Community Working Group on Health

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.
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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

 

As the rest of the world commemorated Cancer Day yesterday, Zimbabwe continues to grapple with shortage of drugs, cancer equipment, specialists, as well as lack of adequate information to rein in the disease, which is largely preventable.

By Phyllis Mbanje

Stakeholders are calling on the government to seriously work on domestic financing of cancer awareness and prevention which falls under non-communicable diseases (NCDs) and treat it with the diligence accorded to HIV and Aids.

“We are not doing much in addressing this sitting time bomb which requires substantial resources to make a meaningful impact,” Itai Rusike, the director of the Community Working Group on Health (CWGH), said on Wednesday.

Treatment of cancer, which is one of the largest killers in the country, has remained quite costly for the average person and public health facilities remain underfunded and overwhelmed by the number of patients.

“While everyone has a right to health, many people from poor resource settings have no means and no access to treatment,” Rusike said.

Cancer is preventable, but due to inadequate information and awareness campaigns, many people come forward late when it is almost impossible to reverse the damage.

According to a report from the Zimbabwe National Cancer Registry (ZNCR), more than 6 000 cases of cancer were recorded countrywide last year and the bulk of these presented in last two stages of the disease.

Of growing concern is the emergence of childhood cancers. They accounted for more than 3% of the cancers recorded in 2013.

According to research done by Kidzcan Zimbabwe, in 2014, 243 new cases of cancer in children were reported and 106 children died from cancer-related illnesses.

“Although childhood cancers (age 0-14) are a rare condition worldwide, the incidence in Zimbabwe is rather high,” ZNCR registrar Eric Chokunonga said.

A shortage of cancer drugs has also been one of the biggest drawbacks.

Last year provincial and district hospitals throughout the country faced an acute shortage of drugs for cancer, a situation which put the lives of many patients at risk.

Cancer Association of Zimbabwe (CAZ) monitoring and evaluation officer, Lovemore Makurirofa said they were worried about the shortages, adding any disruptions in taking cancer medication might result in treatment failure.

“Cancer treatment involves killing off the harmful cells and so if treatment is stopped before the prescribed cycles, cancer might recur,” he said.

Meanwhile, cancer patients might get some relief after the National Aids Council managed to procure medication and reagents worth half a million dollars.

February 5, 2016 in National, News

By Tabitha Mutenga, Features and Supplements Editor

AS the donor community is busy trying to ensure that there is enough food for millions of Zimbabweans facing starvation, another disaster that may soon call for the donors’ attention is unfolding in the country’s hospitals.
A massive shortage of basic clinical drugs at major public health institutions is unfolding.
The situation has been described by health experts as dire, putting the lives of many people at risk.
Basic pain killers are unavailable in hospitals and most rural clinics, where the majority of the country’s ever desperate communities live.
Most of the doctors at major referral hospitals are referring patients to private pharmacies, which are expensive.
“There is no point of travelling all the way to Makanda Clinic; all you get is paracetamol. Even if you have malaria you get paracetamol,” said one villager from Rusape, who preferred to be identified as Magreta.
She had gone to seek treatment at Makanda Clinic.
“Medical supplies such as bandages, syringes, cotton swabs and antiseptic are not even available at the clinic,” she lamented.
Villagers who frequently visit the clinic in the hope of accessing treatment concurred with Magreta saying many were travelling to Murambinda Hospital or Rusape Hospital for treatment.
At both hospitals, it is either that they find the drugs being dispensed at the institutions to be out of reach, or they end up being referred to private pharmacies owing to the prevailing shortages of drugs.
As many fail to access treatment at public institutions, hospitals are fast becoming “waiting rooms for death”.
Community Working Group on Health (CWGH) executive director, Itai Rusike, said 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 sharply at State hospitals.
“This represents an unfair cost burden on poor communities, but also opens the way for the growth of private unregulated drug markets. Procurement procedures at the National Pharmaceutical Company (NatPharm) are still determined by the State Procurement Board, even though NatPharm is not a typical State department, and this has led to delays in decision-making. Further, NatPharm suffers from lack of adequate funding from the Government of Zimbabwe. As a result, the country is now highly dependent on donor support for its drug supplies,” Rusike said.
NatPharm, the country’s appointed agent for procurement, storage and distribution of medical supplies to public health institutions, is owed US$24 million from as far back as 2009 and only received US$800 000 from Treasury in October last year, making it unable to purchase drugs.
“Drug supplies at rural health centre level are also problematic and are a constant source of client discontent. The approximately 1 500 clinics in Zimbabwe are the last step in a long chain of drug procurement and distribution.
“Communities have had to spend scarce local funds to guard clinics from recurrent theft of drugs and other supplies, particularly when facilities have no fencing, burglar bars or other security. Not surprisingly, even when clinics do not charge fees, people bypass them for more expensive hospitals in towns where they think they have a chance of getting drugs. For the poorest, this is an unaffordable solution,” said Rusike.
A CWGH survey on the 2016 National Budget indicated that communities noted that Treasury should have prioritised provision of essential drugs and improving staff pay and training, especially for workers in preventive services, clinics and district hospitals.
Government’s essential drug policy aims at promoting rational drug use and ensuring the availability of low cost, but good quality drugs.
The Ministry of Health backed this policy with investments in primary health care to strengthen drug delivery to primary care and district services.
These changes were supported by a significant reallocation of resources to and within the health sector.
The policy on essential drugs and generic (brand name) labelling of drugs was applied across the public and private sectors, saving the country significant resources from the mark-ups of brand-name products.
Bulk procurement and local production also reduced the costs of essential drugs.
However, a number of factors have affected drug availability such as resource constraints, currency shortages, losses in supplied drugs, expiring drugs and theft of the drugs.
“Cases of drug theft and leakages out of public services into private practice have been cited. Those cases under police investigation have not resulted in concrete finalisation or quantification of the drugs. Burglary into drug storerooms has also been reported and hospital staff has allegedly been implicated in such acts. At clinic level, drug theft has been reported as a problem in a number of districts and has led communities to hire security guards and build fencing and erect burglar bars,” Rusike added.
Theft and leakages of drugs from the public sector and sales of drugs brought onto the country for personal use are reported to have led to some drugs finding their way into the black and informal markets.
Contraceptives are also being sold on the black market and the problem with such sales is that they are unregulated, making it difficult to ensure quality or appropriateness of drugs, avoid side effects and complications and also problems of resistance that can happen in unregulated use of antibiotics.
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DESPITE efforts to roll back one of the world’s biggest killers — malaria, Zimbabwe is struggling to eliminate the vector of the deadly disease, the anopheles mosquito.
Statistics show that there are more than 400 000 malaria cases among all age groups each year in Zimbabwe, which translates to three percent of the country’s population contracting the disease.
Health and Child Care Minister, David Parirenyatwa, has indicated that over half of the population is at risk of contracting malaria at a time the anopheles mosquito is increasingly resisting the commonly used residual sprays.
This effectively means the southern African nation is not among the World Health Organisation (WHO)’s list of African countries expected to reach the year 2020 target of being malaria free.
By World Malaria Day 2020 only six African countries, Algeria, Botswana, Cape Verde, Comoros, South Africa and Swaziland could be free of malaria.
In Zimbabwe, the disease accounts for between 30 to 50 percent of outpatient attendances in the moderate to high transmission districts, especially during the peak transmission period. Transmission is generally seasonal, starting from around November to the end of May, with the peak period being between March and May.
The primary malaria zones in Zimbabwe are in the northern and eastern regions bordering Mozambique and Zambia.
Malaria is the third leading cause of illness and mortality in Zimbabwe. Of the country’s 63 districts, 47 of those districts are malarial, with 33 categorised as high burden malaria areas.
“It is important to note that malaria is not just a health issue, but a socio-economic one as well. Malaria has a direct impact on a country’s human resources. Not only does it result in loss of life and loss of productivity, due to illness and premature death, it also affects children’s school attendance and social development through both absenteeism and permanent neurological damages associated with severe episodes of the disease,” Parirenyatwa has noted.
Although statistics continuously show a decline in malaria incidences, the disease remains a major challenge in certain districts of Manicaland, Mashonaland Central, Midlands, Matabeleland North and South, Masvingo and Mashonaland East. It also accounts for 30 percent of all outpatient cases and 12 percent of hospital admissions in these areas.
According to Zimbabwe District Health Information System data, approximately 83 percent of all malaria cases and 50 percent of all malaria deaths in 2014 originated from three provinces: Manicaland, Mashonaland East and Mashonaland Central, with 42 percent of all cases and 26 percent of all deaths coming from Manicaland.
Despite these disturbing figures malaria incidences declined by 79 percent from 136 per 1 000 people in 2000 to 29 per 1 000 people in 2015, surpassing the Millennium Development Goals set target of 75 percent decline. Mortality declined by 57 percent from 1 069 deaths in 2003 to 462 deaths in 2015.
Prevention has proven to be the best form of intervention for malaria, with the two most successful methods found in insecticide-treated mosquito nets and spraying insecticides in and around homes.
Community Working Group on Health executive director, Itai Rusike, said the spread of health information and safe living were key to malaria prevention.
“Prevention and management of malaria also depends on early detection and treatment. Communities are primarily using the clinics as their first point of treatment for malaria (public and private), so effective malaria management depends first on the resources at this level,” Rusike said.
WHO describes the mosquito as the greatest menace of all disease-transmitting insects, causing several millions of deaths and hundreds of millions of cases of illnesses around the world each year.
“The high poverty levels in Zimbabwe and wide use of public services by poor households mean that improved malaria treatment depends on improving public sector spending. The current levels of public spending per capita are below levels required to fund a basic system, or for meeting Sustainable Development Goals commitments.
“The shortfall limits public sector service provision, in least resourced and most disadvantaged areas, with consequences for raised mortality, illness and reduced life opportunities in those areas. With government resources overshadowed by private and external funding, there is significant challenge for the public sector to know of and align available funds from all sources towards national goals,” Rusike added.
A number of challenges affecting the country’s drive towards eliminating malaria include a re-emerging malaria vector, the anopheles funestus, which is resistant to pyrethroids — the cheapest indoor residual spraying, forcing the country to introduce organophosphates, which are more effective, but much more expensive.
“Outreach resources are not only limited with respect to malaria spraying. A number of communities do not have a village health worker (VHW) due to the limited numbers of the trained VHWs thereby reducing the interface between the communities and this important cadre who provides the basic care at community level,” Rusike said.
He added that in some instances, very little malaria spraying is reported in some parts of the country, indicating that environmental health technicians have lacked the supplies as well as the transport, leaving households dependent on their own resources.
Malaria is, however, preventable despite killing thousands of people every year particularly pregnant women and children.
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