8th COVID-19 Monitoring and Advocacy Report: 28 July 2020
By ZADHR Info on July 28, 2020 in COVID-19 Monitoring Reports, Uncategorized
To date, over 16,612,335 COVID-19 infections worldwide have been confirmed to the WHO, with the number of deaths globally currently standing at over 655,503. Zimbabwe has recorded a total of 2034 confirmed cases of COVID-19 and a total of 36 deaths and 542 recoveries with the cumulative number of tests to date standing at 122 770 (67 939 RDT and 54 831 PCR) (MOHCC Corona Virus (COVID-19) Update: 27 July 2020).
Increases in COVID-19 cases in the country have seen the shifting of the epidemiological profile of the pandemic from imported cases to widespread local transmission with heath care workers and prison officials also testing positive. The impact of COVID-19 in Zimbabwe may be far worse than reported and anticipated due to limited testing capacity, a fragile health system currently plagued by manpower challenges, lack of accountability and persistent underfunding of the health sector. These vulnerabilities pose an existential threat of a devastating and long-lasting pandemic further worsening the plight of vulnerable groups.
ZADHR publishes this brief as part of its continuous audit of the COVID19 response in Zimbabwe and to provide recommendations to the government and health officials.
- Lockdown
In response to the rising cases of COVID-19 in Zimbabwe the government of Zimbabwe on the 22nd of July 2020 promulgated the Public Health (COVID-19 Prevention, Containment and Treatment) (national Lockdown) (Amendment) Order, 2020 (No.14) to extend the lockdown period indefinitely with more stringent conditions. The Order has seen the introduction of a 6am to 6pm curfew and reverts to the initial lockdown order that allows for only essential services workers to move without restrictions. We note that despite the lessons learnt in the initial response the Government has proceeded to instate the same measures without paying due attention to factors that led to numerous cases of people violating the lockdown restrictions, such as the lack of a strong, efficient and responsive social safety programme for the poor. Further, as ZADHR we continue to reiterate that the lockdown measures should not be used for political expediency but for the furtherance of the public health agenda. This can only be achieved through expansion in testing and contact tracing capacity and widespread community education on COVID-19 preventive measures.
We also note a press statement by the ZRP on 25 July 2020 on documents required at checkpoints and roadblocks. Under Medical Resupplies the police require citizens to provide their medical cards/prescription and contact details of their doctor. As ZADHR we reiterate that medical documents such as prescriptions and medical cards are private and confidential documents. Patients have a right to privacy of medical information and the police have no right to access these confidential documents, unless directed by a court of law. We acknowledge the need to restrict unnecessary movement of citizens, but such important measures need to be done whilst upholding basic rights of citizens.
- Quarantine Facilities
ZADHR continues to receive reports of returnees absconding detention due to a number of factors that include but not limited to poor living conditions characterised by a sorry state of WASH facilities and access to other basic amenities leading to greater interaction between the returnees in quarantine facilities and the outside world posing an existential threat to communities. The situation is compounded by extended turnaround times for test results and or delayed testing leading to lengthy stays in quarantine facilities.
ZADHR also noted the petition by the Concerned Residents Waterfalls (CRW) to the Ministry of Health and Child Care, Harare City Health Department, Harare COVID-19 Taskforce and to the ZRP Waterfalls Police Station on the 23rd of July 2020 over reportedly irregular establishment of a quarantine centre at the ZAOGA FIF owned properties located at number RE 3/A Powel Road, Parktown, Waterfalls, Harare and 13B Powel Road, Parktown, Waterfalls, Harare and failure by the authorities to secure the facilities. The CRW notes that persons quarantined at 13B Powell Road were getting in and out of the gate freely without restrictions exposing the community to a potential health threat and that the same persons were entertaining visitors by the gate, exchanging goodies and taking selfies in clear violation of the stipulated Covid-19 guidelines.
We urge the government to respond to the Waterfalls residents concerns and abide by the court order of 3rd of June 2020 by the High Court compelling the government through the Ministry of Health and Child Care to improve the state of conditions i.e. conducive living conditions at the quarantine facilities and improve the turnaround times for test results.
- Personal Protective Equipment
ZADHR laments the growing trend in health professionals who are testing positive to the corona virus, where the majority of these cases are attributable to exposure at the workplace due to lack of PPE. Reports indicate that over 200 health workers have tested positive countrywide. Of note is 25 health workers testing positive at Zvishavane District Hospital, 3 at Claybank Private Hospital in Gweru, 70 in Bulawayo and another 70 at Parirenyatwa with the rest dotted across the country. The failure to provide frontline health workers with adequate PPE flies in the face of the 14th of April 2020 High Court order which ordered the government through the Ministry of Health and Child Care to “provide all frontline health personnel at public health facilities in the country or deployed to trace contacts exposed by infected people, are provided with personal protective equipment (PPE)…” to protect them from the deadly CoronaVirus. Further, we have also noted that there is no priority in providing information in the Ministry’s daily updates on the number of health professionals who have tested positive, recovering or deceased. We urge the Ministry of Health and Child Care and the Health Services Board (HSB) to provide a brief on the numbers, region/province and status of all health professionals’ who have tested positive to COVID-19 to date. We continue to urge the government to improve the workplace safety of health workers through timeous and adequate provision of PPE to protect healthcare workers from contracting COVID-19.
In that regard, ZADHR will launch a HEALTH WORKERS SAFETY TRACKER as part of its initiative to track the implementation of the 14 April 2020 High Court judgement. The TRACKER, which is an advocacy tool will also be utilised in enhancing access to information to the public and to healthcare workers and in engaging with responsible authorities in working towards improved working conditions for health workers.
- Health Sector Strike
ZADHR is deeply concerned with the on-going industrial strike by nurses and other healthcare workers in the public health delivery sector. We also note the ultimatum by the Senior Hospital Doctors Association (SHDA) to go on strike within 14 days starting 16th July 2020 if the government does not respond positively to their demands. We are only two (2) short of the timeline and no effective response from the government as yet. The state of affairs compounds the already dire situation within the public health sector and more importantly in this time of the COVID-19 pandemic. We are also worried about the lack of urgency and the lethargy by the government in addressing the health workers’ genuine concerns. ZADHR urges the government to prioritise the welfare of the health workforce in order to boost their moral and improve the health outcomes as a matter of urgency. The strikes come at a time health workers have been complaining about shortages of PPE in their respective workspace a situation which exposes them to contracting COVID-19. Currently, Parirenyatwa has skeletal staff that can only look after 60-70 patients out of a possible 425 at any given time. This is testament to the fact that government has paid lip service to the concerns of health workers despite court orders imploring the government to prioritise the welfare and health of the health workers. ZADHR stands with the affected and striking health care workers and urges the government to exhibit urgency when confronted with issues that affect the well being of its workers and by extension the citizens.
- Continuity of Care for Other Conditions
We continue to note the difficulties being faced by citizens in accessing health services including access to emergency maternal services. ZADHR has verified reports of citizens who are being turned away from hospitals because they do not have COVID-19 test results. This is a clear violation of section 76(3) of the Zimbabwean constitution which states that “no person may be refused emergency medical treatment in any health institution.” Whilst we note the requirement is in place to protect fellow health workers, we advise that public health institutions should have the testing facilities readily available for emergency cases such that patients are not turned away and told to get tested in private institutions. In addition, public health institutions should make sure that health workers attending to emergency cases have proper PPE to protect themselves and that adequate infection control guidelines are strictly adhered to.
- Ports of Entry
ZADHR notes the growing number of cases of local transmission being reported. We have also noted video clips and photos of people and goods including copses illegally crossing the borders. We urge the government to secure the ports of entry to curb the smuggling of goods and persons. Further, there is need for increased vigilance and surveillance of illegal border crossing where persons and goods which might have been exposed to COVID-19 in neighbouring countries are entering the country.
- Prisons and Prisons Conditions
ZADHR laments the reports of prison officials testing positive to COVID-19. 76 prisoners and 25 correctional officers at Grey Prisons in Bulawayo have reportedly tested positive for coronavirus. Other cases have also been reported in Plumtree and Beitbridge. ZADHR stresses that places of detention are very crucial in the management of COVID-19 pandemic due to a number of reasons. According to the Centre for Disease Control and Prevention (CDC), incarcerated/detained persons reside and recreate within congregate environments, heightening the potential for COVID-19 to spread inside the detention facility once introduced. Further, there are many opportunities for COVID-19 virus to be introduced into a detention facility, including daily staff ingress and egress; transfer of incarcerated/detained persons between facilities and systems, to court appearances, and to outside medical visits; and visits from family, legal representatives, and other community members. Some settings, particularly jails have high turnover, admitting new entrants daily who may have been exposed to COVID-19 virus in the surrounding community or other regions. CDC further posits that options for medical isolation of COVID-19 cases are limited and vary depending on the type and size of facility, as well as the current level of available capacity, which is partly based on medical isolation needs for other conditions. In addition, incarcerated/detained persons and staff may have medical conditions that increase their risk of severe disease from COVID-19. The ability of incarcerated/detained persons to exercise disease prevention measures (e.g., frequent handwashing) may be limited and is determined by the supplies provided in the facility and by security considerations. Many facilities restrict access to soap and paper towels and prohibit alcohol-based hand sanitizer and many disinfectants. ZADHR recommends the government of Zimbabwe and the Zimbabwe Prisons and Correctional Services (ZPCS) to be on the guard through enhancing the screening and testing capacity of detention facilities, enhance access to hygiene supplies such as soap to masks for both prisoners and prison officials and to adopt other relevant measures that promote mitigation of the spread of the disease within the facilities.
- Leadership and Governance
According to the World Health Organisation (WHO, 2004) leadership and governance are at the centre of the building blocks of a strong health system. However, in Zimbabwe, in this time of a pandemic the Health Ministry is operating without a Minister, no substantive Permanent Secretary, line Directors and hospital executives have been fired leaving not only the response to COVID-19 and but the general health delivery system in shambles. ZADHR urges the President of Zimbabwe, the Ministry and the Health Services Board (HSB) to urgently attend to this lacuna and work towards strengthening the sector and the COVID-19 response.
Conclusion In conclusion, we urge the government, civil society, development partners, the private sector and all well-meaning Zimbabweans to work together in fighting the COVID-19 scourge. We also urge members of the public to remain vigilant and exercise good personal hygiene and adhere to social distancing guidelines to mitigate the transmission of the virus.
