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Zimbabwe Humanitarian Situation Report 2 June 2004
UN Relief and Recovery Unit
June 02, 2004

Low sanitation coverage a cause for concern in Kariba District
Health officials now fear that cholera may be endemic in Nyaminyami area of Kariba District. Nyaminyami, located in the North Western part of Mashonaland West province in Kariba District is still reporting sporadic cases of cholera with seven suspected cases treated at Mola clinic between April and May 2004.

The district has been experiencing out breaks of the disease with cumulative cases for this year as of 21 March 2004 being 31 with 2 deaths. Nationally, cumulative figures stand at 94 and 10 deaths. The Case Fatality Rate (CFR) is now almost 11%. This is extremely high when compared to the WHO acceptable CFR of 1%. Most deaths occurred in the community and not at a clinic or hospital. This could be due to delay in recognition of the symptoms or people are not able to get to a clinic to receive appropriate treatment in time.

The major problem affecting the district is poor water and sanitation facilities. Less than 0,5 % of the households have proper sanitation facilities and water is drawn from open wells and rivers.

The Ministry of Health and Child Welfare (MoH&CW) through its provincial health team has come up with a comprehensive plan to provide water and sanitation facilities in Nyaminyami area of Kariba district within the next five years. They plan to construct about 3200 blair toilets and rehabilitate water points as well as intensifying health education.

In order to successfully implement the plan, an amount of about Z$1,2 billion is required and MoH&CW is appealing for assistance from the humanitarian community.

Poverty a Barrier to Quality Health Care
The 2003 Zimbabwe Human Development Report indicates that 69% of the population were below the Food Poverty Line in 2002 compared to 57% in 1995. The number of people below the Total Consumption Poverty Line was estimated at 80%. The report also shows that poverty is generally on the increase in both rural and urban areas.

A quarterly monitoring report on health and education released by Food Security Network (FOSENET) has highlighted the barriers that poorer communities face in trying to access health care services. The report is based on information collected in March 2004 from 53 districts in all provinces of Zimbabwe. The aim of the monitoring exercise is to assess the conditions influencing social and economic wellbeing so as to enhance an effective and community-focused response. The report notes that health is one of the most important and valued areas of social and economic rights for ordinary people in Zimbabwe.

The national goal is to ensure that people have access to health facilities within 5 kilometres of their homesteads. The monitoring results indicate that 58% of the selected monitoring sites nationally reported having a health facility, usually a clinic, within 5 kilometres from people's homes. Table 1 shows results for various provinces.

Province	No sites	% sites reporting distance to health facility( km)
		0-5	6-15	>15
Manicaland	5	60	40	0
Mashonaland East	12	42	25	33
Mashonaland Central	4	100	0	0
Mashonaland West	6	50	33	17
Midlands	11	36	36	18
Masvingo	6	66	33	0
Matabeleland North	7	43	43	14
Matabeleland South	9	33	56	11
Bulawayo, Harare	17	100	0	0
Total	80	58	26	16

The provinces with the best coverage of health facilities are Mashonaland Central and the major cities, while those worst served in terms of distance to facilities are Mashonaland East, Midlands and Matebeleland North and South. Of concern is the fact that provinces such as Mashonaland West and East as well as Midlands and Matebeleland North have a high prevalence of diseases such as cholera and malaria and yet they have the highest percentage of people who walk long distances to the nearest health centre.

The high cost of drugs was identified as another barrier to health services. Where drugs are not available in clinics or public hospitals, poor households find it difficult to afford drugs from commercial operators which are more expensive.

Given the high levels of HIV/AIDS and poverty, it is critical to make sure that a higher percentage of people have access to health services. The FOSENET report also notes that services used in the community (primary clinic and district hospital) do not provide medicine for AIDS related illnesses and patients have to travel to towns or higher level service providers to access such treatment. The high cost of transport may inhibit travel and more poor people are likely to suffer from illnesses that could easily be managed at local level.

Immunisation programs were reported in the last six months in 51% of sites nationally. Highest immunisation levels were reported in Manicaland and Mashonaland Central and the lowest coverage was in Mashonaland East and Midlands, table 2 below.

Province	% sites reporting
Province	Functioning health centre committee	Immunisation programme in the past six month
Manicaland	40	100
Mashonaland East	0	25
Mashonaland Central	0	75
Mashonaland West	17	50
Midlands	27	36
Masvingo	14	71
Matabeleland North	57	57
Matabeleland South	22	44
Bulawayo, Harare	65	59
Total	30	51

The report also indicates that mechanisms for community participation and representation in decision-making such as health centre committees are under-developed or poorly functioning and this needs to be strengthened.

Funding for health projects has been very low and most projects submitted under the Consolidated Appeal Process (CAP) have not been funded as shown below.

An amount of US$20,637,982 requested for health projects, has only been partially funded by about 4%.

Community Based Water and Sanitation Project Reduces Disease out break in Nyamazura
A local non-governmental organization Southern Alliance for Indigenous Resources (SAFIRE) is promoting implementation of community based sustainable development projects in Manicaland Province. A water and sanitation project was introduced to address problems of access to and availability of clean water as well as adequate sanitation facilities.

Prior to the implementation of this project, Nyamazura community collected water from open sources since most of the boreholes were broken down and could not be repaired due to lack of expertise and spare parts. This resulted in sporadic outbreak of diseases particularly cholera in 2000. According to one of SAFIRE's field officers who initiated the project, community members used to spend more than three hours queuing for water at the few functional boreholes.

SAFIRE embarked on training of community members to rehabilitate and maintain borehole hand pumps. Each village identified two people to undergo the training. A water point committee was also established for each borehole. The committee members are tasked with carrying out routine checks on the boreholes so as to detect problems and address them before the borehole pumps break down. Community members also contribute to a repairs fund, which is used to buy spare parts for the borehole pumps.

The initiative has resulted in all boreholes that had broken down at community water points, and institutions such as schools and clinics being rehabilitated. According to Gideon Mafunga, Nyamazura village 7 Chairperson, the project has enabled community members to have more time for other activities such as crop production since they no longer travel long distances to fetch for water.

In order to improve sanitation, SAFIRE trained community members to construct blair toilets and some community members are working closely with the Ministry of Health to assist in raising public health awareness through health education. By using a participatory approach SAFIRE came up with community driven sustainable projects that have reduced risks and vulnerability to water related diseases in Mutare district of Manicaland Province.

UN Trust Fund for Human Security Contributes to HIV/AIDS Programmes
According to the recently released Human Development Report of 2003, it is estimated that 1.8 million of the 11.7 million people in Zimbabwe were living with HIV and AIDS by the end of 2003. In order to help combat the epidemic and support those affected and infected, the UN Trust Fund for Human Security contributed US$1million on 26 May 2004 to UNICEF for HIV/AIDS programmes in Zimbabwe. The money was donated by the Government of Japan to the UN Trust Fund.

The UN Trust Fund for Human Security was set up to translate the concept of human security into concrete activities implemented by UN agencies. The fund helps to provide support for projects that address diverse threats including poverty, environmental degradation, refugee problems and infectious diseases such as HIV/AIDS.

Speaking at the hand over ceremony, the Japanese Ambassador Tsunehige Iiyama emphasised the importance of tackling the insecurity and pain caused by the AIDS pandemic. "We are committed to a broad definition of human security that encompasses all aspects of a person's right to life with dignity," said Ambassador Iiyama.

"With estimates that one in five children in Zimbabwe will be orphaned in 2010, we are facing a crisis of enormous magnitude. It is imperative that we make the needed investments in their emotional and psychological as well as physical well being," said Dr. Festo Kavishe, UNICEF Representative receiving the donation.

The money will be spent over two years with activities targeted at nine districts that include Mount Darwin, Mangwe, Buhera, Zaka, Zvishavane, Gokwe North, Hurungwe, Hwange and Mudzi.

UNICEF will work with Government ministries, local authorities and NGOs to address negative impacts of HIV/AIDS. Some of the planned activities include:

Emergency Preparedness Capacity Building for Matebeleland North Province
Matebeleland North province is one of the provinces which experiences a high occurrence and frequency of emergencies in the country. The province has been affected by floods (2000/2001 along Gwai river), cholera outbreaks in Binga (2003 and 2004), and high levels of malaria cases and deaths with a total of 3,530 cases and 4 deaths recorded for week 18 in 2004.

Almost all the districts in the province are in agro-ecological zone five, which experiences very low and erratic rainfall and drought is a common occurrence. Most of the people in Matebeleland North have been surviving on drought relief even in years of normal rainfall. Clean water and sanitation coverage is very low.

In an effort to promote emergency preparedness and response in the province, the Civil Protection Unit (CPU) will be running a series of training courses for the province starting the last week of June 2004. The target groups are district disaster committees, government agencies and non governmental organisations that are actively involved in risk reduction and development activities. Funding for the capacity building will be provided by UNDP through its Humanitarian budget.

Institutions such as major district hospitals are also to benefit. Training areas were identified by the district disaster committees and they reflect common hazards in the area. District such as Binga and Hwange will have training on planning and response to cholera and malaria which are common epidemics affecting the districts. It is expected that the districts will come up with preparedness plans that will be reviewed annually and simulation exercises carried out to test implementation capacity of the district disaster response teams.

NB: Meetings are by invitation only. Please contact the focal point person if you would like to receive information about any of these meetings

Articles for publication in the next Situation Report should be submitted by 09 June 2004 to our office at the email address: Zimrelief.info@undp.org

Contributions from GoZ, NGOs, International Organizations, or private sector groups are welcome. This information can be accessed on the RRU website at: www.ZimRelief.info

For additional information or comments, please contact the UN Office of the Humanitarian Co-ordinator,
Harare - tel: +263 4 792681, ext. 351 or
E-mail: Zimrelief.info@undp.org

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