Improving NCD Care in Zimbabwe: Outcomes from the NCD Technical Working Group Meeting

Zimbabwe NCDs Technical Working Group

The first quarter NCD Technical Working Group (TWG) meeting, convened under the leadership of Dr. Mudavanhu, Director of NCDs, and Mr. Nkala, Deputy Director of NCDs at the Ministry of Health and Child Care (MoHCC) of Zimbabwe, was an extraordinary gathering aimed at advancing the quality of care for non-communicable diseases (NCDs) across the nation. Held in Kadoma, this pivotal meeting brought together medical directors, and development partners including WHO, UNICEF, CBM Global, CHAI, UNFPA, Cordaid, and representatives from NGOs across Zimbabwe's ten provinces. The event provided a critical platform for diverse stakeholders to collaborate, share insights, and develop actionable strategies. As a representative of people living with NCDs, particularly type 1 diabetes, and as a global advocate for NCDs and a voices for PEN-Plus Advocate, I was honored to participate in these robust discussions that addressed the multifaceted challenges and proposed comprehensive solutions for improving NCD care in Zimbabwe.

Thematic Areas and Working Groups

Participants were divided into four working groups, each focusing on a critical thematic area:

1. Cancer Services (NCCP, ZNCR, Breast Cancer, Cervical Cancer, Childhood Cancers)

2. PEN and PEN-Plus (Diabetes, Hypertension, Asthma, Sickle Cell, Type 1 Diabetes, Congenital Heart Disease, Rheumatic Heart Disease)

3. Eye Health

4. Palliative Care

For each thematic area, groups identified key challenges, and their root causes, and proposed significant actions and responsibility matrices under the following categories:

- Governance and Leadership

- Funding Structure

- Service Delivery

- Health Workforce

- Health Information (including Electronic Health Records - EHR)

- Medicines, Equipment, and Commodities

Cancer Services

Cancer Services emerged as a critical area requiring urgent attention. Key challenges identified include limited access to cancer screening and diagnostic services, insufficient public awareness and education on cancer prevention and early detection, and a shortage of specialized healthcare professionals and equipment. Proposed actions to address these challenges include establishing a national cancer control program with clear guidelines and protocols, securing funding through international grants and public-private partnerships, and setting up regional cancer treatment centers to decentralize care. Additionally, there is a need to train and recruit more oncologists and specialized nurses, implement a national cancer registry to track incidence and outcomes and ensure a consistent supply of chemotherapy drugs and radiation equipment. These measures are essential for improving cancer care and outcomes in Zimbabwe.

PEN & PEN-Plus

The PEN (Package of Essential Non-Communicable Disease Interventions) and PEN-Plus initiatives are vital frameworks for managing severe NCDs such as diabetes, hypertension, asthma, sickle cell disease, type 1 diabetes, congenital heart disease, and rheumatic heart disease in low-resource settings. Key challenges in these areas include inconsistent availability of medications and supplies due to frequent stockouts and supply chain disruptions, limited training and knowledge among healthcare workers, and fragmented healthcare services with poor coordination of care. To address these issues, proposed actions include integrating PEN and PEN-Plus guidelines into national health policies, conducting leadership training programs, developing integrated care pathways, and implementing mobile clinics and telemedicine services to reach underserved areas.

Further, strengthening supply chains to ensure reliable medication and diagnostic tool availability, enhancing training programs for healthcare workers, and establishing continuous education opportunities are crucial. Financial barriers also need to be tackled by advocating for dedicated budget allocations, establishing public-private partnerships, and expanding insurance coverage. Additionally, addressing social stigma and discrimination through public awareness campaigns and supportive policies is essential for ensuring comprehensive care and support for individuals with these conditions.

Eye Health

Eye Health was identified as another critical thematic area, with challenges including the high prevalence of preventable blindness due to conditions like cataracts and glaucoma, a lack of specialized eye care services in rural areas, and insufficient public awareness about the importance of regular eye check-ups. Proposed actions involve developing a national eye health strategy, partnering with international eye health organizations for funding and resources, and establishing regional eye care centers and outreach programs. Training more ophthalmologists and optometrists, creating a national database for eye health statistics, and ensuring the availability of essential eye care medications and surgical supplies are also vital steps towards improving eye health services in Zimbabwe.

Palliative Care

Palliative Care was highlighted as an area with significant gaps, including the limited availability of palliative care services and trained professionals, cultural barriers and stigma associated with palliative care, and inadequate pain management and psychological support for patients. To address these challenges, it is proposed to integrate palliative care into the national health system, secure funding from government and international donors, and develop home-based palliative care programs. Providing specialized training in palliative care for healthcare workers, implementing a registry for patients requiring palliative care, and ensuring access to pain relief medications and supportive care equipment are crucial actions to enhance palliative care services and support for patients and their families.

Multimorbidity

Multimorbidity, the coexistence of two or more chronic conditions in a single patient, emerged as a significant thematic area during the NCD Technical Working Group meeting. This complex challenge requires a holistic and integrated approach to healthcare delivery. The burden of multimorbidity is particularly pronounced in individuals living with NCDs such as diabetes, hypertension, and cardiovascular diseases, which often co-occur and complicate patient management and outcomes. Key challenges identified include fragmented care delivery due to lack of integrated care plans and poor coordination between care levels, limited access to comprehensive care owing to resource constraints and insufficient provider training, and significant financial barriers exacerbated by the high cost of treatment and limited insurance coverage. Proposed actions include developing integrated care pathways with comprehensive care plans and multidisciplinary teams, enhancing training and continuous professional development for healthcare providers, strengthening health systems through better resource allocation and improved coordination, and expanding financial support mechanisms such as insurance coverage and subsidized care programs. Addressing these challenges is critical for improving health outcomes and quality of life for patients with multimorbidity in Zimbabwe.

PEN-Plus Assessment and Rollout

A significant highlight from the meeting was the announcement that the PEN-Plus assessment to scale up sites will commence on the 17th of June 2024. Six provinces—Mutoko, Chiredzi, Karoi/Hurungwe, Rushinga, Tsholotsho—have been identified to start the rollout from November 2024, for a period of three years as a pilot. This initiative aims to extend comprehensive NCD care to underserved regions, enhancing the quality of care for conditions such as type 1 diabetes.

Conclusion

The first quarter NCD Technical Working Group meeting marked a significant step forward in the collective effort to enhance NCD care in Zimbabwe. The collaborative and strategic approach taken by all stakeholders, from government officials to international partners, underscored the commitment to overcoming the pervasive challenges associated with NCDs. Through focused thematic discussions on Cancer Services, PEN and PEN-Plus, Eye Health, Palliative Care, and Multimorbidity, the meeting successfully identified key obstacles and outlined pragmatic actions to address them. The forthcoming PEN-Plus site assessments and the planned roll-out in additional provinces signify tangible progress. By fostering an integrated, well-resourced, and patient-centered healthcare system, Zimbabwe is poised to make substantial improvements in the management and outcomes of NCDs, ultimately enhancing the quality of life for countless individuals across the country.