Prevalence and Incidence of NCDs and their management in Zimbabwe

1. Learning tool for health workers
Prevalence and Incidence
of Non-Communicable
Diseases (NCDs) and their
management in Zimbabwe
1

2. Learning objectives 2
After completing this learning tool you will be
able to:
1.1. Understand the history of health system in Zimbabwe
over the years
1.2. Explain the prevalence and incidence of NCDs and
their driving factors in Zimbabwe’s population
1.3. Describe the strategies that can be adopted to manage
and prevent these NCDs in Zimbabwe

3. Content 3
1. Introduction
2. History of Zimbabwe´s health system
a. Introduction
b. Health during colonization
c. Health after independence
d. Health under Mugabe
e. Health now
3. Incidence and prevalence of NCD´s
a. Introduction
b. Cancer
c. Diabetes
d. Cardiovascular disease
e. Impact of HIV
f. Data
4. Strategies for NCD management
5. Conclusion
6. References

4. Introduction 4

5. History of Zimbabwe´s
health system
5

6. a. Introduction
History of Zimbabwe
• Please read through the
comprehensive timeline by the BBC
(click on the picture above)
• Now have a look at the graph below
illustrating the life expectancy in
Zimbabwe over the last 55 years
Based on your knowledge of the history,
what do you think are the causes of the
increases and decrease in Zimbabweans
life expectancy? 6
(BBC 2018 , World Bank 2018)
6

7. b. Health During Colonisation
The healthcare
system in
colonial
Zimbabwe was
racially divided
and tailored to
the needs of the
small percentage
of white colonists
in urban areas
Healthcare for
whites was
equivalent to that
of a high-income
country whereas
the black
population (most
living rurally)
went without the
most basic
healthcare
services.
The result was
horrendous ill-
health among the
majority: 1%
blindness, very
low
immunisation
and 1/10 with
clean water,
whereas whites
were affected by
diseases seen in
high-income
countries.
(Mhike and Makombe 2018, Manga 1988, Ncube 2012)
7

8. These statistics show the
inequality of healthcare
distribution between rural
and urban areas and the
black and white population at
the time...
8(Manga 1988)
Ratio of
doctors to
patients:
2 largest
cities:
(with private
insurance) -
1:800
(no private
insurance) -
1:4000
Smaller
towns -
1:30,000
Rural
areas -
1:62,000
Ratio of
health
funding, (Z$
per capita):
rural to urban
to private-
1:8:36
Ratio of
nurses to
patients:
Andrew
Fleming
Hospital
(white/urban)
2.7:1
Harare
Hospital
(black/
urban)
0:7
8

9. d. Health under Mugabe
Crisis of the health sector since the late 1990´s
9
Causes:
- economic crisis
(hyperinflation),
- political failure
(lack of interest),
withdrawal of donors
and aid agencies
Consequences for
health system:
lack of professional
staff, infrastructure and
resources for example
in 2009 80% of all
medical graduates were
working abroad
Focus: Health workforce:
Please visit the database from the
World Bank to see how the density of
physicians as well as nurses and
midwives declined during the 1990´s
and particularly in the early 2000´s
and to which consequences it lead,
e.g. a tuberculosis case detection rate
of only 56% in 2008:´ Database
“It became a nightmare for any Zimbabwean to try to access health services”
(Fortune Nyamande, the spokesperson for the Zimbabwe Association of Doctors for Human Rights, Green 2018)
(Unicef, n.d.;Truscott, 2009, WHO 2015; Green, 2018)

10. d. Health during Mugabe
Crisis of the health sector since the late 1990´s
Consequences for Zimbabweans
• Rise in epidemics (e.g. HIV/AIDS),
high fatality and mortality rates
• Please watch the report that shows
the devastating situation in the biggest
hospital of Zimbabwe 2008
440
629
1990 2005
Maternal
mortality
Deaths per 100,00 life births
(Mlambo & Raftopoulos, 2010; Green, 2018)
10

11. e. Health now
Recovery of the health sector since 2009
11
Causes:
- better policy and
strategy clarity,
- Increase of domestic
funding
- less sanctions and
other donor restrictions
and pooled funding
Consequences
for health
system and
population:
Increase of
health
interventions
decline of
mortality rates
Focus: Need for reforms
Hope that the new government will turn
the health sector around were disappointed
There is a call for a new insurance system
and a general health sector reform that
focuses on the following three areas:´
(1) repairing relationships with the
international community by focusing on
human rights and eliminating corruption,
(2) strengthening the health workforce
through retention strategies, training, and
non-specialist providers, and
(3) community engagement.

12. e. Health now
Recovery of the health sector since 2009
Please watch this video which
illustrates the steps taken by President
Mnangagwa, the motivation of doctors
to go on strike and the current
challenges as inflation
77.64
71.15
69.99
68.78
81.58
94.29
0 50 100
2010
2011
2012
2013
2014
2015
Health
expenditure per
capita in USD
Health spenditure per capita in USD
12

13. A few efforts were made to improve
healthcare for the majority:
● Construction of cottage
hospitals and new sanitation
standards for miners in 1903.
● Free anti-epidemic campaigns
and construction of a small
number of rural clinics in 1927.
● Non-governmental funded
missions hospitals in rural
areas.
But these efforts were mostly
superficial and with the end goal of
benefiting the colonists.
In reality the cottage hospitals and
rural clinics were massively under-
resourced, with high mortality rates
and being visited just once monthly
by a medical officer, and the
available healthcare was
unaffordable for most.
(Ncube 2012)
14

14. c. Health after Independence
15
The newly elected
black-majority
Government in the
1980s, lead by young
Robert Mugabe,
brought about massive
social reform,
including in the health
system.
A Primary Healthcare Approach was
adopted, aiming to provide equal
healthcare for all Zimbabweans,
especially in rural areas.
Funding for the
Ministry of Health
vastly increased.
Between 1980-90
around 6% of total
expenditure was on
health.
The Government
announced Free
Healthcare to all
Zimbabweans earning
less than Z$150 per
month - most of the
population at the time.
Racially motivated pay
differences were
dropped and there was
a large increase in
admissions of black
students into medical
schools.
(Manga 1988, AHO 2018, Mhike
and Makombe 2018)

15. The increased funding and health policy reform lead to many interventions
which strengthened and transformed the health system...
1980-81 - ZINATHA (Zimbabwe National Traditional Healer Association)
introduced, and 10,000 traditional healers trained to
national standards.
1981-84 - Plans for building of 316 rural healthcare centres as well as
renovation of 450 existing ones.
1981 - Large child immunisation programme against communicable
diseases.
1987 - Over 7000 Village Healthcare Workers trained in rural areas.
1988 - Over 90% of mothers aware of ORT thanks to interventions against
diarrhoeal disease.
16(Manga 1988, Sanders 1992)

16. Prevalence and Incidence of
NCDs
20

17. Non-Communicable Diseases in Zimbabwe
❏ Increasing Cause of Morbidity & Mortality
❏ Cause 33% of All Deaths
❏ 11 % Cardiovascular Disease (CVD)
❏ 7 % Cancers
❏ 2 % Chronic Respiratory Disease
❏ 3 % Diabetes
❏ 10 % Other Non-Communicable Diseases (Including Mental Health
Conditions)
(World Health Organization, 2018)
21

18. Cancers
Cancer Mortality in Zimbabwe 2014 (World Health Organization 2014)
22

19. Diabetes
4.1% Prevalence in 2010. 235,000 Zimbabweans with Diabetes
Predicted to be 5.3% by 2030 (Shaw, Sicree & Zimmet, 2010)
Attributed to change in lifestyle:
Decreased Physical Activity
Increase in Rich Foods
Limited Availability of Medicines for Diabetes! (World Health Organization, 2016)
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20. Prevalence and incidence of NCDs 4
24

21. Prevalence and incidence of NCDs 5
25

22. Prevalence and incidence of NCDs 6
26

23. Management of NCDs
27

24. Management of NCDs 1
28

25. Management of NCDs 2
29

26. Management of NCDs 3
30

27. Management of NCDs 4
31

28. Management of NCDs 5
32

29. Management of NCDs 6
33

30. Conclusion
34

31. References
35

32. Additional material
Reading:
Watching:
Listening:
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