Zimbabwe Health Cluster Bulletin No 7 - 16 February 2009
Latest information on health partners and health needs in the current crisis in Zimbabwe:
- Almost 78 000 cases reported as of 16 February
- Outbreak not yet under control
- Shift in new cases from urban to rural areas
- Cholera Command Control Centre activities being decentralized to provinces
As of 16 February, 77 650 suspected cases of cholera had been reported in all 10 provinces of Zimbabwe, with 3688 deaths (case fatality rate (CFR) 4.7%). This figure largely exceeds the original estimate of 60 000. The highest number of cumulative cases from August 2008 were reported in the Harare suburb of Budiriro (7844 cases and 194 deaths, CFR 2.5%), Beatrice Road Infectious Hospital in Harare City (4869 cases and 260 deaths, CFR 5.3%), Beitbridge in Matabeleland South (5066 cases and 149 deaths, CFR 2.9 %), Makonde in Mashonaland West (4458 cases and 163 deaths, CFR 3.7%), Kadoma in Mashonaland West (4556 and 180 deaths, CFR 4.0%).
The outbreak has not yet been brought under control in any of Zimbabwe's provinces. Since the end of the festive season there has been a noticeable shift in new cases from a predominantly urban to a mostly rural setting, accompanied by increased rates of reported community deaths (from 45.4% at the end of 2008 to 61% as of mid-February). While transmission continues in rural areas, data indicate the epidemic is stabilizing in urban centres.
Provincial Cholera Response Gap Analysis Meeting
Field assessments have revealed gaps in human resources, case management and social mobilization that need to be analysed and integrated into the Health Cluster's response strategy. Response efforts need to be further decentralized, with provinces and districts empowered to respond rapidly in the areas of surveillance and laboratory, case management, water and sanitation, social mobilization and logistic support. Many households are also suffering from food shortages.
WHO convened a meeting on 3 February 2009 in Harare with provincial and city health authorities and the Ministry of Health and Child Welfare (MOHCW) to explore ways of strengthening the provincial and district response to the cholera outbreak. Participants were updated on the cholera epidemiological situation and the Health Cluster's response strategy. Provincial authorities shared their gap analyses and recommendations to strengthen the response to the outbreak. Participants also discussed the decentralization of the Cholera Command and Control Centre (C4) to provincial and district levels. The C4 monitors, guides and evaluates interventions related to cholera outbreak response in the areas of: surveillance; laboratory and operational research; case management; water, sanitation and hygiene (WASH); and social mobilization and logistics.
The meeting recommended that C4 activities be established in all cities and provinces and that the capacity of community health workers be strengthened throughout the country. Other priority issues discussed included human resource capacity, staff allowances and incentive packages and communication and transport. All present, including staff from C4 and from the Health and WASH Clusters, pledged to take immediate action to fill the gaps highlighted during the meeting.
Health and WASH Cluster Weekly Meeting
The joint Health and WASH Cluster weekly meeting was held on 4 February. An MOHCW document on the health workers' retention scheme was circulated to participants. Participants agreed to circulate the tool on diarrhoea and child-feeding, and the report of the meeting with provincial medical directors, as soon as possible. Health workers are still not reporting for duty because of the dire economic situation in the country. As a result, districts continue to under-report cases. Communications are also erratic: the toll-free telephone lines installed in almost all provinces are not working due to network unavailability and the faltering electricity supply. C4 is planning to donate generators in critical areas.
Social mobilization has been strengthened by the formation of a committee whose task is to provide guidance to the national cholera campaign by reviewing information, education and communication materials including radio messages, cell phone messages, TV and print media. These materials will be transmitted to all communities through existing community-based structures.
The C4 is planning to strengthen and revitalize community health workers, in collaboration with the MOHCW. Measures include updating, printing and distributing the community walker manual.
International Centre for Diarrhoeal Disease Research in Bangladesh
A team of experts from the International Centre for Diarrhoeal Disease Research in Bangladesh (ICDDR-B) visited the country from 11 January to 6 February 2009 to assess and evaluate cholera case management and the laboratory and surveillance systems. Their main recommendations, after visiting health centres throughout the country, included:
- Encouraging the use of oral rehydration salts (ORS) at home, and educating the public about the benefits of ORS;
- Increasing the availability and accessibility of ORS by distributing packets in local pharmacies and other easily accessible places (e.g. grocery shops, local churches, community structures etc.);
- Improving early reporting in health facilities;
- Organizing cholera camps as near as possible to the affected areas, in order to encourage patients to report earlier;
- Providing intensive training to health care providers. This is one of the most important aspects of effective case management;
- Ensuring the availability of supplies and equipment for effective care, including rehydration fluids, antibiotics, disinfectants and other supplies.
- Supporting laboratories in bacteria trend and sensitivity monitoring as well as water quality testing.
The team comprised: Dr. Pradip Kumar Bardhan (case management, teaching and training), Dr. Md Sirajul Islam (environmental microbiologist, laboratory scientist), Dr. Ramendra Nath Mazumder MBBS, MD (case management, teaching and training), Dr. Azharul Islam Khan (case management, teaching and training), Dr. Sirajuddin Ahmed (medical epidemiologist) and Dr. Anwarul Iqbal (medical epidemiologist).
- Provided support and supervision to 10 cholera treatment units in Hurungwe District and four in Makoni District (Manicaland);
- Distributed non-food items including buckets, soap, jerry cans, ORS;
- Conducted health & hygiene promotion activities in Kariba (7200 households), Karoi (6500 households) and Karoi Rural (Tengwe – 2500 households) and Dete (ongoing);
- Initiated a community-based clean-up campaign in Dzivaresekwa, Harare, including distribution of non-food items and hygiene promotion.
World Vision (WV)
- Met with UNICEF, Plan international, OCHA, Oxfam, ACF and Family Impact in Bulawayo on 3 February to discuss cholera response coordination in the province. Participants agreed that WV would assume a coordinating role in liaison with city authorities, and would convene coordination meetings every Thursday. Participants also discussed ways of replicating and strengthening C4 structures in the province, as well as an incentive package being developed for health staff working in cholera treatment centres (CTC);
- Conducted an assessment mission to Mashonaland central. Most of the 47 patients at Mt Darwin CTC are from Mukarazi, where there are gold panning activities;
- Donated a generator, water bladder, ORS, Aquatabs, gowns, body bags, gloves, drugs, cannulae and IV fluids to Mt Darwin CTC, and noted the following needs; knapsack sprays, stretcher beds for staff, mops, brooms, disinfectant, food for patients.
Médecins sans Frontières
- Has treated nearly 45 000 patients since the beginning of the outbreak in August 2008, and supported treatment of thousands more through the provision of supplies, logistical support, technical advice and training to MOHCW staff;
- More than 500 MSF staff are working to identify new cases and treat patients in need of care.
Other partners (including Celebration Health, Red Cross (Movement)
- Working on case investigation and support to case management as well as health promotion activities.
Provincial and City C4 Rollout Workshops
Following the gap analysis meeting in Harare, two workshops were organized to roll out C4 activities at provincial levels. Provincial Medical Directors and their WASH and health promotion managers attended the workshops and shared information on the provincial response strategies in place, in order to analyse gaps and develop a strategy to promote decentralization to provincial and district levels. Issues addressed included surveillance, laboratory support and operational research, case management and infection control, water, sanitation and hygiene, social mobilization, and coordination. Provinces shared best practices in cholera outbreak response: Manicaland gave a presentation on partner coordination, while Matabeleland South briefed participants on how they dealt with the cholera epidemic in Beitbridge, one of the first districts to be affected.
One workshop for the Northern Region was held in Harare from 12–13 February. A second workshop targeting the Southern Region was held in Bulawayo from 19–20 February.
United Kingdom delegation visits C4
A senior delegation of cooperation directors from the United Kingdom's Department for International Development (DFID) visited Zimbabwe to assess the cholera epidemic. They visited the C4, where they were briefed on the evolving outbreak response and Health Cluster funding needs.
Donor Support in Response to the Cholera Crisis
- Africa Development Bank - US$ 1million
- DFID - US$ 658 000 (in addition to $734 000 donated earlier)
- CERF (UN) - US$ 2 051 798
- USAID (OFDA) - US$ 950 000
For more information, please contact:
Dr Custodia Mandlhate, WHO Representative to Zimbabwe
Tel: +263 4 253 724-30
Ms Zora Machekanyanga, Communications Officer, WHO Zimbabwe
Tel: +263 4 253 724-30 ext 38172
Dr Stephen Maphosa, Emergency and Humanitarian Action, WHO Zimbabwe
Tel: +263 4 253 724-30 ext 38158
Dr Michel Yao, Emergency and Humanitarian Action (EHA) Inter-Country Support Team
Tel: +263 4 253 724-30 ext 38210
Dr S. Midzi, Director, Epidemiology and Disease Control
Tel: +263 4 229032
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