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Stakeholder Workshop on the food situation in Zimbabwe - October 2002
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5. Health Delivery System and the Drought Situation
- by Mr. T. Tembo and Mr. Kupe of World Health Organization
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Mr. Kupe presented the main findings of the Rapid Needs Assessment Study for the health sector in Zimbabwe, which was carried out in 2002.
The main objective of the assessment was to guide the WHO/HARP response through identification of the health needs of the population and vulnerable groups in particular. The major findings were highlighted in point form.
5.1 Major Findings
- Patient attendance at health facilities shows a decline in the last 2 years.
- At the same time mortality has dramatically increased.
- WHO defined conditions coming among the top ten conditions - as poor diagnosis
- HIV/AIDS diagnosis laboratory based and thus distorts the disease burden picture
5.1.1 Epidemics
- The epidemic and disease control management committees were either not functional or non-existent at both district and health centre levels.
- Response to the epidemic was not prompt implying that surveillance data was not used in early detection of disease outbreaks.
- Action thresholds for epidemic prone diseases at the level of health facilities were generally not known.
- Lack of training in disease surveillance at peripheral levels.
- The peripheral staff (at field level) did not have training in epidemic preparedness and response i.e. training in recognition, investigation and control of epidemics.
- Inadequate supervision especially at health facility level.
- Shortage of drugs to respond to emergencies and epidemics
- There is no logistical support for lower level staff to carry out investigations.
5.2 Vulnerable groups and access to Health Care
5.2.1 Availability of Health Services
- 24% (2360) of posts are vacant in all provinces posts on establishment.
- Since January 2000 7% of all categories of health personnel left the health service (heavy losses were among nursing -12%, medical practitioners -13% and pharmacy -18%)
- Staff losses that have been experienced since January 2000 amount to 7% among all categories of staff (doctors, clinical officers, nurses, environmental health officers and technicians, pharmacists, pharmaceutical technicians, midwives and health services administrators).
5.3 Availability of Service to Communities
5.3.1 Availability of health services
A population of 326,000 living in communal lands and 209,179 in new resettlements has no access to health services.
5.3.2 Use of outreach services
Outreach services have been scaled down or suspended due to lack of logistical support and finances.
5.3.3 Health Extension Workers Services
General shortage of extension workers and there is no logistical support for the few that are operational.
Generally all population groups in all districts that were assessed were vulnerable due to the general lack of access to health care services and amenities such as safe water supplies and sanitary facilities. He acknowledged that this situation was however, worse among the newly resettled population
5.4 Drugs
The assessment was done at four levels:
Provincial: The provincial data obtained during the assessment reflects that the supply of the majority of the essential drug ranges between two months to zero with a tendency towards zero in most drugs.
District Level: The range of stocks at this level was between a month and two months. This was not deemed acceptable on the basis that any institution should have at least not less than three months supply of drugs.
Mission Hospitals: This category of service providers had critical stock levels in general with Mtshabezi and Zhombe hospitals being the worst affected as they had zero stocks in the majority of the drug categories.
Rural Health Centres: The drug stock levels at this level were critically low making the rural populations vulnerable.
5.5 Recommendations
- MOHCW in partnership with WHO/HARP should strengthen coordination mechanisms by e.g. holding regular consultative meetings with NGO partners in health with the view to operate in unison to maximize efforts directed at cushioning impact of the humanitarian crisis.
- WHO/HARP to support training of peripheral health workers in order to improve disease surveillance.
- WHO/HARP should provide training of peripheral workers in epidemic preparedness and control and expertise to help out control current epidemics.
- Efforts directed at controlling diseases, should be focused at risk groups and areas.
- MOHCW should seriously look at rationalizing staff posts and improving conditions of service in order to retain the remaining staff and WHO/HARP to provide logistical support for supervision of staff at peripheral levels.
- MOHCW should work with the health partners who run primary health care services and rationalize the fee structure to ensure that vulnerable groups such as pregnant women, children and the elderly have access to free health services.
- MOHCW should examine use of extension health workers especially EHTs to reach the vulnerable population groups and WHO/HARP to provide logistical support and training of such cadres.
- WHO/HARP mobilize funds to immediately procure vital drugs, vaccines and medical supplies for all health institutions to ensure adequate cover.
5.6 Lessons learned
5.6.1 Information Management and Use
- Very insignificant/no data analysis and use at primary levels?
- Very insignificant/no data analysis and use at primary levels?
Implications on policy, budgeting and general resource allocation including drugs. Information not organized in a manner that would lead to immediate use. At risk areas and population groups not readily identified. Data on mortality not consolidated and is in different registers
- Data on HIV/AIDS not captured in the current HIS.
5.6.2 Disease Nomenclature
- Internationally agreed disease definitions should be used to avoid ill defined conditions constituting high figures - drug use?
- Clinical definition of HIV/AIDS urgently required to enable all levels to estimate the true disease burden in their localities.
5.6.3 Access to Health Services
- Staff at the periphery of the health system not able to articulate the heath situation appropriately and take relevant decisions - ownership.
- Outreach services to populations with no health facilities could be improved by fully utilizing the potential of EHT's
- VCW's and teachers handle some basic drugs why not the EHTs who could even do more?
- Staff shortages and their implications to the health delivery system - MoHCW to take steps to address the issue of staff retention - motivation, conditions of service, transport, communication, etc.
5.7 Plenary Session
Participants were worried by the occurrence of cholera during the dry season of the year, when in actual fact it is a water borne disease. Mr. Kupe was equally worried. However he told the participants that in this particular case there was a woman who had traveled to Mozambique and contracted the disease there. The woman eventually died. This did not come to the attention of officials until the care giver to this woman had also died. It is suspected that the disease was spread through hand to hand contact.
This case of cholera outbreak occurred in Zaka and Bikita rural and Small Scale Commercial Area. There is 1% sanitation coverage and in Bikita people drink water from the canal, and the water was probably contaminated. Toilets in these areas, were destroyed by Cyclone Eline. The outbreak is therefore related to sanitation problems within these areas.
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