Councils offer online consultation health services in lockdown

Fortunate Muzarabani

Bulawayo, 9 May: Faced with insufficient resources, health institutions in Zimbabwe have not been spared from the pressure of having to adapt to delivering services despite the pressure of having to be prepared for the ranging Covid-19. It has been shown that tele-health and remote health service delivery can also slow the spread of Covid-19, while reaching out to those locked down at home.

As Mpilo Central Hospital and the United Bulawayo Hospitals are currently attending to emergency cases only, Bulawayo residents are swamping municipal run clinics in the city following the closure of Hospital Outpatient Departments (OPD)s in the city and countrywide. The Health and Childcare ministry sanctioned the closure of OPDs as part of measures to curb the spread of Covid-19.

The majority of Zimbabweans rely on public hospitals as they cannot afford private health care.

While people are confined to their homes during the Covid-19 lockdowns, they still need to access health services. Sexual reproductive health services, maternal health services, TB Clinics, general health services, counselling and HIV testing services are all essential services that patients must access even during crisis time.

Bulawayo’s council clinics have been a hive of activity for the first few weeks following the closure of hospital OPDs, however as the country goes into the sixth week of the lockdown, normalcy has returned. Hospitals OPD are still closed, but council is trying out more innovative ways of managing the numbers.

The Bulawayo Ciity Council Assistant Director of health services Dr Khulamuzi Nyathi said council clinics were gradually getting overwhelmed with numbers, with the peak of its numbers this year so far being the week before the lockdown, when hospitals closed OPDs.

The city council runs 19 clinics in the city, which are already understaffed, with only 60 percent staff compliment. Council, however said work was being done to recruit more staff following a partial unfreezing of some posts.

Health personnel at all visited council clinics were this week teaching parents about Covid19. Screening was also being done and people were made to wash hands before entering clinic premises. They were also required to have face masks on before being granted entry to clinic grounds.

The news crew went on a tour of various council clinics and established that queues were growing longer than the norm.

To limit the numbers that throng its municipal clinics, the council is now offering online consultations for specific cases.

Mrs Lina Nkomazana (59) from Northend suburb said she used to collect her Hypertension  and antiretroviral medication from Mpilo Central Hospital, however she said she was told to seek an alternative source until the situation had normalised.

“The clinic staff has come to our rescue as they have come up with a schedule and we do not have to go there all the time. I am on BP medication and I am also diabetic. I take care of a grandchild on ARVs also.  When the lockdown started, I was advised to start collecting all medication from Northend Clinic but it has been difficult as I have to re-register and give proof of residence but I am just tenant and next month I may have moved elsewhere. It was inconvenient, however the clinic staff say they are still working on it and are entering us into the system. If the medication is available we can collect for a whole month, and then we communicate with the nurse using whatsapp. If I do not feel well or the child is not ok, I just get the nurse online and then describe the pain and symptoms. She advises on what I can do then if it does not work within a certain number of days, she then schedules a time I can go the clinic. It is better that way than the queues we endured during the first days of the lockdown,” she said.

Mrs Nkomazana is one of the thousands of Bulawayo residents who have experienced untold suffering as a result of the situation unfolding due to Covid19.

However municipal clinics are working to ensure that the people who have been displaced and cannot get services from nearby public hospitals are accommodated, using tele-medicine among other methods.

Residents on TB, antiretroviral treatment and expectant mothers will now have fewer consultation schedules, on appointment, as council moves to decongest clinics.

BCC has since done away with existing schedules for patients with chronic conditions such as Hypertension, diabetes, those on antiretroviral therapy and those on TB medication.

Those who came for daily medication and observation would now come only once a week, while those who came weekly especially the TB patients for sputum, will now be required to visit the hospital fortnightly.

Those who had biweekly clinic appointments and for collection of medication will now only come once a month. Expectant mothers will no longer come as often but will now have one visit and then only seek health services if they encounter complications.

HIV testing and counselling services have been temporarily suspended however Dr Nyathi said those who had burning issues and needed counselling could visit their nearest clinics for help, considering the stresses that have come with the lockdown.

“We are trying by all means to reduce numbers. As we have limited staff, mind you, we are operating at 60 Percent capacity, so our staff may not be as fast in clearing patients so we have to suspend some services. There is a high risk of Covid19 spreading when people are crowded. Most monitored treatment programmes are therefore partially reduced as our patients will now be monitored remotely from home. We hope that the situation will return to normalcy soon and we urge our patients to stay in constant communication on their respective conditions,” he said.

He however said these patients will remain in continued communication with the clinic as they will be able to communicate with the sister or nurse online via Whatsapp.

The BCC Chief nursing officer Sister Thokozile Hove while addressing journalists at Thorngrove hospital recently said clinics were ready to cater for patients although the high numbers had not been anticipated.

“We will do what we can with what we have but so far we are managing, numbers are growing but we are trying. It’s just a bit challenging as some people continue to defy social distancing rules at the clinic. However our online platforms so far seem to be working as more people are using them. It becomes easier to manage the waiting rooms as we have less people waiting for service as people just come in for scheduled appointments,” she said.

While tele-medicine is seen as the future and is being used innovatively through WhatsApp, which is the widest used instant messaging application in the country, a number of people especially women are still left  behind due to access cost as well as digital literacy issues.

It is estimated that almost half the world is still offline — and the majority of those offline are women in developing countries, which reinforces gender inequalities.

Mobile operators in the country recently announced data tariff increases which means that more people will not be able to recharge and be online to communicate with the clinic staffers. Some people do not even have smart phones and in some households an entire family can share a single phone, in the same case a landline is shared. It then poses challenges of violation of privacy as more people will be able to see what one family member is communicating with the health official about their health.

However despite these challenges, the adoption of provision of online health services by municipal clinics is a step in the right direction as decentralisation of health services is necessary to avail the services to more people.

Fortunate Muzarabani is a journalist from Zimbabwe. This story is part of the GL News Service Gender and COVID-19 news series.