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 Home Campaigns Human Rights in Zimbabwe News
Collapsing Health System12 April 2006Like the educational system, Zimbabwe’s public health sector was once the envy of other African countries. But years of mismanagement, neglect and rampant theft have left public health services in a catastrophic state, with doctors and nurses leaving the country in droves to seek work elsewhere and shortages of medical equipment and even the most basic drugs.
Life expectancy, which was 63 in 1998, has plunged to 37 for men. For women it has plummeted to a mere 34, which, according to the World Health Organisation (WHO), is by far the lowest in the world . This is largely a result of AIDS and widespread hunger, in a country, which was once the breadbasket of Africa. But after years of misgovernment by Mugabe and his corrupt allies, the country struggles with a crippling economy and the highest inflation in the world, leading to 80% unemployment, shortages of every basic survival goods and half the population dependent on foreign food aid. Zimbabwe's public health care system could be compared with a patient who needs intensive care, so close is it to breakdown. Firstly, there is the loss of skilled staff. According to the UN, there is an extreme exodus of health care professionals from the country; fewer than 900 doctors remain in a nation of 11.6 million people - one doctor for every 13,500 people. The ratio is similar with regard to nurses. A developed country like Australia has one doctor for every 400 people. In the Murambinda hospital, for example, one of the few hospitals still relatively operational, there are just three doctors and thirty nurses. But there are even hospitals in Zimbabwe, which have to get by without doctors at all. They leave the country usually for western countries or neighboring African states like Botswana or South Africa. Since tertiary education is so disrupted, replacement of skilled health professionals is slow. If there is any staff left, the situation in hospitals still remains awful. There are shortages of almost everything. Gloves and hand-wash solutions are missing as well as needles, dressings and drips. Lack of supplies and sterilization undermines infection control, so important in high HIV prevalence health care settings. There is even a lack of clean sheets, as the government has not paid laundry bills. Essential drugs and medicines such as antibiotics or simple pain relievers are short too, because Zimbabwe has no foreign currency to import them. A once robust network of hospitals and hundreds of rural clinics has been pushed close to ruin. Only some private clinics and pharmacies are still able to provide health services and medications, but of course at much higher prices, which are unaffordable for most of the population. Access to treatment has ceased to be a basic human right and has become a luxury. The human toll of these breakdowns is difficult to measure precisely, but it is believed to be extremely high. In Zimbabwe's capital Harare, for example, half of the kidney-dialysis patients died, because the government would not spend scarce foreign currency to buy catheters for blood-cleansing equipment. In Bulawayo, the second largest city, a shortage of sutures and other equipment has closed operating rooms and forced obstetricians to curtail Caesarean-section births. Hence some women have died in labor. As a consequence people have lost faith in the system. Now, they seek cures with traditional healers instead of spending money on a substandard, ineffective public health service. The government's Operation Murambatsvina - or 'Drive Out The Filth' - has intensified the problems of the already weak public health system. The campaign, launched to demolish supposedly illegal structures, even though it also included schools, orphanages and churches, left an estimated 700,000 people without shelter or livelihoods. A large number of the evictees remain near their demolished homes, simply because they have nowhere else to go. They live in overcrowded conditions or out in the open, without adequate access to safe drinking water and sanitation. People are therefore not only struggling with the loss of their livelihoods and homes but also with water-borne diseases such as diarrhea, dysentery and even cholera. Due to several deaths related to cholera recently, health organizations are now concerned that there will be an epidemic outbreak of huge dimensions; some settlement areas have become cholera time-bombs. Communicable diseases such as tuberculosis are an additional problem. Many children are reported to have died due to respiratory infections after being forced to stay in overcrowded camps or to sleep out in the open during the harsh Zimbabwean winter. In fact, the whole health system has collapsed in the Murambatsvina-zones. Women give birth in the open. HIV-positive people are cut off their supplies of Anti-Retroviral drugs (ARV) due to either their own displacement to rural areas or the destruction of the dispensing clinics. Interruptions in ARV treatment can result in drug resistance, declining health, and ultimately death. Home-based care for chronically ill people is disrupted as either the patients or the volunteers were forced to relocate. What President Mugabe describes as an 'urban beautification program' has left the affected population in a daily struggle to survive. Another severe problem in Zimbabwe is HIV. Historically, the southern African countries were hit by HIV later than the countries of central and eastern Africa. Nevertheless, Zimbabwe is among the countries suffering the most. Even though there has been a slight decline in new infections reported recently, the dimensions of the disease are still horrifying. According to UNAIDS, over a quarter of the adult population is infected. According to the trade unions and other civil society organisations in Zimbabwe, 5,000 people are dying from AIDS-related diseases every week. Half of hospital in-patients in Zimbabwe today suffer from AIDS-related illnesses. The pandemic affects children as well as adults; each hour, three Zimbabweans under the age of 15 become infected and another three die. Being infected with HIV in Zimbabwe is more dramatic than in the West. With proper nutrition and medical care, people with HIV in the western world are now maintaining manageable health indefinitely. For Zimbabweans, half of whom are short of food and whose immune systems are already weakened by malnutrition, the transition to illness can be a matter of months. Medicines to treat or prevent common opportunistic infections for people with HIV - such as reactivated TB, thrush or pneumonia - are now hard to access. Anti-retrovirals - drugs to slow down the reproduction of the virus - are inaccessible for the average Zimbabwean with HIV. They are always short in supply in public health care facilities, as the government doesn't have enough foreign currency for purchase and, if they are available, they are unaffordably expensive. From the 1.5 million people known to be HIV-positive, only 6,000 are thought to be receiving the medicines. The small amount that is available - often sponsored by donors - is snapped up by members of the corrupt ruling elite. Government, army and police officials abuse their powerful positions to grab ARVs for themselves and their friends, depriving the poor, who were the intended beneficiaries. Zimbabwe used to have a significant generic medicines capability, but the overall economic collapse precludes local manufacture of generic drugs to manage HIV or its opportunistic infections. The pandemic has already affected every sector, from education to agriculture, from economy to public services, from security to central political leadership. Everywhere skilled staff are missing due to the deadly disease. In the wake of HIV the extended African family is threatened with collapse. According to the UNICEF, almost one and a half million children are orphaned. Often they have had to take care of their terminally ill parents. While most Zimbabean families are caring for children of deceased relatives, some relatives prey on orphans. Extremely poor themselves, they use girls as a source of income by marrying them off young and taking the bride price. Orphans are often vulnerable to sexual abuse. According to UNICEF, child abuse has become rampant during the last few years. The suspects are usually those in trusted positions, such as school teachers and headmasters, police or church officials, the staff of orphanages or even relatives, while their victims are often pre-pubescent. Those children are vulnerable to contracting HIV. As a result, nowadays rapist-to-child HIV transmission has become more prevalent than parent-to-child transmission (ie. through birth and breastfeeding). As nutrition is a crucial factor for health status, widespread hunger in Zimbabwe is responsible for lots of illnesses and deaths. The government's seizure of 95% of commercial farms since 2000 has seen food security plummet. The communal lands cannot produce enough food for the population, and commercial agriculture exports no longer earn foreign exchange. Farm houses have been given to those with good connections to the regime, but hundreds of thousands of farm labourers have been thrown off the farms without shelter or food, and those landless families that have moved onto small plots in the commercial farming areas are in great difficulty, without access to seeds, fertilizer, tools, pesticides, irrigation or training. Corruption in the Grain Board and low fixed sale prices deter new farmers from producing staple grain crops. Although there have been good rains this season, next month's harvest is expected to be again way below the country's needs, leaving Zimbabwe with the highest cereal deficit in southern Africa. Zimbabweans are starving - while the government refuses to admit that their people are suffering. President Robert Mugabe is even telling aid organisations to take food aid to other countries and not to 'choke' Zimbabweans with their food donations. Nobody knows the exact figures for malnutrition because the majority of victims cannot afford to go to hospitals. Moreover, the extent of famine is thought to be masked by the scale of the AIDS epidemic. As malnutrition is causing people with HIV to develop AIDS-related diseases much faster, people are simply dying of AIDS before they can starve to death. Children, the most vulnerable group of the population, are hit hardest by the food shortage. Paediatricians in the two main cities of Harare and Bulawayo reported that malnutrition has doubled over the past year. Chronic under-nutrition has irreversible impacts on their development. Children are much smaller than they should be for their age - a child looking like a healthy two-year-old is probably a very underfed four-year-old. Undernourished children have an extremely weak immune system and are therefore much more vulnerable to communicable diseases such as tuberculosis. These illnesses are likely to lead to the child's death, as parents, who cannot afford to feed their children, lack the financial means to pay for medical treatment. So grave is the situation that desperate mothers, unable to support another child, resort to dumping their newborns. At least 20 corpses of newborn babies are found each week in Harare alone, thrown away or even flushed down lavatories. While people are dying in droves due to the collapse of the public health system, they are even denied a dignified funeral, as this has become more and more the preserve of the rich. It costs at least 20 million in Zimbabwe's collapsing currency, or US $200 to bury the dead - a sum beyond reach of most people these days. Bodies are now piling up in hospital morgues. Frequent power cuts due to Zimbabwe's collapsing economy lead to their rapid decomposition. The public health system that remains persists on the astonishing dedication of those health workers who have stayed - and depends even more on the kindness of external donors. Foreign aid, largely from the UN system, global charities, churches, , Europe and Australia, has saved Zimbabwe from running entirely out of drugs and medical supplies.Contact Details Union Aid Abroad - APHEDA Ph: (02) 9264 9343 Fax: (02) 9261 1118 office@apheda.org.au Human Rights in Zimbabwe News
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