Zimbabwe: User Fees a Stumbling Block

Government says consultation fees at state public health institutions remain the biggest impediment to access to treatment by people living with HIV and Aids.

Owen Mugurungi, the head of the HIV and Tuberculosis (TB) unit in the Ministry of Health and Child Welfare told a recent Global Fund dialogue on policy that government was in a dilemma because health centres argued that they needed the money to stay afloat.

"User fees have remained a challenge for us. Clinics say they need the money to keep running," said Mugurungi. "User fees are only useful in denying access to treatment for patients. "They impede access to health care by typically adding the cost of health services to patients resulting in poor vulnerable population groups not always seeking appropriate health care when it's needed."

Various studies have confirmed that many only discover their HIV-positive status when their immune systems are already too weak to support anti-retroviral treatment (ART). This is because they are often discouraged by exorbitant fees to visit health centres for regular check-ups and voluntary HIV testing.

As a result they may unknowingly infect many others. Tabona Shoko, Zimbabwe Network for People Living with HIV (ZNNP+) director said although ART was accessible, treatment for opportunistic infections is unaffordable to the majority of people living with the virus. Shoko said lack of information on available treatment options was also another major challenge in the fight against HIV.

"Universal access to treatment is still unattainable," he said. "There is still need for practical policies. "A case study done by Shoko for Zvimba, Karoi and Kariba revealed that the distance travelled by patients to health centres also acts as a barrier to treatment.

Last year, Zimbabwe recorded further decline in the prevalence rate of HIV from 15.6% the previous year to 13.7% but experts say the figure is still too high and more has to be done to reduce new infections. Meanwhile, the National Aids Council (Nac) recently handed over four CD4 count machines to be placed at Mpilo, United Bulawayo Hospitals, Parirenyatwa and Harare Hospital  - the four central hospitals in the country.

The machines process 40 samples per hour substituting the older ones which took 10 samples per hour. Speaking at the handover ceremony at Harare Hospital, Deputy Health and Child Welfare minister, Douglas Mombeshora said the procurement of the machines and ARV drugs by Nac was testimony that the Aids levy was being put to good use.

The CD4 machines were bought using proceeds from the Aids levy. Workers in Zimbabwe pay three percent of their salaries towards the levy on a monthly basis. The current policy states that Nac must set aside 50% of the Aids levy for the procurement of ARV requirements. Murombedzi Kuchera, the Nac board chairman, said the levy had become useful again following the dollarisation of the economy.

According to new WHO guidelines people living with HIV whose CD4 count falls to 350 should be immediately placed on ART. The new development has seen the number of people in need of ART rising from 340 000 to 570 000.

Zimbabwe HIV and Aids Activist Union (ZHAAU) representative, Bernard Nyathi, speaking at the same occasion, said lack of CD4 count machines had frustrated efforts to extend access of the life-prolonging drugs to ordinary people. Early this year Nac donated a consignment of various commodities including ARV drugs, HIV test kits and condoms to Harare hospital.

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