April 2, 2016 Stan Chiwanga Opinion & Analysis

 

By Tabitha Mutenga, Features and Supplements Editor

 

THE deepening economic crisis has paralysed the country’s public health sector that had become heavily dependent on donor funding.
Donor assistance, which had, over the years, become the backbone of the country’s health sector, has been drying up as a result of a global recession.
Over the years, Zimbabwe has failed to adequately fund its health sector, leaving external donors to fill the gap.
Instead of setting aside at least 15 percent of its national budget towards healthcare in line with the Abuja Declaration, Zimbabwe has consistently failed to do so for the past 14 years.
Instead, the country has abdicated this responsibility to donors.
Government’s 2015 National Budget amounting to US$4,1 billion allocated US$300 million towards the health sector.
Out of the US$300 million, US$177 million was for employment costs, US$53 million for operations and a paltry US$28 million for capital expenditure.
In the absence of donor funding, the public health system faces collapse since the majority of the country’s key health programmes were dependent on it.
Since 2003, Zimbabwe has been receiving assistance from the Global Fund to fight HIV and Aids, tuberculosis and malaria.
Unfortunately, the programme is expected to end next year.
A donor-driven US$435 million Health Transition Fund, which has transformed the face of the health sector since 2009, is also expected to come to an end in December.
What’s next after donor funding is the biggest question in everyone’s mind?
Countries that have been known to depend on donor funding have almost fallen into absolute poverty after their good Samaritans pulled the plug.
Zimbabwe might find itself in a similar situation.
Ideally, government should fund the majority of its health-related activities with partners bridging the gap.
With the majority of Zimbabweans now failing to afford basic health care services, at a time Treasury is financially crippled to subsidise services, it is high time government comes up with concrete plans to rescue the health delivery system.
Development specialist, Maxwell Saungweme, said Zimbabwe is now a charity case.
“We are indeed a charity case as most of our people cannot afford basics such as health care, education, food and so on. It is a very sad situation arising from bad governance which has seen the collapse of the medical sector and, in particular, reducing us to dependency on drug donations yet we used to produce most of the drugs we needed ourselves.
“The desperate situation with medical funding and drugs is reflective of all other sectors and facets of Zimbabwean life mainly due to bad governance and poor policies over the years,” he said.
Already most district and provincial hospitals are operating below 60 percent because of a shortage of drugs.
Low budget disbursements have also impacted negatively on the operations of major referral hospitals in the country.
Rising debts, outdated equipment, poor funding and maladministration have crippled the operations of hospitals.
For over a decade now, government has failed to provide an efficient and effective basic health care system.
A myriad of factors caused by poor governance and a collapsing economy have manifested themselves in the flight of qualified health practitioners, poor remuneration, insufficient funds for the Ministry to run health programmes, lack of drugs in health institutions and unaffordable health care.
Community Working Group on Health director, Itai Rusike, said it was unfortunate that the bulk of the funding was coming from donors.
“While government policies on essential drugs and on equity in health have significantly widened treatment access in Zimbabwe, 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 growth of private unregulated drug markets. Drug supplies at rural health centre level are also problematic and are a constant source of client discontent. The approximate 1 000 clinics in Zimbabwe are the last step in a long chain of drug procurement and distribution. Drug supplies that exist at national level are reported to take up to six months to be delivered to district and clinic level,” Rusike said.
Communities have had to spend scarce resources on security services to guard clinics from recurrent theft of drugs and other supplies, given that some of the facilities have no fencing, burglar bars or other forms of security.
“The cost of medications has increased significantly and medical costs have been the highest rising element of the Consumer Price Index for some time,” he added.
newsdesk@fingaz.co.zw

Thandeka Moyo
WHILE motherhood is often celebrated as a positive experience universally, Musa Sibanda, a woman from Bulawayo, was far from being happy on the day she gave birth to her first child.

The woman cut a lonely figure in the maternity ward at Mpilo Central Hospital while other new mothers welcomed their newborn babies with smiles and chuckles.

She had one wish — that the little life in her hands should just die.

Sibanda, who has a speech and hearing impairment, regarded her life as some form of “punishment” from God for nothing seemed to be alright.

Besides her disability, she had tested HIV-positive four years earlier. Wrongly, Sibanda assumed she had transmitted the virus to her baby and was convinced the baby would not make it.

She had flashbacks of the day she took the HIV test and how the post-test counsellor struggled, using rudimentary sign language, to give her tips and advice on living a healthy life despite her HIV status.

The test result was written on a slip for Sibanda to read.

It appeared the counsellor said a lot judging from the movement of her lips complemented, in vain, with hand gestures. But it was the written “message” on the slip that Sibanda finally understood after a lengthy counselling session.

“I was convinced my newborn child was HIV positive since I was also positive,” Sibanda said. “When nurses discharged me, I left Mpilo Central Hospital maternity ward prepared to spend a few years with the little one, suspecting she would die before reaching five.”

Whenever the baby fell sick, Sibanda prepared herself for the worst.

A brave decision to ask a friend who could communicate in sign language to accompany her to the hospital with her daughter paid off.

“After a traumatic four years, I learnt that my daughter was HIV negative,” Sibanda said.

“That day, I learnt of a new concept: the Prevention of Mother To Child Transmission (PMTCT). I was told it was the reason why my child was negative though I was HIV positive.”

While Sibanda’s baby is a healthy normal child, Sibanda had to live for years haunted by the heart-wrenching assumption that her baby was born with the virus. The mother had to wait for years to draw joy from her daughter’s birth.

The good news, it appears, was lost in translation.

With no working knowledge of sign language, staff at the hospital battled to convey the correct message to her at the time of the child’s birth.

Language and communication barriers hinder people with hearing and speech impairment (PWD) especially women who often find themselves stranded when trying to access antenatal care (ANC).

The World Health Organisation (WHO) says the majority of health problems leading to maternal deaths can be prevented, detected and treated by trained health workers during antenatal care visits.

Zimbabwean health workers and professionals are trained in everything else necessary to give quality ANC except Sign Language although the constitution recognises it as one of the country’s official languages.

Chapter 1 subsection 6 (4) of the constitution stipulates that the State must promote and advance the use of all languages used in Zimbabwe, including sign language, and must create conditions for the development of the languages.

“Sign Language is official only on paper. I’ve never come across a nurse who can easily communicate with me. I relied on reading lips during my ANC visits and I know I missed out on a lot of crucial information as the nurses were educating us on safe sex, HIV and Aids, diet, exercise among other topics.

“The reason our health practitioners don’t use Sign Language is the attitude that our government has on PWD. Millions have been used to research on condom use, elections and everything but to date our government hasn’t given us the correct figure of PWD, thus we are as good as non-existent in Zimbabwe,” says Chiedza Phiri from Bulawayo’s Nguboyenja suburb with the assistance of an interpreter.

Bulawayo High Court Judge, Justice Maxwell Takuva, recently ordered the Zimbabwe National Statistics Agency (Zimstat) and the Minister of Finance and Economic Development, Cde Patrick Chinamasa, to release funds to facilitate the full participation of people with disabilities in future population censuses.

Takuva’s judgement followed an application by the Zimbabwe National League for the Blind (ZNLB) suing Zimstat, Minister Chinamasa and his Public Service, Labour and Social Welfare counterpart, Cde Prisca Mupfumira, for allegedly deliberately excluding its members from participating in the 2012 census programme.

Irene Moyo, a wheelchair-bound paraplegic living with HIV, said while her peers suffer due to communication, she experienced discrimination from health workers who seemed to suggest that she should not have children due to her physical disability and HIV status.

“I don’t have a hearing and speech impairment but I met the most discriminatory experience at Mpilo Hospital because of my physical disability. Delivering my third child brought me a lot of trauma,” said Moyo.

Moyo remembers being surrounded by a group of inquisitive and curious midwives who took turns to interrogate her while giving her questioning looks as she sat in her wheelchair.

“I felt like I had committed a sin by falling pregnant while disabled. It was as if PWD have no sexual organs,” Moyo said. “I simply told the nurses that I deserved privacy and that they weren’t special as we were all subjected to the same risks. They slowly walked away accusing me of ingratitude. A disabled pregnant woman is supposed to open up on her sex life in the presence of about 12 nurses and allow them to scrutinize her.”

Moyo says she made up her mind to fight for her rights from that day.

“Up to today I can’t take any discrimination from health personnel who want to dramatise my condition to entertain themselves,” she says.

Community Working Group on Health (CWGH) director, Itai Rusike, says Zimbabwe requires effective communication tools as it moves towards universal healthcare provision.

“Health must have a universal communication strategy so certain sections of our communities aren’t short-changed. We need to closely review our training curriculum and consider the use of sign language, Braille and other languages which are officialised by the Constitution. We need to appreciate the realisation of the right to health enshrined in the constitution. The attitudes we find in hospitals and low morale among practitioners is also a result of poor health financing and prioritisation,” said Rusike.

Dr Bernard Madzima, the director for family health in the Ministry of Health and Child Care, acknowledged the absence of a specific communication strategy for disabled women.

“However, all communication strategies from the Ministry are inclusive as you’ll appreciate that disabilities are wide. Again there’s no discrimination in service provision. However, those with specific needs are accommodated especially those who are difficult to reach because of the nature of the disability.

“Issues of stigma and discrimination can happen. However, the ministry has a programme of training health workers in Disability Awareness aimed at reducing stigma and discrimination.”

Disability HIV & AIDS Trust (DHAT) head of operations Hamida Ismail says women and girls with hearing and speech impairments miss out on information on maternal health due to the communication barrier and low literacy levels.

“While it’s important to train health practitioners on sign language, there’s a need to ensure the sustenance of the language. It’s crucial to understand that sign language is a language, hence the need to practice it on a regular basis after the training,” she said.

Ismail says failing to provide appropriate information perpetuates maternal mortality among women and girls living with disabilities.

April 2, 2016 Stan Chiwanga Opinion & Analysis

Paidamoyo Chipunza Senior Health Reporter
Tucked away in the thick forests of Makonde district lies Kanyaga village. Apart from agricultural, mining and other social activities that make up the daily routine of an adult man and woman in Makonde, sex and sexuality completes their diary.

At some point, clinics capable of assisting pregnant women to deliver in the event that they decided to get pregnant were limited and scattered.

The few clinics that existed had no shelter to accommodate pregnant women who stayed far away for them to get medical assistance as soon as they started showing signs of labour.

Some women had to travel as long as 30 kilometres to the nearest clinic leaving them with no option but to give birth at homes or along the way as they failed to make it on time to the clinic – a situation that could result in the deaths of both the mother and the newly born child.

Thirty-two-year old Stancia Makochekerwa is one of the strong women of Makonde who lost four babies – all of whom were delivered at home – but can still afford to put on a smile with her fifth pregnancy as she waits patiently to give birth at Kanyaga clinic.

Ms Makochekerwa said on the first and second occasions, she was assisted by a traditional birth attendant and by her mother respectively but sadly both children died within 48 hours of birth.

She said her third pregnancy was a stillbirth, which was also handled by her mother at home while the fourth child died at the age of two years.

The child was also delivered from home and did not receive medical intervention.

She said the child looked sickly from birth and had stunted growth that resulted in his death two years on.

“Then Kanyaga clinic was not there and we would go to Kenzamba clinic, which is far away from our village. Kenzamba did not have a mother’s waiting shelter and women would only go there when they started showing signs of labour,” said Ms Makochekerwa.

She said her other option was to go to Chinhoyi Hospital, about 70 kilometres away but she would still require money for transport and other associated costs.

“I did not have that money to go to Chinhoyi Hospital and after weighing my options I decided to give birth at home with the assistance of a traditional birth attendant,” she said.

Traditional birth attendants are usually paid with a goat, soap, 20kg mealie-meal and hens.

“It pained me as I kept on losing my children one after the other. I was only relieved when I heard that Kanyaga homestead would be turned into a clinic and that a temporary room had been set aside for pregnant women to live in as their day got closer,” she said.

Ms Makochekerwa said she did not think twice when she carried her fifth pregnancy but rushed not only to register it, but also to join 13 other expecting mothers waiting for delivery at Kanyaga clinic.

Although conditions at the shelter were appalling with all the expecting women and two others who gave birth sharing a small tobacco ban with little ventilation and space, all the women concurred that the room was a better alternative as they awaited completion of a proper shelter currently under construction.

The house is being constructed by the community through Kanyaga health centre committee and the district development committee.

Ms Alice Mutendagayi (30) from Katsvamutimu in Murombedzi also testified to the importance of mother’s waiting shelters saying if the homes had been there long ago she would not have lost her child.

Ms Mutendagayi said unlike her other pregnancies, she did not show signs of labour early.

“It was a Tuesday afternoon when I was working in the garden with my other children. From nowhere and with no pain or any discomfort, I broke my waters and I knew it was time,” she recalled.

“I quickly packed my bags and sat foot on the road for Madzorera clinic together with my aunt but before we went any further, the baby was on her way,” she said.

Ms Mutendagayi said her aunt helped her deliver but still they proceeded to Madzorera clinic in a scotch cart with the umbilical code still tied to baby.

Sadly, the baby failed to make it; she was pronounced dead upon arrival at the clinic.

“Then, there was no waiting home at Madzorera clinic but this time around I came early before my expected delivery date so that when it happens, those trained to do the work can take care of me and my child,” she said.

A former traditional birth attendant from Zumbara in Makonde who is now working with the Zumbara health centre committee to educate and encourage villagers on the importance of delivering in health facilities said institutional deliveries served to reduce the number of women and children who died during child birth.

Ms Rumbidzai Kapunga, popularly known as Madzimai Jennifer in her apostolic circles, said she saw light when she fall pregnant and could not assist herself to deliver forcing her to seek medical attention from a health facility.

Although she made it on time to Zumbara clinic at the onset of labour, Madzimai Jennifer said her delivery was marked by complications ranging from the child tying himself with the umbilical code to mucus blocking his nasal passage making it difficult for him to breath.

“I remember vividly sekuru (Petros) Spanera (a nurse at the clinic) getting a little instrument which he used to draw the mucus from my child’s nasal passage. I said to myself, what if it was a client’s child, how could I have handled these complications with no medical equipment at home? The child could have died,” she said.

She has joined the Zumbara health committee as a community monitor.

“We work with communities educating and encouraging them to register pregnancies early and visiting health facilities as soon as they start showing signs of labour. We also encourage those who stay far away from the clinics to consider staying at the clinic’s mother’s waiting shelter so that they do not delay in getting assistance as soon as they get into labour,” she said.

She said the response had been overwhelming as statistics from the clinic showed an upward increase in the number of woman delivering at the clinic per month versus home deliveries.

Zimbabwe’s maternal mortality rate currently stands at 610 per every hundred thousand live births.

Although on a decline, the figure is arguably still one of the highest on the continent with most deaths attributed to home deliveries as villagers lack both skill and scope to assist with deliveries.

Some deaths have also been attributed to delays in reaching a health facility to get skilled attendance.

Complicated deliveries can lead to the death of either the mother or the newly born baby.

This prompted Government to partner with the Community Working Group on Health and Save the Children to conscience communities on what they can do for their health facilities through a programme called strengthening community participation in health.

Through the project, most communities have mobilised resources for developmental projects at their clinics such as construction of waiting mother’s shelters, clinic refurbishments and have assisted in procurement of drugs and other necessities.

The communities have also identified influential people trained to promote health seeking behaviour among villagers particularly regarding maternal and child health.

March 10, 2016 Shingirai Huni Features, Opinion & Analysis