Population: 12.4 million Total TB Cases Notified (2009): 46,453 Treatment Success Rate for new smear-positive TB cases (2008): 74%
Country Director: Barnet Nyathi E-mail: bnyathi @ theunion.org Address: 13 Van Praagh Avenue Milton Park Harare Zimbabwe Telephone: +263-4-705191 Lead Partner: International Union Against Tuberculosis and Lung Disease
Zimbabwe is a land locked country in Southern Africa with a total land area of 390 757 square kilometres and an abundance of natural resources. It is bordered by Zambia in the north, South Africa in the south, Mozambique on the East and Botswana on the West. Administratively, Zimbabwe is divided into eight rural and three urban provinces. A number of areas are situated in hard to reach areas for purposes of TB control. These include Binga district in Matabeleland North Province, Chiredzi District in Masvingo Province, Gokwe North District in Midlands Province, Kariba and Sanyati Districts in Mashonaland West Province and Mbire District in Mashonaland Central Province. According to the Central statistics office (CSO, 2010), the population of Zimbabwe is estimated at 12,4 million, with an annual population growth rate of 1.1%. The country has experienced a decline in fertility, falling from 5.4 births per woman in 1988 to 3.8 in 2005-6. The population pyramid has a wide but tapering base, a pattern that is consistent with a population experiencing a decline in fertility. Around forty-one percent of the population is below 15 years of age, 55% between the ages 15-64 and only 4% in the age group 65 years and above. Approximately 65% of the population lives in the rural areas while the remaining 35% live in the urban areas. The population density is approximately 32 persons per square kilometer.
Operating in Zimbabwe
Since the introduction of TB CARE I support in Zimbabwe in 2009 and managed by The International Union Against Tuberculosis and Lung Disease (The Union), the team has been able to operate in the country without hindrance. There is good collaboration with the National TB Programme (NTP) and the Ministry of Health and Child Welfare as a whole. Among the key challenges is the severe shortage of human resources due to the brain drain which took place during the period of economic decline. Most of the staff at government health institutions are demoralised because of poor working conditions and low salaries, a situation which is greatly affecting service delivery. The high unemployment levels due to closure or downscaling of industries have led to increasing unemployment and poverty levels which affect access to health services.
Government and the Socio-Economic Situation
Government and the Socio economic situation Although the country has been experiencing economic challenges, the Government and its partners have adopted several strategies to ensure continued service delivery in all social sectors including the health delivery system. In September 2008 a power-sharing agreement was reached between the main political parties, resulting in the formation of a Government of National Unity (GNU) in February 2009. Since the formation of the GNU, the Zimbabwean economy has been on the rebound. GDP grew by more than 5% in the year 2009. However, Zimbabweans still face high prices for most essential purchases.
Zimbabwe is one of the 22 high burden TB countries (HBC) that together account for 80% of new TB cases in the world annually. The World Health Organisation estimates an incident rate of 782 new TB cases per 100,000 population per year.
Zimbabwe Meeting on Improvement of TB Control Activities
The HIV/AIDS Situation
Zimbabwe is a country burdened by the HIV pandemic with approximately 14% of the adult population aged 15-49 years estimated to be infected with HIV. Approximately 80% of TB patients are co-infected with HIV in the country. TB is the commonest cause of death among people living with HIV (PLWH).
TB CARE I Program in Zimbabwe
The goal of TBCARE I in Zimbabwe is to strengthen TB control in the country. The implementation strategies comprise of: a) Strengthening of the national level management capacity to provide policy direction and coordinate programme implementation. National level activities included development of the strategic plan, guidelines, and training materials; supporting national training courses; supporting programmatic management of drug resistant tuberculosis (PMDT) programme; and programme evaluation. b) Supporting service delivery levels, i.e provincial/city, district and primary levels of health care in five provinces and the three largest cities, to effectively implement TB control interventions, including TB/HIV collaboration. Activities have included supporting in-service training, support supervision, motor cycle based sputum transport system in urban areas and performance reviews at provincial and district levels. This has benefitted approximately 6 million rural residents and about 2.6 million urban residents. The Union is the lead partner of TB CARE I in Zimbabwe, with the World Health Organization (WHO) and the KNCV Tuberculosis Foundation (KNCV) as the collaborating partners.
Plans for 2011-12
Through TB CARE I funding The Union will continue to provide financial and technical support to the National TB Program to strengthen capacity for programmatic management of TB at the national level through effective planning and co-ordination. At sub-national level TB CARE I will continue to support 5 out of the 8 rural provinces and selected urban areas to strengthen capacity for TB control services delivery through training support supervision and performance monitoring and evaluation. The Union will also continue to facilitate sputum sample transport in the main cities of Harare, Bulawayo and Chitungwiza through a motor-cycle based sputum transport system. Through PEPFAR funding The Union will support integrated care of patients co-infected with tuberculosis in twelve urban sites.