Zimbabwe is likely to face yet another tough year ahead as severe droughts have also been forecast for 2024. This is expected to further impact the quality of children’s nutrition, a troublesome issue now that over 80% of children have already been reported to lack sufficient vitamins and minerals for healthy development and growth. Coupled with the ongoing cholera outbreak, which has badly hit children aged under 5 and young people under 19, the situation is turning increasingly grim.
Against this backdrop, Dr. Alex Adjagba, the head of Health and Nutrition for UNICEF Zimbabwe, gave an exclusive interview to DevelopmentAid to provide first-hand insights into topical humanitarian issues and the contribution of UNICEF to improving the state of affairs during its more than 40 years of working in the country.
DevelopmentAid: UNICEF has been working to protect children’s rights and improve their welfare in Zimbabwe for more than four decades. Which are the main areas that UNICEF has directly or indirectly contributed to over this period?
Dr Alex Adjaba: UNICEF has been supporting interventions to improve equitable access to high-impact maternal, neonatal, child and adolescent health and nutrition services over the years. Specifically, UNICEF along with other partners has contributed to the Government’s efforts to help the reduction of maternal mortality rate (MMR) from 614 per 100,000 live births in 2014 to 462 per 100,000 live births in 2019 (MICS 2019). Under-five mortality only marginally decreased from 75 per 1,000 to 65 per 1,000 live births and also the reduction of child stunting – a chronic form of undernutrition – which has steadily decreased over the last 20 years, by 12%. There is still more to do to ensure this trajectory continues to make sure Zimbabwe meets the global SDG targets in 2030 for stunting.
In 2023, a total of 5,894,574 children, women, and men were reached by integrated service delivery platforms including during emergencies. The following areas saw improvement compared to 2022: antenatal care coverage (40 to 41%); skilled birth attendance from (90 to 92%); postnatal care coverage (57 to 83%); children 0-11 months vaccinated with DTP3 (86 to 97%); and children 0-59 months with diarrhea receiving ORS and Zinc (72 to 84%).
UNICEF also technically and financially supported several outbreak responses on measles, polio, cholera, focusing on social behavior change interventions, vaccine management, and procurement.
DevelopmentAid: Zimbabwe has now been facing a cholera outbreak for a year. What is the general situation and how are children affected?
Dr Alex Adjaba: As of the 5th of March 2024, Zimbabwe has recorded 27,365 suspected cholera cases with 2,742 being confirmed cases, 26,606 recoveries, 71 confirmed deaths and 505 suspected deaths. Sixty-two of the 63 districts have reported at least one case of cholera. Harare, Manicaland, Mashonaland Central, Masvingo and Chitungwiza Provinces have reported the highest cumulative cholera cases to date. From the analysis of available data, 39% of cumulative cholera cases are 19 years old while 14% are children under five years. When data shared by the Ministry of Health and Child Care (MoHCC) on cholera deaths was analyzed, it showed that 21% of cholera deaths were among those under 19 years and 6% deaths were of children under the age of five years.
The peak in cholera cases in the country occurred during the festive season into early January which also coincided with the opening of schools. Children who contracted cholera while at school have lost out on their education during the illness. Indirectly, children have been affected as resources (financial, material and human) that were meant for routine health services have been reprogrammed towards the cholera response. This has seen a reduction in access to services. Caregivers have also been affected by cholera leading to the loss of income. This financial impact has also negatively affected children. The risk of severe malnutrition in children is further heightened with cholera and other diarrhea diseases and more so with food security threatened with the looming El Nino induced drought effects.
DevelopmentAid: What has UNICEF’s contribution to fighting cholera been?
Dr Alex Adjaba: UNICEF has provided both technical and financial support towards the response since February 2023 focusing on coordination, infection prevention and control, case management, risk communication and community engagement, surveillance, oral cholera vaccine roll-out and water sanitation and hygiene services.
Financially, UNICEF supported the current response with approximately US$6 million, thanks to donors such as the Health Resilience Fund (HRF), the US Government, Japanese government and UNICEF internal resources.
DevelopmentAid: What are the main health challenges facing Zimbabwe right now, besides cholera? To what extent do they affect children’s development?
Dr Alex Adjaba: According to MICS 2019, Zimbabwe has a high adolescent (15-19 years) birth rate at 108 per 1000 live births. About 24% of women aged 20-24 years have had a live birth before 18 years of age. High rates of unintended pregnancy, a high unmet need for family planning at 12.6%, a high rate of new HIV infections among adolescent girls, and maternal mortality and morbidity among adolescents and young people are urgent issues that need to be addressed.
The country is on the path to HIV epidemic control with the global targets of 95-95-95 targets attained for adults at 95-100-95. Coverage rates in children lag behind those of adults, at 65-100-86 for children, according to national HIV estimates for 2022. HIV contributes to 20% of mortality in children under five including those with malnutrition. Other key indicators such as immunization in under 5 years old children have started to recover, after critical declines during COVID-19 pandemic, thanks to consistent domestic funding for traditional routine immunization vaccines and the co-payment of new vaccines. While the coverage for Diphtheria-Tetanus-Pertussis (DTP3) vaccine has improved to 93%, marking a 20% increase between 2021 and 2023, Measles vaccination coverage remain low (around 80% for dose 2).
Between 2018 and 2021, there was a 72% increase in the number of zero-dose children (26,556 to 95,500). Contributing factors included shortage of staff, non-functional or obsolete equipment, shortages of commodities, and poor referral systems. Health financing for immunization is consistent for vaccines, but funding for essential health supplies still requires further advocacy. While budget allocations fluctuated between 2018 and 2023, (11 to 14% approx including COVID-19 allocations), the budget allocation for 2024 decreased to 9.8% of the government budget, falling well below the recommended 15% outlined in the Abuja Declaration and lower than the 12.35% allocated last year. In 2023, despite an impressive 93% expenditure rate by the Ministry of Health and Child Care, (MoHCC) the actual value of the funds received was only 25% of the original budget value due to devaluation and inflation.
Child food poverty is extremely high in Zimbabwe with over 80% of Zimbabwe’s young children not eating a diet that provides enough vitamins and minerals for healthy brain development and growth. The number of babies who receive only breastmilk for their first 6 months of life is amongst the lowest in the SADC region – breastmilk alone for the first 6 months provides the best nutrition for the baby to ensure brain development and growth and protects against diseases including cholera.
DevelopmentAid: Some studies rank Zimbabwe 16th in the world in terms of poverty, with millions fighting hard to meet their food needs. Could you provide insights into poverty dynamics and challenges, its impact on children and expectations?
Dr Alex Adjaba: In terms of the science and evidence, what we know is that child malnutrition and poverty are inextricably linked. Malnutrition in early childhood is both a cause and a manifestation of poverty, and poverty is both a cause and consequence of malnutrition. Malnutrition leads to children having poorer cognitive skills, fewer years of schooling, lower school attainment and reduced wages in adulthood, leading to the increased probability of living in poverty. In turn, poverty increases the risk of children becoming and remaining malnourished and of relapsing into malnutrition even after they have recovered. The inter-generational cycle of poverty and malnutrition can persist for generations, as undernourished mothers are more likely to give birth to undernourished children and children born into poor households are at greater risk of being poor in adulthood.
To support MoHCC, UNICEF is working with sister UN agencies to support a Government approach to tackling poverty and malnutrition with the Food and Nutrition Council as well as the MOHCC, MOPSLSW, MOPSE and Ministry of Agriculture. UNICEF also supports efforts to improve Early Childhood Development led by the Office of the President and Cabinet. Focusing on the earliest years and ensuring the best overall development possible of Zimbabwe’s youngest children sets a solid foundation to positively influence the lifetime trajectory of each child.
DevelopmentAid: Shortly after the pandemics, a number of partners announced either withdrawal from partnerships with humanitarian organizations or a significant cut in financial aid, with the UK being among them. Has this step had a negative impact on sustainable development indexes? Was UNICEF Zimbabwe impacted by this state of affairs? To what extent did UNICEF manage to press ahead with its programs and actions in Zimbabwe?
Dr Alex Adjaba: The reduction in donor funding is a global trend, not just in Zimbabwe. And yes, reduced funding does impact the size of activities that were previously supported by donors. So the important thing here is to emphasize efforts to mobilize resources and engage the government in increased domestic financing for health commodities and needs.
DevelopmentAid: To what degree does UNICEF cooperate with the country’s government in health issues as well as food security?
Dr Alex Adjaba: UNICEF works closely with the Government and sister UN agencies to tackle food insecurity through multiple channels – such as supporting inter-ministerial efforts under the leadership of the Food and Nutrition Council to improve the production of nutritious foods at household and community levels to feed families and schoolchildren as well as supply markets.
UNICEF also works with the Ministry of Health to strengthen community-level advice and counselling on a healthy diet, especially for young children and adolescents, aimed at preventing all forms of malnutrition. Working together with social protection counterparts and the MOPSLSW to ensure that social safety nets such as cash distributions, school meals and food distributions (like the Government’s Lean Season Assistance) incorporate nutrition considerations – so are aimed at ensuring better food security for families.
Working with the Ministry of Primary and Secondary Education (MOPSE) to include education on nutrition in the school curricula, as well as providing iron supplements for adolescents to tackle the high rates of anemia and improve the quality of foods available to children in schools.
DevelopmentAid: What would be the main message you would like to deliver in relation to humanitarian issues in Zimbabwe?
Dr Alex Adjaba: This year will be a tough year in terms of the drought and young children are most at risk of malnutrition due to the high need for a varied diet to support their brain development and growth. Care Groups are available in many rural districts to provide support and advice on how to best feed your child, including in the context of drought. They also support how to monitor child’s growth and when to look for medical support if your child is not growing well or has malnutrition – ask your VHW, treatment and support is available at no cost at the local health facility. This is coming at the backdrop of the current cholera outbreak as discussed earlier. Overall, we are all working towards more preparedness and calling all partners and funders to continue to support preparedness activities.
