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Zimbabwe's forgotten street folk
Wallace Mawire
January 28, 2010

While Zimbabwe has just hosted the first regional conference on immunization in Africa to strengthen the delivery of immunization services in all member states in the African region, it is believed that most people living on the streets are being left out in the immunization campaigns being carried out in the country.

As a result of this Zimbabwe is currently facing challenges which include emerging and re-emerging infections of communicable diseases.

Zimbabwe's Minister of Health and Child Welfare, Dr Henry Madzorera was evasive when he was quizzed by journalists at the just ended immunization conference to explain how immunization campaigns are reaching out to marginalized groups like street kids and the homeless who often have limited resources including medical.

Dr Madzorera who appeared not very confident to confront the question posed by the journalist at the press conference convened by the World Health Organisation (WHO) remarked:

"l am sure street kids and the homeless are covered in our immunization campaigns, we go everywhere including into farms." He did not say how they covered the streets.

However, despite the Minister's assertions that there are no groups which are left out in the immunization campaigns, his presentation at the regional conference exposed some glaring shortcomings and challenges which easily point to the fact that immunization coverage is not 100% in the country.

He articulated to regional and international delegates that communicable diseases continue to be a major public health concern in Zimbabwe, which has one of the highest sero-prevalence rates of HIV and is among the highest tuberculosis burdened country of the world.

"This is further compounded by the challenges imposed by the threat of emerging and re-emerging infections," Madzorera says.

He notes that there is a need to improve the country's surveillance systems which are currently faced with human resource constraints, poor communication networks and limited utilization of data collected and lack of transport.

"Communicable disease control needs strengthening," he says.

The main objective of the Expanded Programme on Immunization (EPI) is to reduce under five morbidity and mortality from vaccine preventable diseases in line with MDG number 4 to reduce child mortality.

The Global Immunization Vision and Strategy (GIVS) strategic area number one emphasizes reaching out to more people with vaccinations in a changing world. The EPI in the SADC region was launched in the 80s under the auspices of the Primary Health Care (PHC) programme. It sought to improve the accessibility of health services, quality of life and health of the general populace.

Dr Madzorera adds that although the EPI in Africa has made tremendous progress in the past few years following the stagnation observed in the 1990s, the routine immunization, unlike supplemental immunization has suffered some setbacks partly attributable to the current socio-economic constraints such as inadequately trained and de-motivated staff, high attrition rate and inadequate transport.

"It follows therefore that these challenges need to be addressed if EPI has to make a headway," Madzorera says.

Adding that government of Zimbabwe remains committed to the Zimbabwe Expanded Programme on Immunization (ZEPI) as a pillar for child survival and improvement of the child health goal and the country also registered some progress despite the numerous challenges he alluded to.

According to Mrs Duduzile Moyo, Director of Streets Ahead, a registered welfare organisation which assists under-privileged children aged between 6 and 18 years living and working on the streets of Harare, the organisation has children born on the streets and all those that come into contact with the organisation are encouraged and referred to baby clinics to have their babies immunized.

"We hold workshops with the young mothers giving them information on child care and general health. We do not work on absolute health projects and as such we can only complement, inform and refer our clients to the medical centres," Moyo says.

Moyo adds that most of the street children come from homes and the initial immunisation should have been done by the time they are old enough to come into the streets. She adds that the community of people living and working on the streets is fuelled by the community in which all people live.

"This means that the street dwellers are coming from the communities where the immunisation programmes are supposed to be implemented," says Moyo.

She did not elaborate on how the organisation was making a follow up on whether its members were getting immunized or facing any challenges.

Zimbabwe is not exempt from the global risks of outbreaks of wild polio virus, viral hemorrhagic fevers, avian influenza, SARS, small pox, measles and neonatal tetanus.

Dr Madzorera says that despite achievements made there are still significant challenges in relation to the use of immunization services to reduce childhood morbidity, mortality and disabilities in the region including Zimbabwe. He adds that surveillance towards measles and neonatal tetanus elimination and polio eradication need further strengthening.

In Zimbabwe this has been reaffirmed by the recent measles outbreak which has hit the country and claimed at least 41 victims since November 2009.

A contact from the Community Working Group on Health (CWGH) says that there is an absence of mobile clinics in Zimbabwe which should be re-introduced to help on immunization campaigns.

She said that mobile clinics would be accessed by all children offering them free immunisation. She wondered why children or people were falling prone to communicable diseases like measles when immunisation services should be free to be accessed by all even street people.

She accused government of negligence saying that it has a duty to make sure that communicable diseases are prevented.

Dr Madzorera says that vaccine preventable diseases such as polio still remain a major cause of morbidity, disability and mortality mainly among children in Africa region. It has been documented that immunisation coverage in many countries in Africa has remained stagnant and in some countries has even dropped to as low as 30 to 40% during the past decade.

The reasons for the decline include lack of countries' capacity to incorporate new changes, innovations and technologies, exodus of skilled human resources, competing health priorities for example HIV and AIDS, reduction of government health budgets, non-utilisation of data to improve systems performance at all levels for example reduction of missed opportunities for vaccination, dropout rates, vaccine stock outs and increased vaccine wastage rates.

Also decline in performance of the surveillance for acute flaccid paralysis has been noticed including case-based measles and neonatal tetanus surveillance.

Madzorera also notes that the Ministry of Health has noticed decline in the routine immunisation coverage, especially at the district level.

"In order to prevent the resurgence of wild polio virus transmission in our country and in the sub-region, which may result from importation from countries that still have transmission, there is the urgent need to strengthen disease surveillance through harmonization and alignment with all our partners and the community," Madzorera says.

Strategies which have been introduced include the reaching every district (RED) approach and organisation of integrated child health weeks/days in the delivery of immunisation services.

While some marginalized groups are reportedly being left out, Dr Madzorera reiterates that the region should remain committed to the primary health care principles as agreed 30 years ago in Alma Ata.

He says the International Conference on Primary Health and Health systems held in Ouagadougou in Burkina Faso in April 2008 urged member states through the Ouagadougou declaration which Zimbabwe is signatory to among other issues, address the creation of sustainable mechanisms for increasing availability, affordability and accessibility of essential medicines, commodities, supplies, appropriate technologies and infrastructures, the provision of adequate resources, technology transfer, south-south cooperation, the use of community directed approaches, the promotion of African traditional medicines and strengthening health information and surveillance systems and promotion of operational research for evidence based decisions.

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