Zimbabwe has made giant strides in malaria control, but runaway inflation coupled with the advent of the Covid-19 pandemic may derail progress made in the last 17 years — moving the country away from its goal of eliminating the disease by 2030.
By Moses Mugugunyeki
A surge in malaria cases, particularly in the north-east, has exposed the country’s lackadaisical approach in managing the disease in more recent years.
In 2003, the government came up with intervention strategies to bring Zimbabwe’s malaria burden down, which included mosquito control programmes such as the provision of insecticide-treated nets, indoor residual spraying and community awareness campaigns, backed by the Zimbabwe National Malaria Control Programme.
this resulted in a record decline in malaria transmission across the country from 155 malaria cases per 1 000 people in 2003 to 29 per 1 000 in 2015 and 22 per 1000 in 2019, according to the Health and Child Care ministry. Deaths also fell significantly, from 462 in 2015 to 192 in 2018.
But the past two years have seen a U-turn, with data from the Health and Child Care ministry showing that cases of malaria increased 19% from 2018 to 2019 and a further 58% this year. Deaths from the disease also increased by 51%, from 260 in 2019 to 393 this year.
The majority of cases have been recorded in Manicaland, Mashonaland Central and Mashonaland East provinces.
The surge was aided by the disruption of mosquito control programmes due to the Covid-19 outbreak, says Health minister Constantino Chiwenga.
“Measures meant to prevent the spread of Covid-19, including social distancing and restricting movement of people, however, caused the delays in accessing malaria testing and treatment services, especially in the remote areas,” Chiwenga said.
Between January and October this year, Manicaland province recorded 136 601 cases of malaria and 110 deaths, with Mashonaland East and Mashonaland Central provinces recording 100 006 and 88 608 cases, respectively.
Medical and Dental Private Practitioners Association of Zimbabwe president and public health expert Dr Johannes Marisa agrees the surge was fuelled by the disruption of malaria prevention programmes in some malaria-endemic districts, but says programmes should have been prepared.
“We sat on our laurels when we thought we have managed malaria. We had success stories on the eradication of malaria, but we were not home yet,” Dr Marisa said.
The situation on the ground in Mashonaland East
In Zimbabwe, indoor residual spraying and use of insecticide-treated nets is the mainstay of the malaria intervention programmes as the country seeks to cover 90% of the population at risk, as part of the National Malaria Strategic Plan (NMSP) 2016-2020.
Other intervention programmes contained in the NMSP include improving diagnosis and treatment of malaria as well as improving detection and timely control of malaria epidemics.
However, studies show that sporadic malaria outbreaks may happen due to inconsistent funding as well as economic and political disturbances interrupting these interventions, particularly in rural areas.
Uzumba district recorded the most malaria cases and deaths in Mashonaland East province this year, most likely due to limited distribution of
insecticide-treated nets as well as restricted coverage for indoor residual spraying in Uzumba, Fagio Marowa, councillor for Uzumba ward 14 in Mashonaland East province, said.
Marowa’s district had a malaria outbreak in March, which claimed the lives of five people in one week, despite indoor residual spraying having been done four months before.
“It’s unfortunate we had a number of cases of malaria and deaths following an outbreak earlier in the year,” said Marowa.“We did not receive as much as of the expected insecticide-treated nets in the past two years, forcing villagers to resort to worn-out nets. Several households were not sprayed due to limited resources as well,” said Marowa.
But resources are getting back on track, he said.
“Teams of indoor residual spraying were in the ward last week and they assured us that they would have sprayed in every home of the 8 000 households in the ward,” he said.
Reaching all areas, however, remains a challenge.
“Coverage of 95% of the population targeted for indoor residual spraying is unattainable, considering our underperforming economy,” said Itai Rusike, public health expert and executive director of Community Working Group on Health.
Marowa, however, sits on the Health committee in Uzumba Rural District Council and is currently spearheading the construction of four health centres in the area as communities along the Nyadire and Mazowe rivers, according to the provincial medical director for Mashonaland East, are a malaria hotspot.
Economic crisis and reliance on donors
Public health experts believe Zimbabwe’s feeble budget execution coupled with the hyperinflationary climate during the past two years has restricted the country’s disease intervention programmes, including malaria control activities usually conducted at the start of the malaria season.
“In a hyperinflationary climate like ours, health spending just like in any other sector has been on a free-fall due to growing fiscal pressures,” said Rusike.
Zimbabwe’s annual inflation rate dropped to 471,25% in October from 659,40% in September, according to latest data from the Zimbabwe National Statistics.
“The health budget for malaria intervention programmes has been eroded as a result of exchange rate depreciation and increasing inflation,” said Rusike.
Over the years, Zimbabwe’s health budget implementation has been characterised by deviations of the real expenditure from the approved budget, which in most cases impacted negatively on prevention programmes, including antimalarial activities.
The 2020 national budget allocated US$300 million to the health sector. From this, US$16 million was meant for primary health and hospital care, but rural health centres, which cater for the greatest proportion of malaria cases, were given only 6% of this allocation. This is despite them catering for 70% of the country’s population.
As a result, the sector has become reliant on external financing.
“On malaria control and public health issues, we rely mostly on donor funding,” said Dr Marisa.
The US President’s Malaria Initiative (PMI), the biggest donor of malaria eradication programmes in Zimbabwe, reported in its 2020 malaria operational plan that it had set aside $14 million for malaria programmes, bringing the total PMI investment to nearly $145.5 million since 2011.
Other malaria funding and programme support partners in Zimbabwe include the Global Fund, World Health Organisation, Malaria Elimination 8, Bill and Melinda Gates Foundation, Isdell: Flowers Cross Border Malaria Initiative and United Methodist Church.
“Inadequate resources is a major challenge,” said Dr Joseph Mberi, the National Malaria Control Programme coordinator. “Over 90% of malaria control resources are supported by partners,” said Dr Mberi.
He acknowledged that significant progress had been made towards malaria elimination in Zimbabwe in recent years, but said the country was facing a lot of challenges in its quest to eliminate the disease.
“Our porous borders also lead to movement of people to and from areas of different malaria endemicity, thereby threatening to derail our malaria elimination agenda.”
Now Covid-19 has had a direct and indirect impact on the country’s malaria programme, for example, by delaying the transportation of commodities to high malaria transmission areas, he said. This inevitably affected the management of outbreaks like those in Mashonaland East.
“The halted provision of malaria services, lack of personal protection equipment for Covid-19 for use by village health workers, stock-outs of some malaria drugs and Covid-19 lockdown restrictions prevented the swift movement of teams to respond to the malaria outbreaks,” Dr Mberi said.
l This story was produced by The Standard. It was written as part of Reporting Malaria, a media skills development programme run by the Thomson Reuters Foundation. The content is the sole responsibility of the author and the publisher.