As African Union heads of state consider child and maternal health at the 2010 summit in Kampala, Uganda, the perennial question of user fees has reared its head in Zimbabwe. Fees for services are opening a growing gap between policy and implementation in maternal health care in the Southern African country.
Under government policy, care for pregnant women, new mothers and infants receive free care. But the country’s rapid economic decline in the past decade has compelled health institutions to raise their own revenue to meet costs.
Women complain they are being denied health access because of failure to meet maternity and other hospital costs. New mother Thandeka Mbewe says she has been through it all, and is having second thoughts about having another child.
The 25-year-old Mbewe didn't have the money for either hospital booking fees or even to pay for an ambulance to ferry her to clinic. A month after giving birth, she still has not managed to pull together the funds necessary to pay the hospital bills.
"It’s been tough having this baby," a distraught Mbewe said.
Fees too high for many
Expecting mothers are required to pay a 50 U.S. dollar booking fee at clinics and government hospitals, but this is equivalent to about a third of a low-ranking civil servant's monthly salary, an amount many here cannot afford.
In some cases, new mothers are told by officials that they cannot leave the hospital until they have settled their bills; women have responded by smuggling their babies out of the hospital - one mother in Gweru hid her newborn under a heavy jacket and slipped out of the ward.
Elsewhere, mothers who fail to pay their fees are denied the necessary documentats needed to get birth certificates for their newborns.
"Our children cannot become full citizens of this country until we pay. It’s all so unfair," Mbewe complained, expressing what has become a major talking point here.
Mothers like Mbewe say until they find the money to pay the outstanding fees, they can't get care for their newborn babies.
"Nurses at the clinic have refused to attend to the child for the mandatory two-week check up," Mbewe told IPS.
Development goals threatened
According to a 2009 assessment of progress towards Millennium Development Goals on child and maternal health by the Ministry of Health and Child Welfare, between 1999 and 2006, infant mortality rate declined from 65 deaths per 1000 live births to 60, but this still falls short of the country’s desired target of 22 per 1000 live births.
Healthcare workers warn that progress will be slowed by the insistence on full payment by defaulting mothers before necessary care is given to their children.
"I am now even afraid to go to the clinic when I get the money as the nurses will ask why I have been keeping the child when it is them in the first place who refused him treatment," Mbewe said.
Amid growing concerns about the poor antenatal and post-natal health provision, midwives have lobbied government to scrap maternity fees entirely.
"Many mothers are blaming us nurses for denying them the right to health for their infants," said Ntandokayise Ndebele, a midwife working at a council clinic in one of the city’s high density suburbs. "But we get our directives from the council to make them pay. In the past, many have disappeared after being treated."
Turning to dangerous alternatives
The cost of public health services has spurred the proliferation of dealers in traditional medicine.
"When mothers fail to access formal health care, they will seek out older women who claim to have knowledge of herbs that can treat infants. But this does not always work as it exposes infants to unnecessary life threatening conditions," said Hilda Noko, a senior nurse working with the Bulawayo City Council.
The herbal market is highly visible at the city’s Renkini Bus Terminus and in the oldest township, Makokoba.
Here, men and women who claim to be certified herbalists, sell herbs they claim can treat a variety of infant illnesses or simply "strengthen" the infant.
Deep cuts in social spending imposed by structural adjustment programmes in the late 1990s badly affected Zimbabwe's public health system while failing to restore the health of the economy, though the country is far from alone in demanding fees for service at government clinics.
With some support from international donors, African governments including Sierra Leone - which in 2010 introduced free health care for pregnant women, new mothers and children under five - are exploring ways of eliminating charges at the point of service.
source: IPS news
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