One Doctor for Every 12,000 Patients in Zambia – A Cause for Concern

By Guest Writer Contributing to the Key Correspondent Programme, Prof Father Michael Kelly in Lusaka, Zambia

At the time of writing (7^th April, 2020), Zambia appears to be keeping the COVID-19 infection in check. So far there have been only 39 confirmed cases and one virus-related death, while for the past four days no new case of infection has been identified. Moreover, the confirmed cases of infection have all been either in persons who had recently travelled from high-risk countries or in their local contacts; predominantly, these have been from the better-off categories who can afford to travel abroad. So far the disease does not seem to have taken hold in the local population or among the 60% of the people who live below the poverty line.

This speaks well for the preventive measures that have been taken. We are not in lockdown, though schools, bars and churches have all been closed, funeral attendances very much limited and sports fixtures cancelled (rather a bizarre mixture of venues, but catering for the most frequent occurrences of pubic or quasi-public gatherings). At the sociocultural level, two of the preventive measures are causing some stress among the Zambian people. One is the prohibition of hand-shaking. This is going hard on the Zambian people who, with their open and friendly manner, like to shake hands every time they meet, even if this is several times in a day. The other is the closure of churches which the very religiously-minded Zambian people find hard to accept, especially coming up to Easter.

The fear in Zambia is that some day infections may begin to occur in the general population. This would spell disaster for us because our poor and rapidly growing population means large families, most of them living very close to one another in small houses and relatively few of them with running water in their homes. In such circumstances, social distancing and frequent hand-washing, two of the mainstays against infection by the virus, become almost impossible. These measures are currently being observed in shops, markets and other public places in Zambia, but they are virtually out of the question in the places frequented by the majority of persons – their homes and living quarters.

If the disease gets into the general population its spread would also be facilitated by the inability of the medical services to reach out to all. Very creditably some hundreds of retired health professionals have come forward, offering their services, but this touches only the surface of what would be needed in the event of a more generalized epidemic. With a doctor-to-patient ratio of one doctor for every 12,000 patients, Zambia falls very much below the desirable World Health Organization ratio of one doctor per 1,000 of population. Clearly in the event of a general coronavirus epidemic within the country, Zambia would not have the wherewithal in terms of medical personnel to deal with it. Neither would it have the resources in terms of infrastructure, transport, testing and care facilities to deal with a major outbreak.

In addition to this threatening though not yet actual medical pandemic, Zambia is already experiencing a severe and very adverse economic virus-related epidemic. The mainstay of the country’s economy is copper, with the biggest customer being China. The decline in the global economy, and in particular in that of China, has resulted in there being less demand for copper and a reduction in its price. This means that Zambia won’t generate the revenues needed for its economy to survive and to pay off its debts. In a country that is already saddled with a heavy debt burden, this could lead to debts becoming unsustainable, at a time when the possibility of viral infection is leading to unanticipated increases in health spending.

The tourist industry, another economic mainstay, has been almost wiped out by the global impacts of Covid-19, with air travel being severely curtailed and people from abroad not willing to place themselves at risk through travel. Already almost all of the big hotels in Lusaka (the Pamodzi, the Golden Peacock, the Southern Sun and others) have been closed. Also, access to the Victoria Falls, probably Zambia’s biggest tourist attraction, is no longer allowed, so as to lessen interactions between and with possible virus-carrying persons from various parts of the world. And with those two measures, jobs have gone and livelihoods have been put in jeopardy.

Moreover, in common with other African countries, the informal sector accounts for a large and dynamic part of Zambia’s real economy, providing livelihoods and incomes and supporting development undertakings. But preventive measures against the virus have brought a substantial reduction in income-generating possibilities for street vendors, petty traders, mini-bus operators, dealers in used clothes, casual labourers and small farmers. Regardless of the medical impacts of the virus infection in Zambia, thousands have become jobless, incomes have declined, poverty is becoming more widespread, and with the continuation of prevention measures these adverse outcomes seem set to increase.

With an adult infection rate of 11.3%, and HIV prevalence among young women being more than double that of young men, Zambia is already coping with a very heavy HIV burden. Thankfully, intensive national and international efforts have brought much of this under control, with 78% of infected adults and 79% of infected children reportedly on treatment. Those with well-controlled HIV do not appear to be at higher risk of coronavirus infection (or other severe disease). But given the fragility of the country’s health system there is a significant risk that Zambia would not be able to cope simultaneously with the demands of ensuring universal HIV treatment and services and responding to a new coronaviral epidemic. Although internationally a number of antiretrovirals are being investigated as potential therapies against the coronavirus, the situation at the moment is that Zambia does not have a worrisome medical problem from the coronavirus. But it very definitely continues to have such a problem from HIV while at the same time it is experiencing severe economic shocks arising from the global impacts of the virus. The sooner this virus can be brought under control across the world, the better for the world and the better for Zambia.