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SENATE HANSARD 17 JULY 2019 28-57
PARLIAMENT OF ZIMBABWE
Wednesday, 17th July, 2019
The Senate met at Half-past Two o’clock p.m.
PRAYERS
(THE HON. PRESIDENT OF SENATE in the Chair)
MOTION
REPORT OF THE THEMATIC COMMITTEE ON GENDER AND
DEVELOPMENT ON CANCER TREATMENT AND CONTROL IN
ZIMBABWE
HON. SEN. NCUBE: I move the motion standing in my name that this House takes note of the Report of the Thematic Committee on
Gender and Development on Cancer Treatment and Control in Zimbabwe.
HON. SEN. RAMBANEPASI: I second.
HON. SEN. NCUBE: Thank you Madam Speaker.
1.0 INTRODUCTION
Cancer is set to overtake HIV and AIDS as the leading cause of death in Zimbabwe. The disease is often diagnosed late and with very few Oncologists in public hospitals, most cancer patients lose their lives prematurely. According to the Ministry of Health and Child Care, cancer remains a major cause of morbidity and mortality with over 5,000 new diagnosis and over 1,500 deaths per year1. The incidence of cervical cancer in Zimbabwe is reported to be 35 per 100,000 women compared to the global average of 152. Against this background, the Thematic Committee on Gender and Development resolved to conduct fact finding visits to assess the impact in the visited areas. Ten hospitals were visited including hospitals in Harare; Chitungwiza; Matabeleland North; Bulawayo; Gweru; Kwekwe; and Kadoma.
2.0 Objectives
2.1 To assess the provision of cancer services at hospitals focusing on diagnosis, radiotherapy and chemotherapy treatment; and
2.2 To ascertain adequacy of resources, infrastructure, manpower.
2.0 Methodology
On 28 January 2019, the Committee received oral submissions, from the Ministry of Health and Child Care, on cancer statistics, services and treatment challenges. The Committee also visited and toured cancer diagnosis and treatment facilities at hospitals on 4 March and 29 April 2019.
3.0 Background
According to Zimbabwe 2018 Human Papilloma Virus and Related Diseases Report, human papilloma virus (HPV) infection is now a wellestablished cause of cervical cancer and there is growing evidence of HPV being a relevant factor in other anogenital cancers as well as head and neck cancers. The World Health Organization (WHO) statistics predicted 13.2 million cancer related deaths worldwide by 2030, which is up from 7.6 million in 2008 when the last report was published.
Zimbabwe is among the top 10 countries with a huge cancer burden. Over 5000 new cancer cases are diagnosed in Zimbabwe annually. Due to under reporting there could be many more cases that are not captured by the routine National Health Information Systems. According to the Ministry of Health and Child Care, five common cancers in black Zimbabwean women are: (i) Cervical cancer 33,5 percent; (ii) Breast cancer 11,7 percent; (iii) Kaposi sarcoma 8,9 percent; (iv) Eye cancer 6,5 percent; and (v) Non-Hodgkin lymphoma 4,9 percent. On the same vein, five common cancers in black Zimbabwean men include Kaposi sarcoma at 20,8 percent; Prostate cancer 13,7 percent; Oesophageal cancer 6,3 percent; Non-Hodgkin’s Lymphoma 6,2 percent; and liver cancer 5,7 percent.
4.0 Findings of the Committee
4.1 High Incidences of Cancer
At all hospitals visited, the Committee noted that there were high incidences of cancer cases. At the West End Hospital (PSMI) in Harare, the Committee was informed that in 2018, the hospital had attended to 125 patients. The majority had their cancers at advanced stages and, as a result, 41 patients (30 percent) lost their lives. For the year 2018, Parirenyatwa Group of Hospitals received 7000 cases with 2000 fatalities, representing 29 percent. At CITIMED Hospital, in
Chitungwiza, of the 838 cases that were screened since December 2018, 40 tested positive to VIAC and referred to specialists, with 21 women having undergone cryotherapy.
Cancer statistics at Victoria Falls Hospital was equally disturbing. The Committee was informed that out of 1098 screened in 2016, 189 tested positive to VIAC; of the 698 screened in 2017, 75 had cervical cancer; of the 2 102 screened in 2018, 54 tested positive to VIAC; and that as of April 2019, 559 had been screened and 49 tested positive for cervical cancer. At St Patrick Mission Hospital in Hwange District, the Committee was informed that in 2018, 18 cases of cancers were diagnosed, 8 had cervical cancer and 10 had other cancers. The
Committee was informed that at Mpilo Central in Bulawayo, from
January to April 2019, 769 cases of cancer referrals had been received.
At Kadoma General Hospital, the Committee was informed that in
2017, 1383 were screened for cancer and 114 tested positive; in 2018,
2558 were screened and 123 were found positive; whilst from January to April 2019, only 538 had been tested and 20 of them had tested positive to cancer. In all areas, cervical cancer was described as the leading
killer.
During oral submission to the Committee, the Ministry of Health and Child Care lamented that despite the fact that cancer has high incidences and is one of the main killer diseases, it remains a nonnotifiable disease.
4.2 Shortage of Skilled Medical Personnel at Hospitals
The Committee received reports, with concern, from the Zimbabwe National Cancer Registry (ZNCR) pertaining critical shortage of skilled personnel trained in cancer diagnosis and treatment. Cancer specialists were said to be only found at Mpilo Central Hospital in Bulawayo and Parirenyatwa Group of Hospitals in Harare. In addition, the Committee noted with concern that at Victoria Falls Hospital, there was only oneVIAC trained nurse. When the nurse went on leave in 2017, VIAC department at Victoria Falls Hospital was closed for several months, denying poor cancer patients in the district diagnosis services, which they could only get in Bulawayo, 450 kilometers away. At Mpilo Hospital, a cancer referral for the whole of southern region of the country, the Committee was informed that there was no radiologist whose skills are critical in breast cancer mammography. As a result, the hospital had to outsource radiologist services from the private sector. This is expensive for patients. Similarly, the Committee was also informed that LEEP procedure could not be completed at Kwekwe
General Hospital since there was no laboratory specialist histology. Patients were therefore forced to take their samples to private hospitals for analysis at a cost of US$37, 00 which is beyond the reach of most ordinary people.
The freezing of posts in the public sector has resulted in an acute shortage of radiographers, particularly therapy radiographers, who are essential in fighting against the emerging threat of cancer and other conditions. There are less than 300 practicing radiographers in the country despite almost 40 students graduating every year from training centers. The Committee was informed by administration officials that Mpilo Hospital had received Treasury concurrence to fill 24 vacant posts for radiographers, but no applications were forthcoming. Bulawayo’s only government-employed radiographer who was based at Mpilo Central Hospital died in 2014, leaving only one based in Harare. To ameliorate the situation, the Committee was informed in all the submissions that, UNFPA continue to support the Ministry of Health and Child Care (MoHCC) to set up cancer screening and treatment centers, procurement of VIAC equipment, medical supplies, developing guidelines and training tools on screening and treating cervical cancer at public hospitals.
4.3 State of Radiotherapy Machinery and VIAC Equipment
The Committee was disturbed to note that of the five (5) radiotherapy machines, acquired in 2012 at US$10 million, three (3) at
Parirenyatwa (1 never commissioned) and two (2) (are at 95% commissioning) at Mpilo Central Hospital in Bulawayo, three (3) are down and the only operational machine was at Parirenyatwa. The Committee was informed that each of the machines can treat 70 patients per day. Due to breakdowns, Mpilo Central Hospital reported that it last offered radiotherapy in November 2018, forcing patients to travel to Harare.
However, even those machines in Harare were down at the time of the visit. The Committee was informed that patients who miss radiation therapy sessions during cancer treatment have an increased risk of the disease returning, even if they eventually complete their course of radiation treatment.
The Committee noted with concern that one (1) of the two (2) machines, Unique Linear Accelerator, at Mpilo Central Hospital, had not been installed and commissioned since 2012, though the installation commenced in 2018. Due to long period of non-functionality of some parts, need replacement before being commissioned. The Committee was told that each of the radiography cancer machine requires at least US$53 000 for repairs and service. The machines cannot be repaired by any other companies without service warrant.
The Committee was further informed that upon payment of US$2 million to the manufacturer, Varian Company based in Switzerland, the company would offer repair services any time of breakdown and the payment can be done over a period of two years. The Committee was told that the main cause of radiotherapy cancer machinery breakdowns was frequent power outages. To avoid these costly constant breakdowns, the Committee was advised that the machines can be protected through the Load Balancing Interconnect (LBI) or the Uninterrupted Power Supply (UPS), which can be procured at an approximate price of US$500 000. The Committee was pleased to note that at Mpilo Central Hospital, UPS installation was already under way.
The Committee also observed with deep concern that having all the five (5) radiotherapy cancer machines in Harare and Bulawayo cause congestions at these central hospitals since all cancer referrals would be directed to either Harare or Bulawayo. On that note, the Committee was told during deliberations in Kadoma that cancer patients find it not only expensive to travel to either Harare or Bulawayo but also that due to congestion, booking for cancer services is extremely long-drawn-out and
difficult.
VIAC and LEEP procedures at a single visit for prevention of cancer of the cervix, conducted at district hospitals and other health centres, is supposed to be accessible to the majority of women from all walks of life. However, the Committee noted with deep concern that most of the required equipment, initially donated by UNFPA, at district hospitals visited, were obsolete and constantly broke down.
At Kwekwe General Hospital, the Committee was shown old laptops, camera for VIAC and a broken down goose lamp and the nurse had to use an ordinary torch for the VIAC procedure. The Committee was told in Kadoma, that to improve efficiency and cancer screening turnaround time, the x-ray machine should be equipped with four (4) additional computer monitors and Wi-Fi so that radiologists can read and interpret x-rays from their various stations.
4.4 Funding on Cancer Treatment Services
The Committee learnt that there are different types of cancer treatment which are surgery, radiotherapy, chemotherapy, hormonal therapy and palliative care. There were said to be beyond reach of ordinary citizens as they are unable to purchase the drugs required. During oral submission, the Ministry of Health and Child Care indicated that medicines are costly for patients, especially for those whose condition was at an advanced stage. The Ministry also indicated that prostate cancer screening was very costly for ordinary citizens. The
Committee was further informed by the Ministry of Health and Child Care that cancer, which is taken care of under non-communicable disease, was only allocated $ 50 000 in 2018 budget for awareness campaigns and $75 000 under 2019 budget.
5.0 Committee's Observations
From the submissions made to your Committee and tour of cancer treatment facilities at ten hospitals, the following observations were made.
5.1 In Zimbabwe, cancer is now the second biggest killer disease after HIV and AIDS. Official health figures indicate that the disease is killing more than, 1 500 people every year. Out of this figure, 80 percent of the victims visit health institutions late for treatment when the disease is already at an advanced stage. Oncologists in Zimbabwe attributed this to either poverty or lack of knowledge about the disease.
5.2 Many people still shy away from early screening and only do so in advanced stages of the disease when not much can be done to reverse the effect. In addition, cancer treatment and management is expensive and patients have to foot other ancillary costs such as food, travelling and accommodation because treatment services are centralised at major hospitals. Centralisation of cancer services in Bulawayo and Harare has led to patients incurring extra costs for accommodation and transport.
5.3 Hospitals-community engagement programmes with regards to cancer awareness campaign remains generally low in provinces and districts, yet through cancer awareness campaign programmes and mobile VIAC services, most cancers can be prevented.
5.4 The challenges faced in preventing, screening and treating cancer are many and they include lack of human capital and material resources in the health sector. On the other hand, the public seeking such services grapple with financial and accommodation costs as most of the treatment facilities are centralised at Parirenyatwa Group of Hospital in Harare and Mpilo Hospital in Bulawayo.
5.5 While in many developed countries, notification of cancer cases is compulsory, in developing countries such as Zimbabwe, notification of cancer is not yet mandatory. The Committee realise the importance of notification in as much as it assists in the prevention and control of the disease, and reduce the burden imposed on the fiscus.
5.6 The Committee observed with concern that awareness campaign programmes and care for prostate cancer, skin cancer related to albinism were found to be relatively lower as compared to cervical cancer programmes and services such as VIAC, yet incidences of these other cancers are equally high.
6.0 Recommendations
Cancer is curable and when quickly detected, treatment is possible and death can be reduced. However, most cancer patients die because of late detection and unaffordability of treatment costs. Some even deteriorate during months of waiting for treatment. The Committee therefore, recommends the following measures to improve citizen’s access to cancer diagnosis, treatment and control services in Zimbabwe.
6.1 Apart from the need to adhere to the 15 percent Abuja target for the health Ministry, the Committee recommended the need for alternative financing for non-communicable diseases such as cancer given the specialised procedures and associated equipment. The Ministry of Finance and Economic Development should set up a Cancer Fund by
31 December 2019.
6.2 The Ministry of Health and Child Care should urgently facilitate stakeholders review and finalisation of the draft Non-
Communicable Diseases (NCD) Policy by the end of September 2019.
6.3 The Ministry should decentralise radiotherapy and chemotherapy facilities from Harare and Bulawayo to other provinces and districts of the country for cancer diagnosis, treatment and control by 31 December 2019.
6.4 The shortage of cancer doctors and nurses continue to derail treatment and care for cancer patients. The Ministry of Health and Child Care, in conjunction with universities and major hospitals, should intensify training and development of medical human capital, including VIAC in-training, post basic nursing training, oncologists and ensure that they are retained in public hospitals. This planning should be reflected in the 2020 Budget for the Ministry of Health and Child Care.
6.5 Given that more than 80 percent of cancer cases are only diagnosed at a very late stage, the National Cancer Registry and the Ministry of Health and Child Care, in conjunction with key cancer stakeholders, should roll out extensive outreach programmes akin to those of HIV and AIDS. Funding for those activities should be reflected in the 2020 Budget for the Ministry.
6.6 Considering that the causes of cancer are multifaceted in nature, its prevention and control demands a multi-sectoral approach. In that regard, the Ministry of Health and Child Care should spearhead the creation of Inter-Ministerial Committee on Non-Communicable Diseases, and this should be in place by 31 December 2019.
6.7 The Ministry of Health and Child Care should, in the 2020 Budget, prioritise improvement of infrastructure and support services at all hospitals, including accommodation for medical staff, ambulance services, communication, and transport services.
6.8 That cancer treatment should be subsidised. Free screening currently services offered to cervical cancer should be extended to other cancers, by 31 December 2019.
6.9 There is need for a Cancer Act that will address, among other issues, access to cancer treatment at all district hospitals and creation of cancer fund.
6.10 The radiotherapy and chemotherapy machines in Bulawayo and Harare together with x-ray machines, in particular Nuclear Machines in Bulawayo which requires gamma cameras and service repair should be fully repaired and commissioned by end of June 2019. All chemotherapy and radiotherapy machines which will be repaired and installed should be connected to UPS to protect them from constant and costly breakdowns due to power cuts.
7.0 Conclusion
It can be concluded that currently, the status of cancer management in Zimbabwe is still dire. Early detection, diagnostic, radio- and chemotherapy and palliative care are constrained by a number of challenges. Cancer treatment services are centralised in Harare and Bulawayo, posing challenges related to transport and accommodation costs. Frequent breakdown of radiotherapy and chemotherapy machines, due to power outages, exposes patients’ erratic treatment which makes the virus resistant to medication. Additional challenges include a critical shortage of pathologists, radiologists and surgical oncologists. With regards to treatment costs, it was concluded that many cancer patients, cannot afford fees for services such as screening, biopsy, radiotherapy and chemotherapy, and palliative care medication.
HON. SEN. MAVETERA: Thank you Madam President for
giving me the opportunity to add my voice on the report which was presented to this august House by Hon. Ncube. Let me start by saying the presentation from the Thematic Committee gives a dire situation on what is bedeviling the health delivery system in our country. Let me just zero in on the subject at hand, which is cancer treatment in Zimbabwe. I think a lot of challenges have been raised through the report.
Unfortunately, nothing has been done by our Government to ensure that people who are affected by cancer diseases are helped.
Let me say one of the things which actually affects or drains our fiscus in the health sector is treatment of cancer because most of the patients present very late. When they present very late it is very costly. Unfortunately at that stage nothing can be done. We would have lost the chance to intervene early. So I think it is imperative on the Government to start advocacy and make awareness to the populace on the importance of early screening because we can do a lot through early screening or detection, but once those cancers are diagnosed at a late stage which is unfortunately, the situation in our country, we run the run the risk of causing unnecessary costs and unnecessary loss of life but let me say why are we so behind in this cancer management in this country. I think the issue is about; first of all, manpower. We can talk of all the necessary things which need to be put in place but if we have the requisite skills, we will be able to deliver whatever we plan for. I am sure we heard from the Hon. Member that we have got very acute shortages of manpower. Cancer treatment is not an ordinary disease, it needs skilled specialists, on the side of doctors. You need to be trained as an ordinary doctor then you go on for five years to be trained as a specialist in chemotherapy.
Unfortunately, our Government over the years has never invested in that skills development. That aspect is mainly on tertiary institution but screening is affordable. Early screening depending on whether we develop the necessary skills base can even be done by primary care nurses in rural district health centres. The unfortunate situation at the
moment…
An Hon. Senator’s cellphone having been ringing.
THE HON. DEPUTY PRESIDENT OF SENATE: Order, order!
Hon. Senators, you are reminded once again to switch off your cell phones or put them on silence.
HON. SEN. MAVETERA: I was just talking about the need for early screening and early detection and the skills gap. It is not that we are poor but it is that we are poor in policy implementation or policy formulation. Cancer screening at rural health centres can be done at the lowest level of our health delivery system by a primary care nurse provided the necessary skills and training are given. So, we urge and commend the Committee for raising that need for the State to fund the training and manpower development at that early stage because it will actually assist us in detecting cancer at an early stage and avoid unnecessary costs and loss of lives.
With regards to equipment, one of the perennial problems of our Government is the lack of investment in health which is a very sad scenario because we know health of individual citizens is guaranteed in our Constitution. Everyone would hope that that is the first investment which we should do, if we are actually to get to where we thrive to get as a nation. We can never reach a middle income country in 2030 if we do not invest in the health delivery system or health of our people. So, I think, first things first. It is time that we focus and as Senators who represent the people, we start to advocate for proper and adequate funding. Right now, when we are seated here, we feel we are healthy but let me just scare you a little bit. The qualification age for Senators is 40 years and cancers start at 40, so about 30% of us will actually die of cancer and most of us will be unable to fund ourselves. So, I think it is better we advocate for better delivery so that when we are affected, then we will be able to get treatment.
I am sure most of us have heard the misfortune of nursing or having a relative who had a cancer. It is the most expensive treatment you can ever imagine. If you have got a house, you can sell all the houses but it will not be enough. So, just imagine for the ordinary men in Muzarabani, what will they do? People are dying outside there. As Hon. Members, I think this is the first thing which we have to advocate for. Our primary duty as Members of the august House is to protect and promote the implementation of the national charter, the Constitution. these issues which we are discussing are one of the many fundamental rights which we should be entitled to as long as we are labeled citizens of this country.
It is very sad to note from the report we received from the Hon. Senator that we spend a lot of money, an amount like USD10 million to buy equipment but to date that equipment is not yet fully installed. Unfortunately, with the evolution of technology, most of them are overtaken by event which means that money is put to waste. We also need to improve; this to me shows the lethargy of our governance system in the health delivery system which I think the responsible authorities must make sure that we provide proper governance in health delivery system because it is a waste of the tax payers’ money and when people are dying, we start repairing machinery which has never worked because of poor, slow, lethargic implementation of policies.
One of the most disturbing issues which was raised by the Hon.
Member was the impact of power on the health delivery system. Unfortunately, at the moment, we are in an epidemic of power shortages which if we do not address urgently, will cause devastating effects. These machines are very sensitive and the frequent power outages cause a lot of damages, some of them to the central mother body of the computers to the extent that the machine become useless. So it is very sad that as a nation, we do not have strategic institutions like hospitals having power grids designated for them so that when we have these power load shedding activities, these institutions are not affected. We are currently experiencing one of our worst power problems but you find out that our hospitals are dark which is very unfortunate. That I think we could also solve as a matter of policy. It would also help safeguard our investment especially these sensitive investments which probably we can probably buy after every 10 years.
So, to sum up Mr. President, I think there is need for us as legislators who come from all the four corners of this country to start to advocate for the need and importance of early cancer detection and screening. I am sure the Hon. Member mentioned prostate cancer, breast cancer, cervical cancer but those are just but a few of the many cancers which can afflict people. One of the most common one is the GI cancer, that is cancer of the digestive system which is very common and which can, if detected at an early age, save a lot of money and of course life. However, the moment they are diagnosed late in most of our population when they present to hospital, unfortunately, it will be at an advanced stage where nothing can be done but just a drain on fiscus and they cause a lot of distress to the affected family. So, there is need for us to make sure that these services should be promoted.
Lastly, I think we have a mantra of saying health for all but we cannot have health for all when it is not available, accessible and affordable. If we are called a developed country, one of the things people look at is the health of your people. So, as such, as a nation, we run into the risk of getting onto the list of the least developed countries if we do not address the need to fund the health of our nation. So, it goes without saying Mr. President that the Abuja Declaration is the minimum requirement which any nation which is serious about looking at its citizens should satisfy. It has no absolute figure but it has got a percentage of your budget which is 15%, even if we say we are poor. I do not see why we cannot achieve the Abuja 15% Declaration giving flimsy reason of saying we do not have resources. It is not an absolute figure, they say if you have got $10 take 15% of that and give it to health. So, the reason that we do not have resources, I think it is lack of commitment or even lack of understanding of what drives a nation. The nation is driven by its people and those people have to be healthy. It is the duty of the State and everyone responsible to make sure that we make our citizens healthy. Thank you – [HON. SENATORS: Hear, hear.]
*HON. SEN. TIMVEOS: Thank you Mr. President. First and
foremost, I would like to thank Hon. Sen. Ncube who tabled the report. I am grateful to the Thematic Committee on Gender and Development that conducted the visits all over the country, visiting 10 hospitals. Cancer is not a cheap disease. You have heard that when you are in this august House, there could be two or three amongst us who are suffering from cancer but they are not aware of it because cancer is not painful. Once cancer becomes painful, it will be all over the body. It is quite painful to hear that such a disease has decimated the population. In fact it is the second in terms of fatalities coming on second to HIVAIDS in terms of the deaths to the Zimbabwean population.
In that regard, what is Government saying? I remember last
Parliament, machinery was bought at Mpilo and Parirenyatwa. What is painful is that there is no one who is capable of servicing or knowledgeable about the operations of those machines. There is only one radiographer countrywide if I heard them well. I heard that the Government has also frozen posts for radiographers. Do they not realise that this is not a good situation. I believe that the Ministry of Health should put the issue of cancer as top priority. A state of emergency should be declared so that other countries can come in and help us to alleviate the cancer scourge.
Mr. President, we can say that breast cancer and cervical cancer is killing women but men are also suffering from prostate and colon cancer. If scrutinised, many people have succumbed to cancer illnesses. Once again I want to thank the Committee for a job well done. It has become clear that Mpilo and Parirenyatwa Hospitals cannot treat all cancer patients. In fact, money is not easy to come by. It is difficult for me to come from Gokwe all the way to either Mpilo when referred for cancer treatment and upon getting there, I am told the machine has not been serviced and that there is only one radiographer. Can we not see that we are putting a burden on the populace? A lot of people go back home and look for herbs that are useless in terms of cancer treatment up until they die. It is my plea that I want to make especially to the Minister of Health that he should treat cancer issues seriously.
Furthermore, cancer as we all know it, its treatment is expensive. It has been reported that the machines at Mpilo and Parirenyatwa are not functioning properly. What this means is that a lot of patients are going to the private sector and people are paying through the nose. You would sell a house so that you get treated and remain alive but others will surrender to their fate until they die because cancer treatment is very expensive. Why do we not service the machinery that we have or have it repaired so that those who would be referred to Parirenyatwa and Mpilo respectively may be treated.
Mr. President, from the report, it has emerged that it is difficult for patients to be treated. The Ministry should have qualified personnel to operate machines. As the august House, let us help each other to improve the health of the Zimbabwean population. I thank you.
HON. SEN. DR. SEKERAMAYI: I want to take this opportunity
to thank Hon. Sen. Ncube for introducing the report of the Thematic Committee on Gender and Development on cancer treatment and control in Zimbabwe. Cancer is one of the most serious and dreaded diseases, not only in Zimbabwe but in the world as a whole. In our situation, because of our stage of development, literacy and so forth, there was a time when those afflicted by cancer whether it is of the eye or of the colon, people would say aroiwa. There was no early diagnosis. It is important in my view to have facilities at the various hospitals, be it central hospital, provincial hospital or district hospital where we have facilities and personnel who can diagnose cancer at an early stage. We are currently obviously facing a shortage of manpower as other Hon. Members have said but this is not the permanent state of affairs. We should be in a position to deliberately train, develop professionals in the diagnosis and treatment of cancer to take care of our population. –
[HON. MEMBERS: Hear, hear.] – The machines which we have had at Mpilo and Parirenyatwa Hospitals, yes they are old, some of them have broken down but by coincidence, His Excellency the President, over the last couple of weeks has actually been paying attention to this aspect. Equipment has come from India and so forth. So the thrust to equip our hospitals with the most modern up to date equipment is there and when we have got that equipment, we must obviously train competent personnel to mann that equipment.
It has also been said the treatment of cancer is very expensive. I would really recommend that once a Zimbabwean has been diagnosed with cancer, whatever type of cancer it is, I think treatment should be free – [HON. MEMBERS: Hear, hear.] – If you are coming from the rural areas and you are told you have got cancer and you must now pay for it, you literally sell mombe dzako dzese. If you are in the urban areas, some people have said you would sell your house but it does not mean that after selling the house or mombe dzako wapona, you will still be unwell. So we should persuade the Ministry of Health to adopt a policy where the treatment for cancer is free of charge. That would help a lot of people because people will stay at home not because they are feeling well but they say I have no money to pay. So it is one of those diseases which I believe should be looked at very seriously and consideration should be given to free cancer treatment.
As I have said, the environment is paying attention to the health sector and I am sure when the Minister comes here and report to the President, that which should be available in Zimbabwe will be procured and the personnel trained to use that equipment. Thank you Mr.
President.
*HON. SEN. KOMICHI: Thank you Mr. President. I would like to thank Hon. Sen. Ncube for moving such an important motion on cancer through her report. It is true that cancer is one of the most killer diseases especially in Zimbabwe. Let us remind each other that when HIV/AIDS emerged, it took us a very long time to react to curb the spread of the virus but cancer is even more dangerous than HIV and it is killing a lot of people. HIV is now just as good as flue. If I am HIV positive and stick to my treatment, I can live a normal life but we still put a lot of emphasis on HIV/AIDS. HIV policy in this country is very clear and robust. The general population is now aware of the causes, how to manage it and to live with it comfortably…
THE HON. DEPUTY PRESIDENT OF SENATE: Let me
remind you Hon. Sen. Komichi, the transcribers find it very difficult to transcribe in two different languages. Avoid as much as possible to code switch languages.
*HON. SEN. KOMICHI: Thank you Mr. President for the
guidance. My appeal is to have awareness about cancer so that people are well informed about the causes and how they can prevent it. I personally know that cancer is there and is killing people but I do not know what causes cancer, how I can prevent it or how I can live long with it. So I am appealing to the Minister of Health and those entire organisations which assist to educate people on causes of cancer, prevention and how to manage it.
Some are technologically advanced and they can use Google to get tips but the rest cannot help themselves because they do not have access to that information on Google. So, policy on awareness should be available to the people. I also feel that Government is reluctant to take action. It is useless to act after people have already died or are dying, it will be too late. The cost will be huge for the Government, and with this economy of ours we might fail to curb its spread. As it is now, most deaths are caused by cancer, which means that cancer is spreading like veld fire. As Government and us as Senators, we should also assist in educating the people so that they come to understand that cancer really exist and it is clear that there is no cure as of now.
The issue that equipment worth US$10 million which was not commissioned is painful. It is painful because the country spends such large sums of foreign currency to waste. Government should have taken strong measures against the officials of that Ministry because they slept on duty. Looking at the time we have had cases of cancer, we appeal to the Ministry of Health to have a policy to train cancer doctors for free, a policy which is clear to everyone. There is need to put a budget for that training. Even if personnel needs to be trained outside this country, money should be availed for them to go to India so that we can have specialists on cancer treatment because this disease will devour us all.
I support all those who spoke before me who said that cancer treatment should be subsidised by Government because many people are dying. Where we come from even in urban centres people die in pain because they cannot afford the drugs which ease the pain. Cancer treatment is expensive and so, we should work together as Government and make sure that cancer is put under control. I thank you.
+HON. SEN. PHUTI: Thank you Mr. President for giving me the opportunity to add my voice to this debate which was raised by Hon. Sen. Ncube and seconded by Hon. Sen. Rambanepasi. I would like to talk about this cancer issue. You find that person is serious and tomorrow they are dead. People do not know what is happening concerning cancer. People are ignorant of cancer and allege superstition. Even with esophagus, cancer people allege superstition.
We lack knowledge on cancer as said by Hon. Sen. Komichi. May our people be concientised on these particularly in our constituencies in the rural areas. The people in the urban areas know because they have access to the media but if you go to the rural areas they do not know about cancer or what it is exactly. If people know that you have cancer, they allege that one is promiscuous. We lack information on that and we need people to go around homesteads conscientising people on cancer so that people are taught properly.
It is scary to hear that about 5 000 people have died per year from cancer mostly because people delay in getting medical attention. In 2007, I was in hospital and a lady was admitted who was in serious pain. She lied that she was suffering from a headache but from the smell that was being emitted from her body you could tell that something was really wrong. She was very sick and after two hours she passed on. If people maybe concientised probably we may have less deaths from cancer. Such concientisation should be taken to the rural areas where people are ignorant.
People should be taught about the cancer of the esophagus. In my ward, there are two people who died from that disease. Their treatment was very expensive and ended up receiving home-based care. Sometimes the doctors will be on strike or they are simply not there or there is no machinery. Again, women are affected by breast cancer. Someone once told me that if you put money in your brassieres you will get cancer. May people be concientised up to ward level so that they know how to handle the situations.
We hear that there is only one radiographer in the country. That is a very bad situation because if I need attention from such a person, I will have to part with a lot of money coming to Harare and upon arrival, I will find that the person is on leave. People are not dying from the diseases but due to negligence on the part of Government. We should conscientise patients not to default on their medication as is happening with HIV throughout all the stages. We therefore request Government to put its mind on that matter so that we have machinery at the hospitals. If I go to a radiographer and hear that I have cancer but I do not have any information pertaining to that. As Government, we should not stress our people but we should attend to them so that they get treatment in time. I thank you.
HON. SEN. NCUBE: I move that the debate do now adjourn.
HON. SEN. P. NDLOVU: I second.
Motion put and agreed to.
Debate to resume: Thursday, 18th July, 2019.
MOTION
CULTURAL VALUES ON ENDING CHILD MARRIAGES
HON. SEN. TONGOGARA: I rise to move the motion standing
in my name that this House:
RECALLING that child marriages were a rare occurrence before
Zimbabwe’s independence;
NOTING that the extended family, community leadership and members used to play a critical role of inculcating good morals and values in children, a culture which minimised child marriages; CONCERNED by the disintegration of the extended family unit and the community social moral fabric resulting in increased number of juveniles entering into marriage partnerships with adults;
NOW, THEREFORE, calls upon the Government in collaboration
with other stakeholders including traditional and religious leaders to vigorously enforce the law against offenders engaging in child marriages and inculcate cultural values that ultimately discourage and bring to an end all forms of child marriages.
HON. SEN. THUTHU: I second.
HON. SEN. TONGOGARA: Mr. President, child marriage also
referred to as early marriages is any marriage where at least one of the parties is under 18 years of age. The overwhelming majority of child marriages both formal and informal involve girls under 18 year old, although at times their spouses are also under age. A child marriage is considered as a form of forced marriage given that one of the parties has not expressed their full, free and informed consent. Child marriages were a rare occurrence before independence because the age of majority was 21 years.
Mr. President, in the 19th Century, most people used to live as nuclear and extended families. Parents and adults used to treat each child as their own and show them the right path when they go astray. Aunties and uncles used to teach children many good values, among them not to indulge in sex before marriage. This helped them to be developed into fully grown and mature adults, and helped to prevent early marriages. They also taught what is expected of them when they got married, that is the value of marriage to prevent broken homes.
Mr. President, the disintegration of extended family unit and the community social moral fibre resulted in increased numbers of juveniles entering into marriage partnership with adults. Statistics of child marriages are disturbing. Around the world, one in five girls are married before they mature. It is said over 250 million women alive today were married as children. In sub-Saharan Africa, about one in four girls married before the age of 18. Statistics show that African nations account for 17 of the 20 countries with the highest rate of child marriage globally.
In Zimbabwe, Cluster Indicator Survey Mix of 2014 indicated that 60% of women aged between 18 and 24 had sexual intercourse before the age of 18 years. Currently, 31% of girls under the age of 18 are married. Of these, 4% were married under 15 years of age. There is often a substantial age difference between men and their spouses with the 2014 data indicating that the percentage of young women aged 15 – 19 years who are married or in union and whose spouse is ten or more years older was 19.9%. The unmet need for family planning services amongst girls is 17.1%, - significantly higher than the unmet need among women of child bearing age overall.
Mr. President, child marriage is not uniformly prevalent in Zimbabwe. Prevalence is highest in Mashonaland Central with 50% followed by Mashonaland West with 42%, Masvingo 39%,
Matabeleland South 27%, Harare 19%, Matabeleland South 18% and
Bulawayo 10%. Urgent action is needed to prevent thousands of young girls today from being married in the next decade. If the present trends continue, 246 000 of young girls born in Zimbabwe between 2005 and 2010 will be married before the age of 18 by the year 2030.
Mr. President, many factors interact to place a girl at risk of early marriages including poverty, the perception that marriage will provide protection, social and patriarchal norms, customary or religious laws that condone the practice, weak enforcement of laws, inadequate legislative framework and week civil registration system, peer pressure where children want to experiment what others are doing and end up doing wrong things.
Mr. President, the impact of child marriage is devastating among other things, child marriage results in the following; higher than average, maternal mobility and mortality rates for 15 to 19 year olds, higher infant mortality among their children, increased prevalence of HIV, limited participation in development, limited decision making in relation to their own lives, weaker economic indicators and ability to climb out
of poverty, loss of educational opportunities and social isolation and restricted social mobility.
Zimbabwe has committed itself to eliminate early child and forced marriage by the year 2030 in line with goal number 5 of the sustainable development goals. Zimbabwe has adopted a progressive Constitution which enshrines gender equality and which provides for justifiable rights. There is an elaborate array of children’s rights in the
Constitution. In addition Section 78 of the Constitution, Marriage Rights sets a minimum age for marriage at 18 and prohibits forced marriage. It states, “no person shall be compelled to marry against their will, Section 261 of the Constitution requires the State to take appropriate measures to ensure that no marriage is entered into without the free and full consent of the intended spouses.
Section 22 of the Constitution, requires that the State to take measures to ensure that children are not pledged into marriage. In January 2016, the Constitutional Court ruled that marriage Act which allowed girls as young as 16 to be married with the consent of their parents was unconstitutional and recognised 18 years as the legal age of marriage, after pressures from various international organsiation.
This has confirmed that an overhaul of all marriage laws is required to harmonise with the Constitution. It is vital to note that gaps still exist; laws pertaining to marriage in Zimbabwe remain discriminatory against girls, for instance the Marriage Act allows girls aged 18 to marry while the minimum age for boys is 18. The Customary Marriages Act does not specify the minimum age of marriage. The Government is yet to adopt legislation which harmonizes marriage, family and child laws with the Constitution and with the International Treaty obligations.
As Parliament we must continue to insist on at least amendments to the marriage Act and Customary Marriage Act as a matter of urgency pending a complete review of marriage laws to cover all forms of marriage. It is encouraging to note that the proposed Marriage Bill of 2017 seeks to harmonise marriage laws in Zimbabwe and bring the governance of marriage under a single Act.
Mr. President, this problem requires a multi-sectoral approach where all concerned people are involved, because the high prevalence of child marriage in Zimbabwe is inconsistent with the country’s growth and the development aspirations. The Government of Zimbabwe and its various arms such as the Ministry of Women’s Affairs, Community, Small and Medium Enterprises Development, Ministry of Youth, Arts and Recreation and Ministry of Public Service Labour and Social Welfare have a duty to use practical and effective legal policy and pragmatic measures to hold any phenomenon that destabilises the health, education and economic wellbeing and the general security of its citizens and to further the development of girls in particular. Child marriage is an impediment to development and appropriate action is required in line with the human rights commitments and the rights of children.
Mr. President, as we know traditional leaders used to play a pivotal role in our communities. They should be capacitated so that they resume their traditional roles which help to instill good values, especially to the youth. Mr. President, Zimbabwe is a Christian country. Religious organisations draw the largest gatherings who attend church services of different denominations. If the church leaders can be educated on the effects of child marriages and how to eradicate them, this could help to reduce child marriages.
I call upon this august House to ensure the Bill prohibits and eliminate child marriages and also eliminates all harmful practices and forced marriages in line with the SADC law for eradicating child marriage and protecting children already in marriage. Furthermore, the
CEDAUR Committee in its concluding observations to Zimbabwe’s
state report in 2012 in relation to family and marriage made recommendations to the Government. It made recommendations to amend marriage laws in order to eliminate discrimination and ensure equitable sharing of matrimonial property by women.
We need to insist that these and other clauses are included in the forthcoming Bill. I think if these measures are implemented holistically by all, we will end child marriages and protect them from this malpractice. I thank you – [HON. SENATORS: Hear, hear.]
I move that the debate do now adjourn.
HON. SEN. CHIRONGOMA: I second.
Motion put and agreed to.
Debate to resume: Thursday, 18th July, 2019.
MOTION
REPORT OF THE SPEAKER OF THE NATIONAL ASSEMBLY’S
BILATERAL VISIT TO THE SHURA ADVISORY COUNCIL IN
DOHA
Third Order read: Adjourned debate on motion on the Report of the Speaker of the National Assembly, Hon. Adv. J. F. Mudenda’s Bilateral Visit to the Shura Advisory Council held in Doha, Qatar.
Question again proposed.
HON. SEN. MUZENDA: I move that the debate do now adjourn.
HON. SEN. MOHADI: I second.
Motion put and agreed to.
Debate to resume: Thursday, 18th July, 2019.
MOTION
REPORT OF THE 44TH PLENARY ASSEMBLY OF SADC
PARLIAMENTARY FORUM
Fourth Order read: Adjourned debate on motion on the Report of the Delegation to the 44th Plenary Assembly of the SADC Parliamentary Forum.
Question again proposed.
HON. SEN. MOHADI: I move that the debate do now adjourn.
HON. SEN. MUZENDA: I second.
Motion put and agreed to.
Debate to resume: Thursday, 18th July, 2019.
MOTION
DEVELOPMENT OF WATER INFRASTRUCTURE IN TOWNS
AND GROWTH POINTS
Fifth Order read: Adjourned debate on motion on the perennial shortages of clean and potable water in most towns and growth points.
Question again proposed.
+HON. SEN. PHUTI: Thank you Mr. President for giving me the opportunity to add my voice on the motion that was raised by Hon. Sen. Wunganayi. I want to talk on the issue of water crisis in Matabeleland South. We are in Region 5 where we get very little rainfall. We are like people living in a desert who put water in jojo tanks. Most dams are dry due to siltation. We appeal to Government to assist in desilting the dams so that we can harvest water especially this year with the drought, even our livestock are dying.
If we look in front of us, there is water because water is life but how many people can afford this water. We cannot spend the whole day in this House without water. In rural areas, women have to walk for 10 to 20 km in search of water. They have to carry some water for them to drink on the way to fetch water. Even if you want to drill boreholes in Matabeleland, you can go for 90 metres without getting water. Also in urban areas like Bulawayo, there are water challenges. Recently, there is a case that was reported on the news whereby some people would fetch water in areas that are dirty and some of the areas, the wells are secured using a slab. In that same area, it was reported that there was a child who drowned but was rescued before death.
We need water for many purposes; some people no longer bath because there is no water. I am okay here at Parliament because I have access to water. If you go to Matabeleland women there put face powder without washing because they cannot get water but bathing is essential for everyone. I would like to appeal to the responsible Minister to come out on the open and appeal for assistance from well-wishers so that equipment can be donated which can drill boreholes in
Matabeleland. If assistance for HIV/AIDS was secured, why not also declare this water crisis a disaster so that aid can come from well- wishers. I thank you Mr. President.
HON. SEN. TIMVEOS: Thank you Mr. President for giving me
this opportunity to debate on this very important motion. I want to thank
Hon. Sen. Wunganayi for bringing such a very important motion.
Zimbabwe’s water remains very poor in both urban and rural areas. More than 18% of the population does not have access to improved drinking water sources and 56% do not have access to improved sanitation facilities. According to UNICEF, over 60% of the rural water supply infrastructure in Zimbabwe is in a state of despair and as a result, many boreholes and wells contain non-portable water and are in need of decontamination.
In each urban area now, the tapes have no water at all, which is why we have seen councillors and Members of Parliament going around even in our urban set up. In our high density suburbs, drilling boreholes,– especially this year with the drought, it is really an issue and everyone is suffering right now. I was talking to some councillors in Bulawayo; Bulawayo is totally dry; Gweru is totally dry. I was amazed the other time when we went to Masvingo, we passed through Chevron Hotel and the people there were using bucket system. They were going outside – there was something like a tape outside and I am talking about a town; Masvingo urban whereby you go to a hotel and you actually need a bucket to go around for water. That is a sad situation.
As a country, as Local Government, I think we could have planned early because when I was talking to some of the councillors, they were saying that the infrastructure that they are using; the pipes that they were using were put during the Smith regime, meaning to say that for the past 38 years, we have never as Government; as Local Government considered that especially with the population because a lot of our people have left rural areas and they are coming to urban centres. So it means that the population has gotten bigger as the years went by which is why we should have considered making sure that our infrastructure is ready for the population.
I am from Zvishavane, I remember our councilor, the water started coming out I think brown when the MSU students moved to Zvishavane. I am sure everyone knows that the campus was moved and I think we
got over 20 000 students, if not more but because the town was not ready for those students, the water siltation started giving us problems and you could not drink it. The local councillors and the local authorities were complaining to say they do not have enough water they do not have foreign currency as well to actually buy chemicals. So, as Government, we should always plan ahead.
The tape water as well is not safe to drink in most areas in Zimbabwe, which is why right now we have drinking water here but looking at it, we have purified spring water that we drink all the time but how many people can afford this water? I really have to say that it is only a few people who can afford this water. The rest of the Zimbabwean population cannot afford this water so they end up just drinking any water. This is why you saw that in our country we had cholera; 2008 to 2009 and recently and a lot of people died. You can see that this water situation in our country is a problem and it is something that Government has to take as a priority.
Mr. President Sir, how can we keep our water clean? We must not invade wetlands. Our local councils have allowed people to build on wetlands. Maybe if we had to stick to the plans of the cities, we could avoid some of the problems that we are having now where we have no water in most areas. Wetlands are never meant to be built on. They are meant to be reserved and be kept without any building so that they can help the rivers that are flowing around cities so that we have water.
The Ministry of Local Government, I agree Hon. Wunganayi that it should budget to support local authorities and at this moment in time, most of the chemicals are bought outside the country. So yes, there should be a budget for foreign currency so that our local authorities can operate well and everyone can get clean water. Yes, it is us women who always suffer when there is no water. I have seen even here in Harare and all major cities, you see women going around, some washing clothes even in rivers or dams. They actually spend half a day there trying to get water to feed their families.
Surely, Government at this moment in time has to be proactive and make sure that we keep our Zimbabwean people well and healthy. We cannot be healthy without clean water, of which cholera actually cost this Government a lot of money to try and curb it. I remember the last time we were now running around for this medication or that medication. If we make sure that our infrastructure and chemicals are ready and everything is done properly, we might save a lot of money for Government. We might think by ignoring and not considering infrastructure building we are doing justice but it ends up costing us more including losing lives.
HON. SEN. SHOKO: I want to thank the mover and seconder of the motion, and all the Senators that debated on this motion. This motion is a very important motion in that if you check our Constitution, Section 7, it is also covered where it says it is one of the rights that a person must have. Another writer Simuel Taylor said, ‘water, water everywhere, nor any drop to drink’. That is the situation that you get in
Zimbabwe where you can get water but you cannot drink it because it is either dirty or it can give you diseases. That is the problem that we have got but Mr. President, the Constitution is clear as I said.
Part 2, especially Section 77 (a) says ‘every person has a right to safe, clean and portable water’ and the State must take reasonable legislative and other measures within the limits of the resources available to it to achieve the progressive realisation of this right’. That is a very important statement from our Constitution. That means to say the Constitution is very clear, it says we must have clean water. The problem that we have got now Mr. President in this country is that even in the urban areas, we are having problems in getting clean water. I went to Masvingo over the weekend, there was a queue at that particular borehole and that queue was about 500 metres. I believe that is as far as outside the Parliament. They were all looking for water. They have Lake Mutirikwi there which is a big reservoir of water but they cannot extract water from Lake Mutirikwi because the pipes are old. They were put by the Smith regime and unfortunately, we have not put anything to upgrade the system.
As said, many people have now migrated to the urban areas and because of that, they use more water. The systems are no longer copying. Water Mr. President is one of the most vital natural resources for all life on earth. On earth here we all need water. We need water because water is life. Mr. President, I am not ashamed to state the uses of water and I will state those religiously. We need water to drink, cook, wash ourselves, clothes and utensils such as pots, plates and so on, even to clean our floors. The place that we are seated in today, they use water to clean this place and they do not use dirty water. They use clean and quality water. Water improves life and living standards. If you have poor water, you expect to have a sick nation. That is very important Mr.
President.
It means therefore, the State must take care of the issue of water because water is needed around the society that is the state. What I mean here is people in the urban and rural areas need water. Animals need water. Everyone, including the hospitals, industries, agriculture and so on need water. It therefore means to say and when I am saying ‘need water’ I am talking about quality water. You cannot take dirty water into a hospital. You cannot use dirty water to irrigate in agriculture or industry because in industry as you know we make different things such as food. In whatever we do, clean water is very important and clean water can only be achieved where we have enough foreign currency allocated so that we get clean water.
Mr. President, as I said, the Government needs to support especially local government. The Ministry of Finance needs to see to it that the local authorities get enough foreign currency to get the material that is needed for upgrading their water reticulation systems. As you know, we do not produce everything in this country. Most of the things that we use in this country are imported. Let me say 75 or 85%, I am just plucking from the head but I believe that is what is happening. That is very important for the Ministry of Finance to do something about water.
Mr. President, there is a figure that I saw in some publication where that is very important for the Minister of Finance to do something about water. Mr. President, there is a figure that I saw in some publication where it was said because the cholera outbreak that took place in this country the Government spent about 50 million dollars. That 50 million if we were careful and if we had done our things properly, we would be using that 50 million to get medication. You heard the report from the other Committee where they were talking about the cancers. We would get medication for these particular cancers, the 50 million that we are talking about.
Mr. President, this motion is a motion that is strategic, useful, a motion that all of us especially the Senate must move it together. What we must know is that when we talk about these diseases they do not look at colour, age, political party that you come from. When cholera comes, it will attach Senator Shoko and Senator so and so from the other political party. So, this is very important. It is a motion that we must all stand up and support, push so that when we do our next budget these Ministries that deal with water are taken care of, given enough finances so that the local councils are able to upgrade our water system.
Mr. President, I am not only talking about the local councils but the rural councils because in the rural councils we now have got our growth points. Growth points have settlements that need water although in some growth points they are still using blair toilets which also need a lot of water because there is concentration of the population. With those few words and with those few contributions, let met thank you for allowing me to speak and allowing me to express my views on this motion. Let me also thank the movers of the motion, the seconders and the Senators who have debated on this motion.
HON. SEN. WUNGANAYI: I move that the debate do now
adjourn.
HON. SEN. B. MPOFU: I second.
Motion put and agreed to.
Debate to resume: Thursday, 18th July, 2019
On the motion of HON. SEN MOHADI seconded by HON. SEN MAKONE, the Senate adjourned at Twenty Five minutes past Four o’clock p.m.