Zim’s health crisis deepens

• Nation hit by ARV shortages
• Fears of stockouts grip patients
• Govt moves to procure drugs directly
• Prices of medication skyrocket

Amidst rising cases of Covid-19, Zimbabwe’s health sector has been dealt another heavy blow, key drugs that treat a number of chronic ailments are in short supply.

This has led to price hikes by pharmacies, who are taking advantage of shortages of medications for diseases such as hypertension and diabetes.
Further, the rise of medical aid subscription fees has resulted in many people defaulting, as the charges now take up large chunks of the salaries of the country’s already poorly paid workers.

Until the recent revision of monthly remuneration, most civil servants who make up the country’s highest number of formally employed people, could not afford to pay for medical aid.

Some clients have also defaulted especially during the Covid-19 pandemic where companies were forced to shut down and declare bankruptcy. The working class is failing to pay medical aid subscriptions, which means they now have to pay for medication and related expenses using cash.

Hypertension (high blood pressure) patients are forking out US$25 for a monthly dosage that consists of losartan, atenolol and nifedipine.

Before March, the patients used to pay an average of US$15 per month.
A large number of hypertension patients are senior citizens most of whom rely on pension payouts that average RTGS400 (US$4.90).

Antenatal drugs, which are given to newborn babies and those under the age of five are also in short supply.

“I went to Ruwa Clinic and Ruwa Polyclinic for my two-month old son’s antenatal visit only to be turned away due to lack of medication,” said Millicent Mlambo.

“I was told to keep on checking as they do not know when medication will be available.”

Also, in short supply is first line Anti-Retroviral Treatment (ART) for HIV patients.

This was revealed in a leaked circular dated November 23, 2020, which Nhau managed to authenticate.

The memo, generated from the office of the permanent secretary in the Ministry of Health and Child Care, Dr Jasper Chimedza, informs all provincial medical directors, chief executive officers of central hospitals and directors of health services reviews of a shortage of ARV drugs such as Tenofovir, Lamivudine and Dolutegravir.

The drugs are the recommended first line treatment for every patient including those who are beginning and those on older versions.
“The country has been advised by the supplier that due to Covid-19 induced delays in the production of the above product, shipments to Zimbabwe are going to be delayed and this will lead to shortages being experienced in the country,” said Dr Chimedza.
To lessen the impact of shortages and avoid stockouts, the Ministry of Health recommended that the multi-month dispensing (a six-month supply of drugs) be reduced to three months per patient guided by stocks available at medical facilities.
The multi-month dispensing system is used for stable patients thus limiting visits to medical institutions.
This limited movement is in adherence to Government imposed Covid-19 restrictive measures while it also lessens the burden of travel for patients especially those in rural areas and other remote parts of the country.
Dr Chimedza recommended redistribution of stocks.
“The provinces should actively redistribute stocks between facilities to make sure there is equitable availability amongst facilities,” he said.
“The ministry will provide further guidance once stocks in the country improve,” Chimedza said.
In an address on Monday, Deputy Minister of Health and Child Care Dr John Mangwiro said Government was moving to cut out suppliers of some medical drugs to procure directly from manufacturers to avoid glitches and overpricing.
This is not the first time this year the country has experienced such shortages. In June Atazanavir/ritonavir, a second regimen of ART was in short supply.
People on the treatment were forced to temporarily use Dolutegravir (DTG) 50g as the optional drug Lopinvir/ritonavir was also in short supply.
The shortage was also attributed to reduced global production and delayed shipments from suppliers as a result of Covid-19 lockdown restrictions.
Experts say this lack of adherence to prescribed drugs whether deliberately or forced, is one sure way that causes HIV drug resistance.
Zimbabwe has not been spared by HIV drug resistance with a World Health Organisation (WHO) HIV Drug Resistance Report listing the country among the top six countries out of 11 that are affected from Africa.
In a recent media report, director of the AIDS and TB unit in the Ministry of Health and Child Care, Dr Owen Mugurungi, assured the nation that drug supply would improve.
“We hope there will not be negative effects for patients. Hopefully in the next two months or so the shipment would have made its way here then stocks would be available once more. The delays are beyond our control but we must work around them.”
Zimbabwe has about 1, 3 million people living with HIV and approximately 88 percent of them are on ART. The country has been experiencing a health crisis for close to two decades. Government run institutions have been lagging behind on equipment, expertise and medication, leaving patients to opt for expensive private hospitals.
Government officials are known to fly out to foreign countries including South Africa, China and India for medical assistance.
Locals who cannot afford private treatment are often stranded as public health institutions’ medical professionals are constantly on strike, while the few who are on duty fail to cater for the large numbers of people in need of assistance.
Some travel to missionary run hospitals such as Karanda in Mount Darwin and Howard Hospital in Chiweshe to seek treatment.
The facilities at the aforementioned hospitals are overwhelmed by the large numbers that visit thus family members have to sometimes sleep under the beds of their sick relatives. Nhau/Indaba