ZIMBABWE – Government’s decision to roll out a $3 million HIV survey is a good idea. It is necessary to establish exact data on the virus to inform policy and planning. The Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) which will target 15 000 households randomly selected across the country’s 10 provinces will be the first of its kind in Africa.
The survey will also test participants for syphilis.
It is fitting that Zimbabwe should be the first base of this survey considering its success story in reversing the HIV pandemic. The formation of the National Aids Council and its resultant role in fighting HIV have garnered the country national acclaim. We are cognisant of the fact that until new infections are reduced to zero with those infected assured of access to quality palliative care and possibly a cure found, the war continues and every available weapon is needed.
But we would like to point out that perhaps the Ministry of Health and Child Care should consider consolidating the survey to cater for the real needs of the country’s population and policymakers. The World Health Organisation Zimbabwe Report 2014 shows that HIV linked illnesses are no longer the top killers in the country.
Cancer was responsible for 10 percent of the deaths, cardio-vascular diseases killed nine percent, chronic lung diseases killed three percent and diabetes killed one percent. At the time the report was released the responsible ministry admitted that the insidious ravage of non-communicable diseases had spread because the authorities had been caught up with the HIV pandemic and its attendant opportunistic infections.
It would therefore be logical to expect the Government through the responsible ministry to have planned to tackle the non-communicable diseases as a matter of urgency. We are not trying to underplay the importance of a comprehensive HIV survey. But we are not convinced of the wisdom of carrying it in isolation especially if it is implicitly ignoring the declared top killer diseases.
It appears as though there is a policy of looking at HIV as a stand-alone disease versus the rest. This made sense when Aids-related complications were the biggest killer and there was urgent need to arrest the rate of new infections to reasonably manageable levels. But surely it makes sense for policy makers to realise that HIV and non-communicable diseases are not mutually exclusive and chances are that they are simultaneously attacking the same people.
The launch of a purely HIV survey in the present circumstances seems to show a disjointed approach to solving the problems in the health delivery system in the country. We submit that one of the causes of this has been the separation of service by disease instead of the country adopting a holistic approach to improving the entire system.
A case in point is the Global Fund grants to the health system which concentrate on specific diseases. This may have been necessary when it happened but the shifting picture needs shifting focus. We believe that it would have been more useful for the ministry to roll out a full comprehensive medical check survey in which participants would not only be tested for HIV, but also have their body mass index, blood sugar levels and blood pressure levels checked.
With adequate planning this should not be too difficult for the concept has already been tried at various health functions in the country. We believe that the support of local medical service providers like medical aid societies could be marshalled. After all some of these societies already carry out such initiatives under their corporate social responsibility programmes with public family health days and similar events.
If it is too cumbersome to take such a large team from door to door, there could be mobile clinics whose presence in the neighbourhood would be adequately advertised to give any interested people a chance to get checked. Such a comprehensive medical check would take away the stigma that is still associated with HIV.
For surely the low uptake of testing facilities cannot be blamed on access, especially in urban areas. With a purely HIV and syphilis testing survey there may be high resistance and the teams will fail to meet the set targets for the survey. We really do hope that the ministry will soon announce measures of how they intend to actively take on non-communicable diseases before the situation gets to emergency levels.