Geneva Health Forum Archive

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Managing a Health Crisis with Limited Health Systems Capabilities

Author(s): l. Hwenda1
Affiliation(s): 1Executive Education, IHEID, Geneva, Switzerland
Keywords: Zimbabwe, Southern Africa, health systems, cholera, international organisations, CFR

Cholera is a disease whose management is well-documented. To maximally limit its epidemic spread, interventions that limit the risk of transmission such as surveillance systems, response strategies and public education campaigns must be emphasised. Interventions to control cholera epidemic spread are relatively simple and affordable. Yet the 2008-2009 Zimbabwe cholera epidemic caused an unprecedented 98 592 infections and 4 288 deaths. The case fatality rates (CRFs) of this epidemic vastly exceeded the WHO acceptable CRF of 1%. Given that cholera outbreaks had been regularly occurring in Zimbabwe since 1998, the lack of coherent and effective response strategy was striking. Failure to contain it had wider ramifications. Subsequent cholera spread to neighbouring countries turned it into a regional crisis. However, the impact of the epidemic in other Southern African States was minimal. Unlike Zimbabwe these countries are economically and politically stable and have effective health systems. This study correlates the impact of the cholera epidemic in different Southern African countries with their health systems capabilities and response strategies.

Results/Conclusions: New cholera cases in Zimbabwe increased gradually since August 2008 and peaked in November 2008. Following this, cholera began to spill-over to other Southern African countries with variable CFRs. Notably, overall CFRs in Southern Africa were lower relative to Zimbabwe. For example, Mozambique and Swaziland recorded the highest number of cholera cases outside Zimbabwe but fewer deaths. Absolute numbers of recorded deaths in the whole region were considerably lower than in Zimbabwe. They inversely correlated with the effectiveness of health systems within countries as measured by the number of functional health centres and the degree of freedom with which international organisations could operate within the country. Overall, politically and economically stable countries had more effective health systems and could better harness the help of international organisations to mitigate the impact of cholera. The effective collaboration between these governments and international organisations demonstrated the importance of multilateral health governance in dealing with health crises, particularly when health systems capabilities are limited.

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