The Sunday Mail
Vivian Mugarisi
HEALTH experts believe the country’s response to coronavirus could be further strengthened by resolving transport challenges, impasse in the health sector and roping in communities to actively participate in preventing the spread of the disease, including extending care to patients who suffer from other ailments.
From the time the continent recorded its first Covid-19 case in February, Zimbabwe has kept its caseload relatively low owing to an early lockdown and targeted responses to the outbreak.
Strategies and responses are also continuously being adjusted to meet the ever-changing circumstances occasioned by the pandemic.
At least 480 healthcare workers had contracted Covid-19 as of yesterday, while overall cases nationwide surpassed the 5 000 mark.
This comes at a time when the pandemic is putting an enormous strain on the healthcare system, with many people struggling to access health services for other ailments.
Further, the Covid-19 results turnaround time over the past three weeks has worsened, as the country has seen significant delays in the release of test results, which also means lost time in contact tracing.
A case in point is the first results of tests carried out on Zimbabwe Broadcasting Corporation (ZBC) staffers, which came back 12 days later.
ZBC announced on Tuesday last week that 30 of its staff members had tested positive for Covid-19 after tests were carried out on July 29.
In addition, scores of journalists from various media houses who had their tests done on August 4 are yet to receive their results.
Chief Co-ordinator for the National Response to Covid-19 in the Office of the President and Cabinet Dr Agnes Mahomva said while the country has done well in decentralising testing services, the absence of health workers at their workstations has made testing and contact tracing difficult.
“We know, for example, that some of the places where the PCR is done have to transport the specimen to a central place. We have done a lot of work in terms of decentralising. When we started we only had this PCR only being done at Sally Mugabe Hospital, which is the National Microbiology Reference Laboratory, but it’s still not exactly where we want, so we continue working on that,” said Dr Mahomva.
“But also looking at the human resources component, I think many times people forget that the health sector is really struggling because of the strike that we are seeing. So, as long as we continue having those challenges, we continue to struggle with (results) turnaround time.”
Community deaths
On August 13, the country recorded 18 deaths in just 24 hours. Health experts attributed this to late presentation at hospitals, while most patients are shying away from health facilities for fear of being turned away due to a variety of reasons.
Dr Shingi Bopoto, a surgical pathologist at Parirenyatwa Group of Hospitals, said community deaths occurring outside a health facility could be directly or indirectly linked to Covid-19.
“These could be people who die from complications of coronavirus infection and these people may have pre-existing conditions such as obesity, diabetes, and when they get Covid-19 they get multiple organ failure or some other form of complications that result in their death,” explained Dr Bopoto.
“Then indirectly, we could have somebody who may have Covid-19 who dies from an accident, or suicide or complications of maternal deaths or child deaths. These become Covid-19-related deaths, but not Covid-19 deaths so to speak.”
Provision of health services for other ailments such as malaria, diabetes, and HIV and Aids among various other conditions, he added, have been severely disrupted.
“A lot of resources — human, infrastructural and logistical — have been diverted to fight Covid-19, so people who would ordinarily access care for other conditions such as people on ARVs, people taking blood pressure medicines, diabetes medicines, can no longer access care because it’s now in short supply,” he
said.
Zimbabwe Medical Association (ZiMA) president Dr Francis Chiwora said most people had stopped going to health institutions for services.
“The usual diseases that afflict the population were there before the Covid-19 era, during and will be there even after,” said Dr Chiwora.
“Looking at the patterns of admission into hospitals since lockdown, there is more than 60 percent reduction in admission of patients with various conditions, and this data was only focusing on obstetrics and gynaecology, so imagine all the other diseases.
“Admission has been seriously curtailed because sometimes they are being turned away from institutions while others are staying at home.”
Dr Chiwora said private hospitals remained largely inaccessible because of high costs. There are fears that some patients could be dying at home.
Transport factor
When the lockdown began on March 30, private commuter omnibuses were banned indefinitely. Zupco now has the sole mandate to transport the commuting public.
This has, however, resulted in acute public transport shortages, mainly in Harare and Bulawayo.
Medical experts warn this is threatening Covid-19 containment efforts, as commuters are hardly practising social distancing while in queues.
Dr Chiwora said: “The issues of social distancing and wearing of masks should work very well, but it doesn’t seem to be working if we compare ourselves with other countries within the region and I believe one of the areas we are failing is in the transport sector . . .
“Whatever strategy we are applying, I think we should look into issues of easing public transport woes so that people can have choices and observe social distancing. I think that is one major area where we are missing it,” he said.
Patients’ privacy
The pandemic brought about challenges in terms of patients’ privacy, as sick people are now required to justify their movements at various security checkpoints.
Stakeholders worry that patients’ privacy is violated in the process as some security officers do their checks. Community Working Group on Health executive director Mr Itai Rusike is advocating for the inclusion of security personnel with medical background at roadblocks in order to protect patient confidentiality and privacy.
“Government may need to think further and strategise on how best patients can access services and passage at security checkpoints without sharing their medical records to non-medical personnel at the various security checkpoints.
“We need to be guided by the Public Health Act and the Patients Charter on patients’ confidentiality and privacy that clearly states that a patient shall have the right for the details of their medical records to be treated as confidential and ensure reasonable privacy,” said Mr Rusike.
Solutions
Now that there is ample evidence that Covid-19 has penetrated communities and spreading, experts say there is need for health literacy and community participation.
Mr Rusike suggested that intensive awareness campaigns in communities are now critical to ensure that the general public plays an active role in the country’s response to Covid-19.
He said public response to the pandemic is not the responsibility of the health system alone.
“It also calls on public information, availability of safe water, soap, food, job security and social protection and the work of many other sectors.”
Senior Hospital Doctors Association president Dr Shingai Nyaguse called for a solution to the current impasse between healthcare workers and their employer to ensure that the public has access to health services.
“The most urgent thing is to deal with the issue of health workers that has paralysed service delivery, both for Covid-19 and non-Covid-19 services,” said Dr Nyaguse.
“Then continue to liaise and inform, take the lead in the Covid-19 response nationally and reassure the citizens of Zimbabwe that the health sector is now geared to meet all their needs.”
Dr Chiwora said the appointment of a substantive minister was welcome.
“We are very happy that we now have a substantive minister and we hope that he will address the issues that are affecting the health delivery system,” he said.
“The health sector is in serious problems. The institutions, both private and public, need to be capacitated in terms of infrastructure, equipment, medicines and laboratory testing kits, and this should be addressed almost immediately.”
Harare City Health Services director Dr Prosper Chonzi said while it may be too late to introduce targeted lockdowns due to the spread of the disease, there was need for Government to realign efforts to ensure that the available resources are channelled to the right areas of response.
“What is more important is for us to go back to the basics of outbreak control. What are the steps in determining how you respond to an outbreak? The first one being establishing the existence of an outbreak, which we have already done.
“We now know that we have a pandemic, we know that people with symptoms are the ones that we refer and these are the ones who should be in community or hospital set-up. We need to use case definition of Covid-19, we do not have to solely depend on testing because our capacity to test is very low.
“Once we do that we stop relying on testing, so we need to use other epidemiological means to identify cases and respond appropriately. We now need to come up with community interventions not laboratory-based,” said Dr Chonzi.
“Once we are able to test everybody, we do that but for now we need to refocus our strategies and align those with our resources and ability to respond.
“It might be a bit too late to do a targeted lockdown because it seems like we now have a huge outbreak across the country. We may need to then look at certain hotspots in certain parts of our district, but that action would need to be backed scientifically,” he said.
