Zimbabwe: Cholera in a time of health system collapse


Executive Summary

Although Zimbabwe has experienced cholera outbreaks since 1992, the outbreak which began in August 2008 is the worst ever in this country and is set to become the worst outbreak on the African continent. Violations of the rights to safe and potable water, adequate sanitation and a collapsed health system were the cause of the outbreak. The course of the outbreak has been difficult to predict and to control.

To date, the Government of Zimbabwe has fallen far short of its responsibility to ensure the availability of appropriate health services. Despite the epidemic continuing for more than six months, sanitation remains poor and lack of access to safe drinking water persists against the backdrop of a collapsed health system with degraded infrastructure and very few health workers.

Health is a fundamental human right indispensable for the exercise of other human rights. Despite this, the right to health is becoming an increasingly remote privilege, out of the reach of most Zimbabweans. Health in Zimbabwe is presently largely unavailable, unacceptable, inaccessible and of poor quality. This report concludes that Zimbabwe will require long term commitment of the humanitarian and donor agencies working in the country with large scale, multi-faceted assistance to address the situation. The Government of Zimbabwe must also take responsibility for the restoration of the basic social services that fulfil basic human rights.

ZADHR makes the following recommendations:

On the public health system:

An emergency health response plan to restore function to the public health system must be produced and implemented. This plan should begin by focusing on making primary and secondary care services (clinics and district hospitals) affordable and accessible to all. The Government must also ensure that health workers concerns are addressed to ensure that conditions in which these workers return to work and their skills can be retained are put in place (including adequate remuneration and safe working conditions).

On access to safe water

If the outbreak is to be brought under control, and ultimately to an end, there is an urgent need to restore safe potable water to communities. Where infrastructure for piping water exists this needs to be rehabilitated.

On adequate sanitation

Ensuring that communities make use of sanitary facilities for defecation is vital. Everyone should have access to a toilet connected to a septic tank or working public sewer system or a ventilated improved pit latrine.