…Parliament appeals for more funding for to end TB in Zimbabwe
THE City of Bulawayo currently has the highest TB death rate of 16 percent, which is higher than the nationally set target of less than 5 percent, due to a myriad of risk factors chief among them being the high TB/HIV co-infection, delayed presentation at health facilities and rampart overcrowding in some of the city’s settlements.
By Michael Gwarisa recently in Kadoma
From the death audits carried out by the Bulawayo City council quarterly, the incidents of deaths are high in HIV positive patients and those with other co morbidities while patients also delay in seeking care during the intensive phase.
Speaking during the Stop TB Partnership engagement with City Council Officials on the forthcoming World TB Day Light Up for TB campaign, Bulawayo City Health Director, Dr Edwin Sibanda said the City also receives a high number of TB patients from Zimbabweans in South Africa and Botswana and most come in a very bad shape and rarely make it past two weeks from admission.
Some of the people who come from South Africa and Botswana are actually driven straight from the border into the clinic. This particular group has not been coming for the past two years due to COVID-19 and most would be showing very advanced signs of TB and nothing more can be done.
“There was a steady increase on percentage of HIV+ positive TB patients initiated on ART from 2017 to 2019 because of the physical review meetings and cohort analysis that were done jointly and challenges attended to early. Integrated Supportive supervision and peer review among health center managers are carried out quarterly. Some of the HIV positive TB patients who were not commenced on ART died before ART initiation,” said Dr Sibanda.
In Bulawayo, the 2021 notification rate (174/100 000 population) was higher than the expected target of 167/100 000 population. The notification rate has since declined from 258/100 000 population in 2016 to 174/100 000 population in 2021. Lost to follow has remained at 2% (less than the National target of <5%) since 2016.
Dr Sibanda also raised concern over the uncontrolled allocation of residential stands in Cowdry Park and other settlements which he says has led to overcrowding and in the process exposing more people to the risk of TB.
“We also know about this Cowdry Park, Hlalani Kuhle or Garikai which is the largest of the Garikai settlements following Murambatsvina. The original number of stands there was 5000, but due to the corruption of the recipients and the givers of the stands, double and triple allocations have occurred and to solve that, more stands had to be created and the number has moved from 5000 to about 17,000.
“These people were settling without services meaning they don’t even have roads, sewer and water. If you remove those and people are crowded, TB spreads, HIV also spreads because there is no electricity. We also have got squatter camps namely Killarney and Ngozi mine. We also have malnutrition in the City, urban poverty is real.”
Bulawayo City only has one X-Ray machine even though all central hospitals and private hospitals in the City do have X-ray machines.
Legislator for Bulawayo Central, Honorable Nicola Watson said there is need to resolve the health funding issue in order to address the growing TB burden in Bulawayo and the country at large.
“From a parliamentary perspective this is what we need. We need better funding, we need to stop relying on the councils, draining their own money to run health programs because that’s the bottom line. Dr Sibanda spoke about the Northern Suburbs issues. There are no clinics actually. In my whole constituency that stretches from one end of Bulawayo to right after the airport, there are only two clinics.
“That means there a whole huge part of that constituency and another part have to use public transport to get to a clinic so that is not great. That’s what we need addressed. We need to deal with the auction issues that are surrounding the council with regards to getting foreign currency to pay for drugs and inputs. We need to deal with who funds health in Zimbabwe because it’s about this whole issue with Global Fund and all those issues,” said Honorable Watson.
She added that they have been advocating for an increase in domestic funding to reach the Abuja target but that has not happened as yet.
“We need to double the budget, it’s the same as education because we need new clinics and more health workers. Funding is a big issue. Urban poverty and poverty in general is a reality. So how do you deal with it? You fix the economy. You create formal jobs, if people get formal jobs, you improve the fiscas because you improve tax collection. It’s like a snowball. Then you have got money to increase your budget for education, health and the social sectors. Actually the social sector should be the government’s core responsibility. That is where they are letting Zimbabweans down because we are not fixing the economy and it’s the ordinary Zimbabweans that are paying the price.”
Meanwhile, Jointed Hands Welfare Organisation (JHWO) Director, Dr Donald Tobaiwa said the high urban TB burden was a reality that needed urgent action.
“The urban TB burden is actually big because from the urban facilities, you actually realise that we are having more cases and more notifications coming up from urban areas as opposed to rural areas. Remember now because of the economic situation, people are moving from the rural into the urban areas and especially the high density suburbs that are close to town where people can actually walk.
