Zimbabwe Needs To Strengthen Public Health Sector Capacity and Resilience beyond the 3rd Wave: Lessons not learnt from the previous waves

THE past week or two have particularly been rough for Zimbabwe. 20 people were lost in a horrific road traffic accident, and hundreds more succumbed to COVID-19. Unfortunately, all-cause mortality is probably much higher. Our focus has been so much on COVID-19 over the past 18 months and we seem to have forgotten about our high burden of HIV, malaria and other infectious diseases. Good news is Zimbabwe was removed from the list of high tuberculosis burden countries in the past week; congratulations to the AIDS and TB unit, their supporting partners and other relevant stakeholders for their sterling work.

By Dr Grant Murewanhema

We have had an increasing burden of non-communicable diseases over the past decade to two, including a high prevalence of diabetes, hypertension, obesity, cancers and a whole range of lifestyle diseases, with our increasingly fancy and sedentary lifestyles, and lack of access to regular quality medical check ups.

On the hand, we have a significant proportion of the population now living in extreme poverty as defined by the World Bank, and recent WB releases show that the country has taken a deep plunge, sinking into an economic pit we will struggle to get out of, despite pronouncements of a huge surplus. Malnutrition, a common disorder among children in our marginalized communities, is likely to worsen over the next few years, and will increase the odds of under-fives dying from respiratory infections, diarrhoea and other illnesses.

There is a huge need to take status of the current status quo regarding our health indices, as the focus on controlling COVID-19 might have likely created other serious challenges in other essential aspects of healthcare. Unfortunately, disruptions in other aspects of healthcare may have far reaching consequences in the long run. At the beginning of the pandemic, scholarly mathematical projections estimated that the disruption to HIV care and treatment programmes could bring in excess of half a million additional deaths in Sub-Saharan Africa. Similarly, disruptions in sexual and reproductive health services could potentially result in hundreds of thousands of excess maternal mortality due to failure to access contraceptive services, abortion services and other essential aspects of this area.

Despite having gone through the first and second waves however, we still seem not to have learnt any significant lessons regarding the need to build health sector capacity and resilience, not just during the COVID-19 era but beyond. This seems to be a recurring problem not just in Zimbabwe, but across Sub-Saharan Africa. A continent that has previously been plagued by other natural and man-made disasters, must understand the importance of this, to preserve lives.

Thousands of lives have been lost in West Africa during and beyond Ebola viral disease outbreaks, but from the indirect effects of these. We seem to have a similar pattern during the COVID-19 era, but with very poor surveillance and notification, the actual extent of the indirect damage will always be difficult to estimate.

During the second wave of the COVID-19 pandemic in Zimbabwe, the public health sector was rapidly overwhelmed with cases, hospital beds were quickly filled-up, and there was a shortage of oxygen and consumables. This partly would explain why the general public lost confidence in the public health delivery system and turned to complementary and other alternative sources of medical relief. Its no wonder steaming, which can be dangerous, became popular, and there was a scramble for chloroquine, ivermectin and other treatments.

The failure to protect the public by the responsible authorities has led to the emergence of unscrupulous exploitation by some unethical individuals as they seek to quickly profiteer over the masses’ suffering. As attention is shifted to COVID-19 responses activities, delays emerge in seeking treatments for other conditions, reaching health facilities, and accessing treatment within health facilities, leading to avoidable excess morbidity and mortality.

As we move into the future, governments must set the right priorities and get their acts right. The usual reactive rather than proactive approaches show poor disaster preparedness. When President Barack Obama was still sitting, he warned about this. The COVID-19 pandemic is not going to be the last, but one of many, as the world continues to undergo intense globalization snd climate change. There is a strong need to build and maintain public health capacity and resilience, to deal with outbreaks whilst maintaining all other aspects of healthcare.

Preserving human life is and must always be the priority of governments. To this end, there is a serious need to invest heavily in health infrastructure, human resources, research, training and manufacturing. Four decades post independence, a country must have built sufficient expertise and capacity to produce basics such as personal protective equipment and basic medicines such as paracetamol and cough syrups.

Critical to all this is maintaining a healthy and happy workforce. Governments all over must learn that no pieces of prohibitive legislation can prevent brain drains. Instead, they must work on adequately and satisfactorily remunerating and insuring essential healthcare workers, otherwise the costly loss of experienced critical service providers continues.

(Dr Grant Murewanhema is an independent Epidemiologist, Public Health Physician 
and Obstetrician and Gynaecologist. He writes in his own personal capacity and 
his views don’t represent those of any organisation or affiliation.)

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