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Public Private Sector Partnerships Crucial in Attaining SDG Health Targets

Barbra Farashishiko (46) is a fighter. She has lived with HIV for over 25 years. Farashishiko is the only surviving member of the three siblings in her family following the death of her brother and sister who succumbed to the pandemic.

By Kudzanai Gerede

She says living with HIV during the time she got the infection (in the late 80s) was tantamount to a death sentence as there were very limited treatment options.

The disease has ravaged the Farashishiko family over the years, a situation Barbra regrets if treatment had been accessible could have overturned the fate of her family.

At their humble residence in Harare’s Tafara high density suburb Barba looks after her old father, two children left by her late brother and sister including her own surviving child.

“I have lost 11 members of my immediate family to HIV/AIDS related ailments and that has given me the reason to fight and survive for my remaining family,” narrates Barbra.

“Both my siblings died of HIV related sicknesses. Before they died, my sister had lost 6 children, my brother lost one and I lost two of my children as well, all to this infection,”

She says symptoms of HIV started to show when her health dramatically deteriorated 1989 before being tested and caught with TB. Even health personnel stigmatized her.

“They did not tell me I was HIV positive then because at that time they thought it was not yet “conceivable” so they hid it from me. The death of my first child in 1995 traumatized me and deteriorated my health leading me to Wilkins hospital where I was admitted,”

“My stay at the hospital coincided with the doctors’ strike and that’s when I was told of my HIV status and they discharged me in a very critical condition. I remember my father carrying me in a wheelbarrow from the bus terminus to our home as I was too weak to walk,”

Breaking with tradition, Farashishiko’s parents labored to save her life.

She attributes her survival to the unrivaled support of her father and her now late mother who catered for her special diets before she went on HIV treatment in 2008

“There was stigma in society. But I told myself this was my daughter and I could not afford to lose another of my children so I committed to supporting her through the ordeal,” says Mr Faranando Farashishiko’s father.

Because of poor health care and stigma against people affected by the pandemic, many lives were lost.

“I was lucky to live for so long but I believe all my siblings and children could have survived had they got HIV medication on time,” says Farashishiko.

But thanks to partnerships between government health institutions and development partners, many lives are being saved.

Farashishi is now the focal point of Harare east district for Zimbabwe National Network for People Living with HIV (ZNNP+) and believes various partnerships in the form of financial and medical assistance has improved access to medication for people living with HIV/AIDS; but there is room for more cooperation she says.

While addressing delegates at the official launch of the space creation project in Glenview, Health and Child Care Minister Dr. David Parirenyatwa hailed the partnerships between government and health players.

“We need a lot of help from partners. That is why we are also saying NO to new HIV infections,” he said

The recently completed Space Creation Project spearheaded by the Ministry of Health and Child Care with the financial assistance from the United States Centre for Disease Control (CDC/Zimbabwe) will be key in the provision of a safe, dignified and confidential treatment environment for HIV patients in the country.

The 159 ART Porta-cabins installed nationwide at a cost of US$ 5.9 million are detached from the main health facilities to accord privacy.

Most of the country’s health facilities were built before the onset of the HIV epidemic hence lack desirable facilities for comprehensive HIV/OI services.

“Space has been a challenge in provision of comprehensive, confidential and quality HIV/OI services in some of our health facilities. This donation of Porta-cabin clinics will go a long way in alleviating these challenges,” said Dr. Owen Mugurungi, Director AIDS and TB Programme in the Ministry of Health and Child Care.

Last year PEPFAR supported Zimbabwe with life-saving antiretroviral treatment for 434 131 people and provided antiretroviral medicines for 47 180 pregnant women living with HIV to reduce the risk of mother-to-child transmission.

Most of the country’s health facilities were built before the onset of the HIV epidemic hence lack desirable facilities for comprehensive HIV/OI services.

“Space has been a challenge in provision of comprehensive, confidential and quality HIV/OI services in some of our health facilities. This donation of Porta-cabin clinics has gone a long way in alleviating these challenges,” said Dr Owen Mugurungi, Director AIDS and TB Programme in the Ministry of Health and Child Care.

Barbra says the introduction of Anti Retro Viral (ARVs) drugs and government support from development partners has helped people living with HIV/AIDs to live longer.

“As a result I have survived to help others and currently I am the focal point of Harare east district for Zimbabwe National Network for People Living with HIV (ZNNP+).”

HIV/AIDs treatment drugs are in short supply in rural areas. Drugs for second regiment patients such as Abacivir, Alluvir, Altazonivir and Lamvudine among others are very expensive and are not readily available at most satellite clinics.

Harare provincial AIDS coordinator for the National AIDS Council Mr Adonijah Muzondiona says lack adequate health facilities and sufficient drug in remote areas across is causing an upsurge in people seeking treatment in the capital.

“There are inadequate health facilities outside our main cities which has seen most HIV patients coming to Harare hence increasing drug demand. But at the moment Harare is safe in terms of ARV accessibility,”

“We however have challenges which such people (who come to Harare) as we often lose track of where they end up going once they start treatment. That is a big challenge as we do not have systems of tracking them once they return to their respective constituencies,” he added.

The coming board of health care partners is expected to help decentralize service to remote areas of the country.

Why are PPPs necessary?

This has been largely attributed to little fiscal allocation heading towards the health sector.

Government continues to grapple with budgetary deficits to sustain various development initiatives.

According to the National AIDS Council, Zimbabwe requires about US$ 22.5 million annually to monitor the health of 750 000 HIV positive people who are currently on antiretroviral treatment.

The World Health Organisation (WHO) HIV guidelines calls for patients to receive a viral load test once a year to allow the switching of clients to favorable drugs- but for most locals this is a costly exercise.

The Abuja Declaration stipulates that African governments should allocate at least 15 percent of their entire budgets towards health delivery; a threshold government has constantly fallen short of on a yearly basis.

Over the past 3 years, the Ministry of Health and Child Care has received less than a cumulative US$ 1 billion dollars (less than one quarter of the yearly budget in 3 years) from treasury with the ministry receiving US$ 337 million in 2014, US$ 301 million in 2015 and US$ 330 million in 2016.

While efforts to resuscitate most health facilities and offer better medical services remain a priority to government, the country failed to meet most of its health targets under the Millennium Development Goals (2000-2015).

The continuous ravaging of diseases such as HIV/AIDS despite marginal gains in lowering their prevalence rates have fallen short of achieving the MDG 5 which sought to combat HIV/AIDS, malaria and other diseases.

Shortage of drugs at main hospitals has affected people living with HIV and more so, the failure by government to build more hospitals in the remote areas poses even more threats to human life.

New financing models

As the world enters a new era of Sustainable Development Goals (SDGs), new financing models have been proposed to avert failures of the MDGs.

World governments, especially in the developing world have been challenged to take a leading role in funding and facilitating the implementation of set goals.

However entrusting governments particularly those in the developing world to play a leading role in coordinating and financing SDGs has raised new challenges.

This has been exacerbated by the fact that the shrinking global economy has rendered most governments to operate under tight fiscal constraints daunting prospects of achieving health targets under the SDGs.

Partnerships have proved to be efficient in the provision of drugs and quality health care especially in developing countries battling with resources to self-fund various health initiatives.

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