The Herald (Harare)
15 June 2004
Harare — POST-INDEPENDENCE gains in reproductive health could soon be eroded owing to prohibitive costs of maternity services in most health institutions throughout the country.
The Government, soon after independence sought to address the issue of safe motherhood and family planning, which are some of the major elements in the reduction of infant mortality rate.
This resulted in the construction of maternity wings at all major hospitals, provision of drugs and recruitment of well-trained midwives to complement existing health professionals.
Governments effort was embraced by the private sector and donor community, which immediately provided both funding and equipment to augment the existing infrastructure.
At one time, the Government even abolished maternity fees at all health institutions, except central hospitals, to reaffirm its commitment to safe motherhood.
However, the last 10 years have witnessed a fall in standards at most health institutions.
Reduced fiscal allocation to health coupled with the effects of HIV and Aids are some of the problems that have strained the health delivery system in the country.
Vulnerable groups were left unprotected.
These are the very same people who have been pushed against the wall as maternity charges continue to rise, until they have become every womans nightmare.
The countrys major referral hospitals - Parirenyatwa and Harare Central - maternity wings now demand a deposit of up to $580 000, a delivery fee of $55 000 and charge $55 000 per day for post-delivery care.
In addition, gynaecologists require pregnant mothers to pay an initial deposit of up to $1,5 million.
Inflation has forced both private and public medical institutions to increase their fees to cushion themselves against rising prices and also to enhance their income base.
Recently, private medical institutions increased their fees by up to 100 percent, pushing health services beyond the reach of many.
Belvedere Maternity Home now requires an initial deposit of $1,4 million, for "normal" delivery, a lodging fee of $300 000 a night, bed only. Food is charged on a meal-by-meal basis.
For a Caesarean operation, a patient has to cough up $5,2 million in addition to paying for the prescribed drugs.
Harares Baines Avenue Clinic increased its deposit for maternity cases from $800 000 to $1,6 million, excluding lodgings, drugs and food.
Gynaecologists charge an initial $1,5 million for consultation, demand a top-up after 36 weeks of pregnancy, up to $4 million for a Caesarean operation, and $1 million for a "normal" delivery.
Patients are also required to pay for their drugs.
In Harare, the cheapest maternity health services are offered by City Health clinics, which charge up to $80 000 for normal deliveries. Patients with complicated cases are referred to major hospitals.
"Even if you pay $27 000 or the new rate of $80 000, you still have to buy cotton wool, spirit, maternity pads, drugs and other requirements," says Mrs Chenai Gumbo, cradling her newly-born baby.
"Without money, you get no service. You can even die."
She said many women had resorted to telling lies about their pregnancies to nursing staff to avoid being referred to major hospitals, whose fees they cannot afford.
"Unotonyepa kuti inhumbu yekutanga kuti zvikurerukire," she says.
But such hopes are often dashed when nurses suspect there could be complications during labour.
As patients continue to fail to pay the stipulated maternity fees, hospital sources say it is becoming increasingly difficult to recover their money from defaulters.
Recently 28 mothers and their newly-born babies were detained at Harare Hospital for failing to pay maternity fees.
The amounts ranged from $500 000 to millions of dollars. As if to punish them, the women were not allowed to wear their own clothes until payment was made in full.
The decision by the hospital sparked an outcry from a number of organisations, which called for the release of the mothers and their babies
The action was described as unfair and inhuman, particularly to the newly-born babies.
Harare Hospital medical superintendent Mr Chris Tapfumaneyi said the hospital could not let the women go without settling the fees.
"The hospital has been failing to do a lot of things because patients deliberately do not want to pay, so we have put in place restrictive measures such that out of the 28 women, some have paid us something," he was quoted saying.
He added that following the introduction of restrictive measures preventing convalescents from going home without paying, the hospital had recovered 87 percent of its debts.
As a result of these exorbitant charges some women are now delivering at home, putting their lives and those of their babies at risk.
The faint-hearted are forced to go to the rural areas where maternity services are either free or affordable.
"Some people are now going to some rural hospitals to evade high medical fees in the city," said a source at Parirenyatwas Mbuya Nehanda maternity wing.
"Hospitals are tightening their grip on payments and its increasingly getting difficult for them to get service when you dont have money."
"Kuita mwana kwavakudhura,"(Child bearing is now expensive), said the source jokingly. "You now have to think twice about having a child."
Little wonder many poor expecting mothers are now relying on traditional midwives to cut costs despite the dangers that go with it.
But its not only medical fees that are giving expectant mothers a headache. The cost of babywear has gone through the roof in recent years.
The cheapest napkins now cost up to $13 000 each, while the more expensive brands can set a mother back by anything between $17 000 and $30 000. Imported disposable napkins now sell for more than $90 000 and baby costumes and clothes are going for between $15 000 and $100 000 per item depending on quality.
The same is true of blankets, shawls, towels and other woollen accessories whose prices range between $30 000 and $100 000.
Baby baths, toilet seats, water buckets, feeding bowls and other plastic utensils were selling for between $30 000 and $50 000.
"A new born child can bring joy to a family even when you are poor," says an expectant Ms Anna Chidarikire of Harare. "But preparations are a nightmare. I-maths chaidzo."
She says pressure from husbands and relatives often forced women to succumb to "unwanted" pregnancies.
She says she hopes to raise money for her maternity fees by selling vegetables.
"My husband is not working and Im struggling to sell vegetables just to survive. I went to the Social Welfare Department, but its even worse (because) you cant even get assistance there," she says.
As the cost of motherhood continues to rise, many are wondering how many mothers would get help from the recently launched social responsibility programme, under which medical doctors are expected to offer free treatment to the less privileged.
Says Dr Paul Chimedza of the Zimbabwe Medical Association: "Zima recognises that the majority of members of our society cannot afford medical fees, let alone doctors or even clinical fees.
"We want to reach out to this marginalised group and ensure that they access high quality treatment free of charge as we believe it is everyones right to access health care."
Africa continues to face a rising maternal death toll owing to frequent shortages or lack of medications, essential supplies and equipment, inadequate blood transfusion services and inefficient laboratory support services.
Apart from this, inadequate staffing, shortage of trained personnel, shortages of operating theatres for obstetric emergencies, poor health management systems, negligence and poor attitude have all added to the woes.
Africas average maternal mortality ratio increased from 870 per 100 000 live births in 1990 to 1 000 per 100 000 live births in 2001, according to the World Health Organisation (WHO).
WHO estimates that almost half of the pregnancy and childbirth-related deaths recorded annually around the world occur in Africa.
And there is no doubt that poverty and prohibitive medical fees in addition to haemorrhage during pregnancy, delivery complications, sepsis, abortion, pregnancy-related hypertension, malaria, tuberculosis and HIV/Aids will see Africa continuing to record the highest pregnancy-related deaths in the years ahead.
A leading health policy expert, Dr Sharon Camp, of the Alan Guttmacher Institute, in Europe, recently said providing services for the 200 million women around the globe who need them would cost about US$3,9 billion but could prevent 1,5 million maternal and infant deaths every year.
"It has a very long-term development impact," Camp said.
However, studies have revealed that not many countries are investing in safe motherhood and reproductive health.
"Our report makes it clear that the global community can well afford to make the additional investment needed to close the gap in sexual and reproductive health."
For Zimbabwe the challenge is to convince every citizen that reproductive health and safe motherhood is everyones responsibility.
Be the first to Write a Comment!
Copyright © 2004 The Herald. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com).
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
