Lilosa Muti’s 6-week old baby, Joshua, was due to have his rotavirus and Penta vaccine, which protects against diphtheria, tetanus, whooping cough, polio and other serious diseases. But Lilosa had no intention of taking him to his appointment at the health clinic at Bikita Rural Hospital in Masvingo Province, Zimbabwe.
Lilosa Muti’s 6-week-old baby Joshua getting vaccinated at Bikita Rural Hospital, Zimbabwe 2020. ©WHO/Tatenda Chimbwanda
“l was scared my son might be infected with COVID-19 if he visited the hospital. We have had 3 reported COVID-19 cases in Bikita and rumour has it one of the cases had visited the hospital before,” explained Lilosa.
Thankfully, a village health worker spoke with Lilosa and allayed her fears. Two days later, she visited the hospital where she was surprised to learn that all services were available. On arriving, Lilosa and baby Joshua underwent the COVID-19 pre-screening process before the appointment and then Joshua received all his vaccines.
“We have experienced a huge decrease of clients coming to the hospital for essential services such as vaccines. This has been due to the national lockdown, which restricted movements in March 2020. In addition, the communication gap in Bikita was filled with misinformation, which led residents like Lilosa to not visit the hospital to vaccinate her baby,” said Claretta Majova, the nurse on duty.
This situation is replicated right across Zimbabwe, with a decline in people accessing essential services in health facilities in all 10 provinces. Yet these are crucial for their health and wellbeing.
A woman getting her family planning pills at Mpilo Hospital in Bulawayo, Zimbabwe 2021. ©WHO/Tatenda Chimbwanda
COVID-19 and the need for essential health services
Zimbabwe reported its first case of COVID-19 on 20 March 2020. Within one year, the country recorded 36,717 cases and 1,516 deaths as of 23 March, 2021.
When COVID-19 arrived, the government developed an emergency response and preparedness plan comprising 8 pillars, one of which was case management and continuity of essential health services. It aimed to ensure that essential service delivery did not grind to a halt as a result of the pandemic. This has been a challenge even in well-developed health systems. For Zimbabwe, as elsewhere in Africa, the need to continue non-COVID-19 services such as immunization, access to medicines, sexual and reproductive health including treatment of HIV, and diagnosis and treatment of non-communicable diseases (NCDs) was vital.
WHO, with support from the Universal Health Coverage Partnership, worked closely with the Ministry of Health and Child Care (MoHCC) and provided technical assistance to strengthen the delivery of essential health services at rural, district and provincial health facilities prior to and during the COVID-19 pandemic.
The MoHCC, with technical guidance from WHO, previously developed a tool to monitor disruptions of delivery of essential health services caused by industrial action. The MoHCC conducted a field test and trained health workers to use the tool before it was adopted and implemented.
As a result of the routine monitoring, the MoHCC was able to receive data that enabled them to identify and address the challenges affecting delivery of essential health services. For example, they embarked on integrated outreach and ensured health care workers had access to the much-needed personal protective equipment (PPE) according to the findings of an assessment on infection prevention and control.
Life-saving decisions rely on robust and timely data
Protecting the most vulnerable in times of calm or crisis is one of the core principles of Universal Health Coverage (UHC), and relies on equitable and resilient health systems. Having the right information at the right time makes all the difference in saving lives, providing treatment and preventing disease. Monitoring and analysis of health systems functions followed by practical support is therefore crucial to the decision-making process across the health system.
Zimbabwe is among the 115 countries and areas to which the UHC Partnership helps deliver WHO support and technical expertise in advancing UHC with a primary health care approach. The Partnership is funded by the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the United Kingdom – Foreign, Commonwealth & Development Office and Belgium.