social commentary:with Moses Mugugunyeki
Erica Chironda* looks lost in thought as she sits by the fire in their small hut alongside her husband.
While her husband is talking glowingly about the prospect of a bumper harvest following news of a promising rain forecast across the country, Chironda is thinking otherwise.
She is expecting her third child in the next two months. At some point she will have to go and wait for her turn at the local clinic’s maternity shelter, some 20km away.
For her, giving birth hasn’t been much of a problem considering she has had her previous deliveries at the same health facility — Chiwenga clinic in Muzarabani North.
The rainy season to Chironda and many other expecting mothers in Muzarabani and other malarial endemic areas is not a bed of roses.
If it rains before she gives birth, she will have to face three fronts — crossing a flooded river, exposure to mosquito bites and an ill-equipped health facility.
“I must check in at the clinic in early December,” said Chironda.
“I have gone for prenatal care and been given advice as well as antimalarial drugs.”
For expecting mothers, prenatal care reduces the chances of serious problems like pre-term birth, anaemia and low birth weight.
According to a 2017 study by the Stanford University School of Medicine, babies born to mothers who received no prenatal care are three times more likely to be born at low birth-weight.
Chironda’s biggest fear is giving birth in the midst of a malaria season.
According to the World Malaria Report 2019, in 2018, an estimated 11 million pregnant women were infected with malaria in areas of moderate and high disease transmission in sub-Saharan Africa.
As a result, nearly 900 000 children were born with a low birthweight.
When the government embarked on an antimalarial campaign from 2003 in joint operations with partners, the effort brought amazing improvement in malaria eradication in the country.
However, in the last two years, it has depressingly dawned on the people in malarial areas that what they had believed to be a life-long health menu was in fact a temporary meal ticket.
“The mosquito net that I was given when I gave birth to my second child two years ago is torn,” Chironda said.
“I have engaged our local community health worker over the matter, but they are waiting for a consignment coming from the provincial offices.”
Sleeping under insecticide-treated bed nets and taking preventive medicine for malaria is the mainstay in reducing infections and deaths among pregnant women.
“Recently I went to the clinic for prenatal care and I was given some preventive antimalarial medicines to protect myself and my unborn baby,” Chironda said.
However, The Standard established that government hasn’t started the vector control programme, which include insecticide-treated nets distribution and indoor residual spraying.
Questions sent to the Health ministry through its public relations manager Donald Mujiri had not been responded to by the time of going to print.
However, sources in the ministry said the programme was just delayed due to “logistical challenges”.
“Zimbabwe’s malaria control programme relies mostly on donor support. In some areas, I think they have started the vector control programme,” the source said.
The country’s malaria funding and programme support partners include Global Fund, United States President’s Malaria Initiative (PMI), World Health Organisation, Malaria Elimination 8, Bill and Melinda Gates Foundation, Isdell: Flowers Cross Border Malaria Initiative and United Methodist Church, among others.
PMI is one of the key partners in malaria eradication in Zimbabwe.
“The proposed PMI fiscal year 2020 budget for Zimbabwe is $14 million,” says the PMI Malaria Operational Plan (2020).
“PMI has been a proud partner of Zimbabwe since 2011, helping to decrease child death rates by 18% and reducing malaria incidence to 19 per 1 000 population through investments totalling almost $131,5 million.”
Chironda’s husband, Alfred, said the situation might worsen if it rains more considering that the nearby health facility is across a river.
“If it rains it will be difficult to take her to the clinic because Mukumbura River would be flooded. “There is no bridge,” he said.
Alfred said apart from crossing the river, most roads in the area were impassable.
“Reaching out to communities for indoor residual spraying and mosquito nets distribution will be a problem if it’s delayed because roads and bridges would be flooded if it rains,” he said.
He said the vector control programme starts in September or early October.
However, environmental health technician for Chiwenga ward in Muzarabani North Milton Hwayerera said they had started the distribution of nets in the area.
“We have started distribution of insecticide-treated nets and we were prioritising expecting mothers,” Hwayerera said.
“We are expecting another consignment of nets in the next few days and as of the indoor residual spraying programme, the teams are already in the villages in preparation for the spraying, which starts very soon.”
Hwayerera said efforts were being made to reduce malaria infections and deaths among pregnant women and children at community level.
“We encourage expecting mothers to go for prenatal care where they get malaria preventive drugs, education and in some instances they get insecticide-treated nets,” he said.
“We also move around communities raising awareness on malaria. Unfortunately, some of our awareness material is archaic and we need new material.”
Community Working Group on Health executive director Itai Rusike said there was need for timeous intervention as the malaria season approaches.
“The spike in malaria cases and deaths during the Covid-19 pandemic has been a worrying issue, especially now that we are in the high-risk malaria season due to the rains and high temperatures,” Rusike said.
“This calls for strong public health interventions to protect vulnerable groups such as pregnant women and children less than five years.
“The country needs sustained investment in strengthening the health system that is critical to help Zimbabwe respond to Covid-19 and protect the gains achieved over the years in the area of malaria prevention and control measures.
“Our maternal mortality rates are already unacceptably high and the maternal death rate may also be exacerbated by the risk of malaria infection if adequate prevention measures such as household and river bank spraying are not put in place.”
According to the Health ministry, 131 people have died from malaria in the country in a new outbreak early this year.
“The cumulative figures for malaria are 135 585 [cases] and 131 deaths. A total of 201 malaria outbreaks have been reported throughout the country, mostly from malarious provinces such as Manicaland, Masvingo and Mashonaland East,” reads a report from the Health ministry in April.
Rusike attributed the surge in malaria cases to government’s lackadaisical approach in its health care system.
“The fragmented and verticalisation approach of our health delivery system may result in Zimbabwe experiencing unnecessary loss of life to avoidable and preventable maternal deaths as a result of our failure to control and manage malaria infections,” he said.
“It is likely that we may continue to see malaria cases and deaths rising in the country as our attention is diverted to Covid-19 to the detriment of the other essential health care services.
“There’s need to ensure continuity of the comprehensive essential health services and massive malaria-spraying programmes must be maintained and supported.”
He said the Covid-19 pandemic presents a plethora of challenges to the country’s health delivery system, threatening the existing care capacity.
“Covid-19 has highlighted a deeper problem in the financing of our health systems exposing the majority poor people to preventable illness and death,” Rusike said.
Public health expert and Medical and Dental Private Practitioners Zimbabwe Association president Johannes Marisa said the instability in the health sector was a drawback in malaria eradication efforts since most health centres were not fully operational.
“So many health care services have been suspended with outpatient services being grounded at central hospitals. That was necessitated by Covid-19 control regulations,” Marisa said.
“The University of Zimbabwe’s department of Medicine and Obstetrics and Gynaecology had been shut down with the registrars being told to go away from the teaching hospitals. This, therefore, leaves the division of medicine incapacitated to handle medical cases and malaria is one such condition.
“Vector control measures have been hampered for 2020 with very little progress being made in the distribution of materials like mosquito nets.
“With restricted movement due to Covid-19, malaria control personnel could not penetrate a lot of areas for health education and material distribution.
*Not her real name.