Zimbabwe’s health care infrastructure had been in a state of slow decline for more than a decade, and then experienced a near-total collapse over the last year, said Dr. James Hakim, chairman of the Department of Medicine at the University of Zimbabwe, College of Health Sciences.
This comes as the strife-torn country has grappled with a devastating cholera outbreak—a symptom, Dr. Hakim said, of the health system’s decay—and staggering rates of HIV/AIDS and tuberculosis.
Dr. Hakim spoke today at a forum co-sponsored by the Center for Global Health Policy and the Center for Strategic & International Studies. The Global Center hosted Dr. Hakim in Washington as part of its efforts to bring the voices of developing country physician/scientists into the American foreign policy debate.
Zimbabwe’s political turmoil has taken a deep toll on what was once a strong and vibrant health system, with good medical training programs, drug supply chains, and laboratory services, Dr. Hakim said in his presentation. But today, health care workers have fled to other countries, and other elements of the system have crumbled.
“The health infrastructure has gone through a lot of stress,” Dr. Hakim said. “In the last year or so, things entirely collapsed,” and that was evident in the cholera epidemic.
He noted that the country is an epicenter in the HIV epidemic, with an estimated 15.6 percent adult prevalence in 2007. Women shoulder most of the HIV disease burden.
On a positive note, he said the prevalence of HIV has significantly decreased since 2003, when it was at an estimated 24.6 percent. Part of the decrease came because of changes in modeling projections, but he attributed the rest of the dip to the country’s previously strong health infrastructure, its high literacy rate, and other factors.
There are currently an estimated 150,000 people on HIV therapy in Zimbabwe, nearly all of them on first-line ARVs, he said. Soon, many will of those patients will have to be switched to second line treatment. “That’s a totally different ballgame” in terms of drugs and cost, he noted.
He said Zimbabwe needed to cultivate its own HIV/AIDS activist movement, to raise awareness and commitment to battling the disease.
Zimbabwe also has seen a dramatic increase in tuberculosis in the last decade, which Dr. Hakim called “a shadow of HIV/AIDS” but also a challenge in its own right. He said health officials have no information about whether drug-resistant TB has reached Zimbabwe but he suspects it has. “There must be some,” he said, “but one cannot quantify it” because there are not adequate diagnostic capabilities in the country.
Zimbabwe’s health crises require an emergency response, Hakim said, but right now, “the needs far outstrip” the offers of international assistance. Zimbabwe is not a PEPFAR focus country, so it has not benefited directly from US funding for global AIDS.
Stephen Morrison, of CSIS’s Global Health Policy Center, asked Dr. Hakim about the trustworthiness of the fragile new unity government, saying there’s “great skepticism” about whether the U.S. could invest money into Zimbabwe’s health system and not have it diverted for other uses.
Hakim said that was a genuine concern. “I can glean sufficient commitment and interest” in making the new government work, he said, but “what somebody has up his sleeve or her sleeve, I cannot say.”
In a related note, here’s a link to an IRIN/PlusNews story on AIDS in Zimbabwe. http://www.plusnews.org/Report.aspx?ReportId=84331