“Zimbabwe’s vision is to have a healthcare system that reflects international best practice by 2030. The desire is to have a national health system that ensures that all members of society have equitable access to healthcare services, thereby leaving no one behind,” said Health minister, Vice-President Constantino Chiwenga while discussing his new restructuring exercise of the ministry.
BY Phyllis Mbanje
Stakeholders are sceptical because Zimbabwean authorities’s conduct are synonymous with lip service.They say if the bungling in the management of COVID-19 is anything to go by, the country has a lot of catching up to do. This will require substantial funding, training of personnel and above all plugging corruption loopholes.
The new Health minister’s zeal is commendable, but a huge task lies ahead for him. How the country conducts its fight against the COVID-19 pandemic will determine the future for the healthcare system.
To date there are few success stories and plenty failures since the first case was recorded in March.
The testing deficit
Zimbabwe is trailing behind other countries in the region. There is a myriad of challenges from inadequate test kits, delays in releasing test results especially for those using public facilities. The cost for private tests is quite prohibitive ranging from US$40 to US$70.
Of the 15 million plus Zimbabweans, only slightly over 200 000, about 1% of the population, have been tested since March.In South Africa, close to four million people have been tested, which is about 5% of its population.
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From the onset, there were concerns over low levels of tests as evidenced by the number of tested cases.
Until recently, there was only one National Microbiology Reference Laboratory located at Sally Mugabe Central Hospital in Harare.
It received samples from all provinces for testing and this soon became overwhelming for the staff and the equipment which could only test up to 400 samples per day using the real-time polymerase chain reaction (PCR) machine.
The PCR diagnostic method has a 100% accuracy rate and the testing process takes about five hours.
There were delays in getting results also because of what the government called total quality management, the tested samples were sent to South Africa for further confirmation of the results.
Stakeholders have been raising alarm over complacency, saying this would give people a false sense of security and result in recklessness.
“Continued constraints in accessing diagnostics (PCR) kits in the country has been limiting our case detection despite the reasonable surveillance capacities.
“Testing for COVID-19 has increased as have the reported cases. However, there is need to distinguish between rising reports of COVID-19 due to rising testing and a real rise in the rate of the pandemic incidence,” Community Working Group on Health (CWGH) executive director Itai Rusike said.
“For Zimbabwe, where testing rates are much lower, the rising cases may signal wider suggestions that increases in case numbers are not simply due to rising testing levels, but a real increase in transmission or more focused use of testing in areas where there is higher risk of infection,” he said.
Medical personnel have also warned that community transmission will increase substantially. Nearly 90% are local transmissions, but still the testing levels remain low.
At some point government promised to roll out mass testing in the communities, but that is still to happen.
Poor contact tracing
Many contacts of COVID-19 positive patients are being lost as the ministry has no adequate manpower to follow up on individuals who mingled with people who tested positive in their communities.
In the high-density areas, the lockdown restrictions, and social distancing protocols have mostly never been followed or enforced.
Recently COVID-19 taskforce national co-ordinator Agnes Mahomva said they used to experience challenges in following up and monitoring of those in self-isolation, but she said the situation had improved.
“We have beefed up the staff and it should not be a challenge,” she said.
But personal testimonies of people affected by the disease say otherwise.
Journalist Kudzayi Madzivire, who shared his COVID-19 experience, revealed that there was a lot of bungling in how his case was handled, including delays in formally communicating his results.
The now-recovered Madzivire said delays in release of his results caused him emotional distress.
“Before I got admitted, none of the personnel from the COVID-19 taskforce came to see how I was doing,” he said.
With reports that test kits are in short supply it means many potential COVID-19 positive patients will be roaming the streets, exposing members of the community, thereby and increasing the infection rate.
Management of COVID-19 patients in hospitalsOne the country’s weakest points is in managing COVID-19 patients without necessary drugs.
Institutions like Parirenyatwa Group of Hospitals are struggling to provide patients with basic medication. Those with underlying conditions like diabetes, cancer have had to source their own insulin and other drugs.
The strike by health workers also made the situation worse. Most health workers still do not have appropriate personal protective equipment (PPE) and this continues to hinder service delivery to COVID-19 patients.
This is happening at a time numbers are rising as a result of increasing community transmissions.
Government has an obligation to provide the necessary PPE for its workers to ensure smooth service in hospitals and many people have died when they could have been saved by merely accessing the necessary drugs.
What we did right
Like many countries, Zimbabwe acted swiftly to introduce lockdowns, bans on large gatherings, curfews and border closures.Testing services were expanded making it easy for other provinces to also have access.
“Increased testing in Zimbabwe has improved case detection, although still at low levels for an effective public health response. Average case fatality has risen even though it remains lower than in other countries in the region,” Rusike said.
Isolation and treatment centres were established in every district with health workers being trained on COVID-19 management since it is a novel disease.
Returning residents were placed in quarantine and even though there were challenges of overcrowding and delays in testing, it gave the country an opportunity to halt further spread. However, many escaped, often after bribing their way out, but it could have been worse. This slowed down the rate of transmission but only momentarily.
Poverty versus COVID-19
The United Nations World Food Programme (WFP) and other aid agencies say over seven million Zimbabweans are going to need food aid this year and with the economy at a standstill, the lockdown measures became a near death warrant for most who survived on vending and odd jobs among others. Many faced with a very real threat of starving, braved the risk of getting infected and plunged back onto the streets for survival.
This forced government to reopen vegetable markets, but with no ablution facilities and other measures in place, many were at risk of getting infected and a pilot testing exercise at the market produced startling results.
Missed opportunities
Stakeholders said during the lockdown government should have taken the opportunity to put measures in place and even roll out the mass testing exercise.
South Africa successfully did it and conducted door-to-door testing. This made it easier for many people. Cameroon, Mauritania and parts of Nigeria also launched massive community campaigns to screen people and identify potential cases for testing.
The government failed on its promise to conduct mass COVID-19 tests targeting 100 000 people for a start.
