By Jephiter Tsamwi (Publisher : The SUNDAY MAIL)
ZIMBABWE-“I am a student at Hillside Teachers College and was initiated for ART in Mberengwa. When I wanted to access medication I was told to go back to Mberengwa. I spent some time raising the money and eventually managed to travel to Mberengwa. Unfortunately, when I got there, the nurses told me they were out of supply. I had to come back to Bulawayo empty-handed.”
Recently, our sister paper Chronicle quoted a student from Hillside Teachers College narrating her ordeal during the Anti-Retroviral Therapy (ART) Advocacy Meeting that was held in Zimbabwe’s second largest city.
Indeed, they say every adversity, every failure, every heartache carries with it the seed of an equal or greater benefit, but the story is different for students living with HIV. It is a different story not because they are not trying, not because they are putting less effort, but because of the existence of an interplay of flawed systems and mechanisms that are ironically supposed to at least rekindle a light of hope to the destiny of this often forgotten tribe.
Getting education provides a window of hope and opens many doors of opportunities for every hardworker. The majority of students living with HIV have defied all odds to clinch that hope and make it to college.
It, however, seems they are at the right place at the wrong time. The system has failed to protect them and cater for their sexual and reproductive health rights.
It is not enough to expose the sexual and reproductive health challenges of young people without dissecting the fundamental questions of why the situation is like that and what needs to be done.
Zimbabwe is undoubtedly a classical example of a nation that has demonstrated commitment and determination to stamp down the adverse effects of HIV and Aids and in the process, making it one of the first African countries to witness a sharp decline in HIV prevalence rate.
In recent times, we have seen different countries sending delegates to learn from Zimbabwe in terms of HIV prevention, management and even administration strategies and programmes. It is a good thing for the country.
However, the gains made thus far are at the verge of serious collapse if key emerging issues are not seriously addressed.
What the student quoted above raised is a classic example of the difficult circumstances and challenges that young people living with HIV are facing in colleges.
Many times, we have also read about these students engaging in risky sexual behaviours because of economic challenges. Of course, it is public knowledge that not all students are going astray because of lack of basic necessities at college, but truth be told, most Zimbabwean students are struggling to make ends meet. The burden is even more to the students living with HIV. But why is that so?
Below are some of the key issues:
College clinics are not accredited and/or licensed
This may sound unbelievable to the majority. But it is pretty disturbing that with all the advancement and the progress made so far by the country, only University of Zimbabwe is initiating ART. Universities like Midlands State University, itself a mega-varsity with a total population close to 25 000 is only a follow-up site for Anti-Retroviral Treatment.
Definitely as a country we have to be ashamed of this. There is certainly no excuse for this, either colleges are not serious or the policies are not dealing with this matter. Where are the students supposed to get their ARVs if institutions that house them for three to four months are not providing such?
Under-staffing and limited capacity
Whether it is Government policy or the colleges’ policy, it is unfortunate that only one nurse is often available at most colleges’ clinics. This means that if that nurse is not available for any reason, the college clinic is closed.
In other words, colleges are operating under a deceptive assumption that this one and only college nurse is forever available, every hour and every minute when students are in need of their services! To worsen the matter, the college clinics are sometimes opened only for a limited number of hours.
The reality is that most colleges are enrolling more students than their carrying capacity, yet only one individual is serving the whole college.
In the above mentioned ART advocacy meeting that this writer was part of, it emerged that very few of the college nurses are actually trained in ART initiation, especially according to the 2013 guidelines set by the Ministry of Health and Child Care
Then what after getting tested?
Research has shown us that the most used and accessed service in the college clinics is HIV testing and counselling. Perfect! Such can be used as entry points to begin dialogue with students on sexual and reproductive health matters considering their vulnerability.
However, there is no comprehensive support for students living with HIV who would have been referred to Central Hospitals or those who would have tested HIV positive.
The viral load machines at Mpilo Hospital, for example, are currently not working, yet this is one of the main hospitals where students who would have tested HIV positive are supposed to get help.
It is so unfortunate that during the meeting indicated above, the chairperson of the Parliamentary Portfolio Committee on Health and Child Care, Dr Ruth Labode, was the most shocked when she heard about the prevailing situation at Mpilo. Do policy makers really care about these things?
Flawed system in management, catering for transfers
It is outrageous to realise that in this digital world, Zimbabwe currently does not have a computerised system that tracks and monitors clients’ ARV uptake for effective and convenient record keeping.
What this means is that a student at National University of Science and Technology who was initiated on ART in Siakobvu, Gandanzara or Bocha is expected to go back to the site he/she was first initiated to get supplies of his or her medication.
If he/she wants to try with the nearest hospital, the client is expected to produce a transfer letter. You can imagine the inconvenience. The system does not even have a mechanism for at least using cellphones to confirm these transfers.
Where will a poor student who is already struggling to get at least one meal a day get the money to go back to Siakobvu mid-semester?
Inconsistent ARV supplies and defaulting
You can imagine the ultimate result of such a myriad of challenges that young people are facing in their efforts to access ART. Obviously, a lot end up defaulting taking their medication.
Some are losing their lives as a result. What is also a colossal challenge to the students is that sometimes they get only two months’ supply of medication at a time when they are supposed to spend at least 3-4 months at university or college.
Even if they manage to go back and collect the drugs, other clinics will be out of stock, thus requiring students to have multiple trips as they seek to access the ARVs. With all the hustles and processes that are needed for them to get their ARVs, this will result in them spending more time out of lectures as they go back to collect their medication.
How then are we supposed to produce quality graduates as a nation if students are day by day exposed to such harsh conditions?
That we have a lot of these challenges does not mean the future is bleak. Zimbabwe has done so well in health interventions before and solving these issues can be an easy thing to do with utmost commitment by the duty bearers.
More staff at public hospitals and college clinics
Why are we having shortages of staff in public hospitals and college clinics when the country is rich with unemployed trained nurses? It is high time Government relaxes the freezing of posts, especially within the health sector, to solve staff shortages.
The number of college nurses per college must be proportional to the number of students per enrolment if youth-friendly and quality sexual and reproductive health services are to be given to our young generation, especially those in colleges.
Procurement of drugs with longer shelf life
If young people, including the general populace, are getting two months’ supply of drugs because the available stock will be nearing its expiry dates, then Government, through NatPharm, must ensure that drugs that are being procured have a longer shelf life.
People of Zimbabwe will be able to get at least 6 months’ supply of drugs and this will make life easier for the people living with HIV.
Health service delivery package for colleges
It is pleasing to note that some colleges have set up initiatives where the college nurse can collect the medication on behalf of the students from the public hospitals. Although this is not sustainable and does not empower the student to be in full control of his/her health needs, at least they are trying.
However, what could be more sustainable would be for the Government, through relevant line ministries, to consider coming up with a minimum package for sexual reproductive health service provision that is tailor-made to cater for the college students.
This will ensure that the services are student-friendly with high chances of meeting students’ satisfactions and expectations.
Quality and rights focused service delivery
The health sector must adopt a quality and rights focused approach in service delivery, especially with regards to ART. There is need for a complete overhaul of the “one-size fits all” approach when delivering ART to the people.
Therefore, Government can consider segmenting different sub-groups and strive to cater for their specific and sensitive sexual and reproductive health needs, for example, students and many other sub-groups that may need specialised focus in service delivery.
Capacity building on youth friendly service delivery
The time for our nurses to be given names like “horrible nurses” is over. Nurses in public hospitals are notoriously known for the wrong reasons; ill-treatment of patients, shouting at clients, laziness and mean statements.
Of course, this could be a product of different factors, but the nurses need capacity building, especially on patient-friendly service provision. If the nurses, especially those in colleges are not trained in ART initiation, then colleges and Government must ensure that the nurses are equipped with these critical skills.
Digitalisation of the health system
In recognition of the critical role played by ICTs in development, Zimbabwe has done the right thing by having a stand-alone ministry focusing on that noble cause.
It is, however, surprising that the health sector is stuck in the 1920s, much to the disadvantage and inconvenience of patients. The absence of a systems approach and a digitalised way of data capturing has led the sector to rely on transfer letters as support documents for those who wish to change their collection sites.
In the process, some are being recorded as defaulters when in actual fact they are failing to access their medication due to barriers associated with the primitive systems. It is high time all Government ministries and parastatals move with time and make computers a basic tool of work in their operations.