Ngoni Dapira

PEOPLE living with HIV/AIDS (PLHIV) in Manicaland scored big last week Tuesday after the Ministry of Health and Child Care (MOHCC) withdrew all service fees that were being charged when collecting Anti- Retroviral Treatment (ART) drugs in some public health institutions.

The MOHCC finally intervened in the issue that dates back to over 15 years, which was now forcing some PLHIV not to adhere to their ART because they could not afford the service fees that were being charged, especially in clinics run by local authorities. The instructive letter that mandated free health services for special groups was written to all district medical officers as well as medical superintendents for the Victoria Chitepo Provincial Hospital, Rusape General Hospital and City of Mutare clinics.

“The MOHCC policies are clear on the non-payment of health services at public health facilities. All head of institutions are reminded that at district and provincial level, children under five (5) years old, maternity services, adults above the age of 65-years, OI (Opportunistic Clinics) and ART services are offered free of charge,” read the letter written by the acting Manicaland provincial Maternal and Child Health officer, Dr Tendayi Nyafesa, which was copied to the Manicaland provincial medical director (PMD), Dr Simon Nyadundu.

It further stated, “At primary health care level (Government, mission and council clinics), all health services are free for everyone… May you please make sure that all the facilities are following the guidance,” read the communication.

Hospitals and clinics run by the City of Mutare were reportedly the biggest culprits charging fees for what they called ‘administrative costs and ancillary expenses.’ Zimbabwe National Network of People Living with HIV (ZNNP+) Manicaland provincial coordinator Moses Chananuka said most people on ART come from impoverished backgrounds and could hardly afford to make ends meet, little alone have enough money to pay the administrative fees. He said this has been leading to non-adherence to ART programmes.

ZNNP+ Manicaland provincial coordinator Moses Chananuka

“The issue was discussed early this month during the launch of ZNASP IV (Zimbabwe National HIV and AIDS Strategic Plan) and we raised the matter as a red flag. The Manicaland provincial development and devolution secretary, Edgar Seenza said he was not aware of the issue and promised to investigate the matter further. He later engaged the City of Mutare, PMD and NAC (National AIDS Council) and the fruits of the meeting speak for themselves in the memorandum letter,” said Chananuka.

The ZNASP IV that will run from 2021-2025 represents the aspirations and commitments of the Government of Zimbabwe, local and international stakeholders in scaling up HIV interventions towards epidemic control and eventual ending of AIDS as a public health threat.

Chananuka added that the recent positive development for PLHIV in Manicaland shows how multi- stakeholder engagement can bear fruits, especially when there is goodwill by everyone involved. He however said implementation of the memorandum and to ensure that the directive is followed is now the next step, which they will follow up through their ZNNP+ members.

“In the ZNASP IV document it talks about the need or a strategic shift towards granular targeting of locations and populations and the transition towards a knowledge management-based monitoring and evaluation approach. It also talks about cost-efficient approaches to enhance its implementation and potential to achieve intended results. This is a positive development of meaningful engagement after a problem is raised and we need to continue like this to achieve the 95-95-95 targets for HIV epidemic control and to end AIDS by 2030,” he said.

Adding, “However, we will definitely follow this up through our membership to see to it that they are being given their drugs for free. There are some households where an entire family of five will be on ART, so you can imagine all of them paying US$3 or even if its US$1, most of the PLHIV come from impoverished backgrounds,” said Chananuka.

Meaningful Involvement of People Living with HIV and AIDS (MIPA) Manicaland chairperson, Casper Pound during a workshop organized in December last year by the Health Communicators Forum of Zimbabwe in Mutare revealed that poor adherence to ART would retard the milestones made and reverse the gains achieved so far.

“This may result in treatment failure and the emergence of drug resistant strains of HIV, leading to an increase in morbidity and mortality of people living with HIV and AIDS. It is only in Manicaland where council clinics charge administrative charges to PLHIV. It used to be US$1 and it was later increased to US$3 and currently was now around US$5 per collection,” said Pound in his presentation on how HIV and AIDS milestones could be overturned easily under the current COVID-19 environment.

The ambitious 95-95-95 strategy which was announced by the Joint United Nations Programme on HIV and AIDS (UNAIDS), aims to end the AIDS epidemic by 2030 by achieving 95% diagnosed among all PLHIV, 95% on antiretroviral therapy (ART) among diagnosed and 95% viral suppressed (VS) among treated.