By Michael Gwarisa in Gokwe, Nembudziya
It’s around 12 midday, and the sun is blazing hot despite it being winter in Zimbabwe. There is not much activity, left for the chatter of a few old men seated around a pot of opaque beer at a nearby homestead. From a distance, a buzzing sound like that of bees or hornets approaches from the southern side of Kuwirirana Clinic, a health facility in Gokwe Nembudiziya. As the whirring gets closer, a Biker on a motorcycle emerges from a thick cloud of dust headed for the clinic.
Clad in a black bikers gear with white reflectors, he parks his bike beneath a shed of a thorny Indian Jujube (Masau) fruit tree. He punches some information into his mobile tablet before disembarking the bike. He opens the white cooler box fixed at the rear of his motorcycle and proceeds towards the clinic’s entrance . As he removes his rider jacket, the inscription We Ride To Save Lives vividly shows on the left side of his purple T-Shirt.
“I do this every day,” says 48 year old Christmas Muchanga. “I ride at least 162 kilometers (KM) daily to deliver and collect specimens and sample results from health facilities around here.”
Christmas is among the five riders operating in Gokwe North district working under the Integrated Specimen Transportation (IST) program. The IST is a national program being implemented by the Ministry of Health and Child Care (MoHCC) working with its technical implementing partner, the Biomedical Research and Training Institute (BRTI). The program in funded by the Global Fund (GF) through United Nations Development Fund (UNDP).
We have a route schedule that we follow every day with details of the distance we are supposed to ride and facilities to visit at any given day,” adds Christsmas. “First thing when I get to a clinic or health facility, I log into my tablet to notify the system that I have arrived at the clinic with the samples. Before I departed for this clinic I also logged in because this system is tracked and when I log in the information is transmitted there and then.”
He collects various samples from the four health facilities he services. These include Kadzidirire, Gumunyu, Mashame and Zumba clinics, though he also frequents Kuwirirana Clinic with samples on his was from the district hospital.
Gokwe North has 27 Clinics including four health posts and one satellite Clinic which became operational in 2023. HIV activities in district have been decentralised and are currently being offered in 22 facilities. Out of the 27 health facilities, the furthest facility, Zumba clinic is located 195 kilometres from Gokwe North District Hospital. The distance between Gokwe North Hospital and Kuwirirana Clinic is 31 KM and that from Gokwe North to Kadzidirire is 30 Km, from Kadzidirire to Gumunyu, 14 km and Gumunyu to Mashame its 28 Km, and Mashame to Zumba its 20 Km and Zumba to Gokwe North, 70 km.
Gokwe North is one of Zimbabwe’s vast Districts, spanning 7,268 km² with an estimated population of 316,000 according to the 2020 Population and Housing Census findings. However, the rugged terrain that has formed in the district over the years at the back heavy flooding, massive land degradation coupled with a poor road network makes it inaccessible in some parts and difficult to navigate for riders.
“Our biggest challenge here as riders is the issue of terrains. The roads are bad and most bridges have been washed away by the rains. Funds permitting, we would appreciate bigger bikes suitable for these terrains” said Christmas.
Under the IST program, a total 280 motorbikes and eight provincial vehicles were procured, while 94 bikers are currently employed under the IST initiative countrywide. Additionally, 29 bikes in PEPFAR supported (40) districts are also supported by the Global Fund. Further IST resource support received include Data bundle for Rider Open Data Kit (ODK tablets, triple packaging material including cooler boxes, secondary containers, and ice packs to improve specimen integrity.
Using the IST rider daily report, he collects the samples ranging from Viral Load, Tuberculosis (TB), Dried Blood Spots (DBS), Early Infant Diagnosis (EID) among other samples. Before the IST program, TB patients in Gokwe North were reluctant to get screened or tested owing to the delay in the turnaround time.
Gogo Precious Bhima (53), a Drug Resistant Tb Survivor from Tsungai Village 2D in Gokwe North, said before the IST program, they would use scotch carts to go and get their samples collected and also to follow-up on results.
“When I got diagnosed of TB, it started as severe coughing and I started losing weight. My sputum sample was collected at Tsungai health post and after a few days i was called to collect my results within a few days because the riders are always on the road ensuring our results are returned to the facility on time. It’s been three years now since I have been diagnosed,” said Gogo Bhima.
In Gokwe North, the five riders including Christmas, collect specimens from the 22 facilities and deliver them to the testing hub at Gokwe North District Hospital. The IST program started 2021 with five riders within the districts in Gokwe North, and the five riders were grouped into five clusters with each rider serving about four facilities. There is one rider serving six facilities.
“We have realised that after the introduction of the IST program, our healthcare workers are now motivated. Why are they motivated? It is because the district is basically hard to reach and is characterised by poor road networks, but now because we have have riders service the facilities and delivering results on time and collecting samples, we are guaranteed the results are returned on time,” said Caritas Mbombe, the District Nursing Officer (DNO) for Gokwe North.
She added that before the IST introduced bikers to the district, they would face specimen transportation challenges to the extent that some specimens would be discarded after falling to transport them to district hospital.
“Now because of the IST program, the specimens are being collected and transported to the district within almost two to three days per week because the riders visit the facilities twice or thrice weekly. We are now witnessing improved sample integrity because we are no longer having the transportation challenges we used to experience. We have also realised that there is a faster turn-around time of the results as clients now get results between two to three days.”
Turnaround time for samples in the districts according to Sr Mbombe used to take three weeks to two months before results were sent back to the facility, making it difficult to manage Opportunistic infections (OI) clients. The faster turn-around time is also motivating communities to take up Viral Load testing services in the District as result are now coming on time.
Tests not done at the district hospital are sent to the provincial Laboratory at Gweru Provincial Hospital. The bikers collect samples from local clinics and submit them to the district hospital. They are then ferried to the provincial hospital using vehicles.
Dr Prince Pedzisai the Midlands Province Acting Provincial Maternal and Child Health Officer said the collaboration between the riders and the vehicles in the IST program has improved various indicators in the province.
“I can confirm that the IST program has a footprint in all the eight districts in the Midlands province and I can also confirm that our facilities have three or four visits from riders every week. The riders get to their facilities and collect specimens as well as delivering results. It’s a good thing that now we are guaranteed that every specimen that we collect at the facilities gets to the laboratory, there is no longer that challenge where some specimens would have to be thrown away,” said Dr Pedzisai.
By strengthening Zimbabwe’s IST system, significant improvements have been made in delivering timely and effective treatment, including HIV treatment, ultimately improving patient outcomes and overall public health.
Dr Ayodele Odusola, the UNDP Resident Representative in Zimbabwe said they were working on bridging the gender gap among drivers and ensuring more women participate in the IST program.
“What is intriguing to us is the impact that we have been able to achieve so far. In terms of the support we have given to riders, out of the 94 riders, we have five women drivers and we want to see how we can work to increase the number of women that are participating in this particular initiative,” said Dr Odusola
He added that the IST program has been key in Zimbabwe achieving the goals set for the country, particularly in the HIV and AIDS strategic plan which is ongoing now. He also said the overarching objective of the IST was to strengthen the health resilience system in the country.
Zimbabwe’s past sample transportation system faced significant hurdles that hindered effective treatment, including for People Living with HIV. The IST has come to address the specimen and result transportation gap, designing, implementing, and sustaining a well-coordinated specimen transportation system.
Director of Laboratory Services in the Ministry of Health and Child Care, Dr Riva Simbi said the riders have brought order to the sample transportation system in Zimbabwe.
“Before the IST, we had a haphazard way of transporting samples, we had no formal way of transporting samples. One of our biggest challenges was the turnaround time for results. Samples would take long to get to the testing hubs and results would take long to get back to the testing sites to the clinicians also it would take a lot of time for the results to be used for clinical interventions. We also had no way of tracking samples along the way and several samples would then be lost,” said Dr Simbi.
The challenges directly contributed to barriers and inequities in accessing essential HIV treatment services. Delayed viral load results prevented timely adjustments to treatment regimens for PLHIV, potentially leading to increased viral load: Patients may have remained on ineffective treatments for extended periods, allowing the virus to replicate and potentially develop drug resistance, deteriorating health, delayed treatment adjustments could have led to a decline in patient health and a higher risk of opportunistic infections, poor adherence, frustration with long wait times for results could have led to patients abandoning treatment altogether.
By strengthening Zimbabwe’s IST system, significant improvements have been made in delivering timely and effective treatment, including HIV treatment, ultimately improving patient outcomes and overall public health.
