When Médecins Sans Frontières (MSF) arrived in Gweru in 2004, in a joint operation with the Ministry of Health and Child Care, the effort brought amazing improvement in the city’s health delivery system.
By Moses Mugugunyeki
The people of Gweru were happy with the new health services brought to them. Seven years down the line however, it depressingly dawned on the people that what they had believed to be a life-long health menu, was in fact a temporary meal ticket.
While the government was aware that it was a temporary health delivery arrangement, it failed to capitalise on the availability of the health expertise to impart knowledge to local personnel to enable the continuation of such a health delivery system at the expiry of the joint venture.
So, when the MSF Gweru contract came to an end in 2011, the inadequacy was exposed. Serious challenges in the treatment of HIV and Aids and tuberculosis (TB), especially drug-resistant TB (DR-TB), resurfaced.
MSF, which had by then moved on to Gokwe North, apparently noticed the problem that had befallen Gweru and were determined not to let the same thing happen at their next port of call.
“The strategy that we used in Gweru created gaps in the health delivery system after MSF had left,” said Stambuli Kim, communications officer for MSF. “Our objective in Gokwe North was then to reduce morbidity and mortality as a result of especially HIV and Aids and TB. We also ensured that activities would continue independently after MSF pulled out.”
The international aid organisation wrapped up its operations in Gokwe North at the end of last year having breathed life into the district’s health delivery system.
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Before then, the health delivery system in this part of the country had been a nightmare.
Elisha Chuma (33) from Kasavaya Village under Chief Chireya in Gokwe North battled with tuberculosis from 2008 until he got diagnosed with multi-drug resistant TB on February 14 2013 which was eventually treated in 2014.
During the five years, Chuma sought treatment from distant health care centres; at Gokwe South Hospital and Sanyati Baptist Mission Hospital in Mashonaland West, some 200 km away. He had to travel that far because the nearby health facility, Chireya Mission Hospital, had no capacity to treat TB.
Chuma, a father of six, was finally correctly diagnosed and treated thanks to the MSF supportive activity that came to his home district. He is one of the many people from Gokwe North who have benefitted from the MSF activity for HIV/TB/Sexual and Gender Based Violence (SGBV).
“If there wasn’t this MSF intervention programme I would have died,” Chuma said. “Before they came, I sought treatment from Sanyati Mission in Mashonaland West where I was diagnosed with TB. I had earlier visited the local Chireya Mission Hospital but couldn’t get any help.”
The sorry state of the health delivery system in Gokwe North tends to confirm claims that government has grossly neglected this part of the country, home to about 250 000 people since independence in 1980.
“Besides inadequate medical facilities, there are also many cases where sick people have needlessly died because they could not access medical attention due to bad or nonexistent roads,” said Edmond Kabarapate, the village head of Kafurambanje Village under Chief Chireya.
“Chireya Hospital has a large catchment area serving patients from as far afield as Zumba, Mashame, Madzivazvido and many other villages in Gokwe North. I am pleading with government and other organisations such as MSF to help our hospital with a high-terrain ambulance which suits our roads,” said the traditional leader.
Kabarapate hailed the partnership between MSF and the Health ministry, which he said had improved the health delivery system in the district.
“As traditional leaders, we learnt a lot on HIV, TB and GBV from MSF through their capacity building programmes. We have also seen our hospital receiving equipment and rendering services, which it could not do in the past,” he said.
Kabarapate said the pulling out of MSF from Gokwe North was a huge blow to the district’s health delivery system.
“I don’t think it was the right time for MSF to leave Gokwe North. They had been doing a splendid job for us here. Before 2012 people living with HIV and those suffering from TB travelled long distances to seek medical help,” said Kabarapate.
Despite the challenges, health centres in Gokwe North are now dispensing ART to over 4 822 patients, courtesy of the MSF programme.
One patient, Pauline Siziba (52) from Magavhu village under Chief Makore, said she was happy that she was getting ART from a nearby health centre — Kuwirirana Clinic.
“I used to travel to Sanyati Hospital to collect my drugs and in most cases I would even sell livestock to get bus fare. I want to thank whoever brought this programme closer to home,” said Siziba.
She also praised the professionalism of the health personnel at Kuwirirana Clinic.
“The nurses at the clinic are so jovial. I don’t have problems getting my ART and I have learnt a lot from the nurses here,” she said.
Most of the health personnel at the 18 clinics in the district are now able to administer ART having gone through MSF capacity building programmes. Twelve clinics were also accredited as initiation sites while six are follow-up sites, a development that is likely to boost ART and Opportunistic Infection (OI) services in the district.
However, district medical officer for Gokwe North Mthokozisi Moyo said despite the MSF roll out programme; the district was still facing a lot of challenges.
“The district has few health centres — 22 against a population of 250 000. Besides, we have critical staff shortages, shortage of medicines and surgical consumables,” he said. “There is also no radiology service needed to help in the diagnosis of TB in Gokwe North.”
Moyo said poor transport and communication systems were also a challenge especially in areas like Mashame, Vumba, Gandavaroyi and Norah.”
He hailed MSF for the three-year HIV, TB and SGBV programme in the district which he said had improved the health delivery system.
“MSF capacitated the district hospital with lab machines and backing power, on-the-job training for our nurses in integrated HIV management and drug-resistant TB management,” Moyo said.
“The ministry of health is now equipped with knowledge in management of HIV and TB and all clinics are now administering ART. We will miss MSF support as a ministry. We had established a good working relationship with them,” he said.
Acting provincial medical officer for Midlands, Brain Abel Maponga said the Ministry of Health and Child Care would now try to operate equally effectively without MSF support.
“They have been doing a good job during the three years they worked in Gokwe North. As a ministry, we will try to maintain this because they have capacitated our hospitals and trained our health personnel through capacity building programmes,” Maponga said.
He said MSF was welcome to roll out such programmes in other parts of the Midlands and called the international aid organisation to consider Mberengwa district for a similar project.
Mberengwa, Gokwe North and Gokwe South are the most populous but impoverished districts in the Midlands province.
MSF handed over the HIV/TB/SGBV programmes from 18 health facilities to the Ministry of Health and Child Care.
“All these health centres are providing quality HIV/TB care. Additional support was given to Burure and Zumba clinics,” said Kim.
