| Health Service Delivery |
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Trends and current status The Government of Zimbabwe, in line with the Primary Health Care strategy of organizing services, aims at ensuring the provision of quality and safe health services that meet the needs of the people through a network of health facilities organized to function on the basis of increasing levels of sophistication.
Patients with more complex health problems are expected to be referred up the referral chain. Each level of care is expected to provide a package of well defined services provided by appropriately trained health professionals. The public health delivery system consists of four levels of care: primary, secondary, tertiary and central levels. Core health services have been defined for the primary and secondary levels but have not been costed. Work on defining the core health services for the tertiary level has started.
Primary Level The primary level consists of a network of health centres and community health workers. Village Health Workers, the first amongst community health workers, are the key link between the organized village community and the local health services. The role of Village Health Workers is fundamentally promotive, educative, and preventive, mobilizing the community and the individuals for preventive health activities.
Village health workers are the first line health workers for treatment of simple conditions, disease surveillance and for enhancing health information systems. On-going technical supervision of Village Health Workers is provided by the local staff of the rural health centres, which keep the village health workers supplied with medicines and equipment at government expense. Village Health Workers refer and also encourage communities to seek treatment early from a rural health centre or clinic. The original plan was to have one village health worker for every 100 households.
The Assessment of Primary Health Care in
The other key community health worker is the Community Based Distributor (CBD). The Community Based Distributor’s main function is to promote family planning services including the re-supply of appropriate contraceptives to eligible clients. However, only 332 CBDs are in post compared to an establishment of 900. In response to epidemics a number of other community health workers such as the “Chloroquine/SP holders” have also been established. The primary level incorporates the first point of contact between the people and the formal health sector, the Rural Health Centre or clinic. This is the most peripheral unit of the health delivery system i.e. the Primary Care facility. Each Rural Health Centre is expected to cover a population of 10,000 and should be accessible to the community.
The expectation is that no person should be more than 8 kilometres of walking distance of a RHC. Both the Access the Health Services Study (2008) and the Assessment of Primary Health Care in Zimbabwe (2009) note that physical access to health facilities is still a challenge as some people have to travel more than 10 kilometres to reach a health facility. The “outreach mobile services” that used to serve them are no longer functional.
The Rural Health Centres (RHC) provide basic but comprehensive promotive, preventive, curative and rehabilitative care, concentrating on mother and child care including antenatal care, delivery of uncomplicated births, family planning, child health and nutrition, routine immunization for children and anti-tetanus immunization for child-bearing women, environmental sanitation, especially in relation to small-scale water supplies and excreta disposal systems, control of communicable diseases , other specified problems including mental illness, eye diseases and physical and mental handicap, and general curative care including oral health. Health and nutrition education form part of all the above activities. Rural Health Centres provide support and supervision for community health workers.
Health centres are staffed by two nurses, one of whom should be a midwife and an Environmental Health Technician. Unfortunately midwives are not available in most of these primary care facilities. This has compromised the quality of care given to expecting mothers. The establishment of two nurses at the RHC is no longer adequate given the increase in work load. Environmental Health Technicians are very few with a high national vacancy rate of over 50%. This negatively affects the provision of environmental health services.
Overlooked over years is the role of general practitioners and nurses in running primary care services mostly in urban settings. They concentrate on providing curative services. There is now need to look at the possibility of involving these groups in the provision of selected public health services over and above TB and immunization.
Secondary Level Rural health centres refer patients to District hospitals (Secondary care facilities). Each district is supposed to have a district hospital and should save a population of approximately 140,000 people. The district Hospital provides referral and supervisory support to the network of clinics and Rural Health Centres in the district. They also provide comprehensive preventive and curative services. Patients have their first contact with a medical doctor at this level within the health delivery system. District hospitals refer to Provincial Hospitals (Tertiary care facilities) where patients meet a specialist. There are currently a few districts without a district hospitals or designated district hospital. Some the district hospitals train nurse and midwives.
Tertiary and Quaternary Level Most provinces have a provincial hospital except Matabeleland North where the provincial hospital is under construction. The provincial hospital level provides referral support to district hospitals. There are a limited number of specialists at the provincial and general hospitals. Provincial hospitals refer to Central (Quaternary) Hospitals in
All provincial hospitals train nurses and/or midwives. The referral chain works best when the patients referred from the lower levels receive the benefit of specialist opinion. In reality, because of the shortage of mid level doctors, a patient referred by an experienced Government Medical Officer at District Level, or, worse still, by a Specialist from a provincial hospital, is often being seen by a very junior medical officer at the central hospital.
This is compromising the quality of care being given to patients. The planned decentralization of specialist services to the provincial level in the 1997 -2007 Strategy did not succeeded to a significant extent. Availability of specialists at the provincial hospitals would have facilitated the training of intern doctors and trainee medical specialists at this level. Again, because of the shortage of specialists, this has not been possible. Support to doctors in district hospitals by specialists is limited and in some instances, non-existent. In theory, patients are required to present at the primary level first and then be progressively referred to the Secondary, Tertiary or Quaternary levels depending on the complexity of illness. In practice, the experiences of the past decade have shown that the referral chain has broken down, with all referral hospitals replicating the work of the Primary level. At
This, in itself, is indicative of the gross misuse of resources in the health sector. This is partly associated with the failure to apply administrative measures to enforce the referral chain. However, more fundamental is the fact that availability of funds for maintenance, upgrading and essential supplies have decreased in real terms across the system. This, coupled with increases in demand, has led to the deterioration of the quality of services, particularly primary care services. The result is that people simply bypass this level because services are perceived to be of poor quality. Whilst in the past, the referral facilities were better resourced hence more functional than the primary care facilities, the situation has changed.
Central hospitals are experiencing the same challenges of limited resources. Basic medical equipment and consumables are very often not available. Most of the fixed equipment such as elevators, boilers and heating systems have reached their end of life and are therefore not functional. Specialist professionals in all fields are in short supply. The few staff that are available are overworked and demoralized.
In the meantime, teaching at all levels is suffering. The quality of health personnel trained is heavily dependent on the clinical activity schedule of the institutions. The heavy staff attrition has taken away experienced manpower leaving recently qualified staff to train students. The environment within which heath workers perform their work is key in cementing their relationships with patients. The present state of infrastructure does not create a healthy environment for both patients and staff to enjoy the healing process.
Both patients and staff, expect that facilities and equipment, essential to support recovery paths, are up to standard and functioning .This is a source of disgruntlement among health workers, who feel that their work environment does not further their professional growth and job satisfaction. On the other hand, patients continue to express disgruntlement over the poor quality of services arising from this situation.
Communities, patients, their families and staff, are the best placed to judge quality because of their personal or communal experiences. Ignoring this and failing to involve them may result in the health system not responding to the actual needs of the population. In the Access the Health Services Study (2008), patients and communities rated the service quality they receive at health centres/hospitals as satisfactory or fair, whilst in the Assessment of Primary Health Care in Zimbabwe (2009) less than half of households in the study were satisfied with the performance of the health system (service quality and outcomes). People could have been reflecting the hardships experienced in 2008.
The 2003 Poverty Assessment Study Survey (PASS) revealed, and the 2007/8 Study on Access to Health Care Services reaffirmed, that in the event of illness most people seek treatment from public health institutions.
However, communities complained about the long waiting time they have to endure before being treated. They were also unhappy with chronic shortages of supplies and drugs, poor water and sanitation services at health institutions and lack of electricity, resulting in them being requested to bring candles if they need attention at night. They also complained of shortages of staff leading to long waiting times, shortages of food and poor hospital diet, and lack of ambulances services.
Even if ambulances were available, community members were at times requested to provide their own fuel for emergency services. They were also very unhappy with what they view as a much longer and costly referral system, where basic medicines are not available at local peripheral clinics and they have to be referred to district or provincial hospitals. Communities wanted to see doctors visiting peripheral facilities, so that they can be attended to nearer home and avoid high transport costs.
According to the same study, communities expect to be treated well by committed and motivated staff, with readily available drugs and equipment. They expect good client care, quick service, from adequate numbers of staff working in a clean, safe and hygienic environment. They also expect respect for confidentiality, as well as the availability of adequate and nutritious food at health institutions. Most public health institutions are far from meeting these expectations.
The Ministry of Health and Child Welfare has continued to work with various consumer organizations to identify the needs of consumers and to educate them about their rights. The patient’s charter was one of the first coordinated steps towards informing consumers of what to expect. More needs to be done to incorporate the consumer’s perception of the quality of care in the process of service delivery.
The MOHCW has been encouraging an environment in which stakeholders develop and implement a range of quality assurance tools, such as treatment protocols, management and standard operating procedures, clinical audits and reviews that ensure that all communities have access to quality core health services. The MOHCW has delegated quality assurance responsibilities to appropriate bodies such as professional bodies and technical agencies, operating from the national, provincial and district levels. However, quality assurance programmes are not yet an integral part of health care.
Health Services in Zimbabwe are delivered by a multiplicity of players, both public and private, involved in direct service provision and financing, or in some cases, both. This raises the question of how to ensure that their conduct is in the public interest. This has become a concern because of the tensions existing between public interest and private gain. The work of health professionals is regulated through self regulatory mechanisms, as has been the tradition in many countries.
The professional councils which regulate their training, accreditation and professional conduct, are created for and run by them. Traditionally, this has been based on the belief that the professionals themselves know best, and are better placed to ensure that standards are maintained based on service or professional ethics, written or assumed. The belief amongst health professionals that the practicing licenses granted to them gives them the right to pursue professional interests without being questioned should be discouraged. Licensing is in fact the basis of a social contract between society and health professionals, in pursuance of the public interest and good.
This arises out of the acknowledgement of the nature of their relationship with those they serve, in that the latter surrender their power of judgment to the professional. The context has changed. New pressures and opportunities have emerged over the last few years, creating new and perverse professional values which emphasise private gain at the expense of the public good. Within the public sector, this “cultural” change has been fuelled by policies which have encouraged private provision and subcontracting, in efforts to improve efficiency and quality.
This has also had the effect of reinforcing the belief and view that public sector provision is inferior to private provision. Human resource strategies, which focus on individual incentives and private activities, may also influence the shift from the public sector ethos towards a culture of individualism. Health professionals will no doubt find moral justification for this shift in their low salaries and poor conditions of service, and to a certain extent this is understandable. However, clearly the current means, in the form of self regulatory structures, are weak to deal with these pervasive behaviours.
The utilization of health services is also being affected by the low incomes people are earning. In a bid to raise funds to purchase vital and essential medicines and supplies, some institutions have been charging user fees for services that normally would be free. The Maternal and Perinatal Mortality Study (2007), the Health Services Study (2008), the Assessment of Primary Health Care in Zimbabwe (2009) studies note that user fees for services are considered unaffordable by the community, and are contributing to reduced access to services especially for poor and vulnerable communities. Figure 27 shows this gradual decrease in utilisation of services.
Figure 26: OPD and Inpatient admissions Subsequent sections in this document including those addressing Human Resources for Health, health infrastructure, transport, communications, medical equipment and supplies, highlight the challenges in most health facilities. The major challenge in all the above is the unavailability of funds. Most medical equipment is obsolete and vital medicines are no longer available at health institutions. The few remaining well trained health professionals are frustrated as they are rendered helpless as they are not able to answer to their callings. It is not possible to provide quality care without the tools of the trade.
Improving the supply side capacity response at all levels, in order to improve quality, remains a major activity for the future. The key to success lies in achieving an appropriate balance between resources devoted to Primary Care and hospital services. To this end, the initiative to make hospital services more efficient and responsive to the needs of lower levels and referred patients remains a major goal for the health sector. Secondary and tertiary health facilities need to be revitalized for them to provide the much needed referral, teaching and supervisory services.
Key issues · Mapping of coverage of RHCs · Improving coverage, access and utilization of health service delivery · Institutionalizing quality of care initiatives. · Increasing the number of qualified health professionals. · Strengthening professional ethics through the schools and professional councils. · Strengthening professionals associations and councils. · Strengthening the referral system. · Adequately resourcing each level of care and ensuring minimum stock levels at all times for all strategic supplies. · Re-enforcing the Primary Health Care Approach. · Strengthening the secondary and tertiary service delivery. · Strengthening the health system in a resource constrained environment. · Redefining core health services for each level of care. · Operations research
3.1.2 Transport And CommunicationsTrends and current status Transport Transport and telecommunications form the essential physical link between the different levels of care both in terms of the referral of patients, supervision, outreach services and the supply of commodities. Both are important components of the health care delivery system. The Ministry of Health and Child Welfare aims at providing a complete transport and communication package for each level of care. To that end, a transport policy has been defined and is being implemented. With the aim of meeting the transport standards for each level of care, a number of ambulances, service vehicles and motor cycles, have been directly purchased by the Ministry. The Ministry’s efforts have been complemented by partners, who have also purchased a number of programme vehicles. However, the Health Service is far from meeting its target of vehicle availability as stated in the policy. Lack of transport has been found through a number of studies to be a major barrier to access and quality of health services. A study on the maternal and neonatal services in Zimbabwe (2004), identified transport and communications as one reason for the delay in reaching treatment centres for pregnant mothers and children, thus contributing to increasing morbidity in this group of the population. The 2005 Districts Management Study in 25 districts cited transport shortage as a major obstacle to service provision, contributing to breakdown of the referral system and delays in transportation of commodities (food, vaccine, dugs etc). A child health situation analysis study (2006) indicates that the “referral system, supervision and support to lower level health facilities and outreach for community work” have all been compromised by the shortage of transport. The Maternal and Perinatal Mortality Study (2007) noted that only 52% of rural women delivered in health facilities compared to 94% in urban areas. This difference was caused mainly by the difficulty rural women faced in reaching a health facility. The Access to Health Care Services Study (2008) revealed that most people in rural areas, living far from health institutions, are using wheel barrows and scotch carts to ferry the sick to health facilities. This is because of the very high transport costs (when transport is available), as well as the lack of public transport due to poor road networks. Communities are equally concerned about the transport system. The Access to Health Care Services Study (2008), noted that most rural communities feel that because of the importance and centrality of health in their lives, the solution to ambulance problems requires the urgent injection of funds from central government. In an effort to improve the management of vehicles, the ministry de-linked its fleet from the Central Mechanical Equipment Department (CMED) to Riders for Health and private garages. The objective of this transition has however not been realised as noted by the Access to Health Care Services Study (2008). The study noted that vehicle repairs and maintenance of the fleet needs urgent attention, as there are currently ambulances and health programme supervisory vehicles that are off the road because of none repair and lack of spare parts. The few available vehicles are paradoxically under-utilised, due to difficulties in accessing fuel from CMED and the general shortage of fuel in the country. To ensure constant availability of fuel for critical services, some institutions installed fuel tanks and purchase fuel direct from NOCZIM, when available. Having realized that transport is a key pillar of the health system, not only for service delivery but also for transportation of health workers, and also having noted the breakdown of the public transport system, the Ministry of Health and Child Welfare has actively been sourcing for buses and vehicles. The major obstacle in fulfilling this task has been the shortage of foreign currency. However Government, through the critical staff retention scheme, is complementing the ministry’s initiatives by availing vehicles to selected health staff, as well as buses for others. Transport thus remains a major challenge in the provision of services. Immunization, malaria indoor residual spraying, drug distribution, supervision of districts and clinics, have all been compromised due the shortage and poor maintenance of transport and telecommunications. Inadequate ambulances, high maintenance costs, erratic fuel supply and poor communication systems in health facilities, limit outreach activities and contribute to adverse outcomes, particularly in maternity care, acute care and emergencies. Telecommunication A functional health facility connectivity package (telephones, cellular phones, two-way radios and internet) is essential for emergency referrals to higher levels of care. This is essential for the transmission of important data, epidemic alerts, administrative and management support. Remote areas benefit from clinical advice communicated through various means. In areas where there is telephone connectivity, some telephones have been installed, whilst in areas without, either radios or cellular communication has been provided. At all levels of care, with the exception of Rural Health Centre level, computers have been acquired, thus improving the efficient production of information and its flow through e-mail. Linked to telephones, some institutions now have fax machines and access to e-mail and internet services through HealthNet. In addition, the ministry has established its own web site. However, a lot more work needs to be done as shown by the Access to Health Care Services Study (2008) and the Vital Medicines and Health Service Survey. The 2008 study noted that with the exception of very few rural institutions, telecommunication services are now nonexistent and in a state of disrepair due to lack of maintenance. This has made communication in cases of emergency and referrals extremely difficult, with the inevitable unnecessary loss of life in some instances. At many institutions covered by the study, phone or radio equipment is available but what repair and rehabilitation of the networks is required. Key issues · Inadequate numbers of ambulances and service vehicles. · Poor transport management of systems. · Poor connectivity and communication systems.
3.1.3 Health InfrastructureTrends and current status Distance from the nearest facility is an important factor in planning for health care services. Health facility must be located within a reasonable distance, and the cost of seeking service should be affordable for equitable health care delivery. In the rural areas where transport is less accessible and a higher proportion of people live, the importance of geographical proximity of health services cannot be over-emphasized. The standard practice in health infrastructure planning and development has been to ensure one rural health centre per 10 000 population; one district hospital per 140 000 population; and one provincial hospital per province. By 1997, 85% of the population lived within 8 km of a primary care facility. Population movements, as a result of the agrarian reform programme and natural population growth, have reduced geographic accessibility in some parts of the country. The just completed Access to Health Care Services Study (2008), found that most communities live within a 5km radius of their nearest health facilities, 23% between 5 to 10 km, and 17% over 10km from the nearest health centre. The Access to Health Care Services Study (2008), found that most people walk (85%) to the nearest health facility, whilst a considerable proportion use wheel barrows and scotch carts. Very few people use public transport when visiting their nearest health facility. The study noted that access for those living afar from health facilities is extremely difficult, due to lack of transport in the rural areas, where most roads are in disrepair. In the Maternal and Perinatal Mortality Study (2007), distance to a health facility and lack of transport were found to be major barriers to access to institutional deliveries. The study recommends the construction of “waiting mothers shelters” at strategic health facilities to overcome these two challenges. To increase physical access, a number of construction projects were initiated over the last ten years. However, whenever funds have been made available, construction activities have been very slow, resulting in some of the projects taking up to 10 years to complete. There are currently a number of projects that have come to a standstill as a result of inadequate funding, but also due to poor management of contracts. A position of hospital engineer has been created in the Ministry to address this situation and institutions have also been encouraged to resuscitate commissioning committees to manage new projects. Some institutions have established their own posts for hospital engineers or an equivalent, to oversee the maintenance and refurbishment of health facility infrastructure including estate management duties. Resources being allocated for maintenance under the “maintenance vote” (budget line item) are grossly inadequate to meet all the refurbishment requirements of the dilapidated infrastructure and obsolete equipment. This chronic under-funding for maintenance has resulted in some buildings being abandoned due to cracked and leaking roofs. Lack of accommodation has contributed to the inability to retain health professionals in most institutions. To that end, the Ministry has continued to have accommodation constructed on site where possible. It is worth noting that health infrastructure capital investment has not kept pace with population expansion; notably, a big gap continues to exist in secondary care facilities in urban areas. This situation has resulted in Provincial and Central Hospitals being used as first referral centres leading to congestion and a fall in the quality of services offered (pg 92). It is in this area that opportunities for Private Sector participation should be vigorously examined and exploited. However, there is also need to construct additional secondary facilities in large urban areas. In order to identify the gap in meeting the health infrastructure development standards and improve physical access to health services for the underserved, a comprehensive audit of availability and condition of infrastructure was undertaken in the year 2000. Out of this audit, a 15 year health Infrastructure development plan was developed. The infrastructure development plan aims to produce a minimum package of infrastructure per level of care. However, the 15 year health Infrastructure development plan is not backed by an investment plan. Furthermore, there is need to update it. Table 5: Public Health Facilities as at 30 April 2006
Key Primary level = Clinics and Rural Health Centers 1st Referral level = District, 2nd Referral level = 3rd Referral level = Central hospital and infectious diseases hospital Challenges · Brain drain of technical staff for construction and supervision of projects. · Limited physical access for some communities, especially the newly resettled areas. · Inadequate funding for infrastructure development. · Poor maintenance and repair services. · Delays in completing infrastructure projects. · Poor contract management. Key issues · Strengthen management of Public Sector Investment Programme (PSIP). · Staff accommodation. · Maintenance of existing infrastructure. · Improving estate management
3.1.4 Laboratory ServicesTrends and current status Laboratory services are an integral part of the health delivery system, essential in diagnosis, treatment, monitoring and control of disease. As a result of the change in disease pattern, there has been a huge increase in demand for laboratory services to support national programmes including HIV, AIDS & TB. The laboratory is also required to provide timely confirmation of outbreaks if appropriate control measures are to be instituted early at lower levels of health care service provision. The Laboratory services are comprised of public and private components, and are further differentiated by the type of services they provide. Clinical laboratories, the majority of which are found in and managed by health institutions, are the diagnostic laboratory services geared towards personal health care. Public Health Laboratories mainly focus on disease control and prevention. The major public health laboratories in the country are the National Reference laboratories, Government Analyst Laboratory, National Institute of Health Research and the National Blood Service. Both the private and University laboratories provide clinical and public laboratory services, and actively support research activities in the country. One of the specialized laboratories especially critical to the health of the nation is the National Blood Service. The laboratory is mandated to provide safe blood and blood products to whole health sector. The National Reference Laboratories (Specialized Referral Centres and Services) include the National Microbiology Reference Laboratory (NMRL), the National TB Reference Laboratory (NTBRL), National Virology Laboratory (WHO-Polio and Measles Laboratories at the College of Health Sciences- Department of Medical Microbiology) and the Zimbabwe Quality Assurance Programme (ZINQAP), which provides quality control and quality assurance to all the registered laboratories focused on patient clinical and quality care. Laboratory services are organized to function on the basis of increasing levels of sophistication. Each level of care is expected to provide a package of well defined laboratory services by appropriately trained laboratory health professionals. For each level, minimum standard requirements for equipment, reagents and supplies have been defined. There is however need to finalize and adopt the Zimbabwe Medical Laboratory Standards which have not been implemented, despite having been developed in the late nineties. Appropriate legislation to make participation in external quality assurance mandatory for medical laboratories needs to be developed and put into place, to ensure that public, private, research laboratories etc, can only provide services when their performance is deemed acceptable by the regulatory authority (the Medical Laboratory and Clinical Scientist Council). This is critical as wrong or poor quality laboratory results lead to mismanagement of patients and wastage of resources. To improve case management at the clinic and hospital ward levels, simple diagnostic tests are being carried out. This has been achieved, for example, through the training of nurses in rapid HIV and malaria diagnostic tests at rural health centre level. The Ministry has also been training Laboratory Assistants /Microscopists, and reintroduced the State Certified Medical Laboratory Technician (SCMLT) cadre in 2007 to perform rapid HIV, malaria and TB smear microscopy to service the first point of entry (the clinic or rural health centre). For the second level, the Ministry of Health has re-introduced the State Certified Medical Laboratory Technician (SCMLT) training programme. The State Certified Medical Laboratory Technician is expected to provide services for the level of work carried out at district level. The higher laboratory levels (provincial and national) are to be serviced by laboratory scientists. There has been a general deterioration of laboratory services where the tiered system has failed to provide the standard package of supportive laboratory tests at each level of healthcare. This has resulted in patients seeking services from the private sector where the costs are prohibitive for the majority of the population. However, support from the Global Fund (GF), Expanded Support Programme (ESP) and other partners have however seen an improvement in the provision of CD4, chemistry and haematological services in some hospitals. Human resources remain a major challenge, as experienced Medical Laboratory Scientists and those graduating from the Department of Medical Laboratory Sciences at the University of Zimbabwe College of Health Sciences, continue to leave the country for the region and overseas. The procurement and supply chain management of laboratory logistics including equipment needs strengthening. National reference laboratories ( the National Microbiology Reference Laboratory, the National TB Reference Laboratory and the National Virology Laboratory) need to have their activities harmonized so they are responsive to the needs of the MOHCW. Key issues · Weak supply chain management of laboratory logistics and commodities. · Unavailability of a framework for the coordination of laboratory support and management. · Absence of policy and strategy. · Shortage of human resources. · Weak service delivery. · Weak monitoring and evaluation of laboratory services.
3.1.5 Government Analyst LaboratoryThe Government Analyst Laboratory (GAL) offers analytical services to the MOH&CW (Environmental Health, Port Health Authority, Nutrition Unit, Hospitals and National Institute of Health and Research), other ministries and private sector. The range of services includes scientific and technical analytical support to Food and Drinking Water Safety Programmes, Control of Exposure to Toxic and Harmful Substances Programmes. It has capacity to analyze the food, drinking and effluent water, industrial products, agro- products and clinical, anatomical (post mortem) spacemen as listed below: Foods and Waters · Food samples according to the provisions of the Food and Food Standards Act (CAP 321). · Food samples to provide a quality control service to industry and in cases of suspected contamination. · Water samples to determine suitability for human consumption and effluent water for pollution control · Food and Water samples to provide technical information on matters related to food composition, quality, legislation and sources of water pollution and treatment. · Urine and salt samples for iodine levels to monitor Iodine Deficiency Disorders. Toxicology, Clinical and Industrial · Post-mortem specimens for toxic substances as a service to the Ministry of Home Affairs (ZRP) and Forensic Science Laboratory investigating sudden death cases. · Clinical samples for therapeutic drug monitoring, emergency toxicology; heavy metals, pesticides and muti poisoning and for blood alcohol determination as a support service to health care delivery institutions. · Customs samples for tariff classification · Mutilated currency to assist the Reserve Bank of · Pesticides formulations for active ingredient levels. The laboratory has close links with other laboratories both within and outside the country involved in analytical chemical analysis and research. These include the National Research Institute, Public Health Laboratories, Standards Association of Zimbabwe, Tobacco Research Board, Research and Specialist Services, Forensic Science Laboratory, Medicines Control Laboratory, Water Research Laboratory, Harare Municipality Analytical laboratory, Universities and others The Government Analyst Laboratory is the Secretariat to the Food Standards Advisory Board (FSAB) that deliberates on Food Safety issues nationally and participates in regional and international Food Safety Control initiatives such as SADC / COMESA Sanitary and Phytosanitary Measures and CODEX meetings and sessions. The challenges faced by the Government Analyst laboratory are adequately described under the laboratory section of this document. Key issues · High workload due to increasing demand for services · Non ISO 17025 compliance. · Poor coordination of laboratory services
3.1.6 Medical Imaging (Radiography) And Other Support ServicesTrends and current status The public health sector has a well established medical imaging system that is “available” in all district, provincial and central hospitals. However, most of the equipment is either obsolete or non-functional due to the shortage of spare parts. Because of the need for specialist services, Radiotherapeutic services are centralized in Harare and Bulawayo. Nuclear medicine, which is only appropriate in large referral hospitals is only offered in Harare and Bulawayo. The shortage of imaging professionals is being addressed through the training of radiographers at Parirenyatwa and National University of Science & Technology (NUST) in Bulawayo, and X-ray operators being trained in provincial hospitals. The public health sector has no single radiologist. These are trained outside the country. A personnel monitoring service assessing individual radiation exposure and catering for both the private and public sectors existed before, but is no longer serving the purpose it was created for due to shortage of staff. Key issues · Lack of personnel monitoring service for individual radiation exposure · Inadequate numbers of imaging health professionals being trained. · Poor maintenance of basic imaging equipment. · Obsolete imaging equipment.
3.1.7 Radiation Protection UnitTrends and current status The Radiation Protection Unit has the role of ensuring safety and security of radioactive sources, proper management of radioactive waste and the protection of people and the environment from the hazards of ionizing and non-ionizing radiation, through the effective regulation and use and management of radioactive and nuclear materials for beneficial peaceful purposes. The Unit has to ensure a balance of the benefits of radiation uses against the risks of adverse health effects. The country utilizes nuclear and radiation technologies in the areas of: · Human health - diagnostic and interventional radiology, radiotherapy, nuclear medicine, nutrition and isotope molecular techniques in diagnosis and treatment of HIV and AIDS, TB and malaria. · Agriculture -diagnosis and control of veterinary diseases, tsetse eradication, improvement of livestock productivity through artificial insemination, crop breeding, combating desertification. · Water- dam safety, underground water aquifers development, water treatment. · Industry- industrial radiography e.g. for non-destructive detection of internal defects or cracks in materials or welds. · Sterilization- high intensity radiation sources are used to sterilize medical, blood and pharmaceutical products, insect control or for the preservation of food stuffs · Security e.g. electrically generated x-rays used in airports and other locations to check the contents of packages, mail, baggage etc · Teaching, Research and Development Laboratories and Universities. Radiation Protection fell under the Hazardous Substances Control Act Chapter 322 of 1972 until August 2004. This Act also provided for the safe use of other hazardous substances such as industrial chemicals, their mixtures and compounds. In order to comply with the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources (BSS), a bill was drafted to separate ionizing radiation issues from other hazardous substances. Radiation Protection Act [Chapter 15:15] passed through parliament in August 2004 and was operationalised on 1 July 2005. The Act provides for establishment of national regulatory infrastructure for nuclear and radiation safety that meets international standards as set by the International Atomic Energy Agency (IAEA). The Unit has not been spared from the challenges affecting the health sector including human resources attrition and dwindling financial resources.The activities that the Unit should carry out (authorization, review and assessment, inspection and enforcement, development of regulations and guides, radioactive waste management and personnel monitoring) have been hampered by the prevailing challenges thereby seriously compromising safety. Loss of institutional memory has adversely affected progress and implementation of the Radiation Protection Act. The initial Radiation Protection Board that was appointed in 2006 could not manage to put in place the Radiation Protection Authority of Zimbabwe owing to these challenges. The Minister of Health and Child Welfare strengthened the Board in May 2008 by making new appointments and there are renewed efforts to see the full implementation of the Radiation Protection Act. The Unit aims to develop structures that will see the achievement of all five thematic safety areas within the next five years. Key issues · Setting up of the Radiation Protection Authority of Zimbabwe · Training of Radiation Safety Officers · Creation of synergies with other Governmental Departments that have responsibilities in the safety and security of nuclear and radioactive materials · Radiological protection in occupational exposure, medical exposure and environmental radiological protection, · Emergency preparedness and response to radiological accidents
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