Zimbabwe health cluster weekly bulletin No. 7 - 16 Feb 2009



- 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%).

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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.