Zimbabwe Network for Health
Field Visit to Zim Health Project Sites
December 2009-January 2010
Shiva Murugasampillay & Elizabeth Mason

1. Mbare Poly Clinic, Harare City, December 14^th and 17th

1.1 People met at City Health Department, Rowan Martin Building and Mbare Polycinic:

Dr. S. Mungofa: Director of Health Services
Dr. Chonzi, Deputy Director of Health Services
Mr. Chigwere,  City Health Administrator
Mr. Chrispen Mashura, Adminstrator & Mrs Judith Chibanda , Sister in Charge Mbare Polyclinic

1.2 Background

ZimHealth selected Mbare Poly Clinic as one of the Project sites in 2009. Phase 1 consignment of equipment was dispatched in April 2009 and handover ceremony was conducted in July 2009. Phase 2 Equipment was dispatched in November 2009. ZimHealth was able to conduct a follow-up to verify arrival and utilisation of goods, and ascertain and discuss further needs.

1.3 Objectives

• To follow up use of Phase 1 equipment
• To follow up Phase 2 equipment delivery
• To assess future needs at Mbare Clinic and City of Harare

1.4 Output

The Director of Health Services, City of Harare, the Deputy Director of Health Services and Health Administrator were fully supportive and facilitated the field visit and consultation with the staff at Mbare Poly Clinic and City Health Department.  Use and management of donated equipment and future needs were assessed. Plans for quick delivery of Phase 2 equipment were agreed. Pictures were taken of clinic and staff and donated equipment and future needs.

1.5 Key issues and outcome

1. ZimHealth Phase 1 equipment was found to be in use. Some items, such as patient gowns and stethoscopes, were in storage for use as the need arises to ensure that they remained secure
2. At the time of this visit, phase 2 equipment had arrived in country, but still with suppliers, awaiting clearance for delivery. There had been an issue regards local storage and handling charges. Both issues were resolved and the equipment has been at the clinic since January 2010
3. The polyclinic buildings require renovation and it was understood that the city had allocated a budget in 2008 for the purpose and all the materials had been secured. The work is expected to start in 2010
4. There are regular supplies of drugs from the International Committee of the Red Cross and National Pharmaceutical Company of Zimbabwe (NatPharm) with periodic support through the twinning arrangement with the City of Munich, Germany
5. The clinic requires new furniture for staff and patients as current furniture is seriously dilapidated

1.6 Follow up required

1. Follow up with city authorities to advocate the renovation of the clinic by April 2010
2. Possible support for furniture and other minor equipment

2. Pelandaba Polyclinic, Bulawayo City, December 21^st 2009

2.1 People met at Bulawayo City Health Department and Pelandaba Polyclinic

Dr. Marape, Assistant Director of Health Services, Bulawayo
Ms. Milingo, Chief Nursing Officer
Mr. Zulu, Nurse in Charge, Pelandaba Clinic
Staff at the Pelandaba clinic

2.2 Background

ZimHealth selected Pelandaba Polyclinic, Bulawayo as the second Project site in 2009. Phase 1 consignment of equipment was dispatched in November 2009. The opportunity for follow up arose in December 2009 to ensure the safe receipt and accounting for Phase 1 equipment, and to discuss hand over processes with the City of Bulawayo health authorities as well as to assess future needs for the Pelandaba Polyclinic. This was the first visit by ZimHealth members to Bulawayo − previous communication was by phone and e-mail.

2.3 Objectives

• To follow up delivery of Phase 1 equipment and arrange a handover
• To assess future needs at Pelandaba Clinic and City of Bulawayo

2.4 Output

The Assistant Director of Health Services and the Chief Nursing Officer were fully supportive and facilitated the field visit and consultation with the staff of Pelandaba Polyclinic and City Health Department. Phase 1 equipment was well received and stored but staff were anxious to use the equipment. Plans were discussed for hand over ceremony in January 2010. Pictures were taken of the clinic and staff and outstanding needs. The Assistant Director of Health Services noted that the Thorngrove infectious diseases hospital was in urgent need of support and wondered if ZimHealth could assist.  The handover ceremony was subsequently held on January 13^th and equipment is now in use since that date.

2.5 Key issues and outcomes

1. There was urgent need for replacement of obsolete equipment, linen and mattresses which have been carefully re-utilized again and again
2. There was a well established dental clinic serving a large part of the high density population with highly motivated staff but the dental chairs are obsolete
3. Taking into consideration the ZimHealth supply of equipment in Phase 1 there is need to consider in Phase 2 such items as newborn resuscitation units, suction machines, hemoglobinometers, dental chair, hospital mattresses, maternity gowns for women in labour, drug cabinets, television for the postnatal ward and a heavy duty laundry machine

2.6 Follow up required

• Phase 2 equipment supply
• Need and support for Thorngrove infectious disease hospital to be linked to other support groups

3. Parirenyatwa Teaching Hospital, December 14^th 2009

3.1. People met:

Mr. Zigora , Chief Executive Officer (CEO)

3.2 Background:

Dr. Michael Mbizvo and Dr. Dan Makuto had met Mr. Zigora on a previous visit to Zimbabwe. Both had provided valuable advice regards how ZimHealth should start with small health projects. Dr. Makuto had indicated the needs for replacement of equipment in Parirenyatwa Hospital which was then trying to cope as a referral and teaching hospital and primary health-care centre for residents of the City of Harare. Subsequent to this visit a letter had been received with a list of equipment needed at the hospital and enquiries had been submitted to Geneva University Hospital regarding availability of used equipment. However, as Parirenyatwa hospital was now functioning, a follow-up was needed to reassess current needs for support and to update the CEO on any progress made by ZimHealth to date.

3.3 Objectives

• To assess the needs of teaching hospital
• To look at how future potential support would be better utilized

3.4 Output

Mr. Zigora was anxious to hear about the outcome regards their request for hospital equipment and specialist support for clinical work to address the long waiting list. He indicated the importance of ensuring any equipment donated is in good working order and of good quality. He also indicated that with advance notice, visiting specialists will be well received, patients can be ready and pre-assessed and accommodation made available.

3.5 Key issues and outcomes

1. The hospital urgently needs various types of equipment such as X-ray machines, laboratory and theatre equipment
2. The issue of how to make sure any donated equipment is assessed first and potential for maintenance
3. The hospital is very short on specialist staff to provide clinical services as well as to teach medical students
4. The issue regarding visiting clinical staff, how support would be provided for local accommodation and transport

3.6 Follow-up required

1. ZimHealth needs to follow up of support for equipment and clinical support from University Teaching hospital Geneva
2. Follow up with UK-Zimbabwe Health Training Network regards professional support

4. Ministry of Health and Child Welfare, December 17^th 2009 and January 5^th 2010

4.1 People met:

Dr. Gwinji, Permanent Secretary for Health
Dr. Dhlakama, Principal Medical Director
Dr. Mugurungi, Director HIV and STI
Dr. Mberikunashe, Director Malaria Control

4.2 Background

The Minister of Health and Child Welfare and the Permanent Secretary for Health met with ZimHealth members during the WHO World Health Assembly in Geneva in 2009. Subsequently, the Minister for Health and Child Welfare was present to receive the Phase 1 equipment at the handover ceremony at Mbare polyclinic. This visit was to brief the Permanent Secretary of Health on the progress made by ZimHealth, as well as to meet with other officers in the ministry of health and brief them on the activities of ZimHealth and assess future needs, as per the proposal from Dr. Dan Makuto.

4.3 Objectives

• To brief, consult and mobilize support for ZimHealth’s work
• To assess needs in the health sector

4.4 Output

The health authorities met were fully supportive of the work of ZimHealth and encouraged ZimHealth to continue with the work and promised to facilitate ZimHealth’s work. A briefing was given by the authorities on some of the continuing needs and challenges in the health sector. It was reported that nursing staff are re-entering the health services and that an increasing number of primary health care nurses are being trained. However, the shortage of doctors and other health cadres remains a problem.

4.5 Key issues and outcomes

1. The Ministry of Health and Child Welfare will continue to provide duty free certificates to all ZimHealth equipment
2. Better understanding of ZimHealth and the potential to tap the support of the Zimbabwean Diaspora should be fostered
3. The main need by the Ministry of Health and Child Welfare is funding to retain human resources of all types
4. The Maternal and Child Health programme requires more inputs and support
5. Although funds are becoming more and more available for screening and drugs for HIV antiretroviral treatment and the prevention of mother-to-child transmission of HIV, there is still slow progress in increasing coverage of the people in need of treatment
6. Malaria control continues to hold and is moving towards low transmission and almost elimination. The country is planning to conduct a programme reviews and work on low positive malaria cases and move towards a future elimination strategy
7. Services for tuberculosis are still struggling to provide microscopic diagnosis for all suspected cases and ensure follow-up and completion of treatment
8. There was a suggestion that ZimHealth should consider expansion to all parts of Zimbabwe and support one clinic in each of the main provincial cities

4.6 Follow up required

1. Continue to keep the Ministry of Health and Child Welfare informed and supportive of ZimHealth’s work
2. Consider other cities for ZimHealth support