MSF eases Tsholotsho health care task

TSHOLOTSHO - At the crack of dawn the sound of the rooster rings through a homestead, jolting people out of their slumber.

In reaction, villagers begin cleaning chores while school children begin to consort for their daily jaunt to different distant schools.

For 35-year-old Ntonkozo Mabiza, the alert from the rooster means more strain and hassle.

Mabiza of Dlamini village some 50km west of Tsholotsho Centre has to endure not only the distance she is about to embark on to access the life-saving anti-retroviral drugs but the tortuous queue that she is supposed to beat at Tsholotsho District Hospital.

With transport glitches being a thorny issue in the remote area, the donkey drawn carts come to the rescue but without doing any good to the patient considering the dusty rutted roads that in a very bad state of disrepair due to evident neglect.

This has been the challenge faced by hundreds of HIV/TB patients in the greater marginalised area of Tsholotsho in Matabeleland North Province, about 70 km from Zimbabwe’s second largest city Bulawayo.

But with the coming of the Médecins Sans Frontiers/ Doctors without Borders (MSF) Zimbabwe since the year 2000, the epidemic and other related infections in the usually marginalised areas have been reduced.

Working in conjunction with the ministry of Health and Child Welfare MSF is slowly making positive impact in decentralising HIV and TB treatment in specified remote areas.

This has not only facilitated the treatment and care of people with HIV, tuberculosis (TB) and drug-resistant TB (DR-TB) but Sexual and Gender based Violence (SGBV) interventions and emergency preparedness.

During a tour of the Tsholotsho district early this week, the Daily News managed to get first-hand experience of the decentralisation programme which MSF and the ministry is currently expanding to the communities.

The process seeks to get care out of centralised hospitals and into community clinics and local health posts  which has been the cornerstone of intensifying access to anti-retroviral therapy.

This has resulted in the shifting of health care tasks from medical doctors to nurses and to lay health workers which have proved to be ideal in the district.

Over 52 000 people are receiving the lifesaving anti-retroviral therapy (ART) under the project which also covers such areas as Beitbridge, Buhera, Chikomba, Epworth, Gokwe North, Gutu, Mbare, and Tsholotsho.

Speaking to the Daily News, Victor Garcia Leonor head of mission for MSF, Zimbabwe said despite advances made in offering HIV and TB services as well as putting people on treatment, the infections remained an emergency in Zimbabwe.

“Transmission rates from HIV positive mothers to their babies are still too high and children and young adults are still often excluded from HIV response.

We have patient reality models that allow them to be treated in or close to their homes rather than at central or national level,” Leonor said.

Dr David Wachi who is the Medical Team Leader in the district said they have for the past year been relentlessly endeavouring to scale up facility based treatment, a development that promises to get treatment to every clinic.

He said this has seen them shift health care tasks from a doctor led ART initiation to a nurse led ART initiation.

“We have been having a challenge of bring medical doctors to come and work in the rural areas as a result task shifting became the only option.

Nurses now play a leading role in managing HIV cases in all the 14 health facilities we are supporting in this area, Wachi said.

Wachi said the programme had expanded anti-retroviral therapy access to the all the health facilities through trainings of “task shifting” where it has empowered the nurses to do the jobs that could have been done by the doctors.

“This led to increased ART coverage and reduced delays in ART initiation. “We have a challenge of doctors coming down to these areas, unfortunately the burden of HIV is with the villager,” Wachi said.

MSF which has been one of the organisations strongly advocating for the total removal of user fees has also guaranteed that patients receive free services on HIV testing, CD4 count as well as counselling among other services.

Of the 14 health facilities in rural Tsholotsho under the programme, 12 are static anti-retroviral sites.

There are six start-up sites while the remaining are follow up sites where patients that have started taking medication can receive their medications closer to their place of residence.

There are 19 health facilities in Tsholotsho district.

While the country grapples with its own economic and political problems, reports of HIV treatment scarcities in the district are now history as the supply has improved, Wachi said.

Meluleki Nyathi the information, education and communication project coordinator said working with the community has helped reduce the strain on the health system.

Nyathi said with the continuing shift away from specialised clinic HIV care, anti-retroviral therapy programmes are increasingly looking towards newer models for chronic diseases management hence the active inclusion of the community.

“There are village health workers, TB-HIV collaborative communities that push home-based care programmes and other community based programmes that aloe affected people take charge of their own lives,” Nyathi said.

The Prevention of Mother to Child Transmission (PMTCT) programme has not been left out in the process as expecting mothers have been receiving free medical support from MSF.
 
According to Leonore, the number of pregnant women commenced on ART increased in 2012 in comparison to 2011 due to nurse led ART initiation.

Leonore said despite their concerted effort to fight the HIV/Aids epidemic and related opportunistic infections; there have been some bottlenecks that are threatening the health delivery system.

“Most of the barriers keeping from accessing health care can be linked to a lack of resources.

Health facilities, especially in the rural areas, are understaffed and a freeze on hiring any civil service staff perpetuates this situation,” Leonore said.

In addition, the head of mission said, national funding is not enough to cover the HIV/TB response and an overall donor  retreat as well as late disbursements of funds cause serious stock out of essential medicine and ARVs; shortages in laboratory agents and other crucial equipment like diagnostic tools.

By end of 2012, almost 13, 500 patients have been commenced on ART in the project. Of these  1 139 (8,4 percent) of them were less than 15 years old.

In the same month 9 103 patients were being actively followed on ART in the district’s database and of these patients 875 (9,6 percent) were less than 15 years old.

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