US$120 million required to fight TB among children.

By Masimba Biriwasha | Op-Ed | @ChiefKMasimba | January 09, 2014

According to an ambitious plan launched last year by leaders in the TB field, a total of  US$120 million is required to stem the TB among children.

The plan titled, The Roadmap for Childhood TB: Toward Zero Death, outlines three priority areas that require attention in order to turn the tide in the fight again TB including: a sense of urgency beyond the TB community, improvement in research, policy development and clinical practices as well as increased funding. Continue reading

Pregnancy Imperils Zimbabwean Women’s Lives

By Masimba Biriwasha | Global Editor-At-Large | @ChiefKMasimba | 07 January 2013

A Zimbabwean woman, Tendai Chitsinde, 24, died recently while giving birth to her first child. According to news reports, hospital staff called off a Caesarian section operation which could have saved her and her baby’s life. Because she was a television presenter, her death made news headlines and an outpouring of grief.

But Chitsinde is only one of an estimated 3,000 women and girls who die each year in Zimbabwe due to pregnancy-related complications. That’s 8 women dying every day of the year.

Additionally, 26 000 to 84 000 women and girls suffer from disabilities caused by complications during pregnancy and childbirth each year.

Maternal and neo-natal health services in Zimbabwe face severe shortages which hampers the delivery of quality services. As a result, the maternal mortality rate alarmingly stands at 960 maternal deaths per 100 000 live births – three times higher than the global average and almost double that of the Sub Saharan averages.

Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, regardless of the site or duration of pregnancy, from any cause related to or aggravated by the pregnancy or its management.

The consequences of maternal mortality are felt not only by women but also by their families and communities. Loss of women during their most productive years also means a loss of resources for the entire society. At least 1.23 per cent of GDP is lost annually due to maternal complications in the country, according to UN.

Most of what needs to be done is already known. However, Zimbabwe’s decade-long political, economic and social fallout has had a terrible impact on the public health delivery system, significantly reducing the quality of services provided to pregnant women.

Many women, particularly in rural areas cannot afford the transport costs required to make frequent travels to health centers during and after pregnancy. Rural women opt to deliver at home which significantly increases chances that they will die, especially when the delivery requires surgical intervention, or is carried out by non-skilled persons.

Shortages in personnel, equipment and supplies continue to plague Zimbabwe’s healthcare infrastructure, putting the lives of pregnant women at risk.

According to WHO, most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known.

It is particularly important for health care workers to be well trained so they can properly meet the medical requirements of pregnant women.

Unless significant action is taken to improve health services, pregnancy will continue to imperil the lives of Zimbabwean women.

Rape Victims Find Healing in Telling Story

By Masimba Biriwasha | OpEd | January 02, 2013 | @ChiefKMasimba

The healing power of telling your story while receiving loving attention is probably one of the most portent forms of medication under the sun. But can it heal the trauma of rape?

According to a recent study reported in the Washington Post, telling stories can help rape victims heal. The study says that reliving the rape experience through repeated telling of the story of the rape experience can help victims to overcome psychological distress.

“The results are the first evidence that the same kind of “exposure therapy” that helps combat veterans haunted by flashbacks and nightmares also works for traumatized sexually abuses teens with similar symptoms,” the Washington Post reported.

According to the report, simply offering victims comforting words and encouraging traumatized girls to forget their ordeals is not helpful because it lets symptoms fester.

University of Pennyslavia psychologist, Edna Foa, who developed a “two-part treatment known as prolonged exposure therapy which involves having patients repeatedly tell their stories and then visit places that remind them of their trauma” said that many of the patients are relieved that somebody wants to hear their stories.

Foa exposed sixty one girls ages 13 to 18 who had been raped or sexually abuses randomly assigning them to 14 weeks of counseling or prolonged exposure therapy.

The idea is that by telling and retelling their trauma, victims can developed a psychological distance from the real event and develop a sense of closure as opposed to repression of negative memory.

“They get a new perspective of what happened. They get used to thinking and talking about the memory and realizing that it was in the past, that its not in the present anymore,” said Foa.

Gender Based Violence Drives HIV Epidemic Among Women: US Study

By Chief K.Masimba Biriwasha | Global Editor At Large

Washington DC, US – One out of every four people living with HIV in the US is a woman according to a new study by the University of California, San Fransisco (UCSF). Further, it is estimated that 30 percent of women living with HIV in the country experience post traumatic stress disorder compared to 5,2 per cent in the general population.

The study has broad implications to efforts to turn the tide against the AIDS epidemic across the world in that its expected to shape the discussion on the impact of violence on women’s vulnerability to the disease.

“Women are dying unnecessarily. They can live with HIV, but are dying from the effects of violence in their homes and communities. HIV policies and programmes must prevent and address the effects of gender based violence that weave through women’s lives,” said Gina Brown, a woman openly living with HIV.

 

According to the study, which focused on approximately 6,000 women living with HIV, intimate partner violence is a disproportionately high cause of death for HIV positive women in the US.

The study concluded that traumatized  women fare worse in AIDS treatment more than women who have not suffered traumatic stress. Trauma also puts women in situations where they are more likely to spread the virus.

“For a long time we have been looking for clues as to why so many women are becoming infected with HIV and why so many are doing so poorly despite availability of effective treatment. This work clearly shows that trauma is a major factor in the HIV epidemic among women,” said Edward Machtinger, Director of the Women’s HIV Programme at UCSF in an interview.

Specifically, the study demonstrated that HIV positive women who report recent trauma had more than four times the odds of experiencing virologic failure, a situation where the HIV virus becomes detectable in the blood despite being on antiretroviral mediations.

The study also revealed that women who had suffered recent trauma were almost four times more likely to have had sex with someone without the virus or whose HIV status was unknown to them, and to not always use condoms with these partners.

“Women who report experiencing trauma often do not have the power or self-confidence to protect themselves from acquiring HIV. Once infected, women who experience ongoing abuse are often not in positions of power to effectively care for themselves or to insist that their partners protect themselves. Effectively addressing trauma has the potential to improve the health of HIV positive women and that of the community.”

Zimbabwean, Annah Sango, to Speak at AIDS 2012 Official Opening in US

Washington DC, US – Zimbabwean community activist, Annah Sango, will speak alongside world leaders at the official opening of the International AIDS Conference 2012 in Washington DC on Sunday.

Sango is a peer educator and role model to other young women in Bulawayo, Zimbabwe. She is a member of the International Community of Women Living with HIV and AIDS (Southern Africa) and founded her own community-based support group for women affected by HIV.

“Young people need to move from being passengers to drivers, sexual reproductive health rights are fundamental to everyone the sooner we appreciate that the closer we get to making a difference in the lives of women and young people,” said Sango, a trainer of trainers on issues facing young people.

Sango is a tireless advocate for the reproductive and sexual health rights of young women living with HIV throughout her region, including ensuring their access to woman-initiated prevention options like female condoms.

In Zimbabwe and Africa Cigarette Smoking Grows Despite Health Dangers

By Chief K.Masimba Biriwasha | iZiviso Global Editor At Large

HARARE, Zimbabwe – A man slowly crosses a busy street in Harare, Zimbabwe’s capital, puffing away at a cigarette, and then nonchalantly flicks the cigarette butt onto the tarmac.

The butt rolls away to the edge of the tarmac as the man gets swallowed by the crowd, a trail of smoke hovering behind his head.

In Zimbabwe, as in many parts of Africa, cigarette smoking is growing. According to experts, Africa is expected to double its tobacco consumption in 9 years if current trends continue. The surge in smoking is seen in young people under the age of 20 that constitute the majority of the continents population.

Zimbabwe – as one of the world leading producers of tobacco – has been more focused on te dollar sign over and above the negative consequences of smoking to te public. The government has been reluctant to put in place anti-smoking legislation. Tobacco has long figured prominently in the Zimbabwean economy – tobacco exports bring in a significant share of the country’s export earnings.

Cigarettes can be found everywhere – at street corners and in shops – at ridiculously cheap prices. Alex Madziro lives in Harare. He smokes an average of ten cigarettes a day. He says he has tried to quit but without success. “I just buy single cigarettes at street corners; it helps me to keep the habit in ccheck. I wish I could quit but it’s now very difficult,” he said in an interview. Cigarette companies can still advertise in the media. While the adverts contain health warnings, these have not been sufficient to stem smoking in the country. To put it bluntly, none of the adverts make note of the fact that smoking harms nearly every organ of the body.

According to a 2008 World Health Organization (WHO) survey, twenty-one percent of men in Zimbabwe smoke cigarettes.Across Africa, it is estimated men constitute of 70-85 percent of smokers. For many, smoking starts at a young age. It starts with peer pressure, being exposed to second hand smoking, having parents and best friends who smoke. While it’s almost taboo for women to smoke, the habit is slowly picking up among young women who regard it as a fashion statement.

Globally, tobacco kills more than 14,000 people each day – nearly 6 million people each year. Included in this death toll are some 600,000 non-smokers who are exposed to second-hand smoke. In 2004, children accounted for 31% of these deaths. Almost half of children regularly breathe air polluted by tobacco smoke. There are more than 4,000 chemicals in tobacco smoke, of which at least 250 are known to be harmful, and more than 50 are known to cause cancer.

Without urgent action, deaths from tobacco could reach 8 million by 2030. 63% of all deaths are caused by non-communicable diseases, for which tobacco use is one of the greatest risk factors. A jarring statistic is that around half of all smokers alive today will be killed by tobacco. Tobacco is the single most preventable cause of death in the world today.

On the streets of Harare, smoking continues unabated: how much it is a public health problem is yet to be known. In fact, it is regarded low in the priority of public health issues affecting the country today. The death rate from smoking in Africa where treatment options are absent is high but smoking is not a priority in African public health strategies.

“Tobacco is way down in the public health concerns we have. There is malaria, malnutrition, HIV-AIDS, and tuberculosis. So, tobacco comes as something we know to be harmful, but we are not ready to handle at this time because of the limited resources that are available,” Dr Adamson Muula, a senior lecturer of public health at the University of Malawi was quoted by Voice of America in an interview on the ravages of smoking in Africa.

Just like Zimbabwe, very few countries in Africa have tobacco control acts to protect citizens from adverse effects of smoking, second hand smoking and the rate of new addictions.

GlobalPOWER Women Network Africa Conference Opens in Harare

By Chief K.Masimba Biriwashs | iZiviso Global Editor At Large

HARARE, Zimbabwe – Women parliamentarians, leading African women entrepreneurs, civil society leaders, and development partners from Africa are meeting in Harare over the next two days for the inauguration and launch of the GlobalPOWER Women Network Africa.

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The conference, being attended by approximately 300 participants, is aimed at providing a strategic political platform to accelerate game changing approaches to HIV prevention and sexual and reproductive health and rights responses for women and girls. The idea to create an Africa-specific GlobalPOWER Women Network stemmed fom a September 2010 meeting in Washington DC that saw prominent female decision makers come together alongside their US peers to discuss how to accelerate the implementation of the UNAIDS Agenda for Women and Girls.

Participants at the conference are expected to address the key issues affecting girls and women in Africa including eliminating new HIV infections among children, keeping mothers alive and maternal and child health. The meeting will result in the “Harare Call to Action” to advance women’s empowerment and gender equality through HIV and Sexual and Reproductive Health and Rights responses.

President of the GlobalPOWER Women Network Africa and Zimbabwe Deputy Prime Minister, Thokozani Khupe said that women must take an active role in ensuring their empowerment.

“To achieve the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, it is critical to recognise women and girls as key agents in making this vision a reality – society has to invest in the health of women and girls,” Khupe said.

Addressing the conference, Zimbabwe President Robert Gabrial Mugabe said the launch of the network will take the issue of women’s emancipation and empowerment a step further.

Äfter the launch, the real work will begin and call for the same passion, unity of purpose and consistency in pursuing the goals which have characterized this Women’s Network thus far. Of particular note will be the challenge of giving unstinting support to women candidates of every hue and cry; of varying professional qualifications, driven by different talents and capabilities to realise their potential in the collaborative work of Global Power Women Network, the Africa Union and UNAIDS,”said Mugabe.

In Africa, women and girls carry a disproportionate burden of the HIV epidemic – they constitute 59 percent of all people living with the disease. To make matters worse, gender inequality compounded by gender-based vioence, increase women and girl’s risk of HIV infection.

Ëmpowering women and girls to protect themselves against HIV infection and gender-based violence is a non-negotiable in the AIDS response,”said UNAIDS Executive Director, Michel Sidibe.

MDR-TB Crisis Highlights Gaps in Health Systems

By Chief K.Masimba Biriwasha | Global Editor-At-Large

Despite existing since antiquity, TB is the second biggest killer globally today – and there are more and more cases of TB resistant to first-line drugs normally used to treat it.

In fact, the scope of multidrug-resistant tuberculosis (MDR-TB) is much more vast than previously estimated, requiring a concerted international effort to combat this deadlier form of the disease, according to a statement by the medical humanitarian organisation Médecins Sans Frontières (MSF).

Alarming new data suggests that a concerted international effort is required to combat this deadlier form of the disease.Multidrug-resistant TB (MDR-TB) is a form of TB that does not respond to standard treatments using first-line drugs, MSF said. The deadly TB strain may develops due to insufficient medication or because patients miss some of their treatments.  It is difficult and takes much longer to treat – around two years, with highly toxic drugs.

Drug-resistant tuberculosis (DR-TB) develops during the treatment of drug-sensitive TB, when patients fail to complete their full course of treatment, drug supply interruptions, or when healthcare workers provide improper drug doses or improper, expired, or poor-quality medicine; and is now transmitting from person to person in its own right.

Other factors known to have major impact on treatment adherence include social and economic factors, as well as weaknesses in the health care system itself. In most countries where there are high TB rates, health care systems are often in a shambolic state. This means that even ‘compliant’ patients are at a high risk of TB recurrence, as well as developing and transmitting drug resistant strains.

According to MSF, the global MDR-TB crisis coincides with a huge gap in access to diagnosis and treatment with nearly nine-five percent of TB patients lacking proper diagnosis.

“Existing diagnostic tools and medicines are outdated and hugely expensive, and inadequate funding threatens the further spread of the disease. Worldwide, less than five percent of TB patients have access to proper diagnosis of drug resistance, and only 10 percent of MDR-TB patients are estimated to have access to treatment – far less in low-resource settings where prevalence is highest,” MSF said in the statement.

MSF President Dr. Unni Karunakara added that current knowledge about the extent of MDR-TB did not adequate capture the scope of the problem.

Wherever we look for drug resistant TB we are finding it in alarming numbers, suggesting current statistics may only be scratching the surface of the problem,” he said.

With 95 percent of TB patients worldwide lacking access to proper diagnosis, efforts to scale-up detection of MDR-TB are being severely undermined by a retreat in donor funding – precisely when increased funding is needed most.”

The cancellation of an entire round of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria threatens to seriously undermine a five-year plan to reach a further 10,000 people living with MDR-TB in Myanmar, along with scale-up plans in many other countries.

According to MSF, the global crisis is exacerbated by a perfect storm of lengthy treatment regimens (around two years) with highly toxic drugs, most of which were developed mid-last century and have unpleasant side effects.

Reduced funds—notably recent Global Fund cuts—and a small market with few manufacturers, have kept the costs of some of the drugs prohibitively expensive. Furthermore, expanded use of a new rapid diagnostic tool with the potential to massively increase early detection of drug-resistant TB in low-resource settings is inhibited by affordability.  It is exactly in those places where the ability to detect TB within hours—as opposed to days or weeks—is most needed to save lives.

MSF urged governments, international donors, and drug companies to fight the spread of drug-resistant TB with new financing and new efforts to develop effective and affordable diagnostic tools and drugs.

Far shorter and less toxic drug regimens are needed, along with currently non-existent formulations for children, and a point-of-care diagnostics test.  Regulatory measures need to be enforced to prevent further spread of the disease due to mismanagement by practitioners.

We need new drugs, new research, new programmes, and a new commitment from international donors and governments to tackle this deadly disease,” said Dr. Karunakara.

Only then, will more people be tested, treated and cured. The world can no longer sit back and ignore the threat of MDR-TB. We must act now.”

Pregnancy complications claim eight women daily in Zimbabwe

By Chief K.Masimba Biriwasha

Harare, Zimbabwe – Between 1 300 and 2 800 women and girls die each year due to pregnancy-related complications in Zimbabwe. This translates to eight women dying every day of the year.

According to the Zimbabwe Maternal and Perinatal Mortality Survey (ZMPMS) conducted in 2007, 725 women die per every 100 000 live births, a figure which is far higher than the Millennium Development Goals (MDG) target of 75 per 100 000 live births.

Additionally, another 26 000 to 84 000 women and girls suffer from disabilities caused by complications during pregnancy and childbirth each year.

Given such shocking statistics, it is quite laudable that the government, in partnership with international donor agencies, the private sector, civil society and individuals, is making efforts to redress the unwarranted deaths of pregnant women in the country.

As in most countries in Africa, maternal and neo-natal health services in Zimbabwe face severe resource shortages from both the public and private sector that hamper the expansion of services.

This is despite the fact that the consequences of maternal mortality are felt not only by women but also by their families and communities.

Loss of women during their most productive years also means a loss of resources for the entire society.

Yet giving birth is such an important activity in our nation that every effort must be taken to guard against the loss of life.

In fact, 50% of the deaths are due to factors which can be prevented, such as delays in seeking care and lack of effective treatment.

Pregnancy-induced hypertension, commonly known as blood pressure, bleeding after birth, and puerperal sepsis (a serious medical condition that affects a woman during or shortly after childbirth, miscarriage or abortion) also contribute to the death of pregnant women.

Conditions such as anaemia, diabetes, malaria, sexually transmitted infections, and others can also increase a woman’s risk of complications during pregnancy and childbirth, and are thus indirect causes of maternal mortality and morbidity.

In addition, Aids accounts for 25% of the deaths among pregnant women.

According to the ZMPMS, 34% of pregnant women in the country tested positive for HIV in 2007, but only 1,8% were taking ARVs with dire consequences for their own lives and their unborn babies.

The survival chances of a baby whose mother dies or is HIV-infected and not on ARV treatment are severely reduced.

Undoubtedly, the political, economic and social crisis of the past decade has had a terrible impact on the public health delivery system, significantly reducing the quality of services provided to pregnant women.

Shortages in personnel, equipment and supplies continue to plague Zimbabwe’s healthcare infrastructure, putting the lives of pregnant women at risk.

Furthermore, many women, particularly in rural areas, cannot afford the transport costs required to make frequent travels to health centres during and after pregnancy.

Most women cannot raise the fees required to consult health personnel and hence go through a pregnancy ignorant of potential life-threatening complications.

Instead, they opt to deliver at home which significantly increases chances that a pregnant woman will die, especially when the delivery requires surgical intervention, or is carried out by non-skilled persons.

Other causal factors for high maternal mortality include gender inequality and lack of women’s rights and poor sexuality education.

Like Zimbabwe, many countries in Africa will not attain the MDGs unless urgent action, political will and commitment is strengthened.

Approximately one in every sixteen women in Africa faces the risk of dying in childbirth, while thousands more face delivery-related complications and illness.

In an effort to influence African states to act on maternal and child mortality, the African Union launched the Campaign on Accelerated Reduction of Maternal Mortality in Africa in 2009.

The purpose of the campaign is to mobilise political will and action that will save the lives of pregnant women and newborn babies.

As part of the campaign, the government of Zimbabwe is partnering with international donor agencies, private companies and individual to raise funding and awareness to reduce maternal mortality in the country.

What needs to happen immediately is a thorough revamp of the public health system otherwise efforts to reach women that die from pregnancy complications will remain in vain.

Healthcare programmes to improve maternal health must be supported by strong policies, adequate training of healthcare providers, and logistical services that facilitate the provision of those programmes.

Ensuring that all women and girls have equal access to the full range of services will be key to success.
More importantly, the government needs to implement policies that promote the liberation of women from traditional, economic, legal and cultural fetters.

Female education and empowerment are critical determinants of fertility, and providing girls with access to education is likely to increase their knowledge about how to prevent pregnancy complications.

Simply put, there must be a commitment to make access to services that improve the status of women as much a part of national life as breathing air.

TB/HIV poses challenges for Zimbabwe

By Chief K.Masimba Biriwasha

Harare, Zimbabwe – Charles Raradza, 44, fell seriously ill in 2001, coughing uncontrollably. He went to get tested for tuberculosis (TB) at a nearby hospital but the bacteria was not detected in his sputum.

Unconvinced, Raradza went to another hospital where a sputum and lung X-ray test revealed that he was indeed TB-infected.

“I was immediately enrolled into the hospital’s directly observed treatment therapy (DOTS), and had to take 13 tablets a day. The tablets were very painful. I guess because I love life so much I never defaulted during the six months that I was on the course,” said Raradza.

After two years, Raradza started coughing again. He went to get tested for TB again.

“At the hospital, it was discovered that I had TB, so I was given 60 injections and tablets – its was painful but I stuck through it. I was put on the 6-month long DOTS programme again,” he said.

In 2005 Raradza said he went to a Voluntary Counseling and Testing centre to get tested for HIV.

“It was unheard of then for anyone to go and get tested but I gathered my courage and went to the testing centre. I tested HIV positive, and was enrolled into the anteritroviral programme,” he said.

After noticing Raradza’s poor response to the AIDS drugs, Raradza said that a doctor-friend of his recommended another TB test. For a third time in his life, Raradza had TB, and he had to go through the treatment regimen of 60 injection and tablets.

According to Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB Unit, Raradza’s case of failed detection of TB is not unique and is attributed to changing epidemiological patterns in Zimbabwe.

“Diagnosis of TB is usually straightforward, the best test is sputum microscopy. But HIV changes the way the body reacts to infections. That’s why X-ray is now required but it is very expensive technology and the country cannot afford it at the moment,” said Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB unit.

Murimwa added that the drug distribution in the country had experienced severe challenges over the past decade due to lack of material resources such as transport, fuel and personnel.me

TB is a leading cause of illness and death for people living with HIV—about one in five of the world’s 1.8 million AIDS-related deaths in 2009 was associated with TB. The majority of people living with HIV and TB are in sub-Saharan Africa. The risk of developing tuberculosis (TB) is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection.

According to UNAIDS, TB places a heavy burden on people living with HIV including significant illness that requires at a minimum six months of treatment, with the associated economic costs to the individual, his or her family and the health-care system.

Among African nations, Zimbabwe is one of those most heavily affected by tuberculosis (TB). The deadly combination of TB and HIV epidemics is igniting a silent and uncontrollable epidemic of drug resistant TB that will negate previous national health gains.

The 2009 Global Tuberculosis Control Report from the World Health Organization (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden. Zimbabwe had an estimated 71,961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 population.

For the past 20 years, Zimbabwe has fought TB fairly successfully, providing free access to WHO-recommended treatments. In the past few years, however, the disease has re-emerged as a leading killer, especially among HIV positive people, who are often not identified though long-established TB tests.

An estimated two-thirds of Zimbabweans with TB are also infected with HIV. As a consequence, Zimbabwe has a staggering six times more TB cases than it did 20 years ago. According to statistics, the success rate of directly observed treatment is just 74 percent, far below the WHO recommended rate of 85 percent.

“In Africa, HIV is the potent factor in the progression of latent TB. People living with HIV are susceptible to TB infection. TB is the most common serious infection associated with HIV infection. The two diseases go hand in hand. This call for an integrated and collaborative approach in dealing with the two conditions,” said Dr. Patrick Hazangwe, a WHO official.

In Zimbabwe, the TB problem is compounded by the fact that patients often fail to complete treatment because they cannot afford the transport costs to and from health centers. The lack of access to health services in remote or rural parts of the country adds to the likelihood that large numbers of TB infections are going undetected and untreated.

To complicate matters, the brain drain of qualified front-line health care workers from Zimbabwe has resulted in poor healthcare delivery. Leck of medical practitioners coupled with obsolete machinery has also worsened the problem.

According to Betty Chikava, Member of Parliament for Mt Darwin East, poor financing of the health ministry is a key hindrance to an effective response to TB and other diseases.

“The Ministry of Health and Child Welfare has received paltry funding – only 7 percent of its projected budget; medical personnel in the hospitals and clinics are seriously overworked. The Ministry of Finance needs to be brought into the picture so that they can finance the health ministry adequately,” she said.