Community Working Group on Health

GOVERNMENT and local authorities have been urged to ensure provision of basic water and sanitation infrastructure in order to effectively deal with the cholera and typhoid outbreaks, the former which has claimed the lives of 30 people countrywide and affected over 5 000.
BY VENERANDA LANGA
The Community Working Group on Health (CWGH) yesterday reproached government and local authorities over continuously playing the blame game, saying they must concentrate on restoring infrastructure and social services to save lives.
“The cholera outbreak highlights the failure of government to maintain basic public health standards,” Itai Rusike, the CWGH executive director said.
Rusike said the main problem was that in most urban residents go for months without tap water, forcing them to dig shallow and unprotected wells and boreholes that can be contaminated by raw sewage flowing from burst pipes.
“Cities, once the epitome of good hygiene, have now been turned into big communal villages. Practically and in the short-term, people need clean water – they need adequate aqua tablets, they need boreholes; they need water bowsers as a matter of urgency,” he said.
Rusike said local authorities were in charge of all water delivery, sewerage and refuse collection and were the recipients of all rates paid by residents that expected proper service delivery, yet there were reports that they were diverting money paid by residents to buy luxury cars and giving each other loans.
He said Zimbabwe needs consistent supply of clean water in urban areas if the country is to end the burden of waterborne diseases.
Most of Zimbabwe’s water and sewer pipes are archaic as they were constructed during the colonial era and have not been refurbished for the past 38 years.
ZimRights in a statement also said cholera and typhoid were hygiene-related ailments fuelled by poor water reticulation systems in Harare, apart from lapses in personal hygiene.

HEALTH stakeholders are deeply agitated by the lukewarm approach being shown by both the government and local authorities in addressing the typhoid outbreak that has so far officially claimed nine lives in Gweru and Masvingo.
BY PHYLLIS MBANJE

The outbreak has, however, spread to other parts of the country, with new cases being reported in Kadoma.
“There is need for a serious public campaign for local authorities to deliver safe water. Our water sources are contaminated. What are we doing about it?” Fungisayi Dube from the Citizens Health Watch (CHW) asked.
She said the new local authorities had a mandate to step up and eradicate typhoid and to be open about the situation with the water system so that necessary measures can be taken.
“The water should be tested. We need a proper report on the quality of water,” Dube said.
Community Working Group on Health (CWGH) director Itai Rusike (pictured) said it was disturbing that the outbreak of water-borne diseases such as typhoid and cholera was no longer a new phenomenon in Zimbabwe.
“It is even more disturbing when the authorities take over a month to officially acknowledge the problem, and let alone try to address it,” Rusike said.
Masvingo has been facing serious water challenges, a situation which is conducive for the outbreak of waterborne diseases like typhoid.
Some parts of Kadoma have gone for more than 20 years without running water and in June, the local authority said they needed about $4 million to address the challenge.
“This care-free approach to human life should not and cannot be tolerated and it is a clear indication of the levels of disdain the government has on the ordinary poor Zimbabweans. The Community Working Group on Health is deeply depressed by the lackadaisical approach being shown by both,” Rusike said.
He said the Health ministry, despite being the custodian of the Public Health Act, continued to act as if the situation was normal even in the wake of nine deaths.
“As CWGH, we urge the Health ministry, Gweru City Council and other stakeholders to quickly find common ground and tackle this health crisis,” he said.
The stakeholders have, however, welcomed the signing into law of the revised Public Health Act by President Emmerson Mnangagwa to replace the old and outdated 1924 Public Health Act.
“Local authorities and companies in the country were taking advantage of the gaps and weaknesses of the colonial enacted Act to continue polluting water bodies because it is cheaper to pollute and pay than dispose raw sewer and industrial waste appropriately,” Rusike said.

Paidamoyo Chipunza Senior Health Reporter
In recent months, Zimbabwe has experienced a shortage of one of the most critical drugs for the management of tuberculosis (TB) in its first two months of diagnosis. This tablet, a combination of rifampicin, isoniazid, pyrazinamide and ethambutol tablets, also known as FDC-RHZE is imported, costs of which are wholly supported by a development partner.
Oxytocin is another tablet whose availability is also supported by development partners working with Government in reducing pregnancy related deaths.
It is used to control bleeding after birth, among other uses. Of late, this drug has also been in short supply.
These two medicines are typical examples of supply of critical drugs in the public health sector, where sole responsibility to provide some essential services has been assumed by donors, posing not only repercussions on patients’ road to recovery, but also a serious security threat to the country.
“My sister was diagnosed of TB a month ago at Mufakose Clinic in Harare. I’ve been going with her to collect her drugs weekly until recently when we were told that the drugs were out of stock.
“We went to Kambuzuma, Glen View and Budiriro clinics and the story was the same. We also went as far as Domboshava, but still didn’t get anything,” said Pretty Mandaza from Mufakose who is taking care of her sister.
She said last Saturday they went back to Makumbe Hospital, where they were only given a week’s supply.
“If one skips treatment for three consecutive days, they have to restart the whole two months course for it to be effective. My sister skipped her medication for more than three days now, meaning she is supposed to restart the treatment again.
“We have however, resolved not to give her this one week’s supply until we get enough medication because if her course is further interrupted, she will need to restart again,” further explained Ms Mandaza.
She said her sister’s condition had also deteriorated in the past weeks and they were now afraid that the TB bacteria could easily be passed on to other family members since she is no longer on treatment.
Ms Mandaza said they also feared that her sister would develop the drug resistant strain of TB which is difficult, expensive and takes longer to treat.
Without medical intervention TB is highly contagious and interrupted uptake of medication increase one’s chances of developing resistance to medication.
Deputy director of the Aids and Tuberculosis Unit in the Ministry of Health and Child Care, Dr Charles Sandi said the country needed at least $1,5 million for medicines to respond to drug sensitive TB and an additional $1 million for drug resistant TB.
Sadly, these medicines are currently funded by donors.
“We continue advocating for allocation of resources towards TB programming from our local resources so that donors come in only to complement our efforts not the other way round,” said Dr Sandi.
He said the challenge with relying on donors was that they procure from pharmaceuticals who meet certain standards, which are guaranteed by World Health Organisation accreditation.
“While we have no problems with the insistence on good quality medicines, the implication of this practice is that when the accredited pharmaceuticals have issues with their suppliers,which might impact on production processes, it also affects the whole supply chain resulting in shortages of the medicines such as those that we were experiencing in the past weeks,” said Dr Sandi.
In response to the current shortages, Government has availed US$500 000 from the Health Levy as a mitigatory measure to procure the much needed TB drugs.
Acting Natpharm managing director Mr Newman Madzikwa also confirmed that oxytocin, which was reported to be in short supply countrywide, was also funded by development partners.
Although Mr Madzikwa said the national drug stocks were improving following the introduction of the Health Levy, he said of late foreign currency shortages remain an impediment to procurements.
Mr Madzikwa said Natpharm had not been getting any allocations in the last two months.
“Since the beginning of the year, we have received about $5,5 million and the last allocation was sometime between May and June.
Mr Madzikwa further explained delays experienced in availing medicines after a tender has been awarded saying pharmaceuticals only produce an order once it has been paid for.
He said in that respect, medicines that are beginning to trickle in the country now were actually procured around June.
He said in light of these challenges, Natpharm was now working on utilising the letter of credit facility from the bank to guarantee payment to suppliers, but the facility is also issued based on availability of foreign currency.
However, Community Working Group on Health executive director Mr Itai Rusike said Government should invest domestic resources into local pharmaceuticals.
“With the coming in of the Health Levy, it is also high time Government begins investing in local pharmaceutical companies not only to ensure availability of drugs at reasonable costs but also to boost their potential.
“While donors give us money, they also expect us to buy from their industries, a situation that further contributes to underdevelopment of not only our country, but Africa as a whole,” said Mr Rusike.
He said currently most WHO accredited pharmaceuticals are from India, China, USA and Europe, yet great need of these pharmaceutical products was in Africa.
Mr Rusike further said reliance on funding partners was also a security threat to the country.
“Imagine if these donors are to pull out completely maybe because of differences in political ideologies where would that leave us as a country. Will the country not be held at ransom using these donations,” said Mr Rusike.
HIV activist Ms Martha Tholanah said by failing to prioritise such critical medications in national budgets, Government was doing a de-service to its citizens.
“Our Government has sold citizens out by placing their health and lives in the hands of donors. Why is there no allocation specifically for essential medicines in the national budget? Why is the Reserve Bank of Zimbabwe not fulfilling its promise by releasing the amount of foreign currency that is needed,” she said.
Pan African Treatment Access Movement (PATAM) director, Mr Tapiwanashe Kujinga also expressed concern over continued shortages of critical medicines outlying its implications on efforts to curb drug resistance illnesses.
Mr Kujinga said some of these drug resistant strains, like TB had high mortality rates, hence should be avoided from the beginning.
He said while Zimbabwe has made great strides in coming up with alternative sources of domestic financing through the Health Levy and the National Aids Trust Fund, more needed to be done on transparency and accountability to ensure maximum and effective use of the domestic resources.
He said Government should not only put in place sustainable mechanisms of funding, but also put in place clear structures and budgets on utilisation of those funds.
“As it stand, we do not know what else the Health Levy is funding. “We have been told its now funding costs of blood, dialysis and also drugs but we do not know the actual budgets, its administrative structure or the priority list,” said Mr Kujinga.
Domestic funding has been topical at most international forums, with the donor community advocating for increased domestic funding towards health.
The donors argue that, countries should take charge and responsibility of their challenges with funding partners complementing these efforts.

THE Community Working Group on Health (CWGH) has blasted government for poor planning, resulting in failure to allocate foreign currency for procurement of tuberculosis (TB) drugs, hence their current shortages.
BY VENERANDA LANGA
CWGH executive director Itai Rusike said the shortages of TB drugs for the past two months would expose patients to health complications, including the deadly and costly drug resistant tuberculosis (DR TB).
“The current shortage of tuberculosis (TB) drugs and other essential medicines in the country’s health institutions is a combination of poor planning, misplaced priorities and a complete dereliction of duty by central government to ensure that every Zimbabwean has access to affordable and quality health care,” he said.
“CWGH is concerned and saddened that for the past two months, TB patients have not been able to access the drugs, exposing them to health complications or even to the development of the deadly and costly drug resistant tuberculosis (DR-TB).”
Rusike further said there was no excuse in failing to procure TB drugs because government had been splurging foreign currency on other sectors instead of prioritising health.
Last week, government was under fire from different quarters over its acquisition of imported vehicles for chiefs and war veterans when the country’s hospitals had no drugs.
“We are alarmed and disheartened that the country reaches a point of running out of TB drugs as if Zimbabwe is on auto-pilot — with no functional government or health ministry that superintends that sector.
“The failure, or perhaps lack of political will, to prioritise funding the health sector gives credence to the widely-held perception that government has been acting that way because most of the political elite are not treated locally, but airlifted abroad, even for minor ailments, at the taxpayer’s expense. Only the poor are ‘treated’ at local clinics where there are no drugs.”
Rusike said while TB was treatable, its dangers were that drug interruptions caused strains like DR-TB that were difficult to treat and worsened the TB and HIV and Aids burden in the country.
Currently, Zimbabwe is depending mostly on donor-funded drugs as government is failing to sufficiently support the health sector through the fiscus.
He said poverty, overcrowding and poorly ventilated living and working conditions were some of the direct factors for TB transmission.
“To end the scourge of TB, the government needs to pursue poverty reduction strategies, reduce food insecurity, improve living and working conditions of its citizens as well as promote healthy diets and lifestyles. This is more urgent and most important in mining, plantations and farming communities where knowledge gaps are wide, poverty is rife while living conditions are deplorable,” he said.

Otilia Urengwa (33) of Chipereve village, Zvipani under Chief Dandawa is a disabled mother of five.
BY NHAU MANGIRAZI
In 2005, she was involved in a car accident during which she both her legs were injured and she has been using walking aides ever since.
Like several hundreds of people living with disability, Urengwa’s world is in tatters in this rural outpost 65 kilometres west of Karoi town.
“Persons with disabilities face access barriers to service. As a breastfeeding mother, I am also affected. Those who are infected with HIV are suffering in silence,” she told NewsDay Weekender.
Urengwa’s predicament is fuelled by social and health implications, including impact of HIV and Aids among communities in Hurungwe and Zimbabwe at large.
Makisi Kofi of Hurungwe-based Seka Urema Wafa group confirmed that many of their members were shut out from mainstream community participation by relatives and community leaders.
“People living with disabilities are at times shut out by relatives. Once they are infected or affected with HIV, they become victims of family and societal neglect,” Kofi said.
He has been fighting a lone battle in Hurungwe where he is trying to raise community awareness on the rights of people living with disabilities, which include the right to health, food, water and education.
Community Working Group on Health (CWGH) executive director Itai Rusike admitted that HIV and Aids was a major “socio-economic issue” affecting everyone.
“The risk of HIV and Aids infection is worse for disabled people. Women bear the worst brunt of this pandemic,” he said.
Deaf Zimbabwe Trust (DZT) director Barbara Nyangairi concurred, adding that people living with disabilities faced many challenges.
“These can be physical; from lack of accessible infrastructure and communication barriers for the deaf and blind,” she said, adding that people with hearing impediments often struggled to access counselling and testing.
But Rusike said although they were advocating for major interventions around HIV and Aids prevention, care, support and mitigation, only a few programmes were targetted at disabled people as a “special category”.
“This is so because HIV and Aids services organisations either do not consider disability as their issue, while others say interventions are too costly, especially now where there is global recession. The disabled people’s social exclusion from the mainstream HIV and Aids services makes the situation worse,” he said.
According to National Aids Council (NAC) spokesperson Madeline Dube, coordination of the response to HIV amongst people living with disability has been longstanding.
“Such interventions are not occasional. They are ongoing processes and, with more support, we can do more,” she said.
Nyangairi said cultural, social, religious, economic and environmental factors also affect the disabled people as they do not benefit from programmes aslo meant for them.
Rusike weighed in, saying myths and misconceptions fuelled stigma and discrimination, even among the disabled.
“It is important to carry out advocacy on disability and HIV and Aids as a national cause,” he said.
He said there was evidence of high levels of stigmatisation by communities due to both HIV and Aids.
“However, the disabled stigmatise each other over HIV and Aids and there are elements of self-stigmatisation among disabled. There is lagging attention to PWD who are HIV positive and lack care and knowledge,” he said.
According to Nyangairi, there was limited access to HIV and Aids information and utilisation of services like voluntary counselling and testing and orphans and vulnerable children affected by HIV and Aids as well as people with disabilities due to negative attitudes by service providers.
Nyangairi said it was important for policymakers and development practitioners alike to realise that with roughly 10% of the population living with one form of disability or another, there was need to seriously consider the disabled.
“Disability components must be built in all HIV and Aids development projects,” she said. Rusike also suggested there was need to revisit the approach to dealing with HIV and Aids to ensure the disabled were not overlooked.
“Disabled people are largely overlooked in efforts by the global development community to improve the human welfare and living standards of millions of the world’s poor people,” he said.
But for Urengwa and many like her, impact of HIV and Aids among the disabled remained severe, with no solution in sight.