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Roselyne Sachiti-Features, Health & Society Editor

Managing chronic conditions is critical, especially now when countries are battling the global health emergency, Covid-19.

According to the Centres for Disease Control and Prevention (CDC) heart disease, diabetes, cancer, chronic obstructive pulmonary disease, chronic kidney disease and obesity are all conditions that increase the risk of severe illness from Covid-19.

In Zimbabwe, the Covid-19 pandemic has had direct and indirect effects on people with chronic disease.

One such affected person is private pre-school teacher Mrs Maggie Bamusi of Harare’s Budiriro suburb.

She has diabetes and during the Covid-19 induced lockdown had problems accessing diabetes-related medications and supplies.

“During the lockdown, I relocated to our rural home in Gokwe,” said Mrs Bamusi.

“I did not know much about Covid-19 and as a diabetic I was scared of what could happen if I got the virus.” 

While in the rural area, she did not adhere to her medicines as a result of restricted intercity movement to control spread of Covid-19, and also the lockdown extensions.

When the medicines were available close by, the cost was too high for her as she was only receiving a third of her salary.

“It was a tough time,” she said.

Secretary General of Health Communicators Forum, Catherine Murombedzi, said managing chronic conditions is important in the daily living, any flare of a chronic condition poses a risk. With Covid-19 now being a further risk factor, anyone with a chronic condition must religiously follow treatment plan, even with strict adherence, conditions may get a hyper or hypo and require one to report at health facility for expert handling,” she said.

Murombedzi said it is with this in mind that people with diabetes mellitus require safety and should avoid risk factors.

“With diabetes itself a risk, Covid-19 is a danger so combining the two can be tragic,” she said. “Hence medical experts warn all with underlying conditions to be on guard.” 

Community Working Group on Health (CWGH) executive director, Itai Rusike, said there was evidence from other regions globally that the severity of Covid-19 is greater for people with underlying health conditions such as diabetes, HIV and AIDS, obesity and other Non-Communicable Diseases (NCDs). 

He said the Case Fatality Rate (CFR) seem to be higher in countries with higher prevalence of diabetes. 

“There are things that we can do to help vulnerable people such as those with underlying health conditions to promote good health and prevent exposure such as avoiding unnecessary exposures, especially in crowded places, getting vaccinated, staying active and eating a healthy diet,” he said. 

Rusike said the demand for health care services for people with chronic diseases, especially now with Covid-19 needs to be matched by beds, including in intensive care units, health workers and systems with capacities to manage the pandemic, medicines and other commodities. 

“The Covid-19 pandemic has highlighted a deeper problem in the financing of our health systems,” he said. “The commitment to universal health coverage has generated discussions on improving domestic health financing to address the decline in budget financing.” 

Rusike pointed out that it is important to increase public health financing and reduce the catastrophic health expenditures or out-of-pocket costs being experienced by people with chronic diseases such as cancer or those with conditions requiring dialysis services. 

Health service providers have been left with the dilemma and urgency to find solutions and at the same time balance between protecting people with chronic diseases from Covid-19, while assuring they can engage in disease prevention, manage their conditions effectively, and safely receive needed health care. Service providers like the Premier Service Medical Aid Society (PSMAS) said in their rebranding efforts, one of their top priorities was to ensure management of chronic illnesses. On September 1 this year, PSMAS launched the Chronic Medicines Programme, an initiative aimed at improving access to medications for their members with chronic medical conditions.

According to the PSMAS chronic disease register, 10 452 members have diabetes mellitus; 11 612 hypertension; 464 with cancer; another 232 with chronic kidney disease then 1 042 with HIV. 

Speaking to The Herald, PSMAS director Managed Care Services, Dr Munyaradzi Mujuru, said chronic diseases and NCDs in particular contribute to significant morbidity and mortality amongst the population.

 He pointed out that these conditions are potentially preventable and manageable through lifestyle motivation.

“Which is why we have a programme focused on this premier lifestyle, but once an individual has a chronic condition such as hypertension and diabetes it needs to be well managed so it doesn’t complicate further,” said Dr Mujuru. 

“We saw that even with Covid-19, the majority of individuals who either developed severe Covid disease or lost their lives had these underlying chronic ailments. So appropriate chronic disease management is vital in our population, including to reduce the impact of Covid-19 and future pandemics.” 

Over time, Dr Mujuru said, they have been analysing the burden of these conditions amongst the population they serve using various data analytics tools at disposal. 

“What this enabled us to do was to appropriately quantify our need and to budget for it,” he said. 

“Subsequently we entered into strategic partnerships with suppliers and manufacturers to ensure that the supply chain is in synch with our demand and its potential increase. 

“Most critically, however, is our synergistic partnership with our healthcare arm PSMI. This synergy enables us to use the PSMI distribution network of pharmacies to ensure affordable access.” 

Going forward, Dr Mujuru added, they are going to leverage on all these pillars (data analytics for precision planning, supply chain optimisation and our in-house synergies) to ensure sustainability of the programme.

“Our focus will be a holistic approach to the health care management of our members,” he said. “As mentioned before, we start from prevention. Our wellness programmes are being reinvigorated so we influence our members to stay healthy. 

“A lot of innovations are being promulgated including digital health initiatives to have the wellness program robusted.” 

Secondly, he further noted, they are instituting a programatic approach to disease management. 

“Learning from the nations successful approach to management of HIV in the country the Society will adopt a similar approach of managing members with chronic diseases through a structured approach,” he said. “This includes prevention ( health promotion) , early diagnosis,( affording screening services), case management ( enhanced access to medicines & routine monitoring) and monitoring & evaluation, so as to demonstrate impact on the health of the population.”

Dr Mujuru said these approaches will enable cost savings from losses that accrue from unstructured approach to managing chronic conditions and will ensure a solid foundation to financial and health sustainability.