We’re out to win war on cholera by mid-December
ZIMBABWE’S health sector has over the last five years recorded tremendous milestones that have translated into improved service delivery in public health institutions. The sector has also faced its fair share of challenges that include brain drain and perennial outbreaks of communicable diseases. The Sunday Mail’s
(TR) spoke to recently appointed Health and Child Care Permanent Secretary (AM) on these developments, as well as his vision for the sector. Here we reproduce excerpts of their conversation.
****************** TR: Can you begin by outlining the significance of your appointment? AM:
At an individual level, I feel greatly honoured by the President, His Excellency Dr ED Mnangagwa, for having seen in me attributes he feels would benefit Zimbabwe as a country. It’s a great honour and I appreciate that very much. I can only assume that my prior stations in both civil service and the education sector, through the University of Zimbabwe, might have been seriously noticed.
I will carry the good experiences I have had and deliver on the mandate given to me. So, I feel very honoured.
I will work hard not to disappoint not just His Excellency, but also the nation at large.
Health is the cornerstone of any developing or developed country.
And I feel we are here to serve. This significance cannot be overemphasised in terms of the expectation of a good health sector, ensuring Zimbabwe has a long life expectancy, as well as a productive workforce, as we work towards Vision 2030.
I think there is no greater wealth than good health. So, I think, borrowing from all the sectors I have been involved in, the need to keep a healthy country is very important.
In terms of healthcare workers, we need well-trained cadres with good skills and the right attitude to serve.
Given my background of training, I hope this will go a long way in making this appointment relevant to what we want to achieve.
So, we must train the right people and make sure their skills are retained. At the same time, we must make sure resources are available in our institutions to ensure our people are taken care of by a health workforce that has the right attitude.
TR: What is your assessment of the current state of our health system? AM:
I think our health system has made major strides towards delivering services to our people. We still, obviously, have quite a number of areas which we need to strengthen. But I think the key thing is that we have been able to continue producing quality health personnel. So, our system, in that regard, has been able to deliver quality personnel and expand our training for doctors, nurses and other health professionals.
However, health delivery is only good if simple issues like water provision and sanitation are in place. I think this is where we need to work hard as a country, especially in our towns and cities, where water and sanitation issues are a challenge. These have a huge bearing on the health system and what we can deliver.
I, however, feel our health system is still solid and, despite the challenges we are facing now, we should be able to build from where we are using our human resource as our biggest capital.
TR: As you assume your duties, which specific areas are you going to give immediate attention? AM:
As we speak, the critical area which is topical is that of infectious diseases that are ravaging our country.
Here we are talking mainly about cholera. But remember, we still have issues with drug and substance abuse, which, in the end, have a huge bearing on how our health system reacts, and on the mental health of our people.
On top of that, we know that non-communicable diseases, especially cancers, are rearing their ugly heads and trying to overtake infectious diseases. So, we have a big job on our hands in trying to deal with infectious diseases, and drug and substance abuse, as well as non-communicable diseases, especially cancer.
But with it, you also have your hypertension and diabetes. Unfortunately, as we develop as a country, you might be aware that we are now in the lower- to middle-income society category. We are now likely eating lots of food, which may not necessarily be healthy, and this may result in diseases along those lines that will also need
to be taken care of.
TR: How do you intend to address some of these challenges? AM:
We have high attrition and that, obviously, would need everyone to put their heads together to be able to retain our skilled personnel.
I think you have seen the number of nurses and nurse aides who are leaving the country. It seems everyone now wants to do the nurse aide course and get out of the country. So, we need to make efforts to retain our people so that they can give back to the community.
We invest a lot in the education of our cadres. According to the last study we did, the country invests more than US$70 000 just to train a doctor, only to have them leave the country. This is sad. So, we need to address that problematic area.
We do have a major challenge with the supply of drugs. This is now a huge problem in our hospitals and most patients end up getting prescriptions to buy medication from outside.
We have made steps to capacitate NatPharm (National Pharmaceutical Company) to be able to procure the right type of drugs so that we get enough supplies.
But it is not just procurement that is the problem. The other problem area are leakages. We need to plug leakages of procured drugs.
I have talked about infectious disease outbreaks we are faced with. We need to work with all those who are involved in making sure our environment is clean, and our water and sanitation are good so that we curb the re-emergence of these medieval diseases, which should not be an issue in 2023.
TR: You came in at a time when Zimbabwe is battling another cholera outbreak. Can you take us through Government’s comprehensive plan to address the country’s perennial challenges with this disease? AM:
This latest outbreak has been with us since May and has been going through different cycles. But the latest resurgence was from Manicaland, particularly in Buhera district, where there is an issue of poor water and sanitation, as is the case in our rural areas. However, one of the major factors (that drove the outbreak) was that of religious objectors.
This perpetuated what I would say was a minor problem from being picked up on time.
Because then, you would identify the problem after cases of unsupervised burials, contamination of water bodies, gatherings and sharing of food in unsafe environments. After that, it then spread to other areas. Because by that time, you find that most patients will mention that either they had travelled to or had a relative or neighbour who went to the affected area.
So, what is very important is to address the issue of water and sanitation.
This requires a whole-of-Government effort, with the Ministry of Local Government and Public Works being involved through the
CPU (Civil Protection Unit), our urban and rural district councils and the local leadership all being involved.
What we have done now is to activate our Public Health Emergency Operations Centre, which is at Parirenyatwa Group of Hospitals, and we have also appointed an incident manager, who works with the whole team in the health sector to make sure that all rapid response teams from district level up to national level are mobilised to fight this.
We have tasked them to have quick five-day action plans merging the medium- to longterm action plans, to say by mid-December, we should have contained cholera.
So, all these responses should be timely. One of the key elements of this is education. I have already talked about religious objectors and these need to be addressed through education. Our experience is that when you talk to their leaders, it is easier for the message to cascade to their congregations.
We need to educate and increase awareness, and make sure our response teams are on the ground and working actively with the different leadership in the communities to clean areas and test boreholes, while decommissioning those that are contaminated and provide appropriate water-dispensing units like aqua taps and bowsers.
We also need to make sure those who are sick are immediately isolated and bring the cholera treatment centres to the communities.
With cholera, you don’t want to bring the patient to a big established centre because you end up contaminating the world.
So, we want to mobilise resources to the areas where cholera is and set up those centres and treat the patients and educate them.
One other thing we are also looking at is the acquisition of vaccines, which assisted during the 2018 cholera epidemic.
So, in a nutshell, that is what we are trying to do on the ground.
We need other Government departments and agencies to work together, especially with our Local Government (ministry) and our city councils, to make sure we clear dirt, make sure sewage systems are working and that people are getting water from safe points.
TR: Turning to Government’s broader developmental aspirations, what role do you see your ministry playing towards the attainment of Vision 2030? AM:
In terms of Vision 2030, this means we want to be an upper middle-income economy by 2030. And the well-being of our people, which is the thematic area we fall under as the Ministry of Health, is very critical. There is no wealth without good health. And any wealth becomes useless if you are not healthy. So, we need to make sure that, on the ground, our people are healthy enough to become productive, which is important in achieving the upper middle-income status.
We have to be able to produce. And if we are healthy, there is really a good chance that we will be able to produce. We need, as part of Vision 2030, to have a long life expectancy, and you can only have that if you are healthy.
And on the production and human development side, we train a lot of health professionals. We produce doctors, nurses, pharmacists and various healthcare workers. That goes very well with the aspirations of Vision 2030, under the skilled human resource pillar.
We also need to be a pharmaceutical manufacturing hub. Remember, yesteryear, our pharmaceutical companies used to export. So, together with the Ministry of Industry and Commerce, we have to begin producing pharmaceutical drugs and start exporting them and generate income for the country.
TR: Lastly, Zimbabwe will host the International Conference on AIDS and STIs in Africa (ICASA) next month. Take us through how hosting such a conference is going to help the country’s response to HIV and AIDS. AM:
ICASA is a very important event.
It is a big international conference and it is an honour for Zimbabwe to be hosting it.
This means there is real confidence in the country. Zimbabwe is one of the countries known to have actively put in place measures to fight HIV and AIDS.
We are one of the few countries with an entity called the National AIDS Council, which has the mandate to put measures in place to fight HIV and AIDS.
So, this platform will enhance the sharing of science around the fight against HIV and AIDS, and Zimbabwe will be showcasing what we have achieved in this area, especially in research. But, at the same time, we also want to interact with others and learn from their evidence-based approaches to managing HIV and AIDS.
So, there will be a lot of papers that will be presented during the conference, which can only help in the drive to eradicate HIV and AIDS. The benefits for the country are immense in terms of tourism and the confidence of knowing that Zimbabwe remains a destination of choice for many.
So, I would say this is a huge highlight in terms of our ministry, and we hope it will be successful. We are going to have two major pre-conference sessions. One of the meetings is for First Ladies.
The First Lady, Amai Auxillia Mnangagwa, is going to host first ladies in Victoria Falls just before the conference, where the focus will be on prevention of mother-to-child transmissions. So, our health ambassador will be leading that.
There will also be a pre-conference meeting on finance and financing of health systems. This will also be a very important meeting.