Date: 10 April 2012 Cleared by: H.C.C.

ZIMBABWE HEALTH CLUSTER Started at: 14.30 hours Adjourned at: 15.56 hours

Venue: WHO Annex Boardroom, Parirenyatwa Hospital Grounds 10 APRIL HEALTH CLUSTER MEETING – Minutes Summary of discussions Decisions/ Focal person Action to be taken Item 1: Welcome Remarks and Introductions

1. Introductions were done round the table and the chair welcomed all to the 4th Health Cluster meeting in 2012. 2. The Health Cluster will continue to have role to play in humanitarian response as the health system in is not quite good yet.

Welcome Remarks by WR

1. Ministry of Health and Child Welfare Malaria Unit are carrying a Malaria Indicator Survey which started some weeks ago.

2. Data collection almost finished. Once data is processed a report will be produced which will give An update of the epidemiology of malaria in the country. The Round 10 Global Funding is being used. 3. Neglected Tropical Disease workshop was recently organized in Zimbabwe to discuss the country NTDs master Plans. Zimbabwe finalized its own master plan and will be submitted to the World Bank via WHO/AFRO. 4. Received donation for drugs for schistomiasis from WHO HQ. Arranging with NATPHARM to provide storage for the drugs. 5. Ministry of Health and Child Welfare will do a mass distribution campaign especially in the places where the disease is found following the study done by the MoHCW In 2010 6. Partners operating in the affected districts will be called to assist in the mass distribution of the drugs.

7. ECHO will give a presentation on OCHA Consolidated Appeal.

8. An update on the typhoid situation from City of will be given if they attend the meeting. There were indications that the typhoid outbreak was going down but there was still need to be vigilant and provide assistance to City of Harare. 9. A meeting with ECHO was held last week and ECHO announced it has resources to be made available through a joint proposal i.e. WASH, Health and EHA to work together. The funding will not be more than 2.5 million Euros. The implementation period will be 18 months. 10. The concerned groups will be meeting to discuss how to write a joint proposal on typhoid response.

Item 2: Minutes of the Last Meeting – Corrections & Matters Arising

1 1. 2.1 The typhoid assessment was carried out and completed and a preliminary report is being compiled. 2. WHO, GAA, EHA and some partners participated in the assessments. The Minister of Health and Child Welfare was supposed to do a press conference after the assessment but has not been done yet. 3. Still experiencing differences in numbers of typhoid cases being reported by . Partners on the ground have different figures than those reported by the district. It was noted that this might be

because of the shortage of staff at the district office. Computers were said to be in place but they sometimes faced challenges in electricity availability. A follow up on this reporting issue is to be done. 4. It was pointed out that in an outbreak situation reporting should be done daily and weekly as well. Reporting timeously and correctly should always be emphasized to health workers in the districts/provinces. 5. Correction on minutes - Item 3 – 3.16 to read OCHA instead of ECHO. Same goes for item 4.1 to be changed to OCHA where it reads ECHO.

Item 3 : Epidemiological Update:

Typhoid Outbreak

1. Since 10 October 2011, Harare City has been experiencing an outbreak of typhoid. The disease has spread to

Chitungwiza city, Mashonaland Central ( district), and Mashonaland West (Zvimba and districts). As of 1 April 2012 a total of 4132 cases have been reported of which 4012 cases and 2 deaths

(CFR = 0.05%) were reported from Harare City.

2. From 26 October 2011 to date, of the total samples collected for laboratory confirmation, 52 were confirmed S.typhi. 3. During week 13, a total of 54 cases were reported. From Harare (50) and Norton in (4). In the

previous week 67 cases had been reported countrywide.

4. The number of cases reported weekly has been in general declining since week 52. This year a total of 3031 cases were reported.

5. The most affected suburbs in Harare are as follows:- Dzivaresekwa – 24 (48%); Kuwadzana – 21 (42%);

Crowborough – 3 (6%) and Snake Park – 2 (4%). 6. Response: 7. Weekly coordination meetings with the thematic committees involving Harare City Health authorities and the following partners (WHO, UNICEF, CDC and other NGOs).

8. Social mobilization activities

9. Case Management and investigation

10. Active contact tracing and water quality monitoring.

Malaria 11. This week a total of 8594 cases and 5 deaths were reported compared with 10219 cases and 11 deaths in the previous week

2 12. The following districts are the most affected; -1616 (18.8%), Nyanga - 865 (10.1%), Makonde – 765 (5.9%), Chimanimani – 716 (8.3%), Mutasa – 535 (6.2%), Hurungwe – 512 (6%); – 420 (4.9%) and – 403 (4.7%).

13. Since the beginning of 2012, a total of 109373 cases and 84 deaths (CFR = 0.08%) were reported.

Timeliness and Completeness of data 14. National data reported in week 13:

15. Completeness decreased from 81% to 69%. 16. Timeliness increased from 64% to 74%.

Discussions

17. Typhoid was on the declining trend according to the provided figures. It was however pointed out that the water and sanitation situation should be solved for the country to be completely out of water borne disease

outbreaks. 18. It was reported that Bindura has had no cases of typhoid for some weeks now.

19. MSF Belgium reported they were doing bucket chlorination in Dzivaresekwa and Kuwadzana. This has been going on for the past 4 weeks. Chlorination is done at the borehole to ensure everyone goes home with clean water. The exercise runs from 6 a.m. to 6 p.m. and there will be an attendant at the borehole to do this. Standard containers of water were distributed to residents for this purpose. 20. Should advocate for more resources to solve the water problems facing the City of Harare. 21. Higher cases of malaria were being reported in the country than usual. Malaria deaths were also said to be higher than the previous years. It was noted there were more centres reporting than previous and this might be an attributing factor to the higher numbers. The calculation of thresholds needs to be re-visited taking into

consideration the increase in numbers of reporting centres. 22. It was noted has always been a problematic area in regards to malaria over the past

three years despite the preventive measures put in place. A wide coverage of preventive measures has been done in the country which includes residual spraying as well as a wide distribution of mosquito nets to households. 23. The National Malaria Indicator Survey going on will give some insights and indication of the intensity of transmission levels. 24. A question was raised on whether the survey could identify which areas have and do not have malaria transmitting mosquitoes? The reply was unfortunately this was not possible. It was then pointed out that MSF OCA tested 18 positive cases of malaria in Epworth. They however did not take full history of movement of patients. This should be done in order to validate the information. 25. It was reiterated that information on the actual coverage of malaria prone areas in Zimbabwe should be given for the sake of visitors travelling to Zimbabwe from outside the country. 26. Dr Chimusoro and Mr Pasipamire (WHO Malaria team) who were out in the field were asked to make some follow ups with the affected districts. 3

Item 4: Update from OCHA

1. Status of CAP – funding levels very low compared to the past three years. 2. FTS reporting on currently 6% funding. Health Cluster has 0% funding from that. Everyone was concerned. ECHO HQ and FTS have started talks about the funding levels. 3. Managed to meet with EU and Australia but was not sure about the outcome. 4. There were funds from Japan – going to UNICEF. 5. There is 4.8 million under health – not recorded in the 6% funding. 6. ECHO was urging partners to report all funding received particularly for the Health Cluster. 7. Partners were also being urged to start advocacy programmes for funding of health to improve. 8. A question was raised on whether there was a particular format for reporting after receiving funds from OCHA? OCHA was going to check with its office and give report. 9. Preparations for the CAP Mid-Year Review in May have started. . Item 5 : Any Other Business

1. The NTDs Master Plan was being finalised. Will be ready not later than 30th of April 2012. It will then be submitted to World Bank through WHO for funding. 2. Commemorations of the World Health Day that was on 7th April 2012 will be done on 13th April 2012 in at an old people’s institution. Theme for this year is “Ageing and Health”. Partnered with Help Age in the commemorations. Cde John Nkomo will be Guest of Honour. 3. There will be a meeting at UNICEF tomorrow (11th April 2012) to start writing the joint proposal.

There being no further business to discuss the meeting adjourned at 15.56 hours. Minutes Compiled by: Mrs Regina Mutanhaurwa Sec/EHA Distribution: All Health Cluster members

4