The Government of Zimbabwe introduced Antiretroviral Therapy (ART) in April 2004 and the ‗Plan for the Nationwide Provision of ART‘ was finalized in December 2004 covering the period (2005-2007)90 . As part of its strategy to scale-up ART services towards universal access in 2010, the MOHCW commissioned a review of the ART programme and there were over 60 000 people in both the private and public sector that were receiving treatment out of an estimated 300 000 people that were in need of the drugs.
There are presently 1.6 million people, 12% of the population living with HIV and AIDS in the country (GOZ, 2006). Antiretroviral therapy (ART ) is said to decrease the morbidity and mortality for people that are living with AIDS. The Ministry of Health and Child Welfare, National AIDS Council (NAC) and its partners91 committed to providing universal access to treatment . Providing antiretroviral treatment to people living with HIV and AIDS may seem to be the most effective means of managing AIDS. It is an easily measured service delivery operation. It is a humanitarian activity that prolongs people‘s lives and reduces the social and economic impacts of the disease.
The demand for ARVs had reached unprecedented levels whilst supply still remained insufficient. The main obstacle to universal access of ARV treatment now relates to the
90Plan for the Nationwide Provision of ART 2005-2007, MOHCW, 2004
91 Other local and international partners that are working in the area of ART in Zimbabwe include DFID, WHO, UNICEF, Italian Cooperation, United States Government, Centre for Disease Control, European Union.
weak health systems and budget management, the migration of health workers as the remaining unqualified nurse aids are prohibited from administering ARVs to patients under the National Guidelines.
Many HIV positive patients reported that they had resorted to acquiring the drugs from illegal markets through importation from neighbouring countries such as South Africa where they are readily available but at exorbitant prices. Considering that more than half the population is living below the poverty datum line (US$1 per day), this means the majority of the infected people cannot afford the ARVs and tend to prioritise on other needs such as housing and food resulting in deterioration of their health.
The Government has taken various measures in the past to expand the provision of antiretroviral drugs. In 2002 it declared that the treatment shortage was a national emergency, allowing Zimbabwe to produce and purchase generic AIDS drugs locally under international law, thereby reducing their cost. NAC set aside US$700,000 for the procurement of ARVs, pledging a further US$2.9 million in 2004. The number of centres providing treatment was also scaled up, increasing from just 5 in June 2004 to 48 by September 2005 (Avert, 2008). Figure 5.1 below shows the location of ART sites during the time the research was undertaken.
Figure 5.1 Antiretroviral Therapy Sites, 2006
(Source: MOHCW, 2007)
Unfortunately, the reality for most people living with HIV in Zimbabwe is that drugs are still not readily available. Even at sites where treatment has been made accessible, a severe national shortage of healthcare workers has led to long waiting lists and administration problems. Despite the chronic shortage, there have recently been reports that Government officials who are HIV-positive are being given priority access to ARVs, and intercepting drugs meant for public hospitals for their own use. Research findings were that ARVs were procured for public hospitals were diverted to private chemists and sold at inflated prices.
It is important to note that, if the patients do not take the treatment exactly according to guidelines, there is a risk that the virus might develop resistance to the medication, making
the treatment useless. Some of the HIV positive residents in Harare, were reported to be drug resistant, that is when the virus adapts itself and becomes able to survive the effect of antiretroviral drugs. This normally happens when insufficient doses of ARVs are taken or treatment is interrupted due to irregular supply of drugs to the patient or by poor adherence to treatment. The threat of this prospect puts the strain on both the health delivery system and the patients themselves who cannot afford the costs of travelling to hospitals.
Other critical elements in the health delivery systems observed included the erratic supplies of water and electricity resulting in hospitals resorting to the use of diesel generators, which were further constrained by fuel shortages in the country. Due to the low funding levels, hospitals have not been able to procure ambulances and the majority of existing ones were now out of service. Those that were still functioning were grounded because of fuel shortages. Due to security reasons, no photographs were taken during the research, but it is fundamental to share the picture in Fig 5.2 below that the researcher came across. The picture depicts what became a normality in transporting patients to health institutions.
Fig 5.2 Patient being transported to a Harare Clinic
(Source: The Guardian, November 2008)
Transportation has not just affected the patients, but also the health care providers as they reported not having sufficient resources to commute to their duty stations as expected, due to high transport costs.
Regarding care and treatment of the sick, the burden of care for HIV and AIDS usually falls on the old and the children in Zimbabwe who are not financially sound. Families are usually depressed when the breadwinner falls ill. Such infected persons suffer from emotional and psychological stress, as they feel unable to provide for their families. They feel that they are burdening their families with their illness making their health worse and hampering the recovery process. The research shows that the epidemic has mainly affected the economically active population (15-49 years). The majority of the dependents that care for sick patients cannot afford antiretroviral therapy for their loved ones and they do not have an option but to watch them die slowly.
Despite the numerous strikes by health workers to increase salaries, housing and transport allowances, improve their working conditions and for better provision of health services, the authorities have treated them harshly. Those interviewed at Parirenyatwa Hospital reported that heavily armed riot police often prevented them from submitting their petitions to the Ministry of Health and Child Welfare. On one occasion, the police initially forced the health workers to protest within the grounds of Parirenyatwa Hospital, but after four hours the police entered the hospital grounds and forcibly dispersed the workers, assaulting several.