Outbreaks: Factors hampering solid response

By The Standard | Apr. 26, 2020

The global village has been marred by a lot of outbreaks especially of viruses and bacteria. So many lives have been lost and the world has been quivering lately with the deadly coronavirus, which started in China at the end of 2019.

health talk:with Dr Johannes Marisa

To date, more than 195 000 people have lost their lives, with the United States topping the list of countries with the highest fatalities. More than 50 000 lives have been lost in America alone. Europe has been severely ravaged, with Italy, Spain, France and the UK being the worst hit. Zimbabwe has recorded only 28 cases and has four fatalities while neighbouring South Africa has more than 4 220 cases with at least 79 deaths. If really we have these 28 cases only, then we are a blessed nation that walks under the Lord’s umbrella. Prayer is the solution then on top of measures that our government is trying to put in place to contain the virus, that is, social distancing, lockdowns, quarantine, contact tracing, screening and testing. However, we ought to intensify testing as only less than 3 500 people had been tested in Zimbabwe as of Friday compared to South Africa, which has tested more than 100 000 people.

There are so many incommodious health issues in our country and some of them have been squirming for some time. These issues have been hampering our efforts as a nation to fight outbreaks easily. Between 2008-2009, Zimbabwe experienced a cholera outbreak which killed more than 4 200 people while in 2018, the same disease killed more than 50 people. Cholera is caused by a bacterium, Vibrio Cholera, which is treatable. The disease needs rehydration, so why is it that we continue to lose lives from such old diseases? Are we lacking something that leaves us exposed in terms of preparedness? I personally think the health sector in Zimbabwe has some issues that need all our efforts as a nation if we are to preserve life. Below are some of them:

Underfunding The Abuja Declaration of April 2001 saw African Union member states pledging to allot at least 15% of their annual budget to improve the health sector and urged donor countries to scale up support. Health financing in Zimbabwe is mainly tax-based, with some people, of course, resorting to user fees and private health insurance. However, the pooled funds seem inadequate, with the Health ministry getting between 8%-10% of the total budget for the past five years (8,3% in 2018, 9% in 2019). This has been attributed to inadequate funds in Zimbabwe because of poor budgetary support due to low economic production, and high unemployment rate, low foreign direct investment (FDI), to mention but a few. Sanctions have been pointed to as causing damage to the economy with the Zimbabwe Democracy and Economic Recovery Act (ZDERA) of 2001 being an example. What a catastrophe! Because of inadequate fiscal funds, it is imperative that non-government organisations (NGOs) chip in. Some NGOs have thus chipped in to complement government efforts in the health sector. Bilateral aid has been of great importance and in April 2018, the European Union availed 23 million pounds to the Ministry of Health in order to improve quality health services for women and children, and reduction of under-5 and maternal mortality. Transparency and accountability over fund use are quite critical if we are to get more assistance as a nation. Re-engagement of the West will be of importance and it requires political goodwill. The Foreign Affairs minister has to remain on his toes. One day, sanctions will be lifted!

Poor infrastructure, desolate equipment, drug shortages While everyone has been crying about personal protective equipment (PPE), especially with the Covid-19 scourge, I have noted with concern that some medical professionals are still exposing themselves to the virus by not putting on masks which should be mandatory while at work. I saw nurses at Marondera Provincial Hospital attending to patients without masks. Was it because they did not have the masks and gowns or they simply did not like them? Let us be careful as a nation if we are to succeed in the fight against coronavirus. PPEs are a necessity as well as alcohol-based sanitisers. The cholera outbreak in 2018 had its epicentre in Glen View. Again, the nation was caught unprepared, with fingers being pointed at water contamination. Sewage contamination of water tables has always been an issue for a long time. Simple intravenous fluids like crystalloids should always be in stock on top of antibiotics if such outbreaks as cholera are to be easily contained. Harare needs complete rehabilitation of its water infrastructure.

Zimbabwe has seen a lot of medical equipment being too old and this has affected surgical procedures. Operations like open heart surgery cannot be done at the moment despite us having cardiothoracic surgeons because of the absence of a cath-lab, which is essential for diagnostic imaging in order to visualise the arteries of the heart during a heart operation. It now needs complete overhaul of all old equipment especially in theatres. Some hospitals have been depreciating in terms of face value because of lack of maintenance. Important life-saving drugs are in short supply in hospitals. Cancer patients have been forced to bear the brunt of expensive chemotherapy drugs like Vincristine, Doxorubicin, Methotrexate and Cisplatin. Special anti-hypertensives are rare to find in public systems. Government institutions have been stocking HCT, methyldopa, nifedipine and atenolol while the newly-used ones like Tenoric, Indapamide, Amlodipine and Valsartan are not found at all. Donors can chip in to help our dear Zimbabwe. It requires good administration at the hospitals to just paint or repair some of the repairable things.

Brain drain Zimbabwe continues to lose critical medical staff that includes doctors, nurses as well as pharmacists, physiotherapists and scientists to other countries. Doctors have left for greener pastures that include regional countries like Namibia, South Africa, Botswana, the UK, and the US to mention but a few. Clemens and Peterson (2006) argued that 11% of African-born nurses and 28% of African-born doctors were working in nine major immigrant-receiving countries in 2000. The push factors have constantly been there. Poor remuneration and poor working conditions have been the dormant factors. Medical professionals in our country have endured poor working conditions which have been aggravated by lack of corporate support to the profession.

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A lot of these professionals walk on foot to their workplaces while vehicle companies watch with great reluctance to offer even hire purchase terms. An intern doctor for sure will have no money to pay the exorbitant initial deposit demanded by a large number of garages in our country. This is totally different from countries like Namibia and Botswana where medical professionals can drive off from garages with zero deposit. Other important benefits include own stands, and housing which can make staff more comfortable. Government, through the Health ministry, can be guarantors to such facilities and by so doing, staff turnover can be stemmed.

Job freeze The response to outbreaks like Covid-19 requires adequate and motivated staff. Being understaffed is a disaster. Since 2013, the public health sector has been affected by a job freeze where the government stops the recruitment and selection of employees because of inadequate funds. Job freeze has seen some nurse graduates staying at home for close to two years because they could not be employed. Lately, government has unfrozen about 2 000 health jobs out of about 4 000 vacancies. That is a good move considering the threat posed by the deadly coronavirus as more medical staff will be available in clinics and hospitals.

Shortage of nurses and doctors has an impact on nurse-patient and doctor-patient ratio and the quality of service for sure diminishes. The nurse-patient ratios is supposed to be 1:4, but Zimbabwe stands at more than 1:15, while the doctor-patient ratio is currently above 1:100 000. That alone compromises service delivery. It will be imperative if budgetary support is sought in order to fund the critical health sector. Rural health centres have sometimes been forced to operate without state registered nurses with nurse aides filling the gaps. It is thus my view that the health sector, being critical as it is, should not be affected by job freeze.

Corruption Corruption has derailed development in hospitals and surprisingly, no arrests are being made. One of the biggest talks of 2019 was corruption. Public health institutions have not been spared in terms of corruption. The supply chain of drugs has been compounded by corruption and recently, a pharmacist, one Russel Tatenda Mweye, was in the courts facing charges of manipulating the tender process at Parirenyatwa Group of Hospitals by awarding a tender to his company, Flancon Investments. In 2013, the National Economic Conduct Inspectorate (NECI) report on the procurement processes by government hospitals exposed irregularities at Parirenyatwa, Sally Mugabe Central (formerly Harare Central), Mpilo Central, United Bulawayo Hospitals and Mutare General hospitals. NECI noted glaring irregularities in the tender for a C-arm mobile image intensifier acquired by Harare Central Hospital on September 23, 2009. Mutare General Hospital, which received US$3 million under the targeted approach funds, was fingered for inflating prices of simple basic items such as keys, paint and wire nails by 100%.

All those who are implicated in corruption should face the full wrath of the law and political connections should not matter in their prosecution. Recoveries should be done and hefty punishments meted out to deter would-be criminals.

l Dr Johannes Marisa is a medical doctor and an educationist who can be accessed on [email protected].