put in sewers due to poor waste collection; illegal waste dumps; overflowing septic tanks; and frequent water and power cuts.
Most sewerage reticulation systems and treatment works are in a state of disrepair, raising the risk of diarrhoeal diseases including cholera.
I hope this will assist
Itai Rusike, Executive Director, Community Working Group on Health (CWGH)
ZIMBABWE recorded 31 new suspected cholera cases on Wednesday, bringing the total to 98, with health experts, calling on local authorities to improve access to water and sanitation to avert a national disaster.
In a daily situation report on Wednesday, the Health and Child Care ministry said there was one casualty, while three of the suspected cases tested positive to the diarrhoeal disease on the day.
“The 31 new suspected cholera cases and 3 laboratory confirmed cases were reported today (Wednmesday). These were reported from Centenary (15), Beitbridge (11), Chegutu (4) and Chivi (1),” the ministry said.
“Fourteen of the suspected cases and one suspected death brought in dead (BID) were Mozambican nationals from Kadunje Village who sought treatment at Chiwenga Clinic, Centenary district, Mashonaland Central province, bordering Mozambique.”
The first two cholera case were recorded in Chegutu last month.
“As of 15 March 2023, one case is hospitalised at Chivi District Hospital Cholera Treatment Unit (CTU), Masvingo province. Zimbabwe has 98 suspected cholera cases, eight confirmed cases, 97 recoveries and one death,” the ministry said.
The country’s worst cholera outbreak occurred in 2008, which left more than 4 000 dead and another 40 000 infected.
Community Working Group on Health executive director Itai Rusike said recurrent cholera outbreaks exposed lack of maintenance of the country’s water and sewer reticulation infrastructure.
“Inadequate access to water and sanitation infrastructure is a major source of health challenges and disease outbreaks such as cholera,” Rusike said.
“The aging and unrepaired sewer systems, waste put in sewers due to poor waste collection, illegal waste dumps, overflowing septic tanks and frequent water and power cuts are also causative factors. Most sewerage reticulation systems and treatment works are in a state of disrepair, raising the risk of diarrhoeal diseases including cholera.”
Tinashe Mundawarara, a health policy specialist said Zimbabwe needs to improve its access to water and sanitation.
“From a policy perspective, our health system will always be judged on its responsiveness, that is, will the Ministry of Health be able to stop the spread and at the same time ensure adequate health care provision for those with immediate need? The next few days will be critical on these two issues and funding will be an urgent need,” Mundawarara said.
ZIMBABWEAN men are dying more than women, latest statistics from the Zimbabwe National Statistics Agency (ZimStat) have revealed.
The report, based on the 2022 population and housing census, shows that 120 070 deaths were recorded during the census with 53,6% of the dead being men and 46,4% being women.
Last year, ZimStat preliminary national census results revealed that females constitute the majority of the population, numbering 7 889 421 or 52%, compared to the male population of 7 289 588 (48%).
This was also followed by another set of results showing that life expectancy for females now stands at 68 years compared to male life expectancy which is 61,2 years.
“A total of 120 070 deaths were recorded during the census. Male deaths constituted 53,6% of the total deaths recorded during the census. Throughout all age groups, males had higher mortality rates compared to females,” the report read.
Community Working Group on Health executive director Itai Rusike said health-seeking behaviour among men is poor compared to women.
Rusike said clients at health centres are often women and children less than five years.
“There is a particular focus in primary healthcare on women and children due to their vulnerability and the fact that their ill-health affects the wider community. Apart from the general inputs that all people need for health, women also need services to support safe reproductive health, prevention of mother-to-child transmission of infections such as HIV, child delivery and care, including nutrition during pregnancy,” Rusike said.
“The spread of health information, improvement of nutrition, safe living and community environments are key to disease prevention amongst men. Prevention and management of common diseases also depends on early detection and treatment. We are also aware that unhealthy lifestyles such as smoking cigarettes and alcohol abuse are a lot more prevalent in men compared to women.”
Zimbabwe Association of Doctors for Human Rights secretary Norman Matara said quantitative research is needed to establish why more men were dying than women.
Matara said women practice self-care while men are reckless.
“This is why most men died during the census period compared to women.”
Zimstats data also showed that 78 384 deaths constituting 64,7% were registered while unregistered deaths constituted 30,3% and 5,0% had an unknown status.
THE country’s health sector has been plunged into dire straits as poor remuneration and working conditions drives qualified health professionals into the diaspora where they are being employed as simple nurse aides, health experts have said.
The country has over the years recorded a mass exodus of skilled workers, who have opted for menial foreign jobs owing to poor remuneration back home.
Currently, the country has lost at least 3 000 nurses to the UK alone in the past two years.
Salary negotiations have yielded little and have resulted in perennial job action and deadlocks.
Community Working Group on Health executive director Itai Rusike told NewsDay that skilled health professionals are opting to do care work outside the country simply because government is failing to pay health workers decent wages.
“One of the major challenges facing Zimbabwe’s public health care system is brain drain. Doctors, nurses and pharmacists have left and continue to leave the country to destinations like the United Kingdom, Australia and New Zealand. In fact, Zimbabwean health professionals are now found in nearly all countries, including non-traditional destinations such as Dubai,” Rusike said.
“It is very unfortunate that senior, highly-qualified and experienced health professionals are now opting to do a Red-Cross short course on care work so that they can quickly get the work visa permit for the UK and leave the country with their spouses and children with very little chances of coming back any time soon.
“The country has failed to stabilise the brain drain for a number of decades, and recently some clinics in the capital city have closed for lack of staff. Health care workers continue to be trained but fail to fill in the posts established in the 1980s, let alone the posts and establishment required to deal with the current population, disease epidemiology and health and development targets.”
Public Service International sub-regional secretary for Southern Africa Tichaona Fambisa said: “This is a serious problem because what this means is that poor countries like Zimbabwe are subsidising the health systems of developed countries. Health professionals are trained in the country and after that they leave to serve other countries. Government should make sure that they invest more in public service so that public sector workers and health workers can earn decent salaries and fail to find reasons to migrate.”
Efforts to get a comment from Public Service, Labour and Social Welfare minister Paul Mavima were fruitless. But speaking to NewsDay last week; Mavima said government was in the process of increasing salaries for health workers to slow down the exodus.
THE year 2022 was eventful in the health sector, where outbreaks of diseases considered medieval such as measles and polio overtook the two-year global pandemic, COVID-19, in terms of deaths in a short space of time.
The country also witnessed a reduction in maternal deaths, and introduction of the eye strategy in the wake of increased eye conditions, mainly catalysed by diabetes.
Below are some highlights of the health sector in 2022.
COVID-19
The year 2022 started off on a positive note as COVID-19 cases had dropped compared to the same period the previous year, where fatalities of the dreaded pandemic increased in the blink of an eye, with many deaths recorded from the onset of the pandemic.
As such, the year was quite stable regarding COVID-19 with cases fluctuating, but with decreased deaths.
Government, as of Wednesday June 22, 2022 scrapped the night curfew. Opening hours for shops, bars and restaurants were extended.
Masks were also scrapped during the course of the year for fully vaccinated individuals in outdoor settings. However, for indoors, they remained mandatory.
The lifting of the curfew and wearing of masks was for the first time since the onset of the pandemic in 2020, although the curfew had many variations depending on the magnitude of crisis over the two-year period.
However, towards year-end in December, cases of COVID-19 began to soar in the country.
During the final post-Cabinet briefing for 2022, Information, Publicity and Broadcasting Services minister Monica Mutsvangwa said over 200 new cases and six COVID-19-related deaths were recorded in the country in the previous week.
Government said it was on high alert and would increase testing and screening at ports of entry after reports that China had been hit again by a COVID-19 outbreak.
Measles
Four months into 2022, another health crisis emerged, this time originating from Mutasa district in Manicaland province, an area largely dominated by apostolic sect members.
Measles, a medieval disease whose return on April 10, 2022, raised questions over the country’s health security, was at the centre of the crisis.
The disease, that was considered long forgotten, re-emerged in the country, with a rapid and fatal spread.
It overtook COVID-19 in terms of fatalities, which were way above in comparison with the period of inception.
By September 2022, more than 750 children had died of measles, prompting authorities to hastily put a plan in action, which entailed introducing a measles vaccination programme that began in September.
This was after more than 2 000 people, including adults, had been affected by measles as of August 17, 2022.
By August, measles had claimed the lives of 157 children, all of them were not immunised against the disease.
During the immunisation programme, government mainly targeted apostolic sects, especially in the Mutasa area, where they dominate, encouraging them to warm up to vaccination, which they eventually did.
In October 2022, according to Manicaland provincial medical director Munyaradzi Mukuzunga, the province recorded zero measles cases.
There was a generally low incidence of measles for the same period countrywide.
Polio
In October, the country launched a polio vaccination campaign to guard against the disease that had been detected in neighbouring Mozambique, although no case has been reported locally to date.
A follow-up vaccination exercise was done from December 1 to 4 this year as the country sought to intensify immunity from the disease.
Diabetes
Cases of diabetes were on the rise during 2022, mainly Type 2.
Health and Child Care deputy minister John Mangwiro said: “General statistics show an increase because there is massive rural-to-urban migration. Westernisation of diets is also contributing to the increase. There is need to have a lot of awareness and campaigns and more stories about diabetes. There is need to encourage people to get tested and know how to deal with the condition.”
HIV and Aids
For 2022, the major highlight was the country winning the bid to host the International Conference on Aids and STIs in Africa to be held in December next year.
After winning the bid, National Aids Council chief executive officer Bernard Madzima said: “Winning the bid was a big step in the positive direction as we have been recognised in Africa as a leader in terms of the HIV programme. Our country also recorded successes as per the global HIV report, which says we achieved the 2025 targets of 95-95-95 midway through the projected time. We are very proud of that as a country. We are also happy that we managed to curtail and to incorporate issues of COVID-19 in HIV programming, thereby averting the anticipated increase in deaths due to the comorbidity of HIV with COVID-19.”
The other good thing that happened in 2022 was the Global Fund replenishment.
President Emmerson Mnangagwa pledged US$1 million funding for the Global Fund 2024-26.
“We have contributed to the Global Fund as a country and we are proud of that,” Mnangagwa said.
Overview of the health sector
Health expert Josephat Chiripanyanga said: “In 2022, our health delivery system generally improved. We look back to 2020 and 2021 and see the challenges that we had from the devastating COVID-19 pandemic. It was difficult for us to achieve some of the goals that we had in terms of achieving the Sustainable Development Goals for 2030 because most of the resources were being channelled towards COVID-19.”
He said with COVID-19 milestones having been achieved, there was now need to look after the elderly and chronic patients.
“Treatment has improved significantly and access to health facilities has improved. Generally, the health of our people has improved. In 2021, we had a significant number of neonatal and under five deaths which got to about 5 000 for the whole year, which was very high. We hope this year the figures will be lower than that because there has been an increase in access to health.”
Community Working Group on Health executive director Itai Rusike said: “Zimbabwe is currently grappling with a massive health worker exodus due to low remuneration and poor working conditions in the hospitals, among other health system challenges.
“The once well performing and envied health system is visibly failing to serve the needs of the citizens, as evidenced by closure of clinics and significant reduction in services offered at hospitals across the levels.
“Some central hospitals’ statistics now resemble district or lower-level facilities at a time when the need for health services has increased due to huge disease burden and population increase.”
Rusike said Zimbabwe’s health sector continued to be in the doldrums due to a plethora of challenges.
“The country’s health financing has consistently been well below the 15% proportionate funding from the fiscus since the Abuja Declaration of 2001. Regular power outages at health institutions have added to the disruptions in the few available health services, while at ports of entry there is scanty information available on public spaces about the disease profiles in the districts, provinces and the nation at large,” he said.
“There are continuous health worker strikes that impede access to health as people are not attended to when they seek health services at healthcare centres during strikes. Add to that, the institutions do not have adequate medicines due to inadequate supplies and pilferages as the poorly paid healthcare workers try to make a living within the workspace.
“The weakened and overburdened health system has benefited from the government wide response to COVID-19, but its frailty amidst the huge global challenge after COVID-19 emerged has proved a tough test to nation’s health security agenda.”
MATERNAL and neonatal mortality remains a health concern in Zimbabwe, Community Working Group on Health (CWGH) has said.
CWGH director Itai Rusike told NewsDay Weekender that the country remains off target towards meeting the 2030 United Nations (UN) goals to reduce maternal and neonatal mortality.
“Despite the high coverage of births by a skilled attendant and institutions delivery, maternal mortality remains high at 462/100 000 live births,” Rusike said.
“In addition, the high HIV rates among pregnant women at 14,3% increases the risk of mother-to-child transmission of HIV. Furthermore, neonatal mortality has remained stagnant for the past decade at 321/1 000 live births and under five mortality remains high at 65/1 000 live births.
“Likewise, besides being a priority, preventing the death of newborn babies remains a challenge and the country is off track to meet the Sustainable Development Goal (SDG) target by 2030, that every country should have a neonatal mortality rate of 12 or fewer deaths per 1 000 live births.”
Maternal mortality in Zimbabwe is 363 per 100 000 live births, according to the preliminary results of the 2022 housing and population census.
According to Rusike, while this is an improvement from the 614/100 000 live births for maternal deaths recorded in 2014, the slow rate of improvement indicates that Zimbabwe is unlikely to meet the SDG target for reducing maternal mortality.
Complications during pregnancy and childbirth are leading causes of death and disability among women of reproductive age.
“Most of these deaths are caused by a handful of conditions, from which death is largely preventable. Almost 95 % of our maternal and perinatal death cases are deemed to be avoidable,” Rusike said.
“This speaks to the issue of the quality of care at the point of care in our hospitals. This also highlights the importance of investigating the state of healthcare institutions with the view to devise probable interventions to improve quality of care.”
