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Writes Infection Control Association of Zimbabwe Trust (ICAZ T)
BACKGROUND: WHO ARE WE?
The Infection Control Association of Zimbabwe Trust (ICAZ T) was set up in 1993 as an organisation that promotes Infection Prevention and Control (IPC) in healthcare facilities in the community and the country at large. It is made up of individuals with a passion for IPC from across the health care fraternity. ICAZ-T has been supporting the Ministry of Health and Child Care (MoHCC) to strengthen the National IPC Programmes since 2011 and contributed to the development of the IPC Policies, Guidelines and Standard Operating Procedures.
In response to the COVID-19 Pandemic, ICAZ-T supported the MoHCC to strengthen IPC strategies as part of the National Infection Control Pillar and supported selected healthcare facilities with funding from Resolve To Save Lives (RTSL) and Center for Disease Control (CDC). During the pandemic, ICAZ-T contributed to the strengthening of the Health System through various strategies that included Health Care Worker (HCW) Training and Mentorship, IPC programme setup, programme implementation, monitoring and evaluation, routine screening and triaging, isolation and cohorting of suspected and confirmed cases including site support and on the job training at the supported healthcare facilities.
Why Infection Prevention and Control?
Infection Prevention and Control cuts across health services and all programmes at all levels of the health system. This is achieved through practicing basic principles that include washing hands correctly (hand hygiene), separation of infected persons from everyone else (isolation), use of medical protective clothing such as face masks and gloves, and proper disposal of human excreta and medical waste. If infection control practices are followed, it is easier to eliminate pandemics and save lives.
IPC is critical for protecting healthcare workers, patients, and the community. In recognition of the importance of IPC in preventing the spread of diseases in the hospital, the government of Zimbabwe through the MoHCC created the National Infection Prevention and Control Committee (NIPCC) and in 2014 developed the first National IPC Policy, Strategic and Monitoring and Evaluation Plan.
An updated National IPC Policy (2023) document and IPC Strategy, and M&E Plan (2023-2025) are awaiting adoption by the MoHCC.
However, the National IPC programme is primarily funded by external financing sources and lacks adequate domestic, predictable financial resources for implementation across all levels. According to the draft costed IPC strategic plan, approximately US$4 million is needed for IPC annually.
The government, the corporate world, and everyone needs to invest more in IPC activities through increased budget allocations for the program. Currently, IPC funding is embedded in existing MoHCC priority programmes according to the National Development Strategy 1 2021 2025 (NDS1-) without a stand-alone budget, making it difficult to direct the funds to IPC areas of priority
What are the WHO Core Components of Functional IPC Programmes at all levels of the Healthcare Delivery System?
These are a set of essential core components designed to help plan, organize, and implement an effective functional IPC programme recommended by WHO.
– Infection Prevention and Control Programme
– Guidelines and Policies
– IPC Training and Education to be in place tow by utilizing the team and task-based strategies that include bedside and simulation training.
– Surveillance of Healthcare Associated Infections.
– Multimodal Strategies for IPC – comprising of several elements or components (3-5) implemented in an integrated way with the aim of improving outcomes and changing behaviour. This includes the use of tools, checklists, and bundles to strengthen the IPC programme implementation.
– Monitoring and Evaluation /audit of IPC practices and feedback
– Workload and Staffing Levels and bed occupancy to reduce the risk of HAI & the spread of Antimicrobial Resistance (AMR)
– Built environment, material, and equipment essential for good IPC practice
IPC in Zimbabwe
Zimbabwe has a functional National IPC programme which is coordinated by the Department of Nursing in the MoHCC. Central and provincial hospitals have IPC programmes with full-time IPC focal persons, but there are significant gaps at the smaller clinics. There is lack of dedicated IPC focal points at the district level and trained healthcare workers are constantly leaving their posts for greener pastures.
In an assessment of 41 health facilities, about a quarter (10 facilities) had inadequate IPC programmes. Given the cross-cutting and multisectoral nature of IPC, the amount of funding available and spent on IPC in Zimbabwe is unknown. Past funding sources for IPC: The Zimbabwe Infection Prevention and Control Project (ZIPCOP), a donor-funded project from 2011 to 2016, worked with the MoHCC to strengthen the National IPC programme and implemented an IPC training programme in 120 facilities.
Another donor-funded project – the Healthcare Associated Tuberculosis Infection Prevention Project Zimbabwe (HATIPP-Zim) – worked with the MoHCC to develop a National Healthcare worker TB screening Policy and strengthen TB infection control in healthcare facilities. During COVID-19, greater investments were made in IPC from both external and domestic sources. The gains made from these programmes and investments are at risk without more sustainable domestic IPC financing support. According to the costed IPC programme priority areas in Healthcare settings, a minimum of US$ 4 million is needed annually to implement the planned activities:
Why invest in IPC?
1 A strong national IPC programme is aligned with country development and health sector priorities. Investing in IPC in Zimbabwe can reduce morbidity and mortality. In low- and middle-income countries such as Zimbabwe, 15% of patients will acquire at least one healthcare-associated infection during a hospital stay and as much as 70% of these infections could be averted through improved IPCA Further, investment in IPC is cost-effective, for example, every US$ 1 invested in hand hygiene saves US$ 16.5 in future health care expenditure.5
2 Increasing domestic budget allocations to programmes that implement IPC activities is a best practice recommended by the WHO. A dedicated domestic financing for IPC is critical to achieving the WHO minimum requirements of a functional IPC programme. The number of countries with a dedicated IPC budget line has nearly doubled in the last 5 years due to increased awareness on the importance of IPC.
3. Lastly, the investment needed in IPC is relatively small compared to the total health sector budget, meaning, IPC investment by the government is feasible even in a constrained macroeconomic context.
Role of the Media
The role of the media is to provide accurate, well-researched information to the public and interested parties on any topic that they report on. During epidemics and pandemics, it is critical to avoid infordemics and misinformation. The media plays a critical role in managing such situations and staying ahead Providing short precise messages that are directed to the budget makers, influencers and financers will assist the cause for the dedication of financial resources towards IPC Pandemic preparedness, management, and control is everyone’s business. The media should be well-placed and ready to report timely updates and ensure that the public understands the role they too can play in controlling the spread of infections
Let us all support the MoHCC in the IPC Budget Advocacy Roadmap, target and inform all the relevant stakeholders on the importance of IPC in preventing outbreaks and strengthening preparedness.
Conclusion
The government and people of Zimbabwe need to strengthen the National IPC program, which requires increased domestic budget allocations for IPC under the health programmes in the MoHCC.
