Zanzibar RIZIKI Shaabani (35), is among Zanzibar women who recently gave birth safely at Mnazi Mmoja Referral Hospital. On behalf of her colleagues, she said there was no demand for any payment for the delivery services!
"No charges for the delivery kit, for normal and cesarean birth (the kit includes gloves, soap, sterile razor and thread to tie off the umbilical cord, etc), it is free of charge! And the midwives and nurses are friendlier than in past. We are happy of the changes," said Riziki. She said that worries about labour charge and delivery kits have been diminishing and medical doctors, nurses and midwives conduct towards pregnant mothers since President Ali Mohamed Shein declared 'free services' to women ready to give birth.
It is almost ten months since Dr Shein gave a surprising statement, 'free medical care for pregnant women with immediate effect.' It was surprising because even the hospital staff and the ministry of health did not expect the changes at this time of economical challenges. Moza Ameir (28) and Asha Kombo (33), also delivered safely, saying "We have no problem with doctors and midwives. The hospital demanded nothing from us, everything was available."
Mothers giving birth in Zanzibar are now entitled to free services. "No charges any more for pregnant mothers giving birth in all public hospitals," Dr Shein said in May, last year. Expectant mothers were required to contribute 40,000/- as labour charges and also asked to buy some of the items of the delivery kit. According to health officials, the cost of labour for a single mother ranges between 100,000/- to 400,000/-, depending on the delivery which include cesarean birth. The government was subsidizing for the rest.
Dr Shein was bold by emphasizing that "the government can manage to meet the labour charges for women giving birth in public hospitals. There is no justification for charges; therefore we should stop demanding any contribution from mothers." Since the government under retired president Amani Abeid Karume introduced labour charges for mothers giving birth in public hospitals five years ago, women and backbenchers in the Zanzibar House of Representatives were against the charges, arguing that it was a big burden to majority poor women.
But health authorities were reluctant to abolish the labour fee because the government could not manage to provide delivery kit and cesarean birth, prompting introduction of delivery contribution. Some officials from the ministry of health also said that insufficient resources and infrastructure would not make new programme successful.
President Shein, a medical doctor by profession, maintains that his government will carry all the delivery costs required for an expectant mother. He also added that future budget for medicines and hospital equipment would be increased. Although the medical staff are still worried about sustainability, Zanzibar has started recording admirable success in the programme to provide free medical care to all pregnant mothers.
The challenges facing hospitals in maintaining free medical care for pregnant mothers is shortage of medical skilled labour, including midwives, lack of ambulances in rural areas and improper management. Lack of ambulances means pregnant women living in the more isolated parts of the Islands in the rural area often delay to receive attention.
Zanzibar is likely to be among countries, which may not be able to beat the Millennium Development Goals (MDG) No. 5 (to reduce by three quarters the maternal mortality ratio) by 2015, butPresident Shein's initiative of providing free medical care for pregnant women is already making a difference. According to the latest statistics, Zanzibar mortality deaths in Zanzibar have dropped from 375/100,000 in 2005 to 284/100,000 last year. And with improved health care including the free medical care, the health officers anticipate further decrease.
Globally, more than 350,000 women die annually from complications during pregnancy or childbirth, 99 per cent in developing countries. The Ministry of Health Principal Secretary (PS), Dr Mohammed Saleh Jidawi and the legal advisor of the ministry, Mr Mohamed Adil said at different occasion that the implementation of the 'free medical care for pregnant mothers' has been going on well since the president's declaration.
"The government is trying its best to make sure that pregnant mothers and children get proper medical care, but people should understand that sometimes the hospital may experience shortage and asked to buy some equipments," Adil said with optimism that all is well. The problem of child birth is particularly bad in poor and rural areas, where transportation to health centre or maternal clinics is also a concern. Let's pray that the government manages to turn around the situation and that MDG5 is achieved.
Free healthcare in Zanzibar is expected to save the lives of mothers and children and other countries in Africa, have also been introducing free care to pregnant mothers and children under five in recent years. Development partners are also helping the improvement of health care in Zanzibar including child birth. China and Netherlands have been the latest development partners to approve support in improving hospitals and quality maternity care, to ensure that all women and newborns have access to proper health care.
However, faced with unstable national economies and lacking a good standard of salary, many health practitioners are tempted to seek employment in the private sector or even to leave the health sector to take up other type of work that offers them better economic rewards.