Reviving health services could close gaps in Zimbabwe
By Tapuwa L. Mutseyekwa
HARARE, Zimbabwe, 18 October 2010 – Alongside her unemployed husband, Mutsa Mbore, 27, endured the excruciating pains of labour all night at their home in Mount Hampden, about 15 km west of Harare. The baby arrived in the early hours of the morning, but for Ms. Mbore, the bleeding and pains continued long after giving birth.
Ms. Mbore could not register her pregnancy at the nearest clinic because she failed to secure the $50 required for ante-natal care check-ups and maternity fees. Realizing the threat to her health after the home delivery, she gathered the little energy she had left and set out to seek care from a nearby faith healer. Weak and writhiing in agony, she collapsed along the way and had to be carried to a clinic by well-wishers.
In her five years working as a midwife at the Kuwadzana clinic, Sister Aqualine Magandi has seen this scenario played out again and again.
VIDEO: UNICEF's Vivian Siu reports on programmes reaching pregnant mothers in Zimbabwe.
“Many women end up here in the clinic in this way,” she said. “After failing to raise the required fees for maternity admissions, they deliver at home and are rushed to the clinic when complications arise.”
Reviving the health sector
Over the past decade, health services have been out of reach for millions of Zimbabweans. A maternal mortality rate of 880 per 100,000 live births reflects this critical state of affairs. Most of these deaths are avoidable and treatable, and yet years of decline in the quality of service at the institutions, coupled with a demand for high user fees from clients who are mostly unemployed, has left many with little option but to deliver outside a health facility – where they face death when complications arise.
In an urgent step towards revitalizing the health sector, the Inclusive Government of Zimbabwe – led by the Ministry of Health and Child Welfare with support from UNICEF, the World Health Organization (WHO) and World Bank – has launched the ‘Health Sector Investment Case,’ a roadmap to revive the entire health sector over the next three years. If adequate financing is established, the health sector investment aims to reduce under five and maternal mortality in three years by 38 per cent and 17 per cent, respectively.
And part of the programme would involve abolishing health care fees for mothers and children.
“The Inclusive Government of Zimbabwe has committed that by the end of 2011, no pregnant woman or child under five will be deprived of their right to health care because they cannot afford the fees,” said Deputy Prime Minister Thokozani Khupe.
Regrettably, the medical fees are not the only obstacles that patients face. Upon admission at the primary health facility, for example, Ms. Mbore was referred to a major hospital for further treatment but waited more than nine hours before an ambulance was available to transport her.
In a city like Harare, with more than 50 primary health facilities, only two ambulances are available to respond to emergencies. The Health Sector Investment Case will work to remove these bottlenecks in service delivery and strengthen primary health care systems.
Speaking at the launch of the investment case, Minister of Health and Child Welfare Dr. Henry Madzorera said most of the challenges in the sector result from limitations of funds. He said at current funding levels, Zimbabwe will not achieve the UN Millennium Development Goal target of reducing maternal mortality.
Already, support by international partners and cash injections from treasury over the past year are breathing life into the health sector. The provision of incentives to health workers, replenishing of equipment, drug procurement and supply and a major immunization drive have gone a long way in alleviating major health problems.
Closing the gaps
“We know from experience what needs to be done to prevent more women and children from dying from easily preventable and treatable diseases or mothers dying while giving life,” said UNICEF Representative in Zimbabwe Dr. Peter Salama.
Over the last five years, the country’s poorest quintile has suffered a 40 per cent drop in health care coverage. The Health Sector Investment Case will serve to close the gap of inequity in the coverage of basic health services in Zimbabwe.
“Our primary intent is to support the restoration of the heath system by addressing the various determinants of health and also addressing all the services within and around the communities which affect people’s well being,” said WHO Representative Dr. Custodia Mandlathe.