HUMANITARIAN ASSISTANCE AND
RECOVERY PROGRAMME (HARP)
RAPID NEEDS ASSESSMENT FOR THE HEALTH
SECTOR IN ZIMBABWE
TABLE OF CONTENTS
ABBREVIATIONS
ii
EXECUTIVE SUMMARY
iii
1.0
INTRODUCTION AND BACKGROUND
1
2.0
OBJECTIVES OF ASSESSMENT
1
2.1
2
3.0
OUTPUTS OF ASSESSMENT
METHODS AND LIMITATION
2
FINDINGS
4.0
5.0
6.0
HEALTH STAKEHOLDER ANALYSIS
4
4.1
4.2
4.3
4.4
4.5
4.6
4
5
6
6
7
7
DISEASE SURVEILLANCE
11
5.1
11
12
6.1
EPIDEMICS
13
6.1.1
14
Epidemic Trends
RECOMMENDATIONS
15
ACCESS TO HEALTH CARE VULNERABLE GROUPS
16
7.1
7.2
7.3
STAFFING OF HEALTH SERVICES
COSTS OF HEALTH CARE
AVAILABILITY OF SERVICES TO COMMUNITIES
16
17
18
7.3.1
7.3.2
7.3.3
18
19
19
7.4
8.0
RECOMMENDATIONS
BURDEN OF DISEASE
6.2
7.0
HEALTH STAKEHOLDER PROFILE
STRENGTHS OF OPERATION
W EAKNESSES OF OPERATION
OPERATIONAL PROBLEMS AND CONSTRAINS
PLANS FOR THE CURRENT HUMANITARIAN CRISIS
RECOMMENDATIONS
Availability of health facilities
Use of outreach services
Health Extension Workers Services
RECOMMENDATIONS
DRUGS
8.1
20
21
RECOMMENDATIONS
HARP Rapid Health Assessment Report May 2002
23
i
ABBREVIATIONS/ACRONYMS
AIDS
ARI
CBD
CFR
EHO
EHT
HARP
HAS
HBV
HC
HIV
IMCI
MOHCW
NANGO
NBTS
NGO
NNT
Pharm Tech
PMD
RDC
SM
TB
TM
UMP
UN
UNCT
UNFPA
UNHCR
UNICEF
VHW
WFP
WHO
ZACH
Acquired Immune Deficiency Syndrome
Acute respiratory Infection
Community Based Distributor
Case Fatality Rate
Environmental Health Officer
Environmental Technician
Humanitarian Assistance and Recovery Programme
Health Services Administrator
Hepatitis B Vaccine
Health Centre
Human Immune Deficiency Virus
Integrated Management of Childhood Illnesses
Ministry of Health and Child Welfare
National Association of Non Governmental Organizations
National Blood Transfusion Service
Non Governmental Organization
Neonatal Tetanus
Pharmaceutical Technician
Provincial Medical Director
Rural District Council
School Master
Tuberculosis
Traditional Midwife
Uzumba –Maramba-Pfungwe
United Nations
United Nations County Team
United Nations Population Fund
United Nations High Commissioner for Refugees
United Nations Children’s Fund
Village Health Worker
World Food Programme
World Health Organisation
Zimbabwe Association of Church Related Hospitals
HARP Rapid Health Assessment Report May 2002
ii
EXECUTIVE SUMMARY
A rapid health assessment was carried out in twenty-four (24) districts of
Zimbabwe to guide the Health Sector response to the humanitarian crisis
arising from economic recession and the 2001/2002 drought. The assessment
entailed a desk review to determine vulnerable groups and populations after
which a field assessment was carried out. The findings were:
 Twelve (12) partners in provision of health services were identified. These
organisations run programmes on HIV/AIDS, family planning, primary
health care and emergency relief services. Problems of coordination and
duplication of efforts were found among the partners.
 It was found that peripheral health facilities had no capacity to analyze and
use local data to control locally endemic diseases.
 Trends in morbidity and mortality over the years 1997 – 2002 showed that
for most diseases morbidity rates declined while mortality rates increased.
However, for cholera both morbidity and mortality increased for the years
1999 to 2002. Major causes of morbidity were ARI, malaria skin diseases,
diarrhoea and injuries while major causes of mortality were ARI,
malnutrition, diarrhoea, TB and HIV/AIDS. Both morbidity and mortality
tended to be high in specific districts. In 2001 morbidity rates in under fives
were lower than in persons aged above five years.
 Some 24% of all posts (in all categories of staff) on establishment in all
provinces combined were vacant. Since January 2000 12%, 13%, 18%
and 8% of doctors, clinical officers, pharmacists and nurses respectively
have left the MOHCW. At health facilities where substantial losses
occurred, this had compromised the quality and quantity of services
provided. Charges levied by some health institutions have reduced access
to services by women and children. The large-scale movement of people
under the current humanitarian crisis has resulted in these populations not
accessing health services including safe water supplies and adequate
sanitation. Consequently these populations are extremely vulnerable to
disease outbreaks. It is estimated that 1 million people countrywide are
vulnerable due to lack of basic health services.
 Seventy-three percent (73%) of peripheral health facilities had severely
depleted stocks of essential drugs.
 Epidemic prone diseases such as cholera show an upward trend.
Peripheral health facilities did not seem to have the capacity to detect and
control the epidemics.
 Vulnerable populations are located far from any health facilities and this
compounded by lack of outreach services.
HARP Rapid Health Assessment Report May 2002
iii
RECOMMENDATIONS








MOHCW in partnership with WHO/HARP should strengthen coordination
mechanisms by e.g. holding regular consultative meetings with NGO
partners in health with the view to operate in unison to maximize efforts
directed at cushioning impact of the humanitarian crisis.
WHO/HARP to support training of peripheral health workers in order to
improve disease surveillance.
WHO/HARP should provide training of peripheral workers in epidemic
preparedness and control and expertise to help out control current
epidemics.
Efforts directed at controlling diseases should be focused at risk groups
and areas.
MOHCW should seriously look at rationalizing staff posts and improving
conditions of service in order to retain the remaining staff and WHO/HARP
to provide logistical support for supervision of staff at peripheral levels.
MOHCW should work with the health partners who run primary health
care serves and rationalize the fee structure to ensure that vulnerable
groups such as pregnant women, children and the elderly have access to
free health services.
MOHCW should examine use of extension health workers to reach the
vulnerable population groups and WHO/HARP to provide logistical support
and support training of such cadres.
WHO/HARP mobilise funds to immediately procure vital drugs, vaccines
and medical supplies for all health institutions to ensure adequate cover.
HARP Rapid Health Assessment Report May 2002
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1.0
INTRODUCTION AND BACKGROUND
In the last three years (since early 2000) Zimbabwe has been going through a
severe economic recession that has impacted negatively on the health of the
population and operations of the health sector in Zimbabwe. The humanitarian
crisis spawned by the economic recession has been exacerbated by effects of
two natural phenomena viz Cyclone Eline flooding of some parts of Zimbabwe
in February –March of 2000 and the drought that has been experienced
country wide in 2001/2002 agricultural season. In response to the appeal of
the Government of Zimbabwe the UN Country Team in Zimbabwe developed
the Humanitarian Assistance and Recovery Programme (HARP) to spearhead
efforts directed at averting and or cushioning the community, particularly
vulnerable population groups, from the negative effects of the crisis. In this
regard WHO, the lead UN agency in health, was mandated by the UN CT to
coordinate the health sector emergency response to the humanitarian crisis.
Recent occurrences that have included stock-outs of essential drugs at most
health facilities, severe losses of professional staff from health facilities run by
MOHCW, reduced capacity of MOHCW to control epidemics and large scale
movement of people into areas where basic health services and amenities are
not available to sufficiently cater for these populations has led the health
sector to believe that a humanitarian catastrophe that could put many lives at
risk was unfolding. In order to identify and quantify health problems
associated with this crisis a health needs assessment was conducted in May
2002.
2.0
OBJECTIVES OF THE ASSESSMENT
The main objective of the assessment was to guide the WHO/HARP response
through identification of the health needs of the population and vulnerable
groups in particular while the specific objectives were to:
 Identify key stakeholders working with vulnerable groups in the field of
health – specifically where, how and when key stakeholders are
operating in Zimbabwe and share information with identified key
stakeholders.
 Identify strengths and weaknesses of disease surveillance and
response systems considering human, financial and logistics issues.
 Identify the top ten causes and the trends of mortality and morbidity in
Zimbabwe including case fatality rates between the years of 1996 to
2002 disaggregated by age group and district.
 Identify vulnerable groups and districts in terms of health needs and
access to health care using available data e.g. WFP reports, poverty
indicators, mortality and morbidity figures, previous epidemic data and
district and provincial administration reports, MOHCW reports. Note
access to health care should consider – availability of drugs, supplies
and health staff, costs of care, distance to health facilities and
availability of outreach services.
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

Assess the availability of vital drugs, vaccines and medical supplies at
national and district level.
Identify and assess the health system response to current epidemics.
2.1 OUTPUTS OF ASSESSMENT
The main expected output of the assessment was to provide a full report on
the health needs of vulnerable groups and make recommendations for
WHO/HARP inputs while specific outputs were to:
 Stakeholders (operating in the health field) serving vulnerable groups
identified and relevant documentation from these stakeholders collected.

Recommendations for co-ordination mechanisms between the various
stakeholders made.

Strengths and weakness of the disease surveillance system identified and
recommendations for inputs from the WHO/HARP indicated.

Morbidity and mortality trends (disaggregated by district, age and sex).
Among vulnerable districts and groups described.

Availability of drugs, vaccines and supplies at national, provincial and
district (including selected rural health centres) indicated.

A summary of recent (2002) epidemics and the health system’s response
provided with recommendations indicating inputs for the WHO/HARP
support.

Additional funding required mitigate excess morbidity and mortality caused
by the drought and current economic climate in Zimbabwe indicated.
3.0 METHODS OF THE ASSESSMENT
The following methods were used to carryout the assessment:
(a) Desk review: A review of documentation from various institutions and
organizations (MOHCW, WHO, WFP, FAO, UNICEF, UNHCR, NANGO)
on the current crisis was carried out. This effort was mostly used as a
platform to develop the various approaches/strategies and focus on field
aspect of the study.
(b) Field assessment:
The assessment was carried out in all the eight (8) rural provinces of
Zimbabwe namely Masvingo, Matabeleland North, Matabeleland South,
Manicaland, Mashonaland East, Mashonaland West, Mashonaland Central
and Midlands. From each province, 3 districts were selected for study and
thus all in all 24 districts listed in Annex 1 where included in the study.
HARP Rapid Health Assessment Report May 2002
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The districts selected for study were defined by the UNCT, which selected
them on the basis of various criteria (e.g. levels of poverty, history of
population vulnerability etc). From each district three (3) health facilities were
selected for study namely the district hospital, a mission hospital and a rural
health centre. A total 72 health facilities were included in the study. Health
personnel were interviewed at provincial, district, and health facility (including
mission hospitals) levels. In the community, 20 heads of households per
district (10 from a traditional communal land and 10 from newly resettled area)
were interviewed and thus some 480 households from some 48 villages were
included in the study.
Information on stakeholders (partner institutions that provide health services
other than the MOHCW) was collected through interviews of their in-charges
in Harare who were also asked to provide documentation or literature (annual
reports, mission statements, plans) on the operations of their organizations.
Information on operations of stakeholders was sought from provincial and
district health offices, and from heads of households interviewed in the
community.
A set of data collection instruments for use at provincial, district and
community levels were developed, and criteria for selection of facilities and
communities to be assessed were determined. Prior to the assessment teams
that included health personnel from MOHCW (provincial staff) and WHO were
selected and trained.
Data was entered and analyzed in EPI-INFO Version 6.1 and Microsoft Excel
statistical packages.
Limitations of the Assessment

The effort was constrained for time on account of the urgency of the
assessment. On account of this the development of the data collection
instruments was hurried and they were not pre-tested in the field.

Selection of districts for the study was predetermined on the basis of
criteria that met interest of the MOHCW and various UN agencies included
on the HARP effort.

Districts selected for study were far flung this meant that supervision of
data collection was difficult on account of travel time etc.
HARP Rapid Health Assessment Report May 2002
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FINDINGS
4.0
HEALTH STAKEHOLDER ANALYSIS
Source of information: during interviews with the NGO’s, we collected
literature materials such as reports including annual reports, country profiles,
mission statements and strategic plans. From the WHO library we were able
to look at (a) Country Report on NGO’s Working in the Health Sector Vol II
(1997) (b) the NANGO Zimbabwe NGO Directory
4.1
STAKEHOLDERS PROFILE
Several NGOs, UN agencies and church organizations that operate in the
districts and provide a wide range of health related services have their main
offices in Harare. During the field survey communities were able to indicate
some 16 of these organizations operate among them (see Annex 2). Other
than the MOHCW, two major partners that provide curative and preventive
health services in the rural areas are the church related missions and rural
district councils.
Table 4.1 shows the activities of health sector NGOs that were consulted on
this study. They included Red Cross Zimbabwe, which is providing health
and social services, an AIDS control programme and providing water and
sanitation to over 100,000 people in all the 8 provinces. Lutheran World
Federation operates at national level and in Beitbridge, Zvishavane,
Mberengwa, Chivi, Mwenezi and Gwanda districts where they provide
HIV/AIDS awareness water supply and provision of nutrition. World Vision
International provides health education, water development and food security
in Chivi, UMP, Insiza, Gokwe, Mt. Darwin, Chipinge, Mudzi, Chiredzi,
Beitbridge, Bulilimamagwe, Mberengwa and Hurungwe districts. In the
districts of Kwekwe, Mutare, Chipinge, Mutasa, Chiredzi, Tsholotsho and
Mutoko, Plan International caters for some 580,000 people and runs
programmes that include an STI’s/HIV/AIDS prevention, malaria control and
support for
Orphans.
Care Zimbabwe is involved in women’s health, supporting AIDS affected
people, providing nutrition support and delivering relief in emergencies
through their sub-offices in Gweru, Mutare, Masvingo and Zvishavane. Their
operations cover over 704,500 people. They run a supplementary feeding
programme that caters for over 125,000 children who are either under fives or
elementary school-going children. The Zimbabwe Association of Church
Related Hospitals (ZACH) is responsible for coordinating the activities of
church related hospitals. Most districts have church hospitals, which run
patient care services and other primary health care activities. Some facilities
that are run by members of ZACH such as Mutambara (Chimanimani district),
Murambinda (Buhera district) and Munene mission (Mberengwa district) are
designated district hospitals. ZACH also provides other activities such as
development of AIDS education, family planning and reproductive health,
HARP Rapid Health Assessment Report May 2002
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MCH, strengthening health information and IEC, home based care and clinical
reproductive health services and research.
Other NGOs include Christian Care whose activities include projects for
water and sanitation and supplying food to rural health centres (clinics) in
Beitbridge, Mutare, Insiza, Hurungwe, Chipinge Guruve, Mwenezi, Chiredzi
and Muzarabani districts. In Binga and Kariba districts, Save the Children UK
is providing HIV/AIDS awareness and prevention, home based care training
and equipping and covers over 200,000 people. REDD BANA (a Norwegian
organization) is in the process of putting up a comprehensive nation-wide
programme on HIV/AIDS which will have a nationwide coverage.
The UN agencies with programmes at the national provincial and district
levels include UNICEF, which operates in 26 districts countrywide.
The districts are selected based on PASS survey which is based on 4 top
priorities i.e., lack of basic social services. Their services range from EPI,
IMCI, safe motherhood, reproductive health, water and sanitation, nutrition
and health education. UNFPA works through the PMD’s to access the districts
nationwide and their activities include services in family planning, integrating
HIV/STI, supporting areas with high levels of maternal/infant morbidity and
mortality through upgrading quality of essential and basic emergence obstetric
care. Another UN organization providing health programmes among refugees
is the UNHCR.
In the field of funding, the European Commission (Zimbabwe) donated 57
million EU to cover the following activities for the period 2000 to 2006: assist
MoHCW to develop a sustainable health system, provision of essential drugs
and supplies, institutional strengthening of NATPHAM, enhance planning for
HIV/AIDS pandemic, support increased access to district health services,
support preservation of human capital in the face of HIV/AIDS and provide
equipment, supplies, technical assistance and building works for the national
blood transfusion services (NBTS).
4.2
STRENGTHS OF THE OPERATIONS
Strengths of NGOs and other partners were identified as:
(a) ability to carry out rapid health needs assessment – most organizations
indicated that they regularly carry out needs assessments to determine at
risk populations and communities needing assistance.
(b) funding available for execution of tasks including prompt delivery of
logistical support and manpower (experts) during emergencies and
disasters.
(c) ability to meet among themselves, communicate with MOHCW and other
GOZ departments and hold consultations with various administrators at
provincial, district, health facility and community levels.
(d) Ability to cover large populations including operating at grassroots levels.
HARP Rapid Health Assessment Report May 2002
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4.3
WEAKNESSES OF THE OPERATIONS
Information outlined under this section was obtained by asking various people
at provincial, district, health facility and community levels on how they viewed
the operations of the NGO’s and several problem areas were identified:

Some districts such as Chimanimani, Rushinga, Makonde, Mazowe,
Murewa and Hwedza are not covered by any NGO or partners in health
at all.

duplication of services among NGOs exist

some personnel working on NGO programmes are not quite experienced

poor reporting systems and lack of continuity exists

on occasions government administrators were not aware of the activities
going on
some provincial and district authorities present unnecessary bureaucracy,
which causes unnecessary delays in aid reaching the vulnerable groups.
From interviews with the NGO’s in Harare, it was observed that (i) the
frequency of inter-organization consultation or meetings varied among
NGOs hence the duplication of efforts. (ii) Coordination and consultation
with MOHCW also varied with the organizations. On occasions the
MOHCW does not get feedback and information on the operations of
these organization.


feedback to beneficiaries of some NGOs’ effort tended to be limited
particularly when meetings are not held regularly.

smaller NGOs indicated that they rely on information from either bigger
NGOs or government institutions such as MOHCW because they do not
have adequate manpower to carry out such rapid needs assessments on
the ground.
unfulfilled promises

Although the NGOs had indicated that one of their strengths was their
capacity to consult among themselves and government this contradicts
observations made by the government administrators and the community to
the effect that NGOs on occasions run their efforts without consultations with
authorities. This divergence of opinion seems to suggest that there could be
gaps in coordination, communication, planning and information sharing and
could curtail the capacity of the NGOs to respond to the current humanitarian
crisis and increase duplication of activities.
4.4
OPERATIONAL PROBLEMS AND CONSTRAINS
Some of the constraints indicated by the NGOs were:
 coordination with partners in health is affected by a high staff turnover in
government departments
HARP Rapid Health Assessment Report May 2002
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4.5

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
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

4.6
some populations are in accessible making it difficult to determine the
degree of risk and consequently the health needs.
some operations can be costly making it difficult to meet needs of other at
risk groups elsewhere.
shortage of foreign currency causes delays in procuring materials that are
not locally available.
customs duties and tax when shipping in materials from abroad take up a
lot of moneys, which could have benefited the needy.
some projects tend to be small and hence impact on the community is
minimal.
PLANS FOR THE CURRENT HUMANITARIAN CRISIS
training communities in epidemic preparedness
improving water and sanitation programmes
intensifying health education on basic hygiene, HIV/AIDS
conducting mass community education and mobilization for the
communities to start engaging in drought relief strategies
supporting the vulnerable groups (children, women, the elderly) by
providing supplementary feeding programmes and health care
planning in readiness to respond to epidemics and emergencies
RECOMMENDATIONS
a. There is need for MoHCW and WHO/HARP to hold regular consultative
meetings with NGO’s and other partners in health so as to share
information, discuss strategies for cushioning effects of the
humanitarian crisis, ways of enhancing feedback and elimination of
duplication of efforts and activities.
b. It is strongly recommended that MOHCW in conjunction with
WHO/HARP should, without delay, hold a consultative meetings with
all the partners in health during which coordination, communication and
information sharing strategies are streamlined. The meeting should
also come up with a unified strategy to deal with effects of the current
humanitarian crisis. Meetings of this nature should be held regularly.
c. There exists a host of NGOs working with locally established structures
at national, provincial, district and grassroots levels. WHO/HARP
should exploit these structures and work with these NGOs in order to
effectively and efficiently execute its operations through them.
d. MOHCW, other health related ministries and local administrations as
applicable should be involved at the initial stages or launching of
programmes initiated by NGOs for assisting the vulnerable groups.
e. MOHCW should make NGOs aware of current system where
humanitarian assistance should be brought into the country duty free.
Where difficulties are encountered NGOs should consult MOHCW.
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f. Since some NGOs are already operating among high risk populations
WHO/HARP, where applicable, could provide logistical support to
those institutions carrying the burden of health delivery under
extremely difficult conditions
HARP Rapid Health Assessment Report May 2002
8
Table 4.1. Organisations Involved in Health Delivery Activities
ORGANISATION
ACTIVITY
Zimbabwe
1. Represents church related
Association
of medical institutions
Church
Related 2. Membership provides: clinical reproductive health
Hospitals (ZACH)
services including
MCH: child survival: family
planning/reproductive health: home based care:
development of AIDS education: counselling: strengthen
health information and IEC: planning and coordinate
capacity building programmes for health development:
research
UNICEF
1. woman and child health support (EPI and IMCI)
2. safe motherhood
3. reproductive health
4. water and sanitation
5. nutrition
6. health education
UNFPA
Red
Zimbabwe
Cross
1 integrating HIV/STI
2. high levels of maternal/infant morbidity and mortality
through upgrading quality of essential and basic
emergency obstetric care
3. provision of PAC in all hospitals
4. family planning
5. rural health education
1 health and social services
2. integrated AIDS activity programme
3. water and sanitation
UNHCR
Health among refugees
CARE International
Zimbabwe
1. Women’s health
2. support AIDS affected people
3. nutrition and delivering relief in emergencies
Lutheran
Federation
1. HIV/AIDS awareness
2.. water supplies
World
9
AREA OF OPERATION
1. at national level
2. nation wide
3. coordinates rural church (mission) hospitals and clinics
4. recognized by and works with MoHCW
1. country wide with some distributions to 26 districts selection
based on PASS survey which is based on 4 top priorities – lack of
basic social services
1. National, districts through PMD's
2. covers 3-5 million people annually
1. represented at in all 8 provinces and in given areas of each
district
2. have structures in most districts: e.g. Nkayi
3. covers over 100,000 population annually
1. Harare and Chipinge
1. Covers 10,000 people annually
1.covers 704,500 people
2.has sub-offices in Gweru, Mutare, Masvingo, Zvishavane
3. supplementary feeding covers 125, 000 children under 5 and
primary school children
1. national
2. districts: Beitbridge; Zvishavane; Mberengwa; Chivi; Mwenezi;
World
Vision
International
Save The Children
UK
Christian Care
REDD BANA
National
AIDS
Council
Plan International
European
Commission
3. nutrition
.
1. health education
2. water development
3. food security
1.HIV/AIDS awareness/prevention
2. home based care training and equipping
.
1. Health, water and sanitation
2. supplies food to rural clinics
11. HIV/AIDS
1. funding HIV/AIDS initiatives
2. provide technical support
1. HIV/AIDS – prevention, control and community support
2. control of STI's
3. voluntary counselling and testing of HIV and prevention
4. promote sexual behavior
5. establish community information and resource centres
6. support orphaned children
7. malaria control
1. assist MoHCW to develop a sustainable health system
by contributing to the health services fund
2. provision of essential drugs and supplies
3. institutional strengthening of NATPHAM
4. provide equipment, supplies, technical assistance and
building works for the national Blood Transfusion Service
(NBTS)
5. enhance planning for HIV/AIDS pandemic
6. support increased access to district health services
7. support preservation of the human capital in the face of
HIV/AIDS
10
Gwanda
3. covers over 1.5 million people annually
1.districts: Chivi, UMP, Insiza; Gokwe; Mt. Darwin; Chipinge; Mudzi;
Chredzi; Beitbridge; Bulilimamangwe; Mberengwa; Hurungwe
1. Binga district
2.Kariba district
3. covers 200,000 people annually
1. districts: Beitbridge; Mutare; Insiza; Hurungwe; Chipinge;
Guruve, Mwenezi; Chiredzi; Muzarabani
National
1. national
1. Kwekwe, Mutare, Chipinge, Mutasa
Chiredzi, Tsholotsho, Mutoko
Covers over 580,000 people
1. National
2. donated 57 million EU to MoHCW for period (2000 – 2006)
3. 70% (24.5 EU) to districts
4. 33 million EU for preserving the human capital
5. 26 million EU for drug supply from September 2002
6. 1.8 million EU for institutional strengthening of NATPHAM
7. 2.6 million EU for safe blood transfusion
8. 0.75 million Euros for enhancing planning for HIV/AIDS
5.0
DISEASE SURVEILLANCE
Disease surveillance was assessed at peripheral (health facilities) and district
levels.
Action thresholds for epidemic prone diseases at the level of health facilities were
generally not known. Seventy-four percent (74%) of health facilities (n= 72) only
had standard case definitions for EPI diseases while less than 5% of health
facilities had case definitions for other priority diseases. Some 21% of health
facilities did not have standard case definitions of any of the priority diseases.
Analysis of surveillance data at health facility level was minimal and at times
none. Virtually all respondents at 72 health facilities indicated that they had not
had training in disease surveillance. Response to epidemics was not prompt
implying that surveillance data was used in early detection of disease outbreaks.
Supervision (specifically on surveillance) from district level was found to be
minimal. Timeliness and completeness of data collection by health facilities
(district and mission hospitals and rural health centres) and reported to districts
was found to be 86% and 96% respectively.
At district level 66% of respondents (n=24) had had training in disease
surveillance. Supervisory visits to districts by provincial staff varied. Fourteen
districts (61%) had had supervisory visits in the last 6 months while only 4% of
sub-district level indicated they had such visits. Of these supervisory visits less
than 10% had anything to do with surveillance. Very few reports were available at
district level to confirm these visits. Provincial staff indicated that they could not
make required supervisory visits because they did not have enough vehicles and
fuel for these visits.
Thus, it was concluded that the main problems affecting disease surveillance
related to (a) poor response to epidemics because (i) action thresholds were not
known (ii) lack of training in disease surveillance at peripheral levels
(iii) inadequate supervision especially at health facility level.
5.1
RECOMMENDATIONS
a. Field staff (at health centre level) requires training in epidemiological
surveillance to equip them to effectively control locally endemic diseases.
b. District personnel who are charged with overseeing surveillance will
require logistical support to enable them to mount an effective supervisory
effort and on-the–job training of field staff.
11
6.0
BURDEN OF DISEASE
The study examined trends of major diseases attended to at health facilities and
mortality among admitted patients at health facilities in 1997-2001 in the districts
that were included in the survey.
Limitations of the study:
(a) Data included in this aspect of the study was hospital based.
(b) In Zimbabwe the case definition of AIDS requires that an HIV test be
performed even when the clinical features were suggestive of the disease. On
this survey it was difficult to quantify the magnitude of occurrence of AIDS in
the areas that were surveyed because health facilities (health centres) did not
carry out such tests and district hospitals that could do the tests did not have
the test kits. This is unlike malaria, which has both a laboratory and a clinical
case definition. Consequently even at facilities where there is no capacity to
carry out tests the malaria can be diagnosed clinically.
(c) Records at all levels (national, provincial, district and health facility) do not
indicate the sex of cases of disease and consequently identification of risk
and or vulnerability by gender or sex was not possible.
(d) The nomenclature used on some cases was such that we could not tell which
diseases they represented e.g. ill-defined symptoms, viral diseases, diseases
of digestive system, diseases of the central nervous system. Unfortunately
the number of cases defined in this manner was very high. It is unlikely that
MOHCW can put in place a meaningful mechanism to control these
conditions because it is not clear what they are.
The findings were:

ARI, malaria, skin diseases and injuries were the five top major causes of
attendance at health facilities in the districts where the assessment was
carried out while TB, ARI, HIV/AIDS, malaria and viral diseases were the top
five major causes of mortality in these districts. In the period 1997-2001 rates
of occurrence of top ten major causes of health facility attendance declined
while that of mortality increased. It is unlikely that the decline in attendance
rates at health facilities is due to effective public health control of these
diseases. This decline may be due to in-access to services brought about by
e.g. increases in clinic fees at rural district council clinics and mission health
institutions. Increases in mortality rates in the period 1998-2001 could be due
to several factors namely:
(a) people being admitted when they are very sick due delays in seeking care
(b) reduced quality of care of patients at facilities (severe manpower losses
etc)
(c) effect of AIDS in that the AIDS epidemic has matured and most patients,
although not labeled as AIDS on account of limitations of case definition
as described earlier, are actually AIDS cases who are terminally ill.
12
Trends in morbidity and mortality are shown in Annex 3 & 4. Districts with the
highest morbidity and mortality are also shown in on the same annexes.
Districts that featured commonly among the main causes of morbidity include
Rushinga, Chiredzi, Bikita and Gutu while those for the main causes of
mortality are Chiredzi, Mberengwa and Chegutu.

The top ten causes of attendance at health facilities by under fives and
people aged over five years are indicated in forms Annex 5 & 6 respectively.
Top five causes of attendance by under fives were ARI, malaria, skin
diseases, diarrhoea, and injuries while those for persons aged above five
years were injuries, ARI, malaria, skin diseases and STI’s. In 2001 the mean
rates for top five causes of attendance are higher in persons aged above five
years compared to those of persons aged under five years. In the years
1997-2001 for both the under fives and persons aged above five years there
was decline in the rates of attendance except for skin diseases in persons
aged above five years which showed a marked increase in 2001. The decline
in attendance rates could be due to reasons of in-access as explained earlier.
Main causes of mortality (see Annex 7 & 8) in people aged under five years
were ARI, malnutrition, diarrhoea, TB and malaria while those for persons
aged above five years were TB, Malaria, ARI, HIV/AIDS, and diarrhoea.
Districts with the highest morbidity and mortality rates in both the under fives
and persons aged above five years are indicated in Annexes 5, 6, 7 & 8.
6.1 EPIDEMICS
Diseases of epidemic importance such as cholera, rabies, plague and anthrax
continue to occur through out the country though sporadically especially for
anthrax, plague and rabies. (See Annex 17). However, cholera epidemics have
been experienced annually since 1998 to date (2002). At the beginning of the
year Zimbabwe experienced a cholera epidemic that affected the population of
Manicaland province - Buhera, Chimanimani, Chipinge, Makoni, Mutare, Mutasa
and Nyanga districts. The epidemic has taken time to control as sporadic cases
are still being experienced in the districts of Buhera, Chipinge and Makoni five
months after the first cases were detected. Mutare district was one of the districts
covered under the rapid assessment and the assessment team found that the
district had been experiencing an increase incidence of cholera from 3% in 1998
to 12% in 2002, while the CFR increased from 0.02% to 8.3% respectively. The
national cumulative cases for year 2002 (weekly report of week ending 26 May
2002) was 2342 cases with a CFR of 8.7%. Cholera thus pauses a major public
health threat to the whole country that requires effective surveillance and
epidemic monitoring systems.
During this assessment it was found that epidemic and disease control
management committees were either not functional or non-existent at both
district and health centre levels. Without such management structures response
13
to epidemics and disease outbreaks is severely compromised although the
findings show that fifty six percent (56%) of districts under assessment indicated
that they were able to respond to epidemics while 44% indicated that they could
not. Furthermore, the peripheral staff (at field level) of the health delivery system
did not have training in epidemic preparedness and response i.e. training in
recognition, investigation and control of epidemics. Also, there was little or no
evidence of use of local data for prevention and control of epidemic prone
diseases. This was found to be the case in 81% of the facilities included in the
assessment. Except for EPI diseases, 98% of health personnel who were
interviewed on this assessment were neither clear about other epidemic prone
diseases of public health importance nor their epidemic thresholds. The
implication of all the above concerns was that the capacity to recognize and
effectively control epidemic diseases was severely compromised. Furthermore
51% of the respondents did not know what the case fatality rates meant and that
further compromised their capacity to recognize the need to manage the cases
effectively in order to keep the case fatality rates low.
Control of epidemics was also compromised by shortage of professional health
staff at the peripheral levels resulting in non-qualified personnel having to mann
some health facilities like in Burma Valley rural health centre (Chimanimani
district) that had been under the charge of nurse aids for a long time. Critical
shortage of drugs, vaccines and other logistics that are normally required for
prevention and control programmes further exacerbated the problem. The
assessment found that there were problems in reporting epidemics from the
periphery to the district level due unreliable telephone and radio communication.
Some facilities relied on public transport for communication purposes and
submitting surveillance reports.
6.1.1
EPIDEMIC TRENDS
Trends of epidemic prone diseases in districts that were assessed showed that
rabies, anthrax, neonatal tetanus (NNT), malaria, cholera, dysentery and
diarrhoea continue to occur through out the country (See affected districts as shown
in Annexes 17 and 18). The cholera epidemic trends showed that Manicaland,
Masvingo, Mashonaland East, Matabeleland South, Mashonaland Central and
Harare provinces have had cholera outbreaks in the year 2002. In the 2002
cholera outbreak the highest number of cholera cases were recorded in
Manicaland province which up to end of May 2002, had 1862, 153 deaths and a
CFR of 8.2%. Mashonaland East had 267 cases, 40 deaths and a CRF of 15%
while Masvingo had 185 cases, 8 deaths and a CFR of 4.3%. Thus, the
provinces with the highest risk were Manicaland, Masvingo and Mashonaland
East and Mashonaland Central in that order. Based on this pattern of spread of
the cholera outbreaks indicated that it is associated with provinces or districts
such as Chimanimani, Mutoko, Chiredzi, Mutare, and Rushinga, which border
Mozambique. Thus, the lack of control of border jumpers being a factor in the
sustained occurrence of cholera outbreaks. The districts mostly affected were,
14
Mutare, Chimanimani, Chipinge, Buhera, Mutasa, Nyanga, Makoni, Mvurwi,
Mutoko, Bulilimamangwe, Mudzi, Bikita and Chiredzi.
The outbreaks of cholera in Manicaland (Chimanimani, Mutare and Buhera
districts) and Masvingo (Chiredzi and Bikita districts) provinces was of major
concern as outbreaks have occurred in these same districts in the years 2001
and 1999 (See Annexes 19, 20 and 21).
The continued spread (geographically) and increase in the occurrence of cholera
outbreaks and other epidemic prone diseases could be associated with shortage
of essential professional staff such as nurses, environmental health
technicians/officers, shortage of community health workers, lack of
communication systems/transport, drugs and vaccines, and inadequate control
strategies.
6.2
RECOMMENDATIONS
a. Control of causes of morbidity and mortality needs to be increased in all
districts with a special focus on districts that have been identified as
having the highest occurrence of these conditions (for morbidity:
Rushinga, Chiredzi, Bikita and Gutu and for mortality: Chiredzi,
Mberengwa and Chegutu).
b. MOHCW and WHO/HARP could facilitate control of these conditions by
ensuring that adequate supplies of drugs are available to enable effective
management of these conditions in the priority or at risk districts that have
been indicated above.
c. MOHCW and WHO/HARP could also facilitate control of these conditions
through improvement of surveillance as earlier recommended.
d. The MOHCW with assistance from WHO/HARP should examine
groupings of diseases that are ill-defined disease conditions (e.g. diseases
of digestive system or diseases of nervous system) so as to define them
as per international classification of diseases.
e. The MOHCW with assistance from WHO/HARP should examine the issue
of introducing a clinical case definition of AIDS so that the true magnitude
of the diseases is known in various areas of the country.
f. MOHCW with assistance of WHO/HARP should strengthen epidemic
Management committees and provision of resources and logistical support
(including drugs and vaccines) to enhance the capacity to respond to
disease outbreaks.
g. MOHCW and WHO/HARP work with partners such as UNICEF and others
in the process of providing water and sanitation in the districts at risk.
15
h. Health education in the community must be intensified in those districts
where cholera has proved difficult to control.
i.
Training of public health workers including the community health workers
on surveillance of epidemic prone diseases, capacity to recognize
diseases of epidemic importance, investigation, control and management
of these diseases.
7.0 VULNERABLE GROUPS AND ACCESS TO HEALTH CARE
7.1
STAFFING OF HEALTH SERVICES
Some 2360 vacant posts (vacancies) exist in all provinces combined and this is
24% of the posts on establishment. There is a staff deficit affecting all critical
areas of the operations of the MOHCW. Since January 2000 12%, 13% and 18%
of the doctors, clinical officers and pharmacists respectively left the MOHCW.
Provinces with the worst staff losses are indicated in annex 9.1. Staff losses that
have been experienced since January 2000 amount to 7% among all categories
of staff (doctors, clinical officers, nurses, environmental health officers and
technicians, pharmacists, pharmaceutical technicians, midwives and health
services administrators).
Staff losses at district level are indicated in Annex 9.2, with Murewa district
having lost doctors and midwives, Hurungwe has midwives and pharmacists
while and Kwekwe has lost pharmacists. These three districts rank highest on
losses of the three staff categories indicated.
Staff losses at health facilities since January 2000 are indicated Annex 9.3,
Mutambara Mission (doctors and pharmacists) and Mtshabezi Hospital (nurses
and pharmacists) have lost most staff in the categories indicated. However when
it comes to all categories of staff, Karoi district hospital and Mutambara and
Mtshabezi mission hospitals are the highest ranking in staff losses since January
2000.
Staff losses indicated above are critical in that they could be compromising
quality and quantity of services provided at health facilities. At some peripheral
health facilities that were visited during the assessment nurse aids are in-charge.
Some of the “heroic “efforts of the nurse aids were carrying out deliveries and
dispensing drugs. On this survey it was confirmed that major centres (e.g. district
hospitals) which should act as referral centres now operate like rural hospitals or
health centres due to lack of senior professional staff to run them. In a way this
lack of professional staff could explain why in some areas it has become difficult
to control conditions such as cholera. The implications of this would be that
populations where major staff losses have occurred would be at risk (and
16
therefore vulnerable) on account of inadequate care at health facilities and poor
public health control of disease conditions in the communities.
7.2
COSTS OF HEALTH CARE
In all government rural health centres that were included in the assessment
patients did not pay for services (including drugs). At all rural health centres run
by district rural council patients pay fees for outpatient services. This fee is
inclusive of drugs. At mission hospital patients pay fees for both inpatient and
outpatient care. At some (not all) of these facilities the charges for outpatient and
in-patient services exclude drugs, which are charged separately. The fees are
generally determined by the MOHCW that from time to time sends out circulars
to these institutions indicating the fees to be charged. Table 7.1 below shows
some of fees patients pay at different institutions. At government district hospitals
patients pay outpatient and in-patient fees which are inclusive of drugs when they
are available.
Table 7.1
Fees charged at some of the health facilities in districts where the
assessment was carried out
District
Facility
OPD
<5 years
OPD
>5years
in–patient
<5 years
In-patient
>5 years
Maternity
Care
Gutu
Gutu
Mission
127.0
127.0
60.0
120.0
60.0
Hwange
St. Patricks
Mission
100.0
100.0
60.0
60.0
1500.0
Kwekwe
Kwekwe
district
hospital
211
211
90
180
105
Chegutu
Norton
Hospital
30
500
300
500
1000
Mberengwa
Makuwerere
RDC health
Centre
10
20
-
-
20
The impact of fees on use of services was studied in Hwedza district at four
facilities, two hospitals (one government and the other mission) and two health
centres (one government and the other run by the district council). The study
compared attendance rates at the two hospitals and the two health centres. (See
Annexes 10.1 and 10.2) Mukamba health centre and Mount St Mary’s hospital
charge fees for services they provide while Hwedza rural hospital and Goto
health centre offer free care for patients attended to there.
17
It was found that:
(a) Between 1998 and 2000 while attendance rates at Mount St Mary’s hospital
declined those for the nearby government run Hwedza rural hospital
increased. When in 2001 Mount St Mary’s hospital started free treatment for
children and pregnant women its attendance rates sharply increased while
those for Hwedza rural hospital declined sharply. The greater proportion
cases that brought about the increase in traffic of patients at Mount St Mary’s
hospital were women and children who now had free access to services there
and this gain was a mirror image the loss of patients from the Hwedza rural
hospital.
(b) Between 1998 and 2001 the attendance rates for Mukamba clinic declined
sharply while those of Goto clinic increased.
It was concluded user fees could inhibit use of services by the population.
There are implications to this:
(a) If the women and children had not had alternative facilities to turn to (where
services were not paid for) it likely that the lack of medical attention could
have resulted in considerable morbidity and mortality.
(b) HIV infected patients, both on their progression to AIDS and when they have
developed full blown AIDS, are susceptible to several opportunistic infections
which necessitate frequent use of services. Other than TB that is treated for
free all other AIDS related ailments would require patients to pay at health
facilities, which do not offer free services. Given that AIDS patients
increasingly get sicker as the disease progresses, if they cannot access
services because they cannot pay for them their condition deteriorates a lot
faster leading to early or premature mortality.
7.3 AVAILABILITY OF SERVICES TO COMMUNITIES
7.3.1
Availability of health facilities
On this assessment each district health team was required to identify three areas
in the old communal lands (including an indication of populations in these areas)
that had inadequate coverage by health services or were inaccessible. In each of
the areas the health team was required to indicate services that are lacking and
measures that have been put in place to improve service provision including an
assessment of their effectiveness. Furthermore, the health teams were required
to indicate whether they had recently (in the last 6 months) carried out an
assessment of the situation in these areas. The same was asked the district
health teams in relation to the large scale movement of people into new areas
which has occurred recently. The results of the assessment are indicated in
tables Annex 11 & 12.
It was found that there is a general lack of clinics, sanitation facilities and safe
water supplies. In both the communal lands and the newly resettled areas the
18
problem of lack of health services remains despite efforts in the way of stop-gap
measures such as use out-reach services and health extension workers to bring
services to these populations. The situation of in-access to health services and
amenities seems to be dire in areas that have been affected by the recent large
movement of people due to the fact that these areas never had facilities and
amenities to cater for such populations.
7.3.2
Use of outreach services
District health teams were asked to describe their experience with use of
outreach services. This included an indication of areas where these services are
applied (including populations covered by the services, frequency of services,
reasons for applying the services, effectiveness of the services, constraints
encountered in applying the services, recommendations to improve the services.
The results are indicated in table Annex 13. The services are usually monthly in
areas where there are no health facilities, hard reach areas and generally
inaccessible populations. The service has been found to be fairly effective in
alleviating lack of fixed health facilities.
Major constraints encountered in
running the service include lack of vehicles and staff to run the service.
Observations by the communities were that clinics needed to be built in these
areas to provide health services.
7.3.3
Health Extension Workers Services
District health teams were asked to indicate areas that are poorly served with
fixed health facilities where they have extensively deployed extension health
workers. They were also required to indicate the type (and numbers) of cadres of
the health extension workers operating in these areas and make a brief
assessment of these cadres in the way of weaknesses and strengths of their
operations.
The results are indicated in Annex 14. It was found that a major advantage of
services offered by health extension workers was that communities in which they
serve accept them. District health teams indicated that in order for the services of
health extension workers to improve there had to be regular consultation be held
with the various cadres, more cadres needed to be trained and improvements on
their transport should be looked into.
On this survey the investigation team concluded that generally all population
groups in all that districts that were assessed were vulnerable due to the general
lack of access to health care services and amenities such as safe water supplies
and sanitary facilities. On account of poverty some population groups may not
have access to health facilities due the costs involved. Charges levied by some
NGO health providers, though minimal, are on occasions such that some
population groups may be denied access to services because they cannot afford
the fees charged.
19
In the current environment there has a general movement of people. It is in these
communities where it was found that poor access to health services was greatest
(see Annex 15). It was found that areas where populations have not had
adequate access to health services had outreach services as a stopgap
measure. However on account of shortage of vehicles and staff it has been
increasingly difficult to run regular outreach services in these areas.
.
7.4
RECOMMENDATIONS
a. In areas of major staff losses, MOHCW and WHO/HARP needs to provide
logistical support for extensive supervision of staff especially at the level of
health facilities.
b. The staff that have remained in place will require on the job support and
training
c. There is need for MOHCW and WHO/HARP to review working conditions
and to rationalize staff posts in order to retain those that have remained
and possibly attract new staff members
d. During this period of hardship MOHCW should work closely with MOHCW
WHO/HARP and other partners (particularly mission hospital) to
rationalize the fee structure at health facilities to ensure that vulnerable
groups such as pregnant women, children, AIDS patients and the elderly
have access to care.
e. MOHCW with assistance from WHO/HARP should avail logistical support
to ensure that outreach services are sustained in areas and population
groups that have no access to fixed health facilities. In the long term
MOHCW should plan to build health facilities in these areas.
f. MOHCW needs to thoroughly examine the issue of health workers with
the view to ensuring that enough numbers of these cadres are trained,
deployed and sustained (including supervision and support) in areas with
no fixed facilities particularly in newly resettled areas.
20
8.0
DRUGS
The drug stocks situation in Zimbabwe is very critical as reflected by the May 31,
2002 print out from the National Pharmaceutical Company of Zimbabwe
(Natpharm). The information shows that the country has zero cover in available
stocks for the majority of the essential drugs categories i.e. malaria, TB, IMCI,
cholera and STI. For example, for malaria there is only one month cover for
chloroquine tablets and five months cover for quinine tablets and the rest of the
drugs there is zero cover. There is between one and two months cover on TB
drugs, zero cover for the majority of IMCI drugs and there is no doxycycline in
stock. There is no rabies vaccine in stock though a tender has been issued for its
supply. This trend of low drugs stocks at national level is reflected in the printouts
of March and April 2002. However, Natpharm has issued tenders to suppliers for
all the ranges of drugs. The major problem has been shortage of foreign currency
to import the drugs.
Another drug survey carried out towards the end of 2001 revealed that there was
a skewed distribution of drugs throughout the country leading to some institutions
being adequately stocked and yet others remained in a critical situation.
During the rapid health assessment the drug situation in the provinces, districts,
and sub-district levels was found to be no different from the national level picture.
Provincial: The provincial data obtained during the assessment reflects that the
supply of the majority of the essential drug ranges between two months to zero
with a tendency towards zero in most drugs. There were no data from the two
Matabeleland provinces because there are no provincial pharmacies there.
IMCI: The six provinces that submitted information indicate that there was only
less than two months supply of drugs with the critical ones being Kanamycin,
benzyl penicillin and nalidixic acid.
TB drugs: The picture was found to be identical to the national picture with the
majority of the provinces having a cover of between one and two months except
for Ethambutol and Isonizid which is less than a month supply in Mashonaland
Central, East and West. There were zero stocks in streptomycin in Masvingo and
Manicaland.
Malaria: The stocks showed that the supplies were not adequate for one month’s
supply for Pyramethamine/Sulphadoxine, quinine tabs and injection. However
there were sufficient chloroquine stocks to cover at least three months in all
provinces that submitted information except for Mashonaland West that had only
a month supply.
STI: The Mashonaland provinces are worst affected in this range of drugs
(erythromycin, metronidazole, nystatin pessaries, and procaine penicillin) with
their stocks at less than a month to zero in the majority of cases.
Vaccines: The EPI vaccines supply at this level was less than one month to zero
in all the provinces where data was available. There was no rabies, snake venom
and tetanus toxoid vaccines in virtually all the provinces.
21
District Level: The range of stocks at this level is between a month and two
months. This was not deemed acceptable on the basis that any institution should
have at least not less than three months supply of drugs.
IMCI: Sixty-six percent (66%) of the districts had supplies less than 3 months.
The worst affected districts (less than a month supply) were Karoi, Chiredzi,
Hwange, Rushinga, Guruve and Gokwe.
Malaria: The districts had sixty-eight percent (68%) of the drug stocks. However
the worst affected districts in this category (having less than one month supply)
Gokwe, Chiredzi, Guruve Hwedza, Karoi, Tsholotsho, Chikomba, Chinhoyi,
Mutare and Gwanda. Chloroquine levels are at least more than a month except
for Guruve district.
STI: Stocks in this category were at 37% and nystatin pessaries were the lowest
at 21% of the required levels. Most affected districts (zero stock level) in this
category were Insiza, Hwange, Karoi, Chegutu, Nkayi, Rushinga, Mberengwa,
Chiredzi and Mutare.
TB: Stocks levels under this category are at 51% of normal requirements and the
least available drug is rifampicin at 33%. The worst affected districts (stocks less
than a month) are Chegutu, Chikomba, Chinhoyi, Hwedza, Karoi, Murewa,
Tsholotsho and Mutare.
Vaccines: The EPI vaccine stock levels vaccines are very low at 27% with HBV
being the worst affected at 17% and 70% of the districts are having less than a
month’s supply in more than two categories. The level of the rabies vaccine is
very critical with 46% of the districts having zero stocks and 50% of the districts
having less than a month or zero stocks of tetanus toxoid.
Mission Hospitals: This category of service provision has critical stock levels in
general but a few recently procured drugs externally. Mtshabezi and Zhombe
hospitals are the worst affected as they have zero stocks in the majority of the
drug categories.
IMCI: Drug stocks are at 47% with more than 80% of the facilities having less
than a month or zero stack levels in the majority of drugs in this section.
Malaria: The drug stock level was 66% of the normal but doxycycline was the
lowest at 17%. However, 80% of those with low stock levels have a stocking level
of zero making them very critical.
STI: Drug stocks are at 55%, however, 70% of those with below normal are in
the zero category of available stocks.
TB: Drug stocks are at 46% of the normal levels, streptomycin and rifampicin
with the lowest stock levels at 30% and 40% respectively.
22
Rural Health Centres: The drug stock levels at this level are critically low
making the rural populations vulnerable. This area needs urgent attention.
IMCI: Drug stock levels at these institutions stood at 29% of normal. Of those
that have stocks that are less than three months (i.e. 71%), 86% percent of these
have zero stock or less than a month stock levels.
Malaria: On this category only Makuwerere, Chilonga, Dewure and Nkunzi have
less than three months supply of chloroquine tablets, this excludes the
chloroquine syrup covered under IMCI drugs. Of these on Nkuzi in Tsholotsho
has less than a month supply.
STI: Only 12% of the health centres have adequate STI drugs and 77% of those
with below normal stocks have zero stocks.
TB: The drug stock level was at 35% of the normal. Of those that had less than
normal stock levels 62% have less than a month or zero stock.
Please refer to Annexes 16.1 – 16.4 for more details.
8.1
RECOMMENDATION
a. MOHCW and WHO/HARP should arrange for immediate relief of essential
drug shortages at all health facilities. In this regard it should be ensured
that all health facilities have not less than three months supply of essential
drugs.
b. MOHCW and WHO/HARP should embark on an exercise of rationalizing
drug stocks in health institutions so that those that have over-stocked
some drugs release some to institutions in need immediately.
23
Annex 1: HARP Rapid Needs Assessment Districts May 2002
HU RU N GW E
CEN TENAR Y
GUR U VE MT D ARW IN
RU SHIN GA
KAR IBA
SH AMVA
MU D ZI
U.M.P.
MAKO ND E
MAZO W E
ZVIMBA BIN DU R A
BIN GA
GOKW E
MU TO KO
MU R EHW A
GOR OMON ZI
NYANG A
CH EGU TU
KAD OMA
SEKE MAR ON DER A
MAKO NI
LUPAN E
HW AN GE
NKAYI
CH IKO MBA
KW EKW E
CH IR U MAN ZU
TSH OL OTSH O
BU BI
UMGU ZA
GW ER U
SH U RU GW I
GUT U
W EDZA
MU TASA
MU TAR E
BU H ER A
CH IMAN IMAN I
ZVISH AVAN E
BIKITA
BU LAW AYO
MASVING O
UMZIN GW AN E IN SIZ A
ZAKA
CH IVI
CH IPIN GE
BU LAL IMAMANG W E
MATO BO
MBER ENG W A
GW AN DA
Not Surveyed
Surveyed
CH IR ED ZI
MW ENEZI
N
BEITBR ID GE
W
200
0
200
24
400 Miles
E
S
25