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Zimbabwe Struggles To Scale Up Alleviation Of Communicable Diseases As Politics Overpowers Health Services Delivery.

September 13, 2018

 By Nevson Mpofu.

Dr Portia Manangazira

Dr Portia Manangazira

Zimbabwe is far away from winning the UNITED NATIONS Sustainable Development Goals on Poverty and Health by 2030. If no strong interventions, strategies and policies are put in place and implemented to reduce Water-Bourne Communicable Diseases like cholera and Typhoid, the country will fall out of Health space. This will indicate that the Health delivery system of the country is malfunctioned to spearhead economic growth.

Water and other food borne diseases have had a strong forceful impact on the lives of especially those vulnerable to communicable diseases. Cholera is caused by vibrio-cholera bacteria and Typhoid which is second to Cholera is caused by salmonella typhus bacteria. These two among others diarrhea and dysentery continue to cause Health problems in the country.

The recent outbreak has left doubt if the new Government will come up with any future workable solutions to curb this once and for all .The new outbreak killed 10 people in Budiriro , Glenview and Glenora .These are Harare’s western high density suburbs.

The new sworn in Minister of Health and Child Care Doctor Obadiah Moyo has still to take the fire breathing challenge as he gets in office. He faces a challenge because the country has no financial resources, medication, ambulances and enough Health centers and required facilities. The Annual budget is not enough for Health sustenance to win on Health Goals to eradicate and eliminate communicable diseases.

In 2008, the country was seriously hit by cholera which killed more than 2000 people in the high density suburb of Budiriro . Late last year and in August this year there were outbreaks of typhoid which also broke out in Chegutu and Gweru killing a total of 10 people. High population in urban areas has led to water scarcity. This results in poor, no clean water supply. As a result, handling of food is difficult at house hold level.

Twice in 2016 Cholera, Typhoid, Diarrhea and Dysentery hit in the city center of Harare and in Mbare flats. The Government made its effort to contain the problem. The latest one is the recent outbreak which is still under surveillance as the Government is held accountable for its more focus on politics at the expense of Health.

. A total of 1 223 were tested positive to cholera. One hundred [100] were confirmed to be hospitalized and discharged at Beatrice Infectious Diseases Hospital in Harare by 10 September.

Way-back Pertaining this, Dr David Parirenyatwa the former Minister of Health and Child Care in 2008 said the Ministry will put in place strong measures working with holistic strategies at country level. He made a lot of ‘’now empty’’ promises in terms of Health delivery which were never met since this problem began.

‘’My Ministry is aware of the adverse consequences. We have put in place strong measures and holistic strategies to see to it that we win the battle against the outbreak of cholera which claimed the lives of 4000 people in Budiriro .

‘’We thank UNICEF for helping us fight this battle of which we would not have won. Our greatest challenge is that of resources which we do not have as a country at the moment. However, we are pushing for a better bigger budget and also partnering with other International organizations to contain communicable diseases.

‘’ It is our effort to contain this. Also those affected must receive free treatment. Since this is free, we want to see everyone given support ‘’

In 2015, 2016, 2017 and recently before he left office with the coming of a new cabinet, he said the Government is crucially looking at this issue. He stated that his Ministry had already deployed Health officials in the areas affected.

The Director of the Epidemiology Department Dr Portia Manangazira said the recent cholera which killed more than 10 people by 10 September in Budiriro had been caused by a sewer pipe which contaminated bore-hall water. She added that the Ministry of Health is planning to write a proposal to get cholera injections to curb the problem.

‘’We have taken heed of this serious problem. The Ministry detected and sniffed the cause. The Ministry is planning to do a proposal to get cholera injections for use in affected areas in the near future. We have had this problem for some time, but now we need action on the ground ‘’.

Although the Ministry of Health and Child care and UNICEF in 2008 worked together so hard with other partners to curb the spread, there is much needed to be done. There is need to reflect on the horrible situation of 2008. Stronger interventions related to the spread are needed.

It is clear that the Government failed to control the spread of several issues related to over-population in urban areas.  Movement of people from rural to urban areas is for the search of better living conditions brought by business opportunities and creation of employment. Alas, jobs are nowhere found in urban areas.

This is the main reason why urban communities have become over-populated with heavy dependency ratio. Some have turned to street vending, sex work and shady deals. Urban centers throughout the world have reached almost 4 billion population exceeding rural ones by half a billion. Climate Change impacts are more in rural areas. The urban is affected too when it comes to water and food management.

This in time speaks more about the Great Demographer and Economist, Thomas Malthus who in the 18th century predicted that by the 20th century, population would be almost 6-billion shoot overcoming total resources available. For sure, resources have failed to meet the demand of the total population of this century which is 7 and half billion people.

This was predicted, when the World was at almost 2 billion people or less. Besides scarcity of natural resources, jobs have become scarce, this causing cities and towns to get more populated. No wonder why communicable diseases have taken toll in towns and cities.  They spread more in developing countries of the world still impacted by absolute poverty.

City of Harare Public Relations Manager Michael Chideme said the population in the city had ballooned over the recent decades. He however pointed out that the council was planning to bring proper management related to vending which he said had increased alarmingly.

‘’There are over 10,000 vendors on the streets of Harare. As City of Harare we are working out on to have proper structures where we can take these people to for their business. We have tried to do this .  We want to contain the flow of communicable diseases in the city center.’’

Africa has a total population of 1 billion people .Many of its people are in urban communities where there are no jobs. Worse to it as an Environmental mess , air , water and land pollution has caused communicable diseases . These are Tuberculosis an air Bourne , cardiovascular food and water-Bourne ones , schistosomiasis and vector borne like malaria .

The rural- urban drift has at the same time been exacerbated by Global Warming leading to climate change. This leads to  elnina which is low rainfall and lanina excessive rainfall sometimes leading to metrological and hydrological drought respectively. Economic hardships have led as well to drought caused by lack of sufficient inputs to boost Agriculture sector for Food and Nutrition Security.

Intertwined together, this created problems in towns and cities because population rose to alarming levels. This causes the spread of communicable diseases. Both Cholera, Typhoid, the two are a result of fecal oral route transmission via contaminated food and water. This explains the effect of eating food with unwashed hands and drinking dirty water.

WASH programs by UNICEF and partners prove working in schools. Some Health experts urge the Government working with World Health Organization to launch the Water and Sanitation Health program in highest density areas. This could be in the Central Business Districts of urban areas like at flea markets, bus terminuses, shanty dwelling areas and at huge gatherings. The spread can be maintained.

UNICEF Country Representative Mahomed Ayoya has said in brief that the organization gave support in 2008. UNICEF in 2008 drilled boreholes in Budiriro for the sake of children. Asked to comment, he pointed out that they have not taken a step at the moment but they are ready to.

‘’We work with Minis try of Health and Child Care in giving support when such problems likely to affect children arise. The Ministry is doing its level best as a country. They will make it. What we want achieved by end of the day is to make children and pregnant mothers be kept alive’’, he said.

World Health Organization Country Representative Juliet Nabiyonga echoed the same sentiments adding that the Government of Zimbabwe had done better in many areas in terms of Health delivery. This, she said could be a problem because of lack of resources not drugs. She however added that they have a pack of solutions.

‘’Zimbabwe has done well in Health Service delivery. The country did well with the previous outbreaks. Still it can do better than before. What is needed is better source of resources, medication, training of its Professional staff Doctors and Nurses and capacity building in Community Health Care Workers. ’’, she said.

Let us be back to the Malthusian Theory on population. In 1980 Zimbabwe had a total population of 5 to 6 million. Harare had 1 million people with the same sanitary facilities   like toilets we have in the city Centre. Today it has a total population of about 4 million people still served by the same infrastructure which is dilapidating .Besides toilets, sewer system and water piping is just the same. At one household you get five families with total of up to 20 people using one toilet, water pipeline and disposing waste along the road close by.

This brings us to the point why cholera and typhoid still lingers around .On this point of infrastructure, it is the issue of poor Governance, lack of policies, strategies and lack of political will. Secondly, there are low trainings by the Government and civil society on issues related to Communicable diseases defined under Community Health, Public and Population Health.

Above all, the fact on ground was politically explored .Former Mayor of Harare Councilor Charles Manyenyeni said tricks and power of politics is one challenge behind, and ahead, stressing his points in anger he pointed out,

‘’What we see as Health horror in the country is all about Politics failing Health Delivery in the country. This started long   back. All these people were supposed to have been removed by the Government, but, alas ‘’POLITICS IN ZIMBABWE IS STRONGER THAN HEALTH DELIVERY.’’

‘’The number of vendors has increased alarmingly. This is because those at the top want to remain in power. ZANU PF has always been the problem. All it talks is only politics not Economic Development .What kind of thing is this?

The Councilor talked of Operation Murambatsvina of 2005. Under the program many back door cottages which were not on plan were demolished. According to sources inside Mugabe Politics, this was done to remove opposition out of towns where the majority is .On Health and Social reasons; it was done to reduce number of people in house- holds. Water and sanitation, sewage systems pipelining and garbage removal could be easy in towns if measures were correctly put in place.

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Organizations are few. If there are some, they lack funding and they are plagued by political factions and corruption .Advocacy linked to policy and legislation is highly in demand to capacitate communities on Health issues affecting them on daily basis. Advocacy calls the Law to bring eradication and sometimes elimination of ailments.

The Government’s failure to address such issues normally results in up-risings against t it in many First World countries with Liberal Democracy like in USA , Canada , Australia and Britain , Germany , Netherlands and  a few to mention .

Communities in such countries take collective action, engage civil society and question the Government on such issues.  Communities lack sensitization, awareness and advocacy on Health because of low Humanitarian crisis Education. Secondly, citizens fear their Leaders and issues related to political violence and conflicts. Lastly, in developing countries in Africa Leaders take more time talking politics not business.

People in the developed world are more aware of International instruments like Global Health Policy, protocols and Conventions. Citizens in developed countries hold local community based symposiums before an outbreak. Together with the use of media, much information is vastly disseminated. Apart from media, every local community has its center with full Health facilities, technology and expertise in the form of community health workers prepared for such disasters.

Disaster preparedness is not only centralized in offices where all the work is done. Disaster preparedness must be getting into the local communities teaching people future likely crisis to loom with time .It must be a pilot survey carried out and made aware of before its burst and boom.

Cholera is more epidemically effective than Typhoid.  The fact that Typhoid is in three types, Typhoid, Typhoid Fever and Para- Typhoid would make it more likely to attack several times than Cholera because Typhoid and Malaria are more closely linked to HIV and AIDS Immune suppression.

In high epidemic parts of Africa like in EKPOMA Nigeria, qualitative research reveals that 80% of such patients were linked to HIV and AIDS .Zimbabwe has challenges ahead. Health delivery could remain its perpetual curse compromising more on its national budget .It tells a lot about its likely future attack in an expanding population.

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