A collapsing health system, healthworker strikes and the advent of Covid-19 have fuelled a resurgence of malaria in Zimbabwe, with deaths from the disease rising by more than 50% from the previous year.
By Nokuthaba Dlamini
According to the latest figures from the Health and Child Care ministry’s malaria control programme, there were 393 deaths from malaria as of mid-November — up from 257 the previous year and 183 in 2018.
In fact, malaria deaths surpassed the number of people who have died from Covid-19, which stood at 281 deaths as of December 5.Malaria cases also increased by 58%, from 242 951 cases in 2019 to 384 956 this year, the ministry told this publication.
Experts warn that as the country now enters its next malaria season, cases and deaths are expected to increase further due to the absence of immediate solutions in place.The trajectory shows a reversal in the gains the country was making towards the elimination of malaria.
Battles on two fronts
Zimbabwe’s malaria season, which runs from November to the end of May, coincided with the outbreak of Covid-19, which meant the country, whose economy has been weakened by years of international isolation and droughts, faced battles on two fronts.
Peak malaria transmission typically happens in March, which this year occurred at the beginning of a national lockdown that was partially relaxed in July.Health and Child Care ministry officials said the country recorded significantly more malaria fatalities during that period.
For example, in April, 18 people died in one week in the three provinces most affected by the disease — Mashonaland Central, Mashonaland East and Mashonaland West — the highest number reported all year. Many experts believe the number of deaths is likely to be much higher because tight lockdowns meant fewer people accessed health centres during that time and may have died at home.
“Promotion of measures meant to prevent Covid-19 though noble, contributed to delays in accessing malaria testing and treatment services especially in the remote areas,” Joseph Mberi, director of malaria at the Health and Child Care ministry, told The Standard.
“With malaria, early treatment (within 24 hours of onset of illness) is critical in controlling further infections in the community and it prevents progression to severe disease that can lead to loss of life.”
A nurse at Binga District Hospital in the malaria-prone Zambezi Valley in Matabeleland North province said at the height of the lockdown, they received an average of 10 malaria patients per day.
Before Covid-19 arrived, they typically handled 100 per day.
“Our wards have been empty since the Covid-19 pandemic began,” said the nurse, who cannot be named because she is not authorised to speak to the media.
“It has been difficult for people to visit the hospital, especially those from the Nsungwale area that was affected by floods in February,” she added.
According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), outpatient consultations at public hospitals in Zimbabwe declined by 36% between April and July compared to the same period in 2019.
Lack of Covid-19 preparedness
“No ministry was prepared for Covid-19, Ministry of Health and Child Care included,” said Mberi. “There was inadequate information on how to handle Covid-19 and malaria cases.”
Itai Rusike, the executive director of the Community Working Group on Health (CWGH), a network of community groups, said the upsurge in malaria cases and the advent of Covid-19 had put pressure on a health delivery system already weakened by overdependency on donors, intermittent strikes by doctors and nurses and minimal investment from the government.
“Covid-19 has been a wake-up call for countries with weaker health systems, especially those that have been relying on global donor funding, and this is what we are witnessing in Zimbabwe,” Rusike said.
He explained that Zimbabwe’s national budget in the past had seen very little money being allocated towards health and relied on donors.
“This left the country more vulnerable and exposed to disease outbreaks,” Rusike said.
Last year, Zimbabwe’s budget allocation for health was US$4.80 per capita, almost 90% lower than the US$36 recommended by the World Health Organisation (WHO), leaving many public health facilities without medicines.
The inadequate budgetary support has also been blamed for the brain drain in the health sector with doctors and nurses leaving for better paying jobs in other countries.
Rusike said when Covid-19 arrived, the country immediately shifted its focus wholly towards the pandemic.
“This is why we are witnessing more and more numbers of malaria deaths and maternal deaths alongside rising HIV and tuberculosis cases,” he said.
The number of new coronavirus infections has been declining since August, leading to the relaxation of strict lockdown restrictions, but the crisis in the health sector is far from over.
Strikes ground hospitals
Public hospitals are struggling in Zimbabwe because as well as lack of funding for health, they have also faced intermittent strikes by health care workers over deteriorating working conditions.
At the height of the Covid-19 lockdown in March, health workers, including nurses and doctors, went on strike for three months, which left public health institutions operating with skeletal staff during a global pandemic.
They led boycotts over the lack of medicines at hospitals and inadequate provision of personal protective equipment.
But there are fears that many people died in their homes from diseases like malaria as health facilities turned patients away, meaning these deaths would have gone unreported, according to Zimbabwe Nurses Association (Zina) president Innocent Dongo.
The collapse of the health system has also fuelled clashes between health care workers and government.
Vice-President Constantino Chiwenga, who is also the Health and Child Care minister, ordered the sacking of nearly 1 500 nurses in November for rejecting his ministry’s cancellation of flexi hours for nurses.
Under the arrangement introduced a year ago, following complaints by health workers that they could afford transport fares to work on their meagre salaries, hospitals introduced a two-day working week for nurses.
But the Health and Child Care ministry, in an October memo to heads of public hospitals, said the introduction of flexi hours had resulted in lack of “continuity of nursing care in hospitals, compromised quality of patient care and exaggerated shortage of nurses resulting in inadequate ward coverage.”
Through their union, Zina, the health workers have since gone to court over the issue.
But the strikes, boycotts and limited resources, as well as Covid-19, have all led to reduced malaria prevention programmes in the traditional hotspots, according to Rusike.
“For this year, residual indoor and outdoor spraying was not carried out in communities prone to malaria like in Manicaland and Mashonaland West provinces,” he said.
“This is where most of the deaths have been recorded.”
Manicaland had 110 deaths from malaria, the highest in the country, followed by Mashonaland East with 70.
“Zimbabwe’s efforts to eliminate malaria have been eroded and achieving that goal in future will take years,” Rusike added.
At least 79% of Zimbabwe’s population is at risk of contracting malaria, but the country has made significant progress towards malaria elimination in recent years.
Health and Child Care ministry data shows that malaria cases in Zimbabwe had declined by 44% in 2018, with a 63% reduction in deaths since the turn of the millennium.
But since then, numbers have risen and experts warn that the crisis in the health sector will result in major reversals in the fight against the disease.
The resurgence of malaria also means Zimbabwe will miss United Nations goals to eliminate the disease by the end of 2020.
This story was produced by The Standard . It was written as part of Reporting Malaria, a media skill developments programme run by the Thomson Reuters Foundation. The content is the sole responsibility of the author and the publisher.