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SENATE HANSARD 15 MARCH 2022 VOL 31 NO 28
PARLIAMENT OF ZIMBABWE
Tuesday, 15th March, 2022
The Senate met at Half-past Two o’clock p.m.
(THE HON. DEPUTY PRESIDENT OF SENATE in the Chair)
ANNOUNCEMENT BY THE HON. DEPUTY PRESIDENT OF SENATE
SWITCHING OFF OF CELLPHONES
THE HON. DEPUTY PRESIDENT OF SENATE: I want to remind Hon. Senators to put their cellphones on silent or better still, switch them off,
PENSIONS AND PROVIDENT FUNDS BILL [H. B. 17A, 2019]
First Order read: Second Reading: Pension and Provident Funds Bill [H. B 17A, 2019].
THE DEPUTY MINISTER OF FINANCE AND ECONOMIC DEVELOPMENT (HON. CHIDUWA): Thank you Mr. President. I hereby present the Second Reading of the Pensions and Provident Fund Bill [H.B. 17A, 2019]. Hon. Senators, the Pensions and Provident Fund Bill is aimed at repealing and replacing the Pensions and Provident Fund Act [Chapter 24:09] to address the identified regulatory inadequacies and weaknesses. The principal objective of the Bill is to enhance the integrity of the pensions industry by addressing vulnerabilities which threaten the stability and sustainability of this sector. It lays the foundation of an effective regulatory framework and provident funds that is anchored on
- core principles of effective pension regulation, supervision as espoused by the International Organisation of Supervisors of which Zimbabwe is a member;
- Findings and recommendations of the Justice Smith-led Presidential Commission of Inquiry into the Convention of Insurance and Pensions Values, whose report was considered by this august Senate after its publication in 2018;
- Regional experiences of non-bank financial sector regulators under the auspices of the SADC Committee of Insurance, Securities and Non-Bank Financial Authorities (CISNA); and
- Zimbabwe’s peculiarities, including the structural reforms experienced in the economy over the last two decades. As Hon. Senators are aware it is incumbent upon the State to take reasonable legislative and other measures within the limits of the resources available to it to achieve the progressive realisation of ensuring the protection of the pension scheme members and beneficiaries’ interests, the security and Pensions and Provident Fund and the sustainability of the pension sector. It is therefore in this context that I present the proposed holistic review of the Pension and Provident Funds Act [Chapter 24:09] to address indentified regulatory inadequacies and weaknesses.
Focus on the proposed amendment is on the following main areas:
- Corporate governance in pension funds,
- Consumer protection,
- Resolution of troubled pension fund,
- Provisions to reduce the high incidents of pension contribution arrears,
- Requirements of Pension Fund service providers,
- Pension Fund’s Assets and Investments;
- Contribution to Pensions Protection Fund,
- Enhancing Regulatory and Supervisory Powers of IPEC and Currency
Mr. President Sir, allow me to briefly underscore the critical importance of the pensions industry before I delve into the salient features of the proposed Bill. I am sure it will assist Honourable Senators to appreciate the importance that we should place on this Bill and the industry it intends to regulate.
Hon. Senators will agree with me that the retirement or pensions industry plays both primary and secondary roles in an economy with the primary reason for setting up pension funds being to meet our financial needs at old age and get death benefits to dependents of deceased members. Therefore, retirement income allows smoothening of consumption in the twilight stage of our lifecycle and the need for us to ensure provision of decent lifestyles at an advanced age. Pensions should therefore help us to reduce old age poverty and ensure social security protection, notwithstanding the loss of values suffered by pensioners during the last two decades. The country’s pension industry has remained resilient therefore we should do everything in our capacity to restore confidence in the sector including ensuring its relevance and sustainability.
Mr. President, the secondary benefits of pension schemes or retirement income includes long term savings mobilisation for financial intermediation and deployment into the real sector of the economy, infrastructure development, the broadening and deepening of capital markets. It is important to note that over 80% of commercial real estates in Zimbabwe are financed by insurance and pension funds and the industry has traditionally been the major institutional investor on the Zimbabwe Stock Exchange as well as one of the biggest sources of time deposits. I have no doubt in my mind, Hon, Senators, that the sector can be refocused to play its traditional role in the economy of providing the much needed long term capital. I also appreciate that there is a symbiotic relationship between the performance of this unique industry and that of the real sectors of the economy.
Mr. President, the role of retirement service plans has been growing over time. Indeed, you will note that in some countries the contribution of pension to GDP is immense, with assets of the pension industry exceeding GDPs of most countries. In South Africa pension assets account for 95% of the country’s GDP, as such current efforts under the NDS1 are meant to ensure economic growth that is expected to unleash the potential of this industry and its contribution to the economy.
Hon. Senators you will agree with me that one of the primary enablers to unleash the potential of the pension industry is to have a robust and adequate regulatory system that responds to changes in the microeconomic environment empowering the regulator to intervene in real time and giving direction to the stability and sustainability of the industry. We are also looking at the promotion of the requirements of risk based supervision resulting in efficient allocation and utilisation of resources as well as eliminating unnecessary regulatory burden on pension and providence funds. It should also respond adequately to emerging risks within the operating environment hence restoring and maintaining the confidence of all stakeholders in pension value chains.
Let me transition to deficiencies in the current Act. The current Pensions and Provident Funds Act provides a framework lacking in many aspects to meet the aforesaid requirements for an enabling regulatory framework. The Act is outdated as the legal framework has not kept pace with the dynamic changes currently being experienced in the financial markets as observed by the Justice Smith Inquiry.
The current Act inhibits the Insurance and Pensions Commission as the regulator to effectively supervise the industry to the extent that it contributed to the malpractices that resulted in the loss of value suffered by fund members. The Commission of Inquiry’s main recommendation was the need to review the pensions legislation.
Insurance and Pensions Commission
Mr. President, it is imperative that regulatory bodies be equipped with appropriate regulatory and supervisory powers that enable them to respond appropriately and adequately to a given circumstance. Cognisant to this principle, the Justice Smith Commission of Inquiry recommended the enrichment of the functions of IPEC through legislative amendments to ensure smooth execution of its function. The aim being to close the gaps in regulation that were identified as promoting the malpractices observed in the pensions industry. The Bill has addressed this concern by giving the Commission additional functions and powers.
In line with the principle of risk-based supervision which requires application of regulatory requirements on risk sensitive basis the Bill proposes to give IPEC some discretionary powers to enable the determination of appropriate and efficient supervisory action depending on the peculiarities of each regulated entity. Cognisant of the inherent risk relating to possible abuse of discretionary powers the Bill clearly sets the limits within which such powers shall be exercised while clause 7 subserviates the exercise of this power to section 194 of the Constitution of Zimbabwe.
In addition, the Bill seeks to enhance IPEC’s powers to cooperate with other relevant authorities for the purposes of enhancing proper discharge of its functions. The Commission will have powers to issue guidelines, directives and standards for prudent management of pension funds.
Powers to issue Regulations
Hon. Members I wish to highlight that the Bill empowers IPEC to make regulation in consultation with the Minister. As the industry regulator IPEC is an expert in the field of pensions and in line with its advisory role to Government the Commission is being empowered to come up with regulations for approval by the Minister.
Mr. President you will note that this provision is not unique to IPEC. There are statutory bodies and constitutional entities within Zimbabwe that have delegated powers to make subsidiary legislation subject to the Ministers approval. As you may be aware, local authorities and rural district councils make their own by laws and submit to the Minister for approval. The Chief Justice also has the power to make court rules in terms of Section 56 of the High court Act and Section 34 of the Supreme Court Act. All these are acknowledged for their expertise in their respective field hence their empowerment to make regulations.
Regulations to be issued by IPEC would include.
- Record-keeping and preservation of records by pension funds and administrators,
- Standards and requirements of expenses, capital adequacy, solvency and risk management,
- Principles relating to emergence, treatment and utilisation of actuarial surplus,
- Minimum qualifications for officers of pension funds and administrators and
- Standards of corporate governance to be observed by boards of funds and administrators.
As you will appreciate, Hon. Senators, certain breaches of the law may be minor and may not cause prejudice to the administration of justice or to the society if administrative penalties are imposed.
I wish to acknowledge that the current Act does not provide for an adequate framework of imposing administrative penalties for acts of non-compliance by IPEC’s regulated top entities. This is notwithstanding the fact that administrative penalties are easy to an oath and not time consuming, unlike the criminal court processes which is associated lengthy, costly and complex procedures.
The absence of adequate administrative power in the current pension legislation has therefore resulted in continued malpractices within the pensions industry. Therefore, the Bill before you, seeks to provide a framework for administrative civil penalties that can be imposed by IPEC to deter and penalise such malpractices. The provision for administrative penalties is key as not all businesses breaches need to be criminalised, since it may have an effect of scaring away investors.
In addition, the threats of incurring penalties encourage compliance. It is also important to acknowledge that provisions of criminal penalties in the current Act will be retained.
I wish to reiterate that market contact regulation which is also commonly referred to as treating customers fairly has become an important part of regulation and supervision in recent years. This has become particularly important in our Zimbabwean context, given the loss of value associated with structural changes in the economy during the last two decades. The current Act falls short in improving market contact regulation for the protection and promotion of the rights of pension fund members and their beneficiaries. Thus, there is need for provisions that encourage transparency and accountability of giving fund members and a market participants a clear picture of the fund’s business activities, performance and financial position.
The Bill incorporates universally accepted principles for adequate financial consumer protection to ensure protection of the rights and benefits of fund members and their beneficiaries in line with the treating customers fairly principles.
In addition, the Bill incorporates provisions that:-
- Require funds to publish their financial statements and this will be done on a risk- sensitive basis;
- Provide for stakeholders’ right to obtain copies of or to inspect records and to obtain information of the fund and
- Deter transfer of value from policy holders to shareholders through the misappropriation of fund assets
I wish to acknowledge that issue of an actuarial nature can be highly technical and subjective even among the subject matter experts themselves.
Globally, literature indicates that some of the actuarial aspects may be interpreted differently if not defined in law. It is against this realisation that the Bill contains 28 definitions of the actuarial terms. Which includes actuarial surplus, contingency reserve account and minimum individual member reserve, among others.
The Bill also contains provisions on frequency of actuarial valuations and ways to deal with incidence of and treatment of actuarial surplus, which is one of the controversial subjects.
The Pension and Provident Funds Act does not comprehensively anticipate the underlying thereat to good corporate governance resulting from poor corporate governance and risk management practices. Such corporate governance deficiencies include improperly constituted Boards inadequate skills, conflicted Boards and senior management, inadequate regulatory/monitoring if service providers and poor internal controls.
In addition, the Act does not provide a framework to effectively deal with excessive administrative and other expenses at institutional level, which are contributing to the depletion of fund’s asset to the prejudice of pension fund members. It is against this background that best practice principles relating to corporate governance and risk management have incorporated into the Bill to ensure sound corporate governance and risk management practices.
The Bill makes it mandatory for every Fund to appoint to its Board at least one independent expert member. Te proposed amendment will improve skill mix on the Board. The Bill also provides an exhaustive framework for assessing fitness and probity of Board members, principle officer and service providers within the pension industry covering the criteria to be applied in assessing qualifications and disqualifications.
Statutory obligations are also placed on Board members of the regulated entities to act in good faith, honesty and reasonably to exercise due care and diligence, to act in the best interest of the pension fund and pensions fund members and avoid abuse of positions to gain undue personal advantage, among other things.
The Bill further provides liability of directors/trustees who fail to perform their fiduciary roles by imposing civil and criminal penalties that are deterrent in nature.
Resolution of Troubled Pension Funds
I wish to underscore that one of the mischief identified by Justice Smith Inquiry is the absence of an adequate framework for the resolution of troubled institutions that are registered in the Pension and Provident Act. If enacted into law the Bill will close this gap through providing an effective framework for resolution of troubled funds, including the requirement to submit a recovery plan and penalising willful failure to submit the recovery plan.
Contribution to a Pension Protection Fund
Mr. President Sir, the Bill also contains provisions that make is mandatory for every fund to contribute to a Pension Protection Scheme established in terms of the Insurance and Pensions Commission Act [Chapter 24:2]. Currently there is no fund that is set up to compensate pension/provident funds’ members if a fund becomes insolvent and fails to meet its obligations, hence pension scheme members are experiencing loss after collapse of an insurer or troubled pension fund.
It is important to note Hon Members that the banking sector has the Deposit Protection Corporation while the securities market has an Investor Protection Fund established in terms of the Securities and Exchange Act [Chapter 24:25]. The Bill therefore, obligates every fund to contribute to the Pension Protection Fund unless exempted by the Commission. The fund will be established in terms of the Insurance and Pensions Commission Act [Chapter 24:]. The exemption will, among other factors, consider the design and administration model of the pension scheme as well as its financial soundness.
The current Act as read with Exchange Control regulations does not allow offshore investments by Pensions Funds. Therefore, the Bill seeks to liberalise pension fund investment by allowing a fund to invest all or part of its assets in foreign markets, subject to such terms and conditions as the Commission may fix. However, I propose changing the current wording of Clause 35 of the Bill to reflect that the Commission will fix the share of total assets to be invested offshore in consultation with Exchange Control Authorities and the Minister of Finance and Economic Development
To support the proposal for offshore investments, allow me to share a case in point of NRZ Pension Fund which is the only fund with offshore investments in the United Kingdom. The National Railways of Zimbabwe used to be one of the largest employers in the country offering employment to migrant workers from the region and beyond. At Independence in 1980, most British nationals, who used to work for NRZ returned to their home country and an agreement was made to transfer their pension savings to the United Kingdom.
The investment grew and outperformed the UK liabilities of the defined benefit pension fund, resulting in a surplus of about 10 000 British Pounds which needed to be repatriated to Zimbabwe. However, instead of repatriating the funds, a decision was made to keep the investment in UK for the benefit of the local NRZ Contributory Pension Fund members.
The size of the UK investment for NRZ Pension Fund today is equivalent to US$115 million. This is notwithstanding the repatriations that were being made to Zimbabwe during the last 40 years, with about US$40 million having been repatriated for the benefit of local NRZ pensioners in the last 5 years.
To this end, the point I am making is that allowing offshore investments by pension funds would help stabilise their portfolios to withstand sovereign risk and smoothen investment returns in instances where business cycles are being experienced in the home country. If all pensions’ funds had some exposure of offshore investments, this could have gone a long way in mitigating the impact of loss of value relating to the operating environment.
To allay concerns of possible risk of capital flight, the level of offshore investments will be determined through policy guidance from Government. IPEC will also be empowered to cooperate with exchange control authorities and cross border regulators to ensure effective supervision of those offshore investments.
Separation of Assets
The Bill is also aimed at enhancing disclosures on the extent and nature of assets held by a life insurer regarding its pension fund business. The life insurer will be required to clearly show in the statement of financial position of that insurer being regarded as assets of the Pension Fund. These statements are required to be published. The requirement is aimed at addressing the observed challenge in the industry where life insurers have not been clearly separating pension fund business from insurance business.
Pension Contribution Arrears
I wish to bring to the attention of Hon. Members that the problem of pension contribution arrears has been in our pensions industry since the late 1990s. It is a practice, which involves sponsoring employers of a pension fund making paper deductions on pay slips but not remitting the pension contribution to the pension fund.
The Justice Smith Commission of Inquiry established that arrears that had accumulated since the mid-90s were written off in 2009 on currency conversion owing to the lack of policy and regulatory direction on how they should be treated.
In the post dollarisation period of 2009 to 2019, pension contribution arrears accumulated to the tune of US$610 million, with over 70% of it being attributed to parastatal-related pension funds. In 2019, these arrears were converted to the local currency at a parity exchange rate of US$1: ZW$1 in line with the legal instrument on treatment of legacy debt. Therefore, pension contribution arrears have been one of the major sources of loss of value to pension scheme members.
In this regard, the Bill enhances penalties for non remittance of pension contribution which are currently in regulation. The Bill places personal liability on the director or executive offer who is regularly involved in the management of the participating employer’s overall financial affairs. The Bill also provides for civil penalties against defaulters.
Pension Fund Service Providers
The Bill places obligations to pension fund service providers such as administrators and asset managers to transfer records on termination of service contracts within specified timeframes. Currently, the termination of service is governed by Service Level Agreement and has been resulting in loss of vital records.
The Bill sets the maximum timeframes within which records, assets and liabilities should be transferred. This places the responsibility on the service provider, thus giving IPEC a definite subject to hold accountable.
The currency reforms implemented in Zimbabwe since 2006 have taught us the need to issue sector specific guidance to the insurance and pensions industry as the contracts are of a long term nature and may straddle different currency regimes.
The Justice Smith Inquiry pointed out that the legislation was inadequate to guide the industry on currency reforms that were implemented in 2009. Whilst I applaud IPEC for issuing a guidance paper in response to the 2019 currency reforms, the Commission was supported by Statutory Instrument 69 of 2020, which empowers them to issue standards and guidelines to the industry.
However, given the huge impact of currency reforms on the insurance and pensions industry, the Bill contains provisions on processes to be observed by pension funds in conversion of assets and liabilities from one currency to another. Boards of the funds will also be charged with the responsibility of ensuring compliance with the provisions on currency reforms.
Consequential Amendments to other Acts
I wish to acknowledge that if the Bill is passed into law, it will have consequential amendments to other enactments on pension or provident funds that are regulated by IPEC. Clause 3 (3) of the Bill has this provision which highlights that “this Act shall prevail over any other enhancement inconsistent with it”.
As such, funds that are set up through other statues would have to be guided by this Act in the event of inconsistencies between the laws. A case in point would be the Labour Act [Chapter 28:01] particularly pension funds that are set up by way of collective bargaining agreements.
This Bill recognises that the current Pension and Provident Act is lagging behind market developments and internationally recognised regulatory standards. Most of the Bill’s provisions reflect best practices in pensions industry.
It is my hope that Members of this august House will grant their approval to this Bill, which seeks to repeal and replace the Pensions and Provident Funds Act and lay a solid foundation for minimum regulatory standards that are necessary for the effective regulation of the pensions industry.
Mr. President Sir, I therefore submit the Pension and Provident Funds Bill 2019 for second reading by the House.
HON. SEN. CHIEF CHARUMBIRA: I want to thank the Minister for this Bill. I was trying to look for a rule but I am still researching. I want to propose that this is a Bill which we cannot pass in one afternoon. The issue of pensioners in this country is a very serious issue. We need to do thorough research as parliamentarians and see if the provisions or amendments are adequate to address the problems that people are facing.
Let us not rush to pass this Bill. We have to be given the Bill so that we can study and read it in the Hansard only then can we debate it. I thank you.
HON. SEN. KOMICHI: I would like to support what Hon. Sen. Chief Charumbira has just said. We need time to research so that we can contribute technically and professionally on this particular Bill. I thank you.
*HON. SEN. TONGOGARA: Thank you Mr. President. I stand to support what was suggested by Hon. Sen. Chief Charumbira. The issue regarding pensions is very important. We need to analyse the situation so that we understand what pensioners are getting because what they are getting is insignificant. So we need time to go through the Bill so that we would be well informed the next time we debate in this august House.
*HON. SEN. CHIRONGOMA: Thank you Mr. President. I support the words that were said by Hon. Sen. Chief Charumbira that this issue regarding pensions is very critical. It is not clear what exactly is happening. You find that people are given $10 and insignificant amounts. It is difficult to understand what exactly is happening. There is need for us to sit down and analyse this issue. I thank you Mr. President.
*HON. SEN. CHINAKE: I would like to say a few words Mr. President. The issue that was raised by Hon. Sen. Chief Charumbira is very clear and we support the issue but most of us in this august House are pensioners, no one is happy with what is happening. For us to support what we are not happy with is really painful. We need to sit down and consider the Bill so that we understand it. When we are asked, we need to be able to answer clearly. I thank you.
THE HON. DEPUTY PRESIDENT OF SENATE: I just want to warn you on some technicalities when we get to the Committee Stage. Normally, Bills are submitted well in advance and Hon. Senators are encouraged always to read your Bills. I am sure you have it on your gadgets. Secondly, if you support what Hon. Sen. Chief Charumbira has said, it is advisable not to contribute any further because you risk not being able to debate when it comes to the real debate.
THE DEPUTY MINSITER OF FINANCE AND ECONOMIC DEVELOPMENT (HON. CHIDUWA): Thank you Mr. President. Given the submissions by Hon. Sen. Chief Charumbira that this Bill is very critical and there is need for us to be able to integrate it, I do not have any objections for us to look at what is contained in the Bill and because of that, I move that the debate do now adjourn.
Motion put and agreed to.
Debate to resume: Wednesday, 15th March, 2022.
FIRST REPORT OF THE THEMATIC COMMITTEE ON HIV AND AIDS ON THE IMPACT OF COVID-19 PANDEMIC LOCKDOWN RESTRICTIONS ON HIV AND AIDS SERVICE DELIVERY SYSTEM IN ZIMBABWE
HON. SEN. KAMBIZI: Thank you Mr. President. I move the motion standing in my name that this House take note of the First Report of the Thematic Committee on HIV and AIDS on the Impact of COVID-19 Pandemic Lockdown Restrictions on HIV and AIDS Service Delivery System in Zimbabwe.
HON. SEN. DUBE: I second.
HON. SEN. KAMBIZI:
In the last quarter of 2018, Zimbabwe started experiencing acute shortages of medicines and drugs as well as other essential products in public health institutions. The situation was dire as it rendered the general public at the mercy of the private sector who introduced a three- tier pricing system which was beyond the reach of an average citizen in Zimbabwe. The supply of the antiretroviral drugs (ARVs), also became erratic in the public health institutions, leading to the outcry from the People Living with HIV. Consequently, the Thematic Committee on HIV and AIDS was prompted to visit the National Pharmaceutical Company (Natpharm) in June 2019 to assess the availability, management and distribution system of the ARVs by Natpharm.
Thus, in light of this situation and in accordance with its oversight function and work plan, the Thematic Committee on HIV and AIDS resolved to enquire into the implementation of the Antiretroviral Therapy (ART) –Roll-Out Programme for the prevention and treatment of HIV in Zimbabwe.
OBJECTIVES OF THE ENQUIRY.
The objectives of the enquiry were:
- To assess the progress in the implementation of the ART Roll-Out Programme in Zimbabwe;
- To understand the ARVs supply chain in health institutions;
- To appreciate challenges, if any, being encountered in the implementation of the ART Roll-Out Programme; and
- To recommend possible solutions for improved implementation of the ART Roll-Out Programme.
The Committee held physical oral evidence meetings with the following:
The National AIDS Council of Zimbabwe on 11th February 2019 on its programmes and activities for HIV and AIDS.
The then Minister of Health and Child Care, Hon. Obadiah Moyo on 10th June 2019 on policy measures that the Ministry had put in place to ensure consistent allocation of foreign currency for the procurement of ARVs and other strategies to finance HIV and AIDS programme.
The Committee conducted fact-finding visit to Natpharm on 10th June 2019 on ARV drugs procurement and distribution system.
The Committee also undertook fact-finding visits to selected health institutions in the seven provinces of the country (see Table 1). The Committee intended to undertake the visits in November 2019, however, due to disruptions of Committee business, the activity was deferred to the first quarter of 2020. The activity again failed to take place due to the outbreak of Covid-19 pandemic. The Committee only managed to undertake the activity in May 2021. Due to limited resources, the Committee visited 14 health institutions in seven selected provinces of the country.
Table 1: Selected Health Institutions that were visited by the Thematic Committee on HIV and AIDS
FINDINGS OF THE COMMITTEE
Situational Analysis of HIV and AIDS in Zimbabwe
Table 2: HIV and AIDS Situational Analysis for Zimbabwe as at December 2019
People Living with HIV
Adult HIV Prevalence (ages 15-49)
AIDS Related Deaths
Adults on Antiretroviral Treatment
Children on Antiretroviral Treatment
Source: UNAIDS Data 2020.
Table 2 depicts that in 2019, Zimbabwe had 1.4 million People Living with HIV; 12.8% adult prevalence rate among the ages between 15-49; 40 000 new infections; 20 000 AIDS related deaths, 86% of adults were on antiretroviral treatment and 71% of children were on antiretroviral treatment.
Table 3: 2019 Analysis for the Achievement of the 90/90/90 targets by 2030 for Zimbabwe
Estimated number of people living with HIV—1.4 million
The First 90
People Living with HIV who know their status
The Second 90
People on ART
The Third 90
Virally suppressed among those tested for Viral Load.
Data Source: Zimbabwe 2019 Global AIDS Monitoring Report
Table 3 shows that by 2019, Zimbabwe was very close to achieving the UN targets of 90/90/90. This means that for the first 90 that aims at having 90% of people living with HIV knowing their status by 2020, Zimbabwe was standing at 90% by December 2019. For the second 90 that aims at having 90% of people who test positive to be enrolled on care and treatment, Zimbabwe was standing at 87.36% by December 2019. For the third 90 that aims at ensuring that all those on treatment achieve viral load suppression, Zimbabwe was standing at 73% by December 2019.
National AIDS Council of Zimbabwe (NAC) Programmes and Activities
In order to decisively respond to HIV and AIDS pandemic, Zimbabwe enacted the National AIDS Council of Zimbabwe Act [Chapter 15]. The Act is meant to facilitate management, coordination and implementation of programmes related to HIV. NAC is therefore, mandated to provide for management; coordination and implementation of HIV and AIDS programmes based on the Act. In addition, NAC is mandated to manage and administer the National Aids Trust Fund which is commonly referred to as the AIDS levy, among other functions. For the purposes of this report, only a few key programmes and activities of NAC will be highlighted.
During the oral evidence meeting, the then Acting Chief Executive Officer of NAC, Mr. Raymond Yekeye presented the following as some of the programmes and activities of NAC:
- Provision of monitoring and evaluation of the HIV response in the country; facilitating strategic planning and implementation of the National Aids Strategic Plans for the country; establishing and realising appropriate HIV and AIDS mechanism structures at various levels; promoting advocacy for action to fight HIV and AIDS as well as encouraging and supporting documentation and sharing of best practices and lessons learnt to facilitate the expansion of the response.
- Providing HIV treatment through provision of antiretroviral therapy (ART) and also providing nutritional support wherever possible; creating an enabling environment for the implementation of HIV programmes and by ensuring meaningful involvement of people living with HIV in the response.
- In terms of management of the AIDS Levy, Mr. Yekeye informed the Committee that the biggest chunk of the resources that NAC receives, which is 50% of the resources was meant to support the antiretroviral therapy (ART) programme in Zimbabwe. He also stated that NAC was supposed to buy medicines, laboratory equipment, and reagents and support the Tuberculosis (T.B) programme using 50% of the resources.
Mr. Yekeye, highlighted the following as challenges NAC was facing in executing its mandate:
- NAC was failing to access foreign currency to procure ARVs. The AIDS Levy was collected in RTGS and securing foreign currency to buy ARVs from foreign suppliers remained a challenge. However, according to the Reserve Bank, NAC was under priority number one, and as a result would get remittances from time to time.
- There was over reliance on donors as about 85% of HIV funding was coming from donors. Once donors change their priorities, funding for the HIV response also dwindles.
- The formal sector employment was shrinking resulting in reduced revenue source of the National Aids Trust Fund. So NAC was able to tax those in formal employment but it was very difficult to collect tax from the 80% of the people who are in informal settings.
- NAC was having challenges in finding newly HIV infected people. Those who knew their HIV status for the first time were becoming fewer and fewer due to challenges in accessing testing and counselling services due to religious backgrounds. There were also challenges in accessing services by some emerging key populations such as sex workers, men having sex with men, small scale miners (makorokoza), vulnerable groups such as adolescent girls and men who have poor health seeking behavior. It was comforting to note that NAC at the time of the enquiry, was already working on programmes that were aimed at encouraging these populations to get tested and know their status.
- State of the Antiretroviral Therapy (ART) Programme in the selected health institutions:
Antiretroviral (ARV) Drug Supply:
A visit to the National Pharmaceutical Company (Natpharm) in June 2019 revealed that the institution had in stock, the First Line ARVs wholly funded by the Global Fund, and was expected to last up to the first quarter of 2020. However, there was shortage on the Second Line ARVs which were wholly funded by Government of Zimbabwe (GoZ).
The Committee learnt that there was also an outcry of the shortage of the First Line drug at some health facilities, while Natpharm was overstocked with this drug instead of delivering it to health facilities. Natpharm indicated that it used demand system in its distribution system whereby it received orders from health institutions to deliver ARVs. It further explained that sometimes the medicines would be out of stock in health facilities while at national level there would be adequate stock. Shortages of First Line ARVs could be due to delays by health institutions to restock or distribution inefficiencies within the health value chain system.
Institutions such as Kuwadzana and Mabvuku Polyclinics in Harare, Wedza Rural Hospital, Mukamba in Wedza, Mazowe Clinic in Mazowe and Habane Clinic in Gwanda, reported that they had shortages of ARVs particularly, the Second Line drugs and cotrimoxazole which are wholly funded by the GoZ through the AIDS Levy. Some institutions, such as Mazowe Clinic also reported shortages of pediatric ARVs. Nyanyadzi Rural Hospital reported on stock-outs of HIV testing kits. The shortage of cotrimoxazole was said to have retrogressive side effects as clients suffered from many opportunistic infections which were preventable and manageable.
In some situations, the shortage of the Second Line drug had resulted in corruption at some health institutions. People Living with HIV and AIDS at Kuwadzana Polyclinic alleged that corruption was thriving at Wilkins Hospital as clients had to pay bribe to some health staff US$2.00 for a 3-months’ supply and US$5.00 for 6 months’ supply.
Shelf-Life Extension of Expired ARVs:
The Committee learnt that the Ministry of Health and Child Care
authorised the extension of shelf life of ARVs among other drugs and
medicines. This revelation was quite disheartening to the Committee
which sought to understand the rationale behind this development. A
representative, from the Medicines Control Authority of Zimbabwe.
Mr. Wekwete, presented the genesis of this practice which he said dates back to 2008 when the country experienced sharp economic decline and was struggling to supply new stocks of medicines and drugs in its health facilities.
Although Mr. Wekwete went to town explaining how rigorous the process for the shelf life extension was, the Committee questioned the ethical considerations that were made before making such a resolution. It was further explained that there was a dilemma where two undesirable options had to be weighed: whether to test and allow the patient to take an ‘expired’ product that has been deemed suitable for use by laboratory testing or allow the patient to default treatment if there is no new stock available at that time. This scenario compelled the then Ministry of Health and Child Welfare to resolve to extent the shelf life of some medicines and drugs.
Be that as it may, the Committee expressed concern on the therapeutic benefits and whether clients do not experience more side effects than when taking the ARVs within its shelf life. However, the Committee learnt that there were no indications of any follow up on clients to ascertain the efficacy of the expired ARVs with shelf life extension.
Management of Expired drugs
During the fact-finding visits, institutions revealed that drugs expire because of either over supply by Natpharm that or short-dated drugs. At the time of the visit, Mpilo Central Hospital reported that 200 patients had been administered with shelf-life extended ARV drugs and they had done the same in 2019 and 2020. Filabusi District Hospital and Habane Clinic reported that there had never dispensed expired drugs while Concession District Hospital reported that there were no expiries from 2020 to the first quarter of 2021.
When drugs expire, a body of survey would be conducted and papers are send to headquarter to get approval to dispose of them. However, institutions were faced with challenges of transportation of the expired drugs to the place of incineration. It was reported that monthly reports on expired drugs were sent to the provincial pharmacists.
Integration and Decentralization of Services:
The Committee was informed that the MoHCC had put in place a policy that allowed for integration of health services. This means that clients no longer have to see different nurses in different rooms or locations to access HIV services. Several services such as Visual Inspection with Acetic Acid and Cervicography (VIAC) screening services, Tuberculosis (T.B) screening and Family planning services among others were now being provided under one roof. The institutions visited applauded the MoHCC for such a good initiative of a “one stop shop” as it provided convenience to clients.
The institutions also applauded the MoHCC for decentralizing HIV and AIDS services to the clinic level. At clinic level, nurses can now test and treat clients and only do referrals to higher levels of care for those who require further management. However, it was suggested that these lower levels of care should have CD4 Count and Viral Load machines for the convenience of clients.
Prevention of Mother -To - Child Transmission (PMTCT) of HIV:
PMTCT is defined as the most common way young children contract the virus, and happens when HIV is passed from a mother to her unborn baby during pregnancy, birth or breastfeeding .PMTCT services were being offered in all the institutions that were visited by the Committee and focused mainly on: Preventing unintended pregnancies among women living with HIV; Preventing HIV transmission from a woman living with HIV to her infant; and Treatment, care, and support to women living with HIV, their children, and families.
The Committee was informed that viral load is done on all HIV positive pregnant women who are on ART at first ANC visit and repeated 6 months throughout the breastfeeding period. Pregnant women not yet on ART or those newly diagnosed to be HIV positive on the first ANC booking should be initiated on ART on the same day of first booking and should get a viral load after 3 months of enrolling on ART.
HIV Testing and Preventive Services:
HIV Testing and Counselling was offered to all willing clients in all the institutions that the Committee visited. Concession District Hospital informed the Committee that it also offered HIV Testing services in schools and children in schools were more than willing to get the service. However, consent should be sought from parents and guardians for children under 16 years.
During the visit, the Committee was informed that there are some populations that are difficult to get for HIV Testing services and these include men, small-scale miners (makorokoza), sex workers, men who have sex with men. Institutions that attested to having challenges in providing services to mobile populations or small-scale miners included: Umzingwane Clinic, Mbizo 1 Clinic, Mazowe Clinic and Nyanyadzi Clinic. The Committee was informed that NAC came up with programmes such as moonlight services, roadshows in order to encourage uptake of HIV Testing services among these populations.
Most of the institutions reported that they also provide HIV self-testing kits to clients, however, Nyanyadzi Clinic reported that it had stock-outs at the time of the visit. In terms of HIV preventive services, some institutions reported that they had ran out of condoms for example, Mazowe clinic indicated that their catchment area had high consumption of condoms. Other preventive services that were stated include Pre-Exposure-Prophylaxis (PreP) which is mainly used by sex workers.
Laboratory Services and Equipment:
Most of the health facilities reported either lack of CD4 Count or Viral Load or non-functioning machines due to technical faults or lack accessories. For instance, Mabvuku Polyclinic reported that it had the capacity to conduct CD4, Viral Load and other advanced tests but the machines were not functioning. At clinic level, the Ridders collected viral load specimen on specific days of the week and sent them to a district hospital where the turnaround time was said to be 2-3 weeks. However, for those who come outside the stipulated days, a system called Dried Blood Spot (DBS) was used and the specimen were sent to Harare where the turnaround time was up to a month as the laboratories were busy. In cases, where some district hospitals did not have CD4 Count and Viral Load machines, the institutions, would send their samples to other nearby district/provincial hospitals offering the services or to Harare.
Mpilo Central Hospital reported that the Opportunistic Infections (O.I) Clinic did not have the relevant equipment to conduct a test on alternative drugs to administer to patients that would have failed to respond positively to the 2nd line ARV drugs. At the time of the visit, the Committee was informed that the test costed about US$700.
Patients pay for laboratory services such as urea and electrolytes, liver, kidney function test and full blood count. These services cost US$3 each. It was reported that the clinic did not have a CD4 machine but conducts the tests using rapid test reagent
The staff establishment of 1981 has not been reviewed despite the growth in the population and increase in disease burden. Although all the health institutions reported that they had well trained and qualified health personnel stationed at their O.I Clinics, they lamented that there was an increase in the catchment population size hence, the need for more dedicated human resources. The health workers applauded the GoZ for the efforts made in addressing their conditions of service and salaries, especially payment of Covid-19 risk allowances. However, they recommended that more should be done in order to retain human resources in the health sector.
The infrastructure in some institutions was dilapidated with other institutions experiencing limited space. For example, the O.I Clinics at Concession District Hospital and Mpilo Central Hospital were so small that the officials had to use open areas to provide services to HIV and AIDS clients.
Kuwadzana Polyclinic had dilapidated buildings and its ablution facility was not functioning. Nyanyadzi Rural Hospital also needed expansion and facelift. At Filabusi District Hospital, the buildings were falling apart, rendering it grossly inadequate for its function. Mpilo Central Hospital officials reported that the roof in the pharmacy was leaking during rainy season and this affected the state of drugs in stock.
The challenges below were highlighted in most of the health centres visited by the Committee.
- All the health centres reported that they were understaffed especially when taking into consideration the increasing number of primary health care services as well as the increasing population in their respective areas.
- Most health centres reported that they were in urgent need of a Sister-In-Charge and/or substantive staff at the health centres. In most cases, most health centres had staff that were in acting positions.
There was a widespread shortage of 1st and 2nd line drugs. In all the health centres, it was also reported that Cotrimoxazole was in short supply with some health centres having last received a consignment in 2018. This has resulted in an upsurge in opportunistic infections. Third line drugs were only available at provincial health centres.
All health centres did not have functional testing equipment and were thus unable to provide VLM, VIAC, and other related tests and services to their clients. Additionally, the supply of accessories for testing machines was erratic leading to inefficiencies in the provision of these critical testing services.
All health centres highlighted that they did not have the capacity to transport their specimens to the testing centres. Moreover, it was highlighted that the health centres did not have fully equipped ambulances to provide efficient emergency response.
It was again highlighted that most of the clients were willing to pay for services using the United States Dollars. However, due to the Government policy, the health centres could not accept the USD denominated payments.
It was further highlighted that the lack of a national integrated patient monitoring database had negatively affected patient monitoring and increased the defaulting rate.
From the above findings, the Committee made the following observations:
Lack of CD4 Count and Viral Load machines affected consistent monitoring of clients rendering the service delivery system inefficient in some institutions.
Shortages of pediatric, 2nd Line ARVs and cotrimoxazole can lead to an increase in opportunistic infections and in some cases, corruption and bribery at health facilities thereby short-changing HIV and AIDS patients.
Deplorable infrastructure and limited office space and service provision lead to overcrowding in the health facilities.
Challenges in following up the defaulters for example, makorokoza and other mobile populations may derail the target of ending AIDS by 2030.
Security issues on drug storage facilities are in a dire state especially at Filabusi District Hospital.
One sample is used to confirm the therapeutic value of expired drugs yet these are stored in different environments across the country.
Shortages of ambulances and service vehicles affect the smooth running of the referral system and cripple general operations at the institutions. Delays by some institutions to place orders led to overstock of the First Line ARV drug at Natpharm.
Restrictive policy on use of foreign currency were affecting the institutions especially when they wanted to purchase fuel which is mainly sold in United States of America Dollars while they charge user fees in Zimbabwean Dollars.
Over-dependency on donor funding could be catastrophic to the health service delivery system in the country should the donors pull out at any given time.
In light of the above observations, the Committee made the following recommendations:
MoHCC must ensure that all levels of care are equipped with CD4 Count and Viral Load machines by August 2022.
MoHCC should come up with innovative strategies to mobilise resources for the purchase of pediatric ARVs, 2nd Line ARVs and cotrimoxazole. Furthermore, the MoHCC should put in place whistle blower mechanism such as a hotline for people to report cases of corruption and bribery by June 2022.
MoHCC should prioritise the refurbishment and renovation of some health institutions as well as the expansion of other institutions in the 2022 Ministry’s budget.
MoHCC should put in place more effective mechanisms for follow-ups on hard to reach populations, for example, intensive awareness programmes and the use of Health Centre Committees at health facilities by June 2022.
Going forward, MCAZ should consider having samples of the expired drugs from each health facility as opposed to using one sample whose environment may be different from the rest with immediate effect.
MoHCC should provide ambulances and motorbikes for small centres in the 2023 national budget.
MoHCC at all times, should ensure institutions have adequate stocks for ARVs and consider 6 months’ supply to clients as opposed to 3 months’ supply.
Ministry of Finance and Economic Development should ensure that the MoHCC is allocated the 15% in line with the Abuja Declaration and that funds are disbursed on time and in full annually.
The Minister of State and Devolution in Matebeleland North should consider setting aside part of the Devolution Funds for the facelift of Filabusi District Hospital and other institutions in the Province in the 2022 Devolution Fund budget allocation.
The Committee’s overall assessment on this enquiry is that the country is on the right track in terms of the implementation of ART-Roll-Out programme. The Committee applauds the MoHCC and government in general for ensuring that People Living with HIV access services to have prolonged health lives. However, a few areas need to be attended to as recommended by the Committee. That way, Zimbabwe would be able to end AIDS by 2030. I thank you.
I move that the debate do now adjourn.
HON. SEN. MATHUTHU: I second.
Motion put and agreed to
Debate to resume: Wednesday, 16th March, 2022
SECOND REPORT OF THE THEMATIC ON HIV AND AIDS ON THE IMPLEMENTATION OF THE ANTIRETROVIRAL THERAPY (ART) ROLL-OUT PROGRAMME
HON. SEN. KAMBIZI: I move the motion in my name that this House takes note of the Second Report of the Thematic Committee on HIV and AIDS on the Implementation of the Antiretroviral Therapy (ART) - Roll – Out Programme in the selected Health Institutions in Zimbabwe (S.C.5, 2022).
HON. SEN. TONGOGARA: I second.
HON. SEN. KAMBIZI: Mr. President, the outbreak of Coronavirus (COVID-19) was first reported in Wuhan, China, in December 2019. The World Health Organisation (WHO) declared the outbreak as a Public Health Emergency of International Concern on 30 January 2020, and a pandemic on 11 March 2020. There was further international spread of the virus to many parts of the world and Zimbabwe was not spared as it recorded its first case on 20th March 2020 and first death on 23rd March 2020.
1.2 Shortly after the first death and as the number of infections
increased, His Excellency, the President of the Republic of Zimbabwe, Dr. Emmerson Dambudzo Mnangagwa, declared a 21-day national lockdown which commenced on 30th March 2020. In spite of that, the country continued to record an increase in the number of infections from imported cases and later from local cases. This compelled the President to extend the lockdown measures by a further 14 days and on 17 May 2020, he declared an indefinite shutdown, with restrictions subject to review every fortnight.
1.3 In light of the foregoing and pursuant to its oversight function, the Thematic Committee on HIV and AIDS resolved to enquire into the HIV and AIDS service delivery during the Covid-19 lockdown period in Zimbabwe. Thus, this report is a summary of key findings of the enquiry that took place between February 2021 and June 2021. Hence, the report should be read with the afore-mentioned period in mind as changes in the management of Covid-19 pandemic may have occurred thereafter.
The objectives of the enquiry were:
- To determine the extent of the HIV and AIDS service provision in the context of Covid-19 pandemic;
- To appreciate challenges faced by HIV and AIDS service providers and recipients of care during the Covid-19 lockdown restrictions;
- To assess the impact of Covid-19 lockdown on HIV and AIDS service delivery; and
- To recommend strategies for improved HIV and AIDS service delivery in the wake of Covid-19 pandemic.
3.1 The Committee held virtual oral evidence meeting with the Acting Permanent Secretary for the Ministry of Health and Child Care, Dr. Owen Mugurungi and the Chief Executive Officer of the National AIDs Council, Dr. Bernard Madzima on the 1st of March 2021. The purpose of the meeting was for the Committee to get firsthand information on the status of HIV and AIDS service delivery system in the context of Covid-19 pandemic.
3.2 The Committee also held physical oral evidence meetings with the following:
3.2.1 The Zimbabwe AIDS Network and Zimbabwe Network of People Living with HIV presented on access to HIV and AIDS Treatment and Services during the Covid-19 lockdown restrictions in Zimbabwe on 29th March 2021;
3.2.2 The Pharmaceutical Society of Zimbabwe briefed the Committee on the status of Antiretroviral drugs (ARVs) manufacturing in Zimbabwe on 3rd May 2021;
Varichem Pharmaceutical Company highlighted the factors that caused the entity to stop the production of ARVs;
3.2.3 The Medicines Control Authority of Zimbabwe (MCAZ) representative, Mr. Wekwete presented on the registration process of medicines and drugs in Zimbabwe and the entity’s role in the revamping the production of ARVs in Zimbabwe on 24th May 2021
3.6 The Permanent Secretary for the Ministry of Industry and Commerce, Dr. Mavis Sibanda, briefed the Committee on measures put in place to promote the local manufacturing of ARVs on 14th June 2021; and
3.7 A representative from the Reserve Bank of Zimbabwe, Mr. Masendu explained issues relating to the non-awarding of the full value of the nine bids that NAC won between the months of July and November 2021.
3.8 Furthermore, the fact-finding visits were conducted from 17-20 May 2021 to ART-Roll-Out institutions, to gather more evidence on HIV and AIDS service delivery in the context of Covid-19 pandemic.
4.0 FINDINGS OF THE COMMITTEE
4.1 Disruptions in services supply chains at Facilities Level and Uptake of HIV and AIDS Services
4.1.1 Evidence gathered by the Committee revealed that the Covid-19 restrictions resulted in stoppage of non-emergency medical care at health institutions as attention was shifted to Covid-19 related care and emergency preparedness capacity building. Such a situation led to disruptions in supply chains of consumables for medical care in general and HIV and AIDS in particular. Representatives of People Living with HIV (PLWHI) confirmed that Covid-19 lockdown restrictions disrupted access to HIV and T.B services in terms of: prevention services; testing and counselling services; treatment; and supply chain of medical commodities.
4.1.2 During the fact-finding visits the Committee learnt that schedules for prescription refills and routine laboratory monitoring tests were also disrupted in some institutions, resulting in either a shortened or prolonged supply. For instance, Nkulumane Clinic reported that it was giving two weeks’ supply of ARVs due to stock-outs and Concession District Hospital gave 6 months’ supply. Consequently, its stock depleted at central level. Mazowe Clinic reported that it had stock-outs of pediatric ARVs. There were also reports that the COVID-19 pandemic restrictions further worsened the shortages of Cotrimoxazole and 2nd line ARV drugs in most institutions. In worst cases, institutions were forced to close. Mabvuku Polyclinic closed twice during the period under review due to the exigencies of COVID-19 pandemic that affected the staff.
4.1.3 The Acting Permanent Secretary for the Ministry of Health and Child Care, Dr. Mugurungi, informed the Committee learnt that
resources for HIV and AIDS were channeled towards the fight against Covid-19 pandemic. In support, the representatives of People Living with HIV also informed the Committee that Covid-19 pandemic was prioritised ahead of HIV and Tuberculosis (T.B) programmes as most non-governmental organisations had to redirect resources towards the fight against Covid-19 pandemic. Thus, they attributed shortages of HIV self-testing kits and condoms to the diversion of resources.4.1.4 It was also reported that there was reduced number of staff at Outpatient at some health facilities since more staff were assigned to COVID-19 related duties.
4.1.5 Dr. Mugurungi informed the Committee that there was a sharp decline in HIV Testing between January and June 2020 compared to the same period 2019 as the COvid-19 induced lockdown restricted movement of people. Some HIV and AIDS prevention programmes such as Voluntary Medical Male Circumcision and road shows were curtailed consequently, due to reduced number of people tested, the number of people initiated on treatment was reduced. The number of follow ups was also reduced.
4.1.6 Dr. Mugurungi further informed the Committee that the number of pregnant women booked for Antenatal Care (ANC) visits declined by during the Covid-19 lockdown restrictions in 2020. However, most sites continued to offer ANC services during the lockdown period and ANC service significantly improved.
4.2. Interventions by the Ministry of Health and Child Care and other stakeholders
4.2.1 Dr. Mugurungi informed the Committee that although the Government of Zimbabwe (GoZ) had made significant progress in responding to HIV epidemic, the recent Covid-19 pandemic became one of the most significant threats in HIV programming in the country. He however, stated that in spite of the threat posed by Covid-19 pandemic, the MoHCC instituted various innovations to ensure that communities continue to access essential HIV services by:
- The Ministry Disseminated Comprehensive HIV Communications Strategy
- It provided guidance on provision of essential health service with the following Guiding principles:
- -Protect & Maintain gains achieved in fight against HIV;
- -Adapt service delivery to assure safety of Healthcare Workers;
- -Reduce risk of transmission of Covid-19 among recipients of care; and
- -Maintain social distancing
- It developed and coordinated Information, Education and Communication (IEC) materials on COVID-19 pandemic and HIV.
4.2.2 The Ministry introduced multi months dispensing (clients to get minimum 3 months- max 6 months ARVs). However, Dr. Mugurungi pointed out that some of the ARVs were not available and the Ministry was forced to rationalise to less than the intended minimum of 3 months’ supply. There were challenges in sourcing the medicines from the source countries due to lock down restrictions. More so, when the lockdown restrictions were lifted, there were limited flights to bring the medicines into country. Representatives of PLWHI reported that prior to the outbreak of Covid-19 pandemic, shortages of ARVs especially the 2nd line medicines were a perennial problem which got worsened by Covid-19 induced restrictions. They also reported that there were no pediatric ARVs at some facilities such as Makoni District, where some health facilities were forced to improvise for the pediatric ARVs. In other instances, people ended up sharing the ARVs in communities.
4.2.3 The Ministry also introduced Differentiated Service Delivery (DSD), that is, tailor made to the needs of the client and decentralised treatment to allow patients to collect medicines from the lowest and nearest health facility. It also supported and facilitated the Community ART Refill Groups (CARGs) to ensure that clients get their ARVs.
4.2.4 The Ministry scaled down on some prevention activities like VMMC while increasing access to HIV self-Testing and PrEP. However, the Committee was informed that self-testing kits were not available in some remote or rural areas with the exception of Mazowe and Mberengwa.
4.2.5 The Ministry used the Information and Communication Technology (ICT) to book and follow up clients especially adolescents and young people.
4.2.6 The Zimbabwe Technical Assistance Training and Education Centre for Health (ZimTech) provided outreach programmes to dispense ARVs at health facilities in Harare during the Covid-19 lockdown period to ensure continuity in the uptake of the drugs. Some institutions visited by the Committee reported that they also had outreach teams to provide integrated services that included HIV and AIDS services and these included Wedza Rural Hospital, Concession District Hospital and Nkulumane Clinic.
4.3 Communication and Participation Deficit
4.3.1 Representative of PLWHI reported that tardy official communication of policy promotes disinformation and misinformation. They stated that there was noticeable confusion and misunderstanding among PLWHI in terms of how Covid-19 virus will affect them and what they were supposed to do. Generally, there was lack of knowledge on the nexus between HIV and AIDs and Covid-19 virus.
4.3.2 A Rapid Assessment that was conducted by the NAC, ZNNP+ and UNAIDS in April 2020 revealed the following issues:
- There was stigma and discrimination at health facilities as healthcare workers were also not clear on how Covid-19 virus could be spread and contained, hence, patients were made to stand 100 metres away from the facility or outside the gate.
- Privacy and confidentiality were no longer observed as the health worker would come out and request PLWHI to identify themselves in the presence of other patients. Moreso, at police roadblocks, PLWHI were forced to disclose their status as letters granting them permission to travel were required at roadblocks.
- There were mental health issues due to depression and anxiety among PLWHI.
4.3.3 Representatives of PLWHI also expressed concern over their exclusion in the Covid-19 vaccination programme as they have a vital role to play especially in assisting with information dissemination to their members.
4.4 Economic Effects on the Livelihoods of PLWHI
4.4.1 Representatives of PLWHI reported that most of PLWH were economically disempowered because their source of income had been eroded. They stated that this increased the levels of vulnerability among PLWHI and resulted in the rise of Gender Based Violence (GBV) cases.
4.5 Local Manufacturing of ARVs
4.5.1 Varichem, a local company was among the first companies in Africa to manufacture fixed dose combination ARVs in 2003/2004. It was among the three (3) companies to achieve the WHO pre-qualification for ARVs in Africa. The Committee also learnt that historically, some HIV medicines were procured locally. However, changes in treatment regiments and increase in donor activity reduced demand for locally manufactured medicines. Verbal pronouncements on local manufacturing support were not backed by clear written policies and signed contracts. As a result, almost all ARVs were being imported because local manufacturers had dis-invested in ARV drug. Treatment guidelines were also changing approximately every two years thus, return on investment in ARVs was not guaranteed.
4.5.4 The conditions of donor procurement through international tenders were not easy to meet thus, blocking out local manufacturers and discouraging investment in ARVs. Donor procurement accounted for approximately 80% of consumption in the country.
4.6 Challenges in the local production of ARV drugs
4.6.1 WHO pre-qualification is required to achieve economies of scale and be competitive, which is an additional cost. This will also allow participation in the donor funded procurements.
4.6.3 Erratic the supply of electricity and water and the quality of water does not meet the standards for ARV manufacturing.
4.6.4 Lack of financial support into scientific research of new formulas made it difficult for manufacturers to produce internationally acceptable new ARV regiments.
4.6.5 The lead time for the registration of drugs and medicines of 12-24 months is too long and does not allow the manufacturers to be able to recoup the costs of manufacturing ARV drugs.
5.0 Initiatives by the Government of Zimbabwe to resuscitate the Pharmaceutical Sector
5.1 The Permanent Secretary for Industry and Commerce briefed the Committee on the various initiatives by the Government of Zimbabwe (GoZ) aimed at promoting the local production of pharmaceutical products. One such initiative was the implementation of Pharmaceutical Strategy for Zimbabwe (2021-2025) which was launched in the first week of June 2021 and was aimed at achieving the following:
- Increased market share of local pharmaceutical products from 12% to 35% by 2025;
- Increased local production of essential medicines from 30% to 60% by 2025;
- Increased sales revenue of local production from US$31.5 million to USD150 million by 2025;
- Increased new product registration from 5% to 20% by 2025;
- Improved compliance to Good Manufacturing Practice (GMP) for at least four (4) companies by 2025; and
- Improved export of pharmaceutical products from 10% to 25 by 2025.
5.2 The Permanent Secretary informed the Committee that the above targets will be achieved through implementation of the following strategies:
- Product diversification;
- Market expansion;
- Upgrading of Good Manufacturing Practice (GMP) quality to international standards;
- Mobilisation of the required financial resources;
- Import Management;
- Rebate of duty on imported equipment
- Engagement with Varichem Pharmaceuticals on local production of ARVs—the Permanent Secretary for the Ministry of Industry and Commerce informed the Committee that GoZ had engaged Varichem Pharmaceuticals with the view to resuscitate local manufacturing of ARVs and that Hon. V.P Gen. (Rtd.) Dr. C.D.G.N Chiwenga had visited the company on the 10th of June 2021 on the subject matter.
5.3 The Permanent Secretary further informed the Committee that Varichem indicated that the following will need to take place before they can start production of ARVs:
- Research and Development and Bio-Equivalence test at a cost of US100 000.00;
- Expediting the process of registration of medicines by MCAZ; and
- A Signed Offtake Agreement with the GoZ to be able to recoup their investment.
6.0 COMMITTEE’S OBSERVATIONS
6.1 The Committee noted that shortages of ARVs during the Covid-19 lockdown restrictions worsened because of lack of local production of the ARVs. It applauds the Government of Zimbabwe for taking some initiatives to resuscitate ARV drugs local production.
6.2 There was apparently lack of financial support for the local production of ARV drugs.
6.3 The local market size for the consumption of ARV drugs was considered to be small or not known and this compelled local pharmaceutical companies to disinvest in ARV drug production.
6.4 There was a poor or lack of dissemination of the correct information on Covdi-19 vaccine to people living with chronic health conditions and lack of psychosocial support in communities.
6.5 Certain rights of patients were infringed on, for example, the right to privacy and confidentiality as police requested disclosure of information regarding patients’ movement during the lockdown and health service providers were asking patients to que for services in accordance with their health conditions.
6.6 The lead time for the registration of ARV drugs is too long (12-24 months) and discourages local pharmaceutical companies from investing in view of the fact that the drug regiment changes very often (from 2-5 years) such that by the time it gets registered, the drug may be considered to be outdated on the market. This would lead to losses by the manufacturing company as it would fail to recoup the costs it incurred during production of the drug.
6.7 Apart from costs, erratic supply of water and electricity also affected production of ARV drugs by local companies.
7.1 Ministries of Finance, Health and Industry should support local pharmaceutical companies to ensure predictable supply of ARV drugs in the country by July 2022.
7.2 The Ministry of Industry and Commerce should facilitate partnership between local pharmaceutical companies with Indian and other potential companies in the manufacturing of ARV drugs by September 2022.
7.3 The Ministry of Industry and Commerce should consider making it mandatory for local health institutions to procure ARVs from local manufacturers in order to create the market for the product in support of local manufacturing of ARVs by December 2022.
7.4 Ministry of Health and Child Care (MoHCC) should put in place measures to ensure continuous provision of adequate and appropriate information on Covid-19 virus to communities particularly people living with chronic health conditions. These measures should include continuous training of Village Health Workers to provide such services to the communities. In addition, NAC should also continue to vigorously use all its structures to disseminate the information on Covid-19 virus and HIV and AIDS.
7.5 Ministries of Health and Home Affairs should institute training programmes to ensure rights of patients are not violated during the restrictions on movement and gathering of people by June 2022.
7.6 MCAZ should consider shortening the lead time of registering ARV drug from 24 months to 3-6 months by June 2022.
7.7 Companies can as well come up with own arrangements to ensure cheap supply of water and electricity by investing in solar and drilling of boreholes.
It is evident from the findings of this enquiry that Covid-19 pandemic had short-changed HIV and AIDS patients in various ways in terms of receiving their normal services. The Committee applauds the MoHCC for making efforts to secure interventions that helped in sustaining the service delivery during this pandemic. Be that as it may, the Committee encourages the Government of Zimbabwe to prepare itself adequately for such pandemics in future. I thank you.
*HON. SEN. TONGOGARA: Thank you Madam President. I want to thank Hon. Kambizi for presenting the report that we just heard which is very clear and demonstrates that ARVs are not being distributed fairly. I would like to thank the Committee on HIV/AIDS for the good job that they did, moving around different hospitals and taking note of the challenges. They also visited NatPharm to see the state of affairs there. The visit gave us knowledge that we still have a lot of things to be fixed. We noted that first line ARV drugs are being received as donations. We cannot rely on donor funding in case one day they might just wake up and decide to withdraw their donations, then we will face a big challenge as a nation.
Our clients who are beneficiaries of ARVs who are HIV positive might be facing some challenges. The second line drugs are in short supply at NatPharm and different centres because our Government did not procure these ARVs. The ARVs that are in stock are being sold to clients, some are being sold for US$3 and they are receiving their three months supply and some are going for US$6 for a six month supply. This is a challenge because it is difficult to raise such monies. People who are living with HIV are the ones who are suffering because ARVs are being sold yet they are supposed to be given for free. This implies that there is corruption in the distribution of ARVs. People are forced to buy drugs that are meant to be given for free and this is corruption. At the end of the day, if one needs these drugs, they do not have an option but to buy so that they survive because we know that everyone is concerned about their health and no one wants to die.
We also noted that other hospitals are not in a good state for example Filabusi District Hospital is dilapidated. The roof cannot be repaired because it is beyond repair. People go to this hospital but it is not safe for the staff and patients. The report mentioned that the devolution funds should cater for that district so that this issue is pursued. If patients are admitted or attended to in a hospital without proper infrastructure, the condition of the patient might be worsened. I would also like to thank the Ministry of Health for the good job that they are doing. If the decentralisation that is obtaining right now...
THE TEMPORARY PRESIDENT OF SENATE: You are not connected. You can continue.
*HON. SEN. TONGOGARA: Should I start from the beginning.
THE TEMPORARY PRESIDENT OF SENATE: No, you can continue from where you left.
*HON. SEN. TONGOGARA: I was saying that I would like to thank the Minister of Health and Child Care because we heard that services were decentralised, it is no longer necessary to go to places far to get assistance, everything is central and all service are obtained at one place. This is quite beneficial in that you go to one hospital and you are attended there. People need confidentiality and when people are ill, they need confidential consultation between the health staff and the patients. People will be free to seek medical assistance knowing that they will not be heard by other people.
There is shortage of CD4 counting machines, so I would like to urge the Ministry of Health and Child Care to look into the issue so that the medical equipment is replaced or new machinery bought. Nurses and doctors need to diagnose their patients using diagnostic sets which assist them in discharging their duties correctly. They must be confident that what they are doing is the right thing because they will be having the right machines.
Madam President, I would also like to end by saying that the report is a good report. We appreciate and believe that the recommendations should be taken to the relevant Ministry so that the different challenges are fixed so that our hospitals would function properly. This is going to help also in assuring that the funds from the Abuja Declaration will be allocated to the Ministry so that things go well. Our patients should receive good quality health care because there will be proper funding for all the necessary drugs and equipment. I thank you Madam President for giving me this opportunity.
HON. SEN. KAMBIZI: I move that the debate do now adjourn.
HON. SEN. TONGOGARA: I second.
Motion put and agreed to.
Debate to resume: Wednesday, 16th March, 2022.
BUSINESS OF THE HOUSE
HON. SEN. MUZENDA: I move that Orders of the Day, Numbers 4 to 7 be stood over until the rest of the Orders of the Day on today’s Order Paper have been disposed of.
HON. SEN. TONGOGARA: I second.
Motion put and agreed to.
CONSTRUCTION, UPGRADING AND REHABILITATION OF THE ROAD NETWORK IN THE COUNTRY
Eighth Order read: Adjourn debate on motion on the importance of a sound road network.
Question again proposed.
(v)HON. SEN. MABIKA: Thank you Madam President. I rise to thank all those who contributed on this, motion. I now move for the adoption of the motion.
Motion that this House;
COGNIZANT that a sound road network is the nerve centre of economic development;
NOTING with concern that the Chipinge Mt. Selinda road right up to Espungabeira Border Post has not been attended to, resulting in its current state of disrepair;
ANTICIPATING the huge benefits that can be accrued to the country if this road and other similar roads country wide could be given a facelift;
ALSO NOTING that the Border post at Mt. Selinda has the potential of being developed as an investment centre and the shortest route to the port of Beira from Zimbabwe thereby enhancing the ease of doing business in the country;
NOW, THEREFORE this House,
CALLS upon the Ministry of Finance and Economic Development to avail through the Ministry of Transport and Infrastructural Development adequate funding for the construction, upgrading and rehabilitation of the road network in the country,
APPLAUDS the Second Republic for the commendable efforts taken to fulfil the aspirations of the people by embarking on tangible developmental programmes that have become the order of the day country wide, put and adopted.
PRESIDENTIAL SPEECH: DEBATE ON ADDRESS
Fourth Order read: Adjourned debate in reply to the Presidential Speech.
Question again proposed.
HON. SEN. KAMBIZI: I move that the debate do now adjourn.
HON. SEN. MATHUTHU: I second.
Motion put and agreed to.
Debate to resume: Wednesday, 16th March, 2022.
CONDOLENCES ON THE DEATH OF HON. SEN. SIMON KHAYA MOYO
Fifth Order read: Adjourned debate on motion on the untimely passing on of the late Senator for Matabeleland South, Hon. Senator Simon Khaya Moyo.
Question again proposed.
HON. SEN. MATHUTHU: I move that the debate do now adjourn.
HON. SEN. TONGOGARA: I second.
Motion put and agreed to.
Debate to resume: Wednesday, 16th March, 2022.
PREVALENCE OF DRUG ABUSE BY YOUTHS
Sixth Order read: Adjourned debate on motion on the devastating effects of drug abuse by youths.
Question again proposed.
*HON. SEN. SIPANI-HUNGWE: Thank you Madam President for affording me this opportunity. I would like to thank Hon. Sen. Dube for a very pertinent motion of our children who are being affected by drug abuse. Our children are abusing drugs and as parents and citizens of Zimbabwe, we should come up with ways so that our children leave drugs. The challenge we have is that the drugs that the children are abusing are being sold by people who are known but they are not prosecuted. In light of this, we urge our Government to be really involved and craft laws which can nail all those who are selling those drugs. They should be given stiff penalties.
We are looking up to that generation as tomorrow’s leaders. They are the ones who are going to take up from where we would have left. This means that children should be monitored closely. Parents who do not monitor what their children are drinking, the law will take its course on them. You will find the girl child being abused because they have been drugged. We just wonder what this country is going to be. We expect those girls to be tomorrow’s mothers. It means our nation is being destroyed.
As leaders, we should vigorously educate our communities, campaign in churches for stoppage of drug abuse. We should even talk negatively about this even in our political parties. Our communities should be well engaged until our children stop abusing drugs.
The Government should come up with rehabilitation centres where these children will be taken for rehabilitation purposes and counselling. Our country is now shattered. They now even abuse cough syrup which they are using as a drug. May be it is due to technology which they are so much exposed to.
As Parliament together, let us go and engage the communities where we come from so that we educate the children against the dangers of drug abuse. Some say that engaging in drug abuse affects the fertility of the youths. We are saying all that should be investigated. The Ministry of Health should be involved and investigate so that our children are healthy.
The youths who are taking drugs are not healthy at all. As leaders let us go out there and engage our communities by doing awareness campaigns so that we teach children not to take drugs. I thank you.
(v)*HON. SEN. CHISOROCHENGWE: I would like to thank the mover and the seconder of this motion. Surely drugs have destroyed young people - a lot of them are now depending on drugs. If you look at our communities where we come from, if you see five or six youths getting into the forest, they are going there to take drugs. There is no life to them because their health has been destroyed. They end up being affected by AIDS because of this drug abuse.
Government should come up with stiffer penalties for those who are peddling drugs to our youths. There are some drugs which are being smuggled into our country through illegal entry points, that should be investigated. For those who are doing drug trafficking, stiffer penalties should be given to them. Some drugs like Crystal Meth are being smuggled into the country and these things should be investigated because it is affecting our children mentally. We are now afraid of our children because they no longer have respect to anyone even to us parents.
A you walk into the streets there you find a lot of kids saying a lot of obscenities. These days our children are so intelligent and we do not know whether it is being caused by drugs. We do not know how we are going to end this as parents. We should put our heads together and help each other in order to come up with solutions. At times if you report to the police and when the police come to pick the drug traffickers, you find that nothing will happen to those people. They will come back and we do not know whether they are paying bribes so that they are not prosecuted.
We should unite as Zimbabweans so that we protect our children. As women in Zimbabwe we were very happy with the introduction of disposable diapers but you find that our youths now are taking those disposable diapers and extracting dangerous substances from those disposable diapers. Due to their knowledge in chemistry they take different things and put them together and they come up with drugs. Long back children would smoke marijuana but now they are no longer smoking that, they are taking substances which will drug them quickly.
I strongly recommend that people who peddle drugs should be prosecuted. The police should not receive bribes in order not to prosecute perpetrators. The issue at stake is that we are supposed to unite and come up with solutions because they are mixing different things to come up with drugs. If it were possible the youth should be given projects to do because by just sitting they will end up being involved in drugs. I urge our Government to find projects for our youth to be engaged in so that they will not be idle. I thank you.
*HON. SEN. MATIIRA: I would like to add a few words and I would like to thank Hon. Sen. Dube for moving this crucial motion. Madam President, this issue of drug and substance abuse is quite a challenge. In the past when this issue was new it was prevalent in urban areas but now it is proliferating to the rural areas where you find people selling drugs even in rural areas. This is really painful.
Looking at the situation where we find that we have old women who are looking after orphans, you find orphans taking drugs and misbehaving in front of old grandmothers who looked after them and this affects the relationships in families and in the nation. When drug abuse started in Zimbabwe it was lower in girls but nowadays you find young girls also partaking in drug and substance abuse.
You find in a homestead a boy and a girl having the same behaviour of abusing drugs and this affects their behaviour. This is really disturbing peace in the homestead and nation. My advice is that Government should take stern measures because this is alien culture which we are seeing but there are no stern measures that are being taken to curb this. For the reason that we do not have punitive laws to punish offenders, these are young people who are supposed to be leaders of tomorrow, some are destroying their livelihood, some are committing suicide and some are even drowning themselves in pools because they do not know what to do because of drug abuse. I felt that I should share a few words because indeed, this motion is very important.
Government should take stern measures so that perpetrators of illicit drug selling should be prosecuted and even being given live sentences because they are destroying young people’s lives. We are saying that these are young people who are supposed to be procreating and to be found to be creating future generations. Thank you Madam President and I would like to thank Hon. Sen. Dube for moving the motion.
*HON. SEN. CHIMBUDZI: Thank you Madam President for giving me this opportunity to support this motion which was moved by Hon. Sen. Dube. I would also like to thank Hon. Sen. Dube for moving this crucial motion and thanking those who seconded it. I stood up to support this motion because this is an important motion which speaks to people’s live styles in Zimbabwe. Drug issue is a problem in Zimbabwe. I would like to support the previous speakers who mentioned that there should be punitive laws which will punish offenders because the police cannot arrest offenders when there are no punitive laws.
The Government should promulgate laws that the people of Zimbabwe should know that there are laws. If someone commits a crime, they should know and understand the law. So, they observe and note that nothing is happening to those who take the drugs. There is a fellow Senator who spoke about rural areas. However, let me also mention that in universities and colleges, drug abuse is prevalent. This means that there is no safe place which has no drugs.
Let me say that drugs are dangerous and because of the influence of drugs, a young person can kill his/her mother, brother, sister or friend after having beer together. This is really a challenge to the nation. Parents should look after their children. They should mould the moral values of their children before they go out and end up partaking drugs. We must not leave this to Government only because these are young people who are coming into society from families where there is father and mother.
We want young people to go to school to learn and to choose their professions. Now they no longer value that. Peer pressure is bad. It was not our culture in Zimbabwe to have drugs but because of copying global culture, you find people now peddling in drugs. Even young girls are falling pregnant at a tender age. Sometimes after abusing drugs, you find some getting pregnant. This should not be expected from our young people.
The other thing that we have seen is that it is important to have laws. The Hon. Minister responsible for this debate should come and respond to issues that are being raised so that we understand where he is coming from and how he understands the issue because now it is important that people know the Government position regarding this issue. The other issue which is affecting us is seeing that young people are now populating urban areas like Bulawayo, Harare and Gweru. There are a lot of young people and they will be deceiving each other.
I do not know what the law says regarding urban migration because a lot of people are now found in urban areas. I believe that Government should solve that because we cannot have development if young people are abusing drugs. This affects their future because we are talking to young people who are intoxicated with drugs. Even if they are not working, this cannot solve problems.
If there is someone who wants to make money through drug peddling, they should be arrested and incarcerated. Offenders should be given punitive sentences so that they understand that drug peddling is not right. They will be making money yet destroying other people’s children and like what was said by other Hon. Senators, Government should do something about this because it is affecting this nation. I thank you.
HON. SEN. MUZENDA: I move that the debate do now adjourn.
HON. SEN. MATHUTHU: I second.
Motion put and agreed to.
Debate to resume: Wednesday, 16th March, 2022.
On the motion of HON. SEN. MUZENDA, seconded by HON. SEN. MATHUTHU the Senate adjourned at Five o’clock p.m.