22 November 2012

Zimbabwe: Have Maternity Fees Been Scrapped or Not?


There has been grave confusion over the scrapping of maternity fees, one report I read in July claimed the Ministry of Health had sent letters to hospitals and clinics stating fees are dropped, but the Herald reported in September that the Minister of Health claims this is not true. Whatever the case is, government continues to dither while the fate of our mothers and children are threatened. The reality is that most clinics continue to demand fees of between US$30 to US$50, a sum our poor can simply not afford.

Nyaradzai Chimanga (not real name) lives in Mabvuku and gave birth at Overspill clinic after failing to register her pregnancy. She was taken to the clinic by neighbours. When she got there the health care officials asked for the fees before they would attend to her.

"They demanded the money from me despite the fact that I was already in labour. After me begging, they assisted me but told me that I was not going to leave the health care centre without settling the bill. A relative of mine rescued me after two days by paying the money," she said.

Many rural women have resorted to giving birth at home because of the fees demanded by the hospitals.

"I have a sister who recently gave birth at home. We could not raise the money to pay for her pregnancy. We had no option but to look for an old woman to assist her when she gave birth " said Nyaradzai.

It is difficult to believe statistics for Zimbabwe as so many unrecorded numbers of women are dying in the country's rural and poor communities from home births attended by untrained midwives. A report from Crisis Coalition makes for tragic reading:

According to the Zimbabwe Demographic Health Survey (ZDHS 2010-2011), the country has a Maternal Mortality Rate (MMR) as high as 960 deaths per 100 000 live births. An upward trend can be seen as statistics from the 2010 Millennium Development Goals status report that show that in 1994 the MMR was 283 per 100 000 live births, rising to 695 in 1999 before declining to 555 between 2005 and 2006 and 725 deaths per 100 000 live births in 2007 according to the Zimbabwe Maternal and Perinatal Mortality Study (ZMPMS, 2007).

The same report makes it very clear that our government is lagging in clear and effective decision making processes, declaring that fees should be scrapped but not availing institutions with adequate funds to cope with the increased demand for maternity beds.

From the day of the policy inception, Harare Central Hospital maternity wing is reported to have failed to cope with the surge in numbers of pregnant women as it can only accommodate 180 people at any given time, but had become over-stretched after admissions began averaging 70 per day. Such is a clear case of a possible implication that was not well thought of. Further to that, the Ministry officials were quite aware when they made the decision that staffing levels are compromised at most if not all state health institutions. According to the UN-FPA in the ZDHS (2012-2011) only 22 percent of posts for midwives were filled. With such a scenario imagine the quality of services that will be offered when the expected average figures are surpassed. What boggles one's mind is why someone entrusted with the nation's health would pursue a policy that is counterproductive without assessing all imperatives and which in all respects lacks a semblance of sustainability. Be that as it may, the temporary policy shift exposed the government and the nation at large to the inadequacies of the health vote and the need to increase the health allocation in subsequent years.

The final paragraph of this report rings true with me and all Zimbabweans:

The GNU has been extravagant with resources in splashing huge sums of money in purchasing luxury and top of the range vehicles. The inclusive government also gobbled US$45 million in foreign travel in 2011 alone according to Minister Biti. This is all at the expense of service delivery.

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