Enhancing capacity of Zimbabwe's Health System to respond to climate change induced drought.
Zimbabwe has been experiencing negative effects of the devastating cyclone Idai which affected several districts in the country, and the drought due to low rainfall that has affected the whole country. Because of these catastrophes, the food and nutrition security situation in the country has deteriorated resulting in an increase in malnutrition cases. Malnutrition is both caused and exacerbated by drought, especially if a population is dependent on locally-grown food that is in reduced supply during a drought. Acute malnutrition is the stereotypical presentation of decreased food security leading to mass hunger, starvation and famine. A decreased intake of calories and nutrients results in wasting, with loss of body fat, muscle bulk and body weight. The effect of a longer-term reduced intake of protein, fat, carbohydrates and micronutrients leaves young children stunted and compromises cognitive development.
Generally, malnutrition is managed by giving supplementary foods high in energy and nutrients and vitamin and mineral supplements.
To assess the health system's readiness to deal with climate change induced drought and subsequent malnutrition, the Ministry of Health and Child Care (MOHCC) with support from UNICEF and WHO carried out a rapid assessment of health facilities in 19 sampled high global acute malnutrition and high food insecurity districts from the ten provinces of Zimbabwe to ascertain the preparedness of the facilities to respond to drought effects. The assessment also assessed the capacity of health workers to manage acute malnutrition and to provide Infant and Young Child Feeding (IYCF) package. The WHO recommended checklist (Multi-Cluster/Sector Initial Rapid Assessment (MIRA) was adapted and administered as the assessment tool.
The assessment revealed that 94% of the districts had less than 50% health workers trained to manage acute malnutrition and that 63% of the districts had no trained staff in baby friendly hospital initiative (BFHI), and that 34% of the health facilities were not admitting according to the integrated management of acute malnutrition (IMAM) protocol. Infant and young child feeding in emergencies (IYCF-e) support to parents and care givers of children below the age of two years is compromised due to incapacitation of health care workers. 12 districts (63%) had none of their staff trained in infant and young child feeding (IYCF).
Regarding supplies and logistics, Manicaland province had 80% of the its facilities short of RUFT considering that this is the province with the two districts affected by cyclone Idai. About 80% of the provinces had no resomal stocks, 60% did not have combined mineral and vitamin mix stocks, 30% did not have ready to use supplementary food stocks, and 20% had no micronutrient powder stocks. Almost all health facilities were not adequately stocked with growth monitoring cards. In this assessment 20 pellagra cases in the health facilities during the drought period were observed, and most of the interviewed health care workers had poor knowledge on pellagra. This picture projects a worsening situation as the drought progresses.
Based on the above findings, MOHCC, UNICEF and WHO recommended the procurement of life -saving therapeutic and supplementary foods, standard anthropometric equipment and growth monitoring cards. Another recommendation was that health care workers should be capacitated on managing acute malnutrition, Infant and Young Child Feeding (IYCF) and IDSR; and that strong surveillance systems that help to identify existing and emerging malnutrition cases like Pellagra should be put in place. They also recommend that food fortification be strengthened. Regarding the pellagra cases, a recommendation was made to establish the actual burden of pellagra and respond according to the IDSR guidelines.