Changing outcomes through people-oriented health policies

22 Sep, 2022 - 00:09 0 Views
Changing outcomes through people-oriented health policies some of the medical equipment during the commissioning of Stoneridge Health Centre in Harare South in May this year

The Herald

 Elliot Ziwira and Donald Mujiri

Introduction

The attainment of Independence in 1980 brought more than majority rule to Zimbabweans, as it also saw citizens’ access to healthcare facilities and ancillary services improved on through the Government’s commitment to the provision of social security to the previously marginalised black people.

Rhodesia’s system was skewed in favour of whites, which created income inequalities and disparities in the provision of healthcare facilities.

Colonial injustices led to the establishment of two economies in one country: the white people’s economy and the black people’s one. Rather, there existed two nations: the European nation and the African nation.

The European nation, determined by whiteness, was urbanised, and had many facilities matched by high concentration of health personnel, especially professionals. The African nation, on the other hand, was ruralised, and was marked by inadequacy in terms of arable land, rains, schools, health facilities, roads, and sustainable livelihoods.

Independence, therefore, ushered in a new era in economic and social reforms for the betterment of citizens’ livelihoods. A new healthcare approach was adopted to address a plethora of discrepancies that Rhodesia’s system fed on.

Accordingly, the Government of Zimbabwe devoted itself to completing the exercise of restructuring and reorganising the Ministry of Health (now the Ministry of Health and Child Care) to enable it to take on the above challenges.

To achieve its target, the Ministry partnered private stakeholders to bring together resources to create a vibrant economic base ideal for the provision of healthcare services for all citizens.

At the helm of the Ministry is Vice President Dr Constantino Chiwenga, who is deputised by Dr John Mangwiro. Air Commodore Dr Jasper Chimedza is the Permanent Secretary.

The mandate of the Ministry of Health and Child Care (MoHCC) is to promote the health and quality of life of the people of Zimbabwe. Its purposes are to: achieve equity in health by targeting resources and programmes towards the most vulnerable and needy in Zimbabwe; facilitate primary healthcare provision for health development; identify priority health problems and allocate resources to alleviate them.

The mandate of the Ministry is to promote the health and quality of life of the people of Zimbabwe.

It endeavours to provide appropriate and accessible high-quality care and facilitate health promotion programmes aimed at disease prevention.

The Ministry of Health and Child Care aims to; keep as many citizens as possible in good health; provide appropriate quality services; provide high quality hospital services at the appropriate level for all citizens; and mobilise resources for the provision of healthcare services, distribute the same equitably and ensure proper financial management and control of funds.

The journey and milestones in brief

 Since Independence in 1980, the Government’s immediate task was to enact legislation that would put in place policy frameworks to correct colonial injustices in healthcare provision, among a litany of other inequalities.

The publication of “Equity in Health”, reinforced the Ministry’s strategy of “centralising policy and decentralising implementation” through the adoption of the Primary Health Care Approach.

In 1983, the foundation for an inter-sectorial approach towards “Health for All by the year 2000”, was firmly laid out across the country. Many ministries contributed towards the implementation of health and developmental programmes.

In colonial Rhodesia, Andrew Fleming Hospital, now Parirenyatwa Group of Hospitals, was the largest health institution. Named after the first medical director appointed to the Rhodesian Health Service, the hospital served the white community.

Blacks had Harare (Gomo) Central Hospital (now Sally Mugabe Central Hospital), which relied on equipment and drugs deemed as excess baggage at Andrew Fleming Hospital, built for them. 

Following Independence in 1980, the hospital was renamed in honour of Tichafa Samuel Parirenyatwa, who was the first black Zimbabwean to qualify as a medical doctor.

The institution encompasses Mbuya Nehanda Maternity Hospital; Sekuru Kaguvi, which specialises in eye treatment, an annex for psychiatric patients and several specialist paediatric wards. It also houses the University Of Zimbabwe College Of Health Sciences.

Notwithstanding economic challenges, the group of hospitals has continued to provide quality and cost-effective specialist healthcare services to the people of Zimbabwe. It has also remained consistent in the provision of modern training and research facilities for health personnel.

In the early 1980s, Zimbabwe’s health delivery system was enhanced through Government and private sector partnerships, which gave citizens access to affordable healthcare due to increased numbers of clinics and hospitals constructed countrywide.

In the mid-1980s, the Ministry of Health partnered with the World Bank to establish a family health project to expand and upgrade selected district hospitals across the country.

As a member of the United Nations (UN), Zimbabwe also partnered with other stakeholders that include World Health Organisation (WHO), United Nations Population Fund (UNFPA), World Food Programme (WFP) and United Nations Children’s Fund (UNICEF) to achieve its objectives.

In its endeavour to provide healthcare facilities for all Zimbabweans, the Government was supported by the Church through construction of mission hospitals.

The Zimbabwe Association of Church-related Hospitals (ZACH) partnered the Government in running national programmes aimed at expanding facilities on both preventive and curative health issues.

More than 65 provincial and district hospitals, among them, Chinhoyi, Chitungwiza, Guruve, Shamva, Murehwa and Hwedza, opened their doors after 1980.

The bias towards construction of more hospitals and clinics continued through the 1990s to the early 2000s and beyond.

As a way of mitigating challenges associated with access to healthcare, in September 2020, President Mnangagwa said the Government had earmarked funds for the construction of 6 600 clinics to ensure that no one travels more than 10km to reach a healthcare facility.

In its quest to give all Zimbabweans access to healthcare, from 1980, the Government provided free services to those earning less than $150 per month.

Special programmes were also initiated in the early 1980s to close the yawning chasm colonialism opened between urban and rural areas regarding healthcare provision. For instance, before 1980 immunisation programmes were confined in urban areas.

To address colonial disparities, in 1982 the Government initiated an all-encompassing immunisation programme against infectious diseases among children, and tetanus among pregnant women.

The programme, whose objective was to make immunisation available and accessible to every child by 1990, considerably benefited children in rural communities.

Almost 80 percent of children below the age of 12 months were successfully vaccinated by the end of 1990. According to the World Health Organisation’s estimates, the Expanded Immunisation Programme prevented more than 80 000 deaths of children under the age of five every year.

By September 2022, Zimbabwe had expanded many programmes on immunisation.

Investments have been made by the Ministry in equipment, vehicles, human resources, and cold chain equipment to sustain the expanded programme on immunisation with focus on eradication of childhood killer diseases.

The programme has matured, and has taken a lifespan approach to vaccination, including the more recent Covid-19 vaccines which have been rolled out nationally.

The Ministry achieved 77 percent coverage for tetanus toxoid and pertussis (DTP3) in routine childhood immunisation for the year 2021.

The target is to reach at least 80 percent coverage for this proxy indicator of the national immunisation programme. While this coverage is high by regional standards, the country has taken a dip from usual coverage due to effects of Covid-19 and human capital shortages.

The Ministry continues to strengthen measures to reach all children and meet universal immunisation coverage goals.

 NB: DTP 3 coverage is the proxy indicator for general EPI performance.

Prioritisation of diarrhoeal diseases control in 1982 paid dividends as by 1988 over 90 percent of mothers were conscious of oral rehydration therapy. Also, rural-urban discrepancy in antenatal care was significantly reduced.

Zimbabwe plans to maintain the elimination status for maternal and neonatal, tetanus and polio-free certification status until they have been eradicated.

By the early 1990s, the country had attained the highest rate of contraceptive use in sub-Saharan Africa.

A nutritional programme was started to help feed over 250 000 children to mitigate the impact of drought at the peak of the 1980s and early 1990s. To date, in collaboration with donors and the private sector, the Government of Zimbabwe runs nutritional programmes aimed at feeding children and other vulnerable groups in rural and urban communities.

Moreover, Zimbabwe achieved elimination status for maternal deaths in 2000, and is in the pre-elimination phase for measles, and achieved polio-free certification status.

In March 2020, the Zimbabwe National Statistics Agency (ZIMSTAT) circulated wide-ranging findings from the Multiple Indicator Cluster Survey (MICS 2019) indicating a decline in maternal deaths.

This shows that the country is in the right direction towards eradication of the scourge.

In the latest MICS report, Zimbabwe recorded a decline in maternal mortality from 614 to 462 maternal deaths per 100 000 live births since 2014, and a surge in full immunisation coverage to 85 percent.

The country has remained committed to its pledges at the 2019 International Conference on Population and Development (ICPD25) in Nairobi, Kenya. Halving maternal deaths from 614 to 325 per 100 000 live births by 2030 topped the list of Zimbabwe’s pledges at the summit. 

As Sachiti (2020) notes, the reduction in maternal deaths has also been necessitated by Government’s policies on healthcare provision. These are, among others, construction of mothers’ waiting homes, scrapping of maternity fees in public hospitals and issuing of free blood coupons.

The donor community’s efforts, in collaboration with the Government’s, have also contributed to the decrease in maternal deaths.

Waiting shelters have come in handy to rural women who, in some cases, had to endure long distances to access healthcare facilities. Shelters or maternity waiting homes help in the reduction of maternal and perinatal mortality by facilitating access to skilled birth attendance and emergency specialised care for women, especially those in rural communities.

They also arrest the three delays; delay in decision to seek care; delay in reaching care and delay in receiving sufficient healthcare.

Development partners like the United Nations Children’s Fund under programmes such as the H4+ and Health Transition Fund (HTF), and the United Nations Population Fund (UNFPA), provide funding for mothers’ waiting shelters through technical and financial support to the Ministry of Health and Child Care.

Direct and quantifiable causes of deaths in pregnancy and childbirth in Zimbabwe are largely severe bleeding (after childbirth), infections, and high blood pressure during pregnancy (pre-eclampsia and eclampsia).

The Government has partnered stakeholders to curb these causes.

For instance, United Bulawayo Hospitals, which records about 4 756 deliveries yearly with a 40 percent C-Section rate, has benefited from a partnership between the Ministry of Health and Child Care and UNFPA.

The Government of Zimbabwe, however, has taken over the funding of blood coupons.

Before Independence, training in Medicine, and other health sciences was a preserve for whites, who enjoyed free and easy access to university education, with blacks having to pass through a bottlenecked system that squeezed them out.

Thousands of doctors and nurses have been trained since 1980, to close the rural-urban healthcare provision gap. Between 1980 and 1989, the number of doctors graduating from the University of Zimbabwe increased by about 40 percent (Sanders, 1992).

However, the distribution of health personnel was still a challenge, especially so as the numbers fell short of requirements. Another challenge in the early 1980s and 1990s was that health personnel, especially doctors, shunned rural mission and district hospitals.

According to Sanders (1992), in 1983, 67 percent of doctors were at central level, with 1 596 at provincial level, and a further 15 percent at district mission hospitals. The proportion of doctors at central level had increased to 72 percent, 12 percent of whom were in the provinces and 16 percent in district and mission hospitals, by 1988.

To address the issue, the Government recruited expatriate doctors to man provincial and district hospitals, while putting in place mechanisms to attract and retain personnel. 

Following Zimbabwe’s independence from Britain in 1980, Zimbabwe’s health sector adopted a strong focus on PHC.  Zimbabwe moved from a “curative, urban-based and minority-focused healthcare system to one which emphasized health promotion and prevention, and provided some acceptable level of healthcare to the majority rural population.”  

As part of the shift toward PHC, the National Village Health Worker Programme was formally launched in 1981 with a goal of training 15 000 village-based basic health workers, and extending healthcare coverage to people who would otherwise have no access.

From 1982 to 1987, the Government trained between 900 and 1 000 village health workers annually, so that by 1987 there were 7 000 of them to enhance promotive and preventive care in rural areas.

The programme focuses on disease prevention and provision of community care at primary level in rural and peri-urban areas, thus, serving as a key link from the community to the formal health system.

Where economic stratification exists, as is usually the case in rural areas, villagers are divided among themselves to ensure that the neediest are the first to be served.

The 1990s and early 2000s saw demand for healthcare services surging due to HIV/AIDS prevalence, hence encumbering authorities in their efforts to contain the condition, leading to loss of many lives.

However, through Government’s partnerships with donors and other stakeholders, inroads have since been made in the provision of antiretroviral therapy, containment of prevalence rate and curbing of stigmatisation.

Zimbabwe is making progress towards the UNAIDS 90-90-90 goals.

 The UNAIDS targeted that in 2020, 90 percent of people living with HIV would know their status, 90 percent of people who know their HIV-positive status would be on treatment, and 90 percent of people on treatment would have a suppressed viral load.

According to the Zimbabwe Population-based HIV Impact Assessment (Zimphia) 2020 study, more than 95 percent of targeted people were tested for HIV in the first phase launched in 2019.

The Zimphia 2020 study is a population household survey led by the Ministry of Health and Child Care working in collaboration with the Zimbabwe National Statistics Agency (Zimstat), National Aids Council (NAC) and ICAP at Columbia University.

The study, which is supported by the United States President’s Emergency Plan for Aids Relief (Pepfar) through the Centre for Disease Control and Prevention, is aimed at determining Zimbabwe’s progress towards UNAIDS’ 90-90-90 goals, as well as guiding policy and funding priorities.

Major highlights

 The National Health Strategy (NHS) 2021-2025 was developed taking into consideration the challenges that the country has gone through. These include the economic instability since 2008, the changeover from the First Republic to the Second Republic, and the onset of the Covid-19 pandemic.

The NHS (2021-2025) builds on the NHS (2016-2020) by addressing identified existing gaps following the Mid-Term Review of the NHS (2016-2020), and, more importantly, seeks to sustain the gains achieved so far through a comprehensive response to the burden of disease and strengthening of the health system to deliver quality health services to all Zimbabweans.

This strategy aims to strengthen the provision of equitable, affordable and quality health and related services at the highest attainable standards to all Zimbabweans.

It targets to attain an even distribution of health facilities at a level commensurate with that of a middle income country, through attainment of specific health impact targets.

The country’s health sector strategic focus is guided by the national Vision 2030, which seeks to transform Zimbabwe into an upper-middle income economy by 2030, and the National Development Strategy 1: 2021-2025 (NDS 1).

The NDS 1 identified health as central to human happiness and well-being, making it an important contributor to economic progress, as healthy populations live longer, are more productive, and save more.

The blueprint’s vision is to ensure the highest possible level of health and quality of life for all citizens of Zimbabwe by 2030. And, this is anchored on the identified 10 health outcomes.

Communicable diseases still constitute a major share of the disease burden affecting Zimbabweans.

HIV/AIDS still remains the main burden, with an HIV prevalence rate of 12,8 percent among adults aged 15-49, 15,4 percent among females, and 10,1 percent among males (UNAIDS 2018).

Among pregnant women in antenatal care (ANC), HIV prevalence is 14,2 percent. 

Zimbabwe has made significant progress towards the 95-95-95 targets.

In 2019, 91 percent of HIV-positive people (aged 15 and older) knew their status, with 93 percent of these on antiretroviral therapy (ART). About 86 percent of those on ART were virally suppressed.

In addition, the estimated tuberculosis incidence in 2018 was 210 per 100 000 population (Global TB Report 2019). Two thirds (62 percent) of notified patients were co-infected with HIV in 2018.

Males bear the brunt of disease burden, particularly the economically productive 25 to 44-year age category due to smoking behaviours and work-related environment.

Furthermore, malaria continues to be a key driver of morbidity and mortality rates in Zimbabwe. Malaria transmission intensity has seasonal and geographic variation corresponding closely with the country’s rainfall patterns and topography. Transmission is perennial in malaria-prone areas. Seasonal increases occur annually, with most transmission occurring during or just after the November to April rainy season.

There is higher malaria transmission in the northern and eastern border regions, with more limited transmission in the central and south-western parts of the country.

At the national level, annual incidence (cases per 1 000 population) has decreased substantially over the last 15 years, from 153 in 2004 to 19 in 2018.

Non-communicable diseases (NCDs) affect people of all ages and classes, and are currently the leading cause of deaths in the world. NCDs have similar risk factors, which are mainly attributable to lifestyles, such as physical inactivity, unhealthy diets, tobacco use, and drugs and alcohol abuse.

There is a need to conduct comprehensive epidemiological studies to ascertain the burden of most NCDs in the population. However, hospital data indicate that NCDs are an emerging problem and require urgent attention.

In response to the challenges posed by non-communicable diseases, the Government has set up a NCDs Department at the Ministry of Health and Child Care.

Another area of reflection is excess mortality in malaria-prone areas among rural communities. The excess mortality, and the associated morbidity, among the rural and African populations has been identified to be overwhelmingly due to nutritional deficiencies, communicable diseases, maternity-related and neo-natal problems.

The performance of the health sector in the area of leadership and governance is analysed along the following key areas: public policy, legislation and regulation; organisation and management; planning and resource mobilisation; transparency and accountability; and monitoring and evaluation.

The main sources of healthcare financing in Zimbabwe are, Government budget appropriations and donor funding, with household health expenditure coming through out-of-pocket expenditure.

Total government health expenditure (TGHE) as a proportion of total expenditure has been slightly improving over the years, particularly from 2015 to date. External support is currently targeted towards vertical programmes, such as those for HIV/AIDS, malaria and TB.

Vertical donor support is characterised by certain rigidities and cannot be moved to other priority areas less favoured by donors. The private health insurance is also in existence in Zimbabwe, and is characterised by several employer-based and voluntary medical schemes.

To bridge the financing gap, the Government is currently working on the establishment of a National Health Insurance (NHI) as a complementary source of health financing.

Moreover, child mortality indicators, infant mortality rate and under five mortality rate have shown some signs of declining over the same period.

Generally, the coverage of reproductive, maternal, new-born, and child health (RMNCH) interventions have been improving over the five-year period from 2014 to 2019, and has varied from 71,4 percent (four ANC visits) to 82 percent for mothers and 91 percent for new born babies (PNC) (MICS 2019).

National immunisation coverage has shown that the proportion of children who received Penta 3 below one year rose from 89 percent (ZDHS 2015) to 90,6 percent (MICS 2019).

Districts with DTP3 coverage (80 percent) increased to 59 out of 63(93,6 percent) in 2018, up from 54/63 (86 percent) in 2017. Dropout rates for all antigens remained below 10 percent in all antigens except for MR1 – MR2 that was 11 percent.

Integrated outreach services

In the context of the Covid-19 pandemic, ZEPI introduced the concept of integrated outreach, whereby a comprehensive package of health services is taken out to communities who live far away from existing centres.

The package rides on the existing monthly EPI outreach conducted in all districts. Health services available through this strategy include childhood and Covid-19 vaccination, HIV, reproductive health, rehabilitation, mental health, nutrition and telemedicine services.

The integrated approach has assisted communities to access services near their homes, particularly after the disruptions caused by the new coronavirus. The outreaches are still ongoing, and communities have given positive feedback on them.

Roll-out of Covid-19 vaccination

The Ministry has rolled out a massive Covid-19 vaccination drive, which is currently underway, targeting 70 percent herd immunity. The programme was launched on February 18, 2021. As of September 19, 2022, 6 505 085 (57,9 percent)  people have received the first dose and  4 858 951 (43,2 percent), the second dose.

Best practices in the programme include:

Sustained and timely procurement, deployment and delivery of vaccines by the Government strategic engagement of private sector in vaccine procurement and delivery models Integration of Covid-19 vaccination with existing health services for wider reach.

The Ministry expanded medical training programmes in different specialties

Investment in solar direct drive refrigerators

In another development, the Ministry, with support from its partners, has invested in solar direct drive (SDD) refrigerators to improve vaccine handling (Cold Chain Capacity), benefiting all HFs in remote rural areas where electricity may not be available/reliable all the time.

Solar for health project

A total of 1 051 solar direct drive refrigerators have been procured and installed in all clinics, and some hospitals have been commissioned. Further investments in this direction are being made to cover the few remaining health facilities, mostly in urban areas, with the more reliable solar powered refrigerators.

Introduction of Typhoid Conjugate Vaccine

Another significant milestone is the delivery of lifesaving vaccines to the nation by the Government, through the Ministry of Health and Child Care, was the national campaign to introduce Typhoid Conjugate Vaccine (TCV) into routine childhood immunisation in Zimbabwe as part of a broader strategy to eliminate epidemic prone diseases.

The campaign was conducted in 2021

The introduction of typhoid vaccines was done in line with the Government’s thrust to improve the quality of life of citizens of Zimbabwe, particularly children, by protecting them from outbreak prone diseases through the use of vaccines.

Since then, children in Zimbabwe are now receiving TCV through routine immunisation at nine months of age.

This is expected to significantly reduce the number of children susceptible to typhoid in the country, and move forward the Government’s agenda to eliminate the malady and other outbreak prone diseases like Cholera.

Zimbabwe was one of the first countries in Africa to take the bold step of introducing TCV into routine immunisation.

Milestones in surgery

Zimbabwe has held her forte in medical annals by successfully performing a major operation on Siamese twins born on April 22, 2014 to a Murehwa couple.

A team of 50 Zimbabwean medical personnel, led by academics from the University of Zimbabwe’s College of Health Sciences, worked on the eight-hour delicate procedure at the Harare Children’s Hospital in July 2014.

The twin boys; Kupakwashe and Tapuwanashe Chitiyo, were joined from the lower chest to the upper abdomen and shared a liver.

In September 2019, Zimbabwean surgeons broke yet another world record by successfully conducting an operation to remove a 12,3kg 11-year-old kidney cyst from a patient at Parirenyatwa Group of Hospitals.

The cyst became the largest to be removed in the world, with the previous record set in Japan where a similar one weighing 11,5kg was removed.

Dr Shingirai Meki, a consultant urologist and lecturer at the University of Zimbabwe’s College of Health Sciences, led the team of Zimbabwean doctors that conducted the complicated surgical procedure.

Hospital and medical infrastructure since 2018

Zimbabwe healthcare is provided through primary, secondary, tertiary care and quinary hospital, to cover all disciplines. Since 2018, the Ministry of Health and Child Care made significant achievements in the development of health infrastructure ranging from the construction of new health facilities to rehabilitation/refurbishment of existing infrastructure.

In view of the above, a total of 47 health facilities were constructed and completed, 94 projects were under renovation/ rehabilitation to completion, a total of 1 074 health facilities were solarised, and 201 health facilities benefitted from the borehole water project.

The Stoneridge Health Centre in Harare South

The construction of Lupane Provincial Hospital has progressed significantly on the central stores, pharmacy, casualty, outpatient department, administration block, junior staff house, maternity block, surgical ward, paediatric ward, dental clinic, eye clinic, kitchen substation, and antenatal and post-natal section.

The Ministry has invested an estimated US$210 million on bringing quality healthcare to all Zimbabweans, with the project set to provide four by 20-bed and 26 by 20-bed health centres as well as five by 60-bed district hospitals. A hi-tech equipped Stoneridge health centre was opened with outpatient, maternity, ART and inpatient facilities and staff accommodation.

 

The nearly complete Lupane Provincial Hospital staff residence

Medical equipment

The Government of Zimbabwe has procured medical equipment at national level as well as through its institutions. The equipment is part of the initiative by the Ministry of Health and Child Care to retool its hospitals.

The equipment is to the tune of US$23m, and deliveries and installations of the same have started. Some of the equipment include the following:

Magnetic resonance imaging equipment

Mammogram

Image intensifiers (C-Arm)

Fixed Digital Xray machines

Mobile digital x-ray machines

Anesthetic machines

Ophthalmic microscope

 Dental sets, which include dental chairs, dental x-ray and dental autoclave

Vital signs monitors

Covid virtual hospital equipment

Ventilators

Theatre lights

Multiparameter monitors

Ultrasound scan machine.

The Ministry of Health and Child Care is also at an advanced stage to procure CathLab equipment to resuscitate the open-heart surgery. Site visits by prospective suppliers have been done as part of the efforts to avail a full complement of medical services to the citizens.

Human capital -specialised medical training programmes

The Ministry expanded medical training programmes in different specialties, to deliver the bespoke workforce required by the Government, including accident and emergency nursing, midwifery, mental health, Mmed, intensive care unit, renal nursing, and operating theatre. Others include oncology, and palliative, B-tech environmental health, nursing anaesthesia, advanced orthopaedic nurse training, ontology surgery, advanced clinical nursing (clinical officer).

The medical rehabilitation technicians’ course has now been upgraded from certificate to diploma level. Radiography training in therapy and diagnostic, which was being offered at Parirenyatwa Group of Hospitals, is now under the Harare Institute of Technology on an affiliation framework.

The Ministry will soon be resuscitating the biomedical equipment technician training in conjunction with Harare and Bulawayo polytechnics. This is a critical course, which will increase the stock of technicians responsible for the repair and serving of the biomedical equipment.

Medical transport

One of the most important aspects of medical transport is safety and quick response time to mitigate casualty numbers. To this end, the Ministry is in the process of procuring the upgraded model of ambulances for the 63-district hospitals, eight provincial hospitals and six central hospitals. These ambulances, which are a lifeline during emergencies, are equipped with the latest medical equipment and designed with the latest technology and software. Already 32 vehicles procured by the Government, and eight from supporting partners, have been received.

Access to medicines: Local production of pharmaceuticals

For the Government, the pharmaceutical sector has implemented measures that will see increased production, enhancement of competitiveness, market expansion, production diversification, export development, improved ease of doing business and mobilisation of the required financial resources.

The pharmaceutical manufacturing strategy for Zimbabwe 2021-2025 was launched to enhance productivity and competitiveness of the manufacturing industry in the country.

The objective of the strategy is to increase market share of the local pharmaceutical products from the current 12 percent to 35 percent by 2025; to increase local product of local medicines from US$31,5 million to US$150 million by 2025; to increase local production of essential medicines from 30 percent to 60 percent by 2025, and to improve export of pharmaceutical products from 10 percent to 25 percent by 2025.

The newly constructed warehouse at the National Pharmaceutical Company (Natpharm)

National Pharmaceutical Company (Natpharm) has increased its capacity to manufacture pharmaceutical products, while the Medicines Control Authority of Zimbabwe has been capacitated to ensure registration of pharmaceutical products and upgrading in quality management systems. For ease of distribution, the Government, through the Ministry of Health and Child Care, has secured US$6 million funding from the Global Fund and US$25 million grant from the Chinese government to construct state-of-the-art Natpharm warehouses across all provinces. While the Harare warehouse is awaiting commissioning, the Masvingo and Mutare warehouses are nearing completion, with the remainder at varying construction stages.

Investment

Zimbabwe is set to become a hub of pharmaceutical manufacturing for international and regional consumption following the joint venture agreement between global medical consumables manufacturing giant Intrapharma (UAE) and the Government. Intrapharm will start by investing US$100 million, and gradually grow its investment in response to market demand.   

 The National Institute of Health Research (NIHR)

Infections remain a major public health problem, and warrant research in order to reduce morbidity and mortality. NIHR plays a critical role in providing information on risk factors and disease trends, functional abilities, patterns of care, healthcare costs and use, as well as outcomes of treatment or public health interventions. NIHR is also a leading research institute for the WHO specified Preventive Chemotherapy Neglected Tropical Diseases (PC-NTD).

To date, the department has conducted the following researches:

A baseline population-based age-stratified sero-epidemiological prevalence survey for covid-19 in Zimbabwe

a national Lymphatic filariasis confirmatory survey triggering annual mass drug administration for the control and elimination

The national entomological survey: status of malaria vector bionomics in Zimbabwe; baseline assessment to determine the distribution of mosquito vectors responsible for the transmission of malaria in Zimbabwe.

 Like any other segment in Zimbabwe, the health sector has not been spared by economic challenges which are hindering the Government’s efforts to fund public health delivery, thus restricting citizens’ access to healthcare.

In the past two decades, the Government’s capacity to provide adequate, efficient and reliable healthcare services and facilities has mainly been hamstrung by the illegal economic sanctions imposed on Zimbabwe by Western countries in response to the country’s post-2000 Fast Track Land Reform Programme aimed at correcting imbalances in land ownership.

Due to financial constraints, infrastructural development projects have been hindered. The health sector has also been burdened by brain drain, inadequate equipment and drugs, which impede ordinary citizens’ access to quality healthcare.  

Donald Mujiri is the Ministry of Health and Child Care spokesperson. He can be contacted on [email protected]

Elliot Ziwira, The Herald.

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