Zimbabwe's struggling health system leans on unsung heroines

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By Marko Phiri

Groups of women volunteers are taking care of HIV and TB patients at home, making sure they take their medication

BULAWAYO, Zimbabwe, March 1 (Thomson Reuters Foundation) - A s Zimbabwe's health service buckles amid low levels of public funding and a government freeze on hiring medical staff, volunteers have stepped in to take the strain.

Home-based carers can be found across Bulawayo, Zimbabwe's second largest city, where they work with local clinics to monitor tuberculosis (TB) and HIV patients, making sure they take their medication as prescribed.

Led by local religious organisations such as the Roman Catholic Church, Seventh Day Adventists and Brethren in Christ, the volunteers - almost all women - work in groups to attend patients who need support.

"Some of the patients stay alone, and it is easy for them to just stop taking their medications," said Silibaziso Moyo, a 41-year-old volunteer. "Others cannot even bathe themselves. We make sure they are clean and the places they live in are also clean."

A Bulawayo municipality spokesperson said volunteers had worked with the city council since the early 1990s under the Community Participation for Health Initiative, but the need had grown over the years with the spread of HIV and opportunistic infections such as TB.

In 2015, the World Health Organization said Zimbabwe had failed to meet its Millennium Development Goal target to reduce TB prevalence, noting that this was largely due to an increase in new infections since 2000.

Meanwhile, UNAIDS says Zimbabwe is among the countries in sub-Saharan Africa worst-affected by the HIV and AIDS epidemic, and has around 1.4 million people living with HIV, although prevalence rates have dropped steadily since the late 1990s.

In their 2001 Abuja Declaration, African Union governments pledged to allocate at least 15 percent of their annual budgets to improve the health sector.

But in 2015, cash-strapped Zimbabwe earmarked just 6 percent of its budget for that purpose.

This January, the ministry of health announced it would not be hiring any more doctors, while the recruitment of nurses was suspended last year.


Despite the huge challenges to providing adequate care in a country where the health ministry's budget has been cut by over half since 2000, community volunteers are providing some relief.

In Bulawayo, the local government helps the teams of volunteers by providing them with surgical gloves and other protective clothing, and occasionally gives them food packs to thank them for their efforts.

"Patients tend to ignore medication once they feel they are better, and some stop coming for their check-ups altogether, but we have these volunteers who follow up the patients, making sure they at least prolong their lives," said Tabeth Nkomo, a senior municipality nurse who has worked with volunteers for more than a decade.

"They have helped a lot in managing HIV-related mortality."

The city has 19 clinics, each of which can register up to 200 TB and HIV patients at any given time, Nkomo said, highlighting the need for back-up care.

Simon Bhebhe, a pastor who coordinates 15 volunteers from his local church, said they were doing "God's work".

"It is not easy - but for anyone to be found doing this kind of work, it means they have compassion for the sick, which is a basic Christian ethos," he said.

According to the Home-based Care Alliance, located in the Netherlands, there are more than 44,000 healthcare volunteers spread across 11 countries in Africa, but this may not be enough as some communities are failing to cope with the number of TB and HIV patients.

The National AIDS Council of Zimbabwe, a government agency, estimates there are around 3,000 volunteers across the country, and Irish Aid, which runs Ireland's development assistance, has supported 15 home-based care programmes in Zimbabwe since 2005.

"It wasn't easy at first to have strangers coming to my house to assist me, but I thank these women for my recovery," said Jacob Conjwayo, a TB patient convalescing at his home in Bulawayo.

"I think we need more of these volunteers, as I know many more patients who are in need of this kind of help but are not getting it," he said.

(Reporting by Marko Phiri; editing by Megan Rowling. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, climate change, resilience, women's rights, trafficking and property rights. Visit http://news.trust.org/)