IT is the rainy season in Zimbabwe and although this day is misty with light rain, Tinashe Chamahwinya is driving a huge 30-tonne white delivery truck filled with life-saving medicines and medical supplies.
BY DOREEN HOVE
He is on his way to four hard-to-reach, rural clinics in Hwedza district, located on the eastern side of the country.
Chamahwinya has already made similar stops at over 100 clinics in the last 25 days.
Almost 20 delivery trucks are on the road each day delivering medicines and medical supplies to clinics in different parts of the country.
Next up is Mukamba Clinic, which serves nearly 7 000 people. This is the second delivery of the day for Chamahwinya and the rest of his team.
“We deliver these medicines and medical supplies once every three months and give the clinics six months’ supply to avoid stock outs, or clinics running out of supplies,” he said.
“Today, we are distributing condoms, antiretroviral (ARV) drugs, HIV test kits, CD-4 count point of care cartridges (used in technologies that monitor HIV viral loads), syphilis test kits and early infant HIV diagnosis test kits.
“At times, we travel up to 700km to ensure that people in hard-to-reach communities get access to medicines that prevent and treat HIV and malaria.”
When the day is over, they sleep at their final delivery medical facility to avoid running behind schedule.
For over eight years, Chamahwinya has been working for a United States Agency for International Development (USAid)/Zimbabwe partner, making deliveries to over 1 500 health facilities across the country.
Although his role is arguably the most visible, he is part of a remarkable chain of actors, delivering life-saving medicines to Zimbabweans.
A dire situation
About 14 years ago, when USAid first began this work, and as far back as the 1980s, thousands of people were dying every week in Zimbabwe from Aids, and a significant majority of patients in hospitals were Aids patients.
The only care offered at the time was HIV testing and condoms to reduce new infections as well as education on positive living.
The Mukamba Clinic was like many others in the country facing the HIV epidemic, making little progress, and seeing one Aids-related death after another.
According to UNAids, Aids-related deaths in Zimbabwe peaked between 2000 and 2003, where an estimated
120 000 people died annually over this period.
Viola Chisadza has been a nurse aid at Mukamba since 1982. She vividly remembers how difficult it was for people living with HIV in the 1980s leading up to late 2003, when USAid started delivering medical supplies to the clinic.
Things changed when USAid (Zimbabwe), working with the Health and Child Care ministry, started providing anti-retrovirals (ARVs) and established a functioning supply chain management system to deliver these life-saving medicines and other medical supplies to communities.
There is sadness in Chisadza’s eyes as she recalls what it was like before the distribution system kicked off.
“ARVs and HIV rapid test kits were not available for patients who came to the clinic. Condoms were also not easily available to them, so people could not protect themselves from the disease,” she said.
“Sadly, too many patients only came to the clinic when they were extremely sick, and at times, were carried on wheelbarrows because they could no longer walk.
“Since medicines and even test kits were not found at the nearest clinic, community members who got sick had to travel up to 50km to the district hospital to get tested.”
Chisadza said as some patients could not afford the transport costs, they either went late or they just did not go.
Consequently, many died while HIV-positive mothers gave birth to infected babies.
In the midst of this dire situation, David Alt, who served as chief of party for the project over its 14 years and retired earlier this year, recalls the major challenge.
“Some medicines and medical supplies, for example, contraceptives and condoms, were available in Zimbabwe’s capital city, Harare, but there was no system in place to help distribute them to different facilities in the country,” he said.
Transporting medicines, transporting life
“We set up a logistics system in 2003 because we wanted to create systems that could distribute medicines to communities.
“USAid (Zimbabwe) worked closely with the Ministry of Health and Child Care, the Global Fund, National Aids Council and United Kingdom’s Department for International Development to make this happen,” Alt explained.
“Over the years, we established a fleet of 43 vehicles to deliver medicines and other medical supplies to help monitor the stocks at hospitals.”
USAid continues to support the Health ministry’s directorate of pharmacy services’ logistics unit, which, for effective co-ordination, is based at the National Pharmaceutical Company (NatPharm) in Harare.
“USAid, in collaboration with other partners, supported improvements to the medical storage facility, increasing the storage capacity from 3 000 to 6 000 square metres,” Flora Nancy Sifeku, NatPharm’s managing director, said.
According to Chisadza, the nurse aide from Mukamba Clinic, this intervention changed lives.
“When these delivery trucks started to bring free medicines to our clinic, people had access to a wide range of medical supplies, which made life less difficult,” she explained.
“For example, the HIV rapid test kits enabled them to get their results in 20 minutes instead of travelling 50km to get tested. In addition, having improved access to ARVs enabled HIV-positive mothers to give birth to HIV-free babies, and it saved many more lives because these life-saving medicines were now right at their doorstep.”
Alt said the supply chain management system reduced stock-out rates at clinics and hospitals from 40% to about 5%, calling it an achievement that partners “are all very proud of”.
USAid’s support of the effort continues today
“USAid supported the first pilot public health sector HIV treatment in Zimbabwe in five hospitals and clinics across the country. Before then, ARVs were only available through the private sector at a prohibitively expensive cost,” Peter Halpert, who was the director of USAid/Zimbabwe’s health office between 1999 and 2014, said.
“We began with 500 patients nationwide, while Zimbabwe’s Ministry of Health and Child Care provided anti-retroviral treatment to 40 000 Zimbabweans.”
He recalled that progress was slow during the first few years, as it was hard to get people to use the medicines due to stigma and discrimination.
“USAid became the first donor to provide anti-retroviral medicines to Zimbabweans,” Halpert said.
“Ensuring a continuous supply of HIV commodities such as test kits and medicines was a critical component of the programme.”
Alt also remembered how important it was to provide ARVs to Zimbabweans.
“This was an important initial step to the beginning of hope for the Zimbabweans living with HIV,” he said.
Alt pointed out that Zimbabwe became the first country in the world to provide USAid-supported ARVs for treatment on a routine basis; in other countries, they only conducted clinical trials.
“However, when the Zimbabwean dollar collapsed in 2007, the Ministry of Health and Child Care was unable to provide ARVs to the 40 000 they were supporting because they no longer had the foreign exchange to buy the life-saving ARVs,” he said.
“USAid stepped in and started providing ARVs to over 40 500 people.”
USAid’s support quickly expanded, increasing to over 160 000 each year, and, in 2017, to over 190 000.
“What struck me was that, even if others were sceptical, criticising USAid for putting people on treatment without guaranteeing a lifetime of uninterrupted supplies, we persisted in our belief that saving lives today is what matters,” Stephanie Funk, the mission director in Zimbabwe, said.
“I am happy that ARVs are now the lifeline to any HIV programme, both preventing new infections and saving lives.
“Although we did not know at the time that ARVs would reduce the incidence of HIV infection, we now know that we were contributing to significant reductions in new HIV infections, while also reducing Aids-related deaths, and preventing a new generation of orphans.”