The COVID-19 pandemic has wreaked global havoc, severely impacting individuals, communities and countries. As of 7 July, over 11.5 million cases have been recorded, placing a significant strain on economies and healthcare systems. People living with chronic conditions like diabetes have been particularly impacted by the health, social and economic effects of the virus and the measures put in place to tackle it. Zimbabwe has been no exception.
Zimbabwe was placed under lockdown on 30 March 2020 and restrictions on travel were imposed. Only professions considered essential were allowed to transit beyond the five kilometre radius established by the Government. The lockdown was initially imposed for 21 days, renewed for a further two weeks thereafter and subsequently extended indefinitely with less restrictive conditions.
The lockdown was welcomed by some parts of society, but not the majority. Zimbabwe has a very large informal economy, with most people living hand-to-mouth. Most households were left vulnerable, including many people with diabetes. The lockdown has had disastrous effects on their ability to access the healthcare and medication they need.
Though availability was not seen as an issue, first-hand accounts indicate that most people with diabetes could not access their medication during the first month of lockdown. Many were turned back by security forces at road blocks when trying to collect their medicines as only people with letters stating they worked in an essential services sector were allowed through. The security forces subsequently tried to rectify the issue by allowing safe passage for people with valid medical records. While this has been very welcome, it has not been applied consistently and does not take into consideration people who do not have their medical records readily accessible.
Access to hospitals, outpatient clinics and other medical services has been another significant issue. People with non-communicable diseases (NCDs) rely on these services to collect their prescriptions and receive urgent advice to help manage their conditions. Information on the availability of healthcare facilities during lockdown has not been communicated effectively, with several people reporting they were not informed about service closures, only discovering that health services had been suspended upon arrival at their medical centre. This has meant that people with diabetes have missed out on vital medical advice concerning their treatment.
A local clinic turned a person living with diabetes away at the door because the clinic was only attending to “emergencies.” This suggests a lack of understanding of just how serious an issue access to medication and care is for a person living with diabetes.
As a result, people with diabetes have had to turn to private pharmacies, where medicines are much more expensive. Since the lockdown, diabetes medications, particularly insulin, have doubled in price as some have taken advantage of the pressure on supplies. In a country where the unemployment rate is over 90%, the number of people who can afford these medicines is very low.
There have also been reports of people who have been turned away at pharmacies because they have “exhausted” their medication funding for the year, which is determined by the medical aid package they are on. This is occurring much earlier than usual due to the increased cost of medicines and supplies.
This has led to people with diabetes rationing their supplies, no longer taking their medication regularly or opting for cheaper alternatives that can affect their health in the long term. For example, some people who require injections of insulin to survive have switched from insulin pens to vials, which are generally cheaper but less convenient.
The consequences can be devastating in terms of the increased risk of complications, the worsening of existing complications or early death. Many young lives could be cut short due to the high cost of life-saving drugs in a very informal economy. The implications on Zimbabwe’s health system are also potentially severe. The system risks being overwhelmed by an increase in the number of people with diabetes developing complications in the long-term.
It is therefore important for policy makers, health authorities and civil society to ensure the protection of populations that are particularly vulnerable to the effects of COVID-19. We must advocate for measures and policies to ensure wider accessibility, affordable prices and ease of movement for people living with diabetes and other NCDs. There is no wisdom in waiting for more complications and deaths before their plight is taken seriously.
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