PHA-Exch> The Health Situation in Zimbabwe: Letter to WHO DG

[Claudio Schuftan]

11 December 2008

The Director General

World Health Organisation

Geneva

Switzerland



Dear Dr Chan

* *

*An appeal to the World Health Organisation; on the health situation in
Zimbabwe*

We, the members of the Community Working on Health (CWGH) in Zimbabwe, with
a membership of about 35 civil society organizations representing a wide
range of constituent groups, from Residents Associations to Community Based
Organizations are writing to you to express our deepest concern at the
severe decline in heath and in the health system in Zimbabwe, with negative
consequences for people- high mortality, extremely low life expectancy, and
significant risk of untreated communicable and chronic disease. We do this
because we understand public health, as articulated in the Millennium
Development Goals, to be a global public good, and a matter for
international solidarity.

We recognize that the current health crisis does not emanate from the health
sector- it comes from wider economic collapse and the increasing extent to
which people are not accessing basic public services like education,
transport water and electricity. Education is a major determinant of health,
but many public sector schools are now closed. Public transport has all but
collapsed and private transport services are unaffordable for many. Many
urban communities including Harare have gone for weeks and months without
adequate water supply in a situation that has now declined over several
years, leaving people vulnerable to diseases like cholera. People have not
been able to access seed and fertilizer to produce food, and are unable to
afford commercial supplies of food. Our assessments indicate that basic
supplies for hygiene like soap, toothpaste and sanitary towels are
unavailable or unaffordable for poor communities. People in this situation
are facing a public health crisis of considerable proportions.

Zimbabwe's public sector health services have since independence been a
buffer between people and the impoverishing and fatal impacts of ill health
caused by such conditions. The massive decline in our public health sector
is thus a major crisis for poor people in the country, and leaves people
starkly exposed to severe risk. The cholera epidemic that the country and
the international community is responding to is a sign of this. While this
has obtained significant international attention, we are concerned that more
chronic problems like maternal mortality, reproductive illness and
malnutrition are less obvious, but equally meriting of attention. People
with chronic diseases like diabetes are struggling to meet costs of their
treatment. Such groups have difficulty taking medications when they do not
have adequate food to eat. We are concerned that the same lack of
information and silence that concealed the cholera epidemic in its early
stages is also leading to inadequate recognition of other health problems.
This depresses an early response to preventing and managing these responses
in the community.

While we have a significant health infrastructure and a highly literate
population, these assets are wasted for health in the context of lack of
medicine, equipment, services and staff, leaving public hospitals and
clinics non functional with consequences in preventable loss of life. Again
the alarming death toll from cholera is a warning of wider risks to health
and of wider failures to manage these risks. The fact that this disease,
which has been successfully prevented and managed in past years, is now
rampant and high fatal, is a warning bell of the severity of the problem. We
hope that the public health community, and the WHO, will respond to this not
only with an emergency response to cholera, but with a public health
response and measure to rescue our public sector health system, especially
our primary health care and services.

We are aware that the World Health Organisation Assistant Director General
for Health Action in Crisis Eric Laroche has been in Zimbabwe to identify
how to scale up the existing UN and WHO responses. At a time when the global
community is marking 30 years of Alma Ata we hope that these responses will
not stop with a vertical response to cholera. We urge WHO to more widely
address what needs to be done and what resources and support are needed to
rebuild our health systems from primary health care level upwards. While
much attention is focused  on the cholera situation there needs, for
example, to be UN attention to providing inputs now during the closing
window of opportunity for people to grow food, to prevent the widening of
the current hunger and malnutrition situation; to prepare for supplementary
feeding using local foods, to distribute bed nets and resources for spraying
to prevent malaria and to ensure drug availability for malaria treatment at
clinics so we do not also face a malaria crisis with the rains.

In all of this we urge you to bring people back into the centre of focus and
to involve communities in your deliberations and plans on the way forward.
Zimbabweans are not numbers of cholera cases or fatalities. We are people
who have responded to an increasingly difficult situation, who are entitled
to health as a right and who should be central in any response and
rehabilitation of our system. We were concerned that WHO has not drawn us
into consultations on the response to the current situation, despite our
long experience and network at community level of people with abilities to
organize and support primary health care, even under harsh conditions. We
have a network of people trained in health literacy who with minimal
resources and support from social partners have organized people to improve
health with what resources are available. Community, health workers have
cared for ill people and supported local health issues with minimal support.
While we have, with the public sector health system, mobiles teams of our
members in 25 districts to support the response to the cholera epidemic and
have begun actions at community level, this could be scaled up if these
roles were recognized and supported. We, as national membership based civic
society, are an essential element in a primary health care oriented
rehabilitation of our health system



We welcome your intervention as World Health Organisation, urge that you
intervene in a way that addresses our wider public health crisis, including
in our public sector health system, and that you involve us as communities
and health civil society in your planning on this.

 We look forward to your earliest response

Yours Faithfully

Mr. Itai Rusike

Executive Director

Community Working Group on Health (CWGH)

114 McChlery Avenue

Eastlea

Harare

Zimbabwe

Tel: +263-4-788 099 / 788 100

Fax: +263-4- 788 134

Email: itai at cwgh.co.zw

Website: www.cwgh.co.zw





Endorsed by:

The Peoples Health Movement

Zimbabwe Doctors for Human Rights

Zimbabwe Congress of Trade Unions

Women and AIDS Support Network

Zimbabwe Diabetic Association

National Council of Disabled Persons of Zimbabwe

Consumer Council of Zimbabwe

Bulawayo Unite Residents Association

Women's Action Group

Informal Traders Association of Zimbabwe

Zimbabwe Homeless Peoples Federation

Zimbabwe Network of HIV Positive Women

Zimbabwe Young People Development Coalition

Associated Mine Workers Union of Zimbabwe

General Agricultural and Plantation Workers Union of Zimbabwe

Bulawayo Health and Community Welfare Task Force

Public Service Association

Rusape Residents and ratepayers Association

Gweru Residents and Ratepayers Association

Mutare Residents and Ratepayers Association

Chinhoyi Residents and Ratepayers Association

Marondera Residents and Ratepayers Association

Shiloah Zimbabwe

CARELITE Counselors

Students and Youths Working on Reproductive Health Action Team

Zimbabwe Council of Churches
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