‘Matapi flats should be destroyed’…David Parirenyatwa

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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