From a Crisis Response to Institutional Capacity Building: Experiences from Zimbabwe on Cholera Outbreak

Total Page:16

File Type:pdf, Size:1020Kb

From a Crisis Response to Institutional Capacity Building: Experiences from Zimbabwe on Cholera Outbreak From a crisis response to institutional capacity building: Experiences from Zimbabwe on cholera outbreak From a crisis response to institutional capacity building: Experiences from Zimbabwe on cholera outbreak Zimbabwe WHO/AFRO Library Cataloguing – in – Publication From a crisis response to institutional capacity building: experiences from Zimbabwe on cholera outbreak 1. Cholera – prevention and control 2. Disease outbreaks – prevention and control 3. Emergencies – supply and distribution 4. Capacity building 5. Organizational Case Studies I. World Health Organization. Regional Office for Africa ISBN: 978-929023261-2 (NLM Classification: WC 264) © WHO Regional Office for Africa, 2013 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Copies of this publication may be obtained from the Library, WHO Regional Office for Africa, P.O. Box 6, Brazzaville, Republic of Congo (Tel: +47 241 39100; Fax: +47 241 39507; E-mail: [email protected]. int). Requests for permission to reproduce or translate this publication, whether for sale or for non-commercial distribution, should be sent to the same address. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use. Disclaimer: This report was prepared by the Ministry of Health and Child Welfare and the World Health Organization for sharing experience with participants at the 2011 World Conference on Social Determinants of Health. The opinions expressed in this report are those of the authors, based on experience gained in managing the cholera outbreak, in-depth interviews with key informants and discussions undertaken for the purposes of developing this report. Contents Acknowledgments ............................................................................................................ iv Abstract ............................................................................................................................. v 1. Introduction .................................................................................................................1 2. Context ........................................................................................................................3 3. Methodology ...............................................................................................................4 4. Results ........................................................................................................................4 5. Cost .............................................................................................................................9 6. References ................................................................................................................12 From a crisis response to institutional capacity building: a crisis response From Zimbabwe on cholera outbreak Experiences from iii Acknowledgments This case study was prepared jointly by the Ministry of Health and the Social Determinants of Health Unit, World Health Organization, Regional Office for Africa. Financial support was made available through the Spanish Core Contribution Grant for Social Determinants of Health (SDH) received by the Department of Ethics and Social Determinants of Health of the World Health Organization. The overall aim of Spanish Core Contribution Grant for SDH is to strengthen leadership and stewardship role of Ministry of Health to addressing social and economic determinants of health. It supports documentation of country level experiences in using intersectoral actions aimed at addressing the key social determinants of priority public health conditions. An earlier draft of this case study was included in a special collection of global experiences on intersectoral actions which was widely disseminated during the World Conference on Social Determinants of Health held in Rio de Janeiro, Brazil in 2011. At the country level, the review process leading to the finalization of the case study generated multi- stakeholder policy and strategy discussions on implementing intersectoral actions to address social determinants of health. The final product is a result of collective efforts of many individuals and organizations. However, the drafting team included Dr Davies Dhlakama, Dr Portia Manangazira, Director, Disease Control and Prevention, Ministry of Health & Child Welfare; Dr Anna Miller, (Consultant); Mr Laxon Chinhengo, Ministry of Labour & Social Services; Dr Stanley Midzi, WHO Country Office, Zimbabwe. The overall guidance and technical inputs to the project from WHO Regional Office for Africa are gratefully acknowledged, namely: Dr Tigest Ketsela, Director Health Promotion Cluster; Dr Davison Munodawafa, Programme Area Coordinator, Determinants and Risk Factors; Dr Chandralall Sookram and Mr Peter Phori; and Dr Eugenio Villar, SDH Coordinator in WHO HQ, Geneva. We are indebted to the many people who made valuable inputs throughout the process who cannot be mentioned by name. Last but not least, we express great appreciation for the support received from the Government through the Ministry of Health to conduct this activity. From a crisis response to institutional capacity building: a crisis response From Zimbabwe on cholera outbreak Experiences from iv Abstract This paper evaluates the multisectoral response to the 2008/09 cholera outbreak in Zimbabwe and examines the extent to which the social determinants of health (SDH) driving the outbreak, in particular, water and sanitation, were addressed. The study provides the evidence that determinants of health are important in that most drivers of health consequences emanate from social, economic, political and environmental spheres. It also showed that, in order to institute a comprehensive emergency response, intersectoral actions to address the SDH driving the outbreak, particularly given the prevailing context of poverty and national systemic constraints, were needed. A comprehensive desk review of documented response efforts to the cholera outbreak of 2008/09 was undertaken. Key informants were identified and interviewed to provide their experiences of the outbreak as well as suggest what could have been done differently. The study also assessed whether the multisectoral collaboration contributed to addressing the social and other determinants that caused and/or propagated the outbreak. The study revealed that the combined multisectoral efforts eventually resulted in the control of the cholera outbreak which was declared officially over in July 2009. There have been reports of sporadic outbreaks thereafter, but the concerted efforts and multisectoral measures put in place since December 2009 to address the identified SDH have enabled the country to realize dramatic reductions in both cholera cases and deaths across the country. Subsequently, almost a year elapsed without cholera cases being reported. This outbreak demonstrated that responding to an outbreak requires addressing the health emergency at the same time as the SDH. From a crisis response to institutional capacity building: a crisis response From Zimbabwe on cholera outbreak Experiences from v vi From a crisis response to institutional capacity building: Experiences from Zimbabwe on cholera outbreak 1. Introduction Between August 2008 and July 2009, Zimbabwe experienced a catastrophic cholera outbreak which ultimately resulted in 98 592 cases and 4288 deaths. Fifty-five of Zimbabwe’s 62 districts (89%) were affected. The overall crude case-fatality rate was 4.3%, well above the acceptable WHO level of 1%. 61.4% of all reported deaths took place in the community1. This outbreak took place against a backdrop of increasingly frequent outbreaks since 1998 as shown in Figure 1. Figure 1: Cholera occurrence in Zimbabwe, 1975-2010 Source: Ministry of Health and Child Welfare, 2009 Previous outbreaks had been confined to discrete geographical zones, were of limited duration and affected far fewer people. Notably, this unprecedented outbreak coincided with heightening socioeconomic decline where water and sanitation infrastructure had deteriorated to its worst level. Additionally, all six building blocks of the health systems had virtually collapsed. Several risk factors were identified in this outbreak, including inadequate and unsafe water sources, poor sanitation and poor
Recommended publications
  • Participation of Women in the Health
    Ayaz et al. Hum Resour Health (2021) 19:94 https://doi.org/10.1186/s12960-021-00635-7 REVIEW Open Access Participation of women in the health workforce in the fragile and confict-afected countries: a scoping review Basnama Ayaz1* , Maria Athina Martimianakis2, Carles Muntaner1 and Sioban Nelson1 Abstract Introduction and background: The full participation of women as healthcare providers is recognized globally as critical to favorable outcomes at all levels, including the healthcare system, to achieving universal health coverage and sustainable development goals (SDGs) by 2030. However, systemic challenges, gender biases, and inequities exist for women in the global healthcare workforce. Fragile and confict-afected states/countries (FCASs) experience addi- tional pressures that require specifc attention to overcome challenges and disparities for sustainable development. FCASs account for 42% of global deaths due to communicable, maternal, perinatal, and nutritional conditions, requir- ing an appropriate health workforce. Consequently, there is a need to understand the impact of gender on workforce participation, particularly women in FCASs. Methods: This scoping review examined the extent and nature of existing literature, as well as identifed factors afecting women’s participation in the health workforce in FCASs. Following Arksey and O’Malley’s scoping review methodology framework, a systematic search was conducted of published literature in fve health sciences databases and grey literature. Two reviewers independently screened the title and abstract, followed by a full-text review for shortlisted sources against set criteria. Results: Of 4284, 34 sources were reviewed for full text, including 18 primary studies, fve review papers, and 11 grey literature sources. In most FCASs, women predominate in the health workforce, concentrated in nursing and mid- wifery professions; medicine, and the decision-making and leadership positions, however, are occupied by men.
    [Show full text]
  • Investment Case Sixth Replenishment 2019 Ending the Epidemics of Hiv, Tuberculosis and Malaria by 2030 Is Within Reach, but Not Yet Fully in Our Grasp
    INVESTMENT CASE SIXTH REPLENISHMENT 2019 ENDING THE EPIDEMICS OF HIV, TUBERCULOSIS AND MALARIA BY 2030 IS WITHIN REACH, BUT NOT YET FULLY IN OUR GRASP. WITH ONLY 11 YEARS LEFT, WE HAVE NO TIME TO WASTE. WE MUST STEP UP THE FIGHT NOW. I. TABLE OF CONTENTS I. Executive Summary 1 II. Ending AIDS, TB and Malaria is Critical to Achieving the SDGs and Universal Health Coverage 8 III. Step Up or Slip Back? 12 IV. More Innovation, Collaboration, and Execution 19 V. The Global Fund Needs at Least US$14 Billion for the Next Three-Year Cycle 29 VI. The Global Fund Partnership Builds on a Robust Track Record of Impact 39 VII. Conclusion: Now is the Time to Step Up the Fight 44 ANNEX 1: Selected Global Fund 2017-2022 Key Performance Indicators and Targets 47 ANNEX 2: Methodology for Estimating the Resource Needs 48 ANNEX 3: Projection of Available Resources 49 ANNEX 4: Methodology for Impact Modelling 51 ANNEX 5: Methodology for ROI calculation 54 ANNEX 6: Results: Essential Indicators 55 STEP UP THE FIGHT 2019 I. EXECUTIVE SUMMARY 1 STEP UP THE FIGHT 2019 Ending the epidemics of HIV, tuberculosis and malaria The Global Fund plays a vital role in achieving this target If we don’t prevent teens, particularly girls, from getting by 2030 is within reach, but not yet fully in our grasp. and in accelerating progress toward universal health infected with HIV, the massive increase in the youth With only 11 years left, we have no time to waste. We coverage. While governments and communities must population in Africa will lead to more new infections must step up the fight now.
    [Show full text]
  • The Impact of Economic Performance on Health in Zimbabwe
    The Impact of Economic Performance on Health in Zimbabwe Policy Brief By Dr. A. Makochekanwa Gaborone, Botswana Mobile: +267 76 19 19 97 : +267 7552 7583 Email : [email protected] :[email protected] 4th July 2012 1 1 Introduction The nexus between economic growth and health outcomes has been extensively studied. However the relationship between the two is not clear. Historically, decline in both infant and child mortality rates, and the fall in both male and female adult mortality rates especially since the turn of the 20 th century has been attributed to a multiplicity of factors associated with economic and social advancement. These factors include rising availability of material goods, urbanization, improved infrastructure and housing, rising levels of education, improvement in personal and social hygiene, medical advances, the disappearance of slavery, and other host of significant reductions in discrimination for gender, religious, ethnic groups, etc Whilst most studies and logical reasoning posits a positive relationship between economic growth and improved health, it is important to note that sometimes improved economic growth can result in decline in health. Granados and Ionides (2007) indicate that the negative association found between economic growth and health progress in the most recent half century. These modern studies reveal a short-term tendency of death rates to increase during economic expansions in industrialized countries in recent decades (Graham et al., 1992; Abdala et al., 2000; Ruhm 2000 and 2003). Despite existence of inverse relationship between increase in gross domestic product (GDP) and decline in health in some instances, this study is however going to dwell on the positive correlation between these two variables.
    [Show full text]
  • CSO GFF Platform-Building and Action-Planning Meeting Report
    Zimbabwe CSO GFF Platform-building and Action-planning Meeting Report Hosted by the CWGH in co-operation with the GFF Zimbabwe CSO Interim Steering Committee With support from CSO GFF HUB 19-21 February, 2020 PVO 01/2014 Harare, Zimbabwe Contents I. Background 1 II. Health Sector Investment Case & GFF Process in Zimbabwe 2 III. The HSIC We Want 5 IV. Coalition structure & leadership 7 V. Next steps 12 Appendix 1: Programme 13 Appendix 2: List of Participants 18 Zimbabwe CSO GFF Platform-building and Action-planning Meeting ound I. Background r Backg Zimbabwe joined the GFF in July 2019 to improve the health and nutrition of Zimbabwean people. The Government of Zimbabwe through the Ministry of Health and Child Care (MOHCC) is currently leading the GFF process. The experience of GFF countries has shown that civil society is most effective when it is structured and coordinated in a coalition. Through forming a new GFF CSO Platform, or designating an existing platform for engagement on GFF, Zimbabwean civil society can be stronger together. Civil society can collectively dene priorities to share information, ensure that policy and program “asks” by different members of the platform are mutually reinforcing and emphasize shared concerns, and streamline engagement with government and donors. A small team of Zimbabwean civil society organizations working in the health sector formed an interim coalition steering committee: CWGH, supported by Zimbabwe AIDS Network (ZAN), Women’s Action Group (WAG), and The Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe). This group worked with the CSO GFF Resource and Engagement Hub to design a workshop to orient Zimbabwean health civil society organizations to the GFF, and develop plans to engage in the process.
    [Show full text]
  • Annual Report 2018 Contents Message from Leadership
    annual report 2018 Contents message from leadership . 2 how we work . 4 our values . 6 where we work . 8 hiv/AIDS . 10 universal health coverage . 18 malaria . 26 maternal, newborn, and reproductive health . 32 diarrhea and pneumonia . 40 vaccines . 46 tuberculosis . 50 hepatitis . 54 nutrition . 60 cancer . 66 financials . 72 acknowledgements . 75 our leadership team . 76 board of directors . 76 image, front cover: boys laugh and pose outside a village madhya pradesh, india image, opposite: workers collect samples of malaria-carrying anopheles mosquitos guna yala comarca, panama message from leadership Every human life is sacred. Every child, regardless an eye toward universal health coverage. And, we of their place of birth or their family’s financial are supporting them to tackle non-communicable circumstances, deserves to have the opportunity diseases including cancer, a growing issue in many to fulfill his or her potential free from premature low-income countries. death or debilitating disease. Good-quality national CHAI’s strategy is defined by our approach to health systems that can accomplish these goals are accomplishing our mission. We take on large, essential to lift people from poverty. These are the ambitious projects that will have a major impact beliefs that motivate CHAI and our people. in saving lives. We do not deliver health services In 2018, CHAI grew almost 20 percent. We are ourselves. We believe the best way to create on track to do the same in 2019; increasing the large scale sustainable programs is to improve contribution to our mission of saving lives, reducing government and local private health delivery the burden of disease, and strengthening health systems so that the programs can continue long systems in low- and middle-income countries.
    [Show full text]
  • Complete Issue (PDF)
    Dedicated to what works in global health programs GLOBAL HEALTH: SCIENCE AND PRACTICE 2021 Volume 9 Number 1 www.ghspjournal.org EDITORS Editor-in-Chief Stephen Hodgins, MD, MSc, DrPH, Associate Professor, Global Health, School of Public Health, University of Alberta Editor-in-Chief Emeritus: James D. Shelton, MD, MPH, Retired Associate Editors Matthew Barnhart, MD, MPH, Senior Science Advisor, USAID, Bureau for Global Health Cara J. Chrisman, PhD, Deputy Division Chief, Emerging Threats Division, USAID, Bureau for Global Health Elaine Menotti, MPH, Deputy Division Chief, Service Delivery Improvement, USAID, Bureau for Global Health Jim Ricca, MD, MPH, Director, Adaptive Management, Monitoring, Evaluation, and Learning, MOMENTUM, Jhpiego Madeleine Short Fabic, MHS, Supervisory Public Health Advisor, USAID, Bureau for Africa Abdulmumin Saad, MD, PhD, MPH, Senior Advisor, USAID, Bureau for Global Health Rajani Ved, MD, MPH, Executive Director, National Health Systems Resource Center, India Malaria: Michael Macdonald, ScD, Consultant, World Health Organization, Vector Control Unit, Global Malaria Programme Maternal Health: Marge Koblinsky, PhD, Independent Consultant Nutrition: Bruce Cogill, PhD, MS, Consultant Managing Staff Natalie Culbertson, Johns Hopkins Center for Communication Programs Sonia Abraham, MA, Johns Hopkins Center for Communication Programs EDITORIAL BOARD Zulfiqar Bhutta, The Hospital for Sick Children, Toronto, Aga Emmanuel (Dipo) Otolorin, Jhpiego, Nigeria Khan University, Pakistan James Phillips, Columbia University,
    [Show full text]
  • Zimbabwe Health System Assessment 2010
    ZIMBABWE HEALTH SYSTEM ASSESSMENT 2010 January 2011 This publication was produced for review by the United States Agency for International Development. It was prepared by John Osika, Danielle Altman, Leah Ekbladh, Itamar Katz, Ha Nguyen, Josh Rosenfeld (Abt Associates Inc.), Taylor Williamson (RTI International), and Sam Tapera (Best Practices, Ltd.) for Health Systems 20/20 Project. Mission The Health Systems 20/20 cooperative agreement, funded by the U.S. Agency for International Development (USAID) for the period 2006-2011, helps USAID-supported countries address health system barriers to the use of life-saving priority health services. Health Systems 20/20 works to strengthen health systems through integrated approaches to improving financing, governance, and operations, and building sustainable capacity of local institutions. January 2011 For additional copies of this report, please email [email protected] or visit our website at www.healthsystems2020.org Cooperative Agreement No.: GHS-A-00-06-00010-00 Submitted to: Robert Emrey, CTO Health Systems Division Office of Health, Infectious Disease and Nutrition Bureau for Global Health United States Agency for International Development Recommended Citation: John Osika, Danielle Altman, Leah Ekbladh, Itamar Katz, Ha Nguyen, Josh Rosenfeld Taylor Williamson, and Sam Tapera. November 2010. Zimbabwe Health System Assessment 2010. Bethesda, MD: Health Systems 20/20 Project, Abt Associates Inc. Abt Associates Inc. I 4550 Montgomery Avenue I Suite 800 North I Bethesda, Maryland 20814
    [Show full text]
  • Zimbabwe WHO Special Initiative for Mental Health Situational Assessment
    Zimbabwe WHO Special Initiative for Mental Health Situational Assessment CONTEXT Zimbabwe is located in Southern Africa, bordered by South Africa, Mozambique, Botswana, and Zambia. The landlocked country has a tropical climate with high plateau and mountains in the east. There are 8 rural provinces and 2 metropolitan provinces, which are further divided into 63 districts and 1200 wards. The majority of Zimbabwe’s economy comes from the service sector (65.8%), followed by industry (22.2%) and agriculture Table 1: Demographics (12%).2 Zimbabwe’s informal economy is responsible for Demographic information 1 60% of all income; the rate of formal unemployment is Population 14,030,368 Under 14 years 44.4%1 extremely high.2 Over 65 years 3.2%1 Poverty is endemic in Zimbabwe: an estimated 70% of Rural population 67.8%2 the population is living below the poverty line, and 34% Literacy 88.8%3 are living in extreme poverty. Shortages in fuel, Languages Shona, Ndebele, English2 electricity, drought, and climate related events have Ethnicities 99.4% African2 Religions Protestant (74.8%), Catholic drastically impacted the agriculture sector and inflation 2 rates in recent years.10 Having experienced years of (7.3%), other Christian (5.3%) GDP per capita 1,079.61 USD4 austerity policies, economic decline, and the 2008 Electricity 33.7% of homes5 hyperinflation crisis, Zimbabwe’s health system – which Sanitation 37% of homes5 was once one of the most robust in the region – has Water 78.1% of homes5 suffered decreased government spending, high Education 88.4% completed primary school5 workforce emigration, and human rights violations.11 In Health information 2017, President Robert Mugabe was forced to resign as Life expectancy 60.86 president after nearly 40 years in power.
    [Show full text]
  • Issues of Equity in and Access to Health Care in Zimbabwe *
    The African e-Journals Project has digitized full text of articles of eleven social science and humanities journals. This item is from the digital archive maintained by Michigan State University Library. Find more at: http://digital.lib.msu.edu/projects/africanjournals/ Available through a partnership with Scroll down to read the article. Journal of Social Development in Africa (1990), 5,1, 31-38 Issues of Equity In and Access TO Health Care in Zimbabwe * SAMUELAGERE + ABSTRACT The purpose of this paper is to identify and analyse, within the health care delivery system in Zimbabwe, certain categories of people or social groups who mayor may not have access to health care. An attempt will also be made to give the reasons for the maldistribution of health resources and the implications this has for the population of Zimbabwe. Brief and appropriate solutions are proposed within the socioeconomic and political context of the Zimbabwean s~ge of development and its historical past. Introduction Health care is delivered within and by a hierarchically organised and structured system. The system includes the production, distribution and consumption of health services. Within the system, there are a number of major actors such asphysicians, nurses, paramedics, pharmacists and the pharmaceutical industry, insurance companies, hospitals and clinics, through which curative and preventive services are administered, delivered and consumed. This group of actors in the health care delivery system have a monopoly, and control, of the technical knowledge of producing and administering medicines. Within this group of actors, doctors dominate and control the system, from production of knowledge of medical care, distribution of medical services, and, more importantly, the consumption of health care.
    [Show full text]
  • Assessment Report on the Mozambican Influx Into Chipinge
    ASSESSMENT REPORT ON MOZAMBICAN INFLUX INTO CHIPINGE DISTRICT, ZIMBABWE Chipinge District Civil Protection Committee Abstract This document is a culmination of a partnership between UNHCR, the Department of Social Welfare and the Chipinge District Civil Protection Committee with multi-sectorial representation comprising both humanitarian partners and government line ministries in an assessment of the influx from Mozambique to establish inter alia population statistics, migration trends, access to basic services and general safety to inform interventions. October 2016 Chipinge Civil Protection Household Profiling Report on Mozambique Influx October 2016 LIST OF ACRONYMS DSW Department for Social Welfare FHH Female Headed Household FRELIMO Frente de Libertação de Moçambique GoZ Government of Zimbabwe HH Household INGO International NGO IOM International Organization for Migration IP Implementing Partner LNGO Local NGO M&E Monitoring and Evaluation MFT Multi-Functional Teams PoC Persons of concern RENAMO Resistência Nacional Moçambicana SGBV Sexual and Gender-Based Violence STIs Sexually Transmitted Infections TRC Tongogara Refugee Camp UASC Unaccompanied or Separated Children UNHCR United Nations High Commissioner for Refugees VIP Ventilated Improved Pit (latrine) WASH Water Sanitation and Hygiene WR Woman at Risk - 1 - Report on Mozambican Influx, Chipinge Civil Protection Unit Chipinge Civil Protection Household Profiling Report on Mozambique Influx October 2016 1.0 Executive Summary The United Nations High Commissioner for Refugees (UNHCR) in collaboration with the Department of Social Welfare (DSW), under the auspices of the Chipinge District Civil Protection Committee, supported the district initiative to establish the accurate number, nationalities, bio-data and needs of the persons of concern fleeing civil strife in Mozambique’s Manica Province into Chipinge District of Zimbabwe.
    [Show full text]
  • The Temporospatial Dimension of Health in Zimbabwe Evans Chazireni Phd Geography University of South Africa
    THE TEMPOROSPATIAL DIMENSION OF HEALTH IN ZIMBABWE by EVANS CHAZIRENI Submitted in accordance with the requirements for the degree of PHD in the subject GEOGRAPHY at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: DR A C HARMSE Date: March 2015 Declaration I, Evans Chazireni hereby declare that the thesis, which I hereby submit for the degree of Doctor of Philosophy at the University of South Africa, is my own work and has not previously been submitted by me for a degree at this or any other institution. I declare that the dissertation /thesis does not contain any written work presented by other persons whether written, pictures, graphs or data or any other information without acknowledging the source. I declare that where words from a written source have been used the words have been paraphrased and referenced and where exact words from a source have been used the words have been placed inside quotation marks and referenced. I declare that I have not copied and pasted any information from the Internet, without specifically acknowledging the source and have inserted appropriate references to these sources in the reference section of the dissertation or thesis. I declare that during my study I adhered to the Research Ethics Policy of the University of South Africa, received ethics approval for the duration of my study prior to the commencement of data gathering, and have not acted outside the approval conditions. I declare that the content of my dissertation/thesis has been submitted through an electronic plagiarism detection program before
    [Show full text]
  • Health Information and Surveillance System in Zimbabwe
    DHIS Zimbabwe Content • Introduction: Health in Zimbabwe Pag 3 • Zimbabwe’s Response: Key Achievements Pag 4 • The Introduction of a modern Health Information and Surveillance System in Zimbabwe Pag 5 • Key Results Pag 8 • Key Success Factors Pag 8 • Building for the Future Pag 9 • Support to Zimbabwe’s response: UNDP, the Global Fund and Partnership Pag 9 • Partnership for the DHIS Pag 10 • Sources Pag 11 2 DHIS Zimbabwe Introduction: Health in Zimbabwe In 2015 Zimbabwe is still recovering from a prolonged period of economic decline that occurred from 1999 to 2008, which resulted in a decrease in funding for social services, and directly contributed to a deterioration of health infrastructure, loss of experienced health professionals, drug shortages and a decline in the quality of health services available. The capacities of most national institutions diminished, with limited finan- cial resources and reduction in the numbers and skills in the workforce. It is estimated that over two million Zimbabweans left the country during this period, including many skilled health professionals. The situation negatively affected the health outcomes of the country: maternal mortality ratio in 2006 was 555 deaths per 100,000 live births translating to six maternal deaths per every 1000 live births; under-5 mortality rate was at 82 per 1,000 live births and neonatal mortality rate at 24 deaths per 1,000 live births (2005-2006 ZDHS). Since 2009 economic growth and a more stable macroeconomic environment have re- turned to Zimbabwe, but the country continues to battle high levels of unemployment and the economic recovery remains fragile.
    [Show full text]