By Perpetua Murungweni
In his presentation on the Mid Term Budget and Economic Review sometime in July, the Minister of finance and economic development professor Mthuli Ncube in the 2024 budget said, government committed ZiG$9.5 billion towards health system in the country.
“Mr Speaker Sir, the 2024 National Budget committed resources amounting to ZiG9.4 billion towards consolidation of the recovery of the public health system in all levels through provision of the necessary medical personnel, medicines, accommodation, rehabilitation and construction of health facilities, as well as provision of the appropriate medical equipment.
Of this amount, ZiG3.8 billion was earmarked for rehabilitation and construction of health infrastructure and procurement of medical equipment. In this regard, during the first six months of the year, ZiG2.5 billion had been extended to the sector with the bulk, ZiG2.3 billion going towards employment costs, as well as ZiG166 million for hospital support and ZiG66 million towards Infrastructure Development,” said Prof Ncube.
However, there is nothing to show for it as the health system in the country is still in bad shape characterised by shortage of medicine and equipment in health institutions. Expecting mothers are forced to spend own money to buy necessary equipment despite the fact that government says maternity health is free.
While others look back to the journey of motherhood with joy, it is a different case for Tariro Taonei (not real name) after witnessing the sharp end of the poor health service delivery in the country, recalling how she gave birth to a decomposing baby despite following her antenatal visits religiously.
“My first maternity experience was terrible, I never missed my antenatal visits for regular checkups where they check the wellbeing of the mother and the unborn child. What breaks my heart the most is I went for a checkup 3 days before I gave birth to a decomposing baby. I was left with questions regarding the importance of these checkups if they couldn’t notice that my child was dead. They even said everything was ok,” said Taonei.
Taonei said, together with her husband they were left shattered by the incident and the costs they incured to have the mother cured thereafter.
“After the incident I had to go to a private doctor for the removal of retained products of conception, and had to pay around US$300. We are shattered; the free services came at a price for us and we will never forget this incident,” said Taonei.
This is the situation a number of women go through in Zimbabwe, losing babies and forking out money to pay for maternity services despite the Zimbabwean government’s promise for free maternal services.
Expecting mothers are still facing hidden costs, of private hospitals and private doctors and cost of basic medical supplies leaving many to wonder if the policy is making a difference in reducing maternal mortality rates or masking a more complex issue.
Contacted for comment why people pay for equipment needed during birth, Masvingo Provincial Medical Doctor (PMD) Dr Amadeus Shamhu said maternity was indeed free but could not comment more saying the best person to comment was the Permanent Secretary in the Ministry of Health and Child Care (MoHCC).
Another lady claims that at six months, she was told that her stomach was full of water an ultrasound scan was performed which also came out saying the same thing.
“On my third pregnancy, I went to Masvingo Provincial Hospital to register for my six months pregnancy and the nurses told me that I was not pregnant but my stomach was full of water.
“The ultrasound scan was done and came out saying the same thing. I was very angry and disappointed because I could feel the baby kicking and moving in my stomach. I then went to a private hospital where the doctor confirmed my pregnancy and I had to pay USD 20 consultation fee for every checkup until I gave birth and a sum of US$300 for delivery,” said the woman.
Another woman from Rujeko in Masvingo told this publication about her traumatic experience with her first pregnancy at a local clinic after being told to buy a number of requirements which the hospitals should provide.
“I had a very traumatic experience as a first timer, I almost bled to death because I had no cotton wool during labor. I was told to come with a delivery pack on the day of delivery which consist of cotton wool, surgical and latex gloves, cord ties and cord clamps but could not afford it and nurses attended to me after I had bled for 2 hours saying that they had no cotton wool.
“After a long time of bleeding I was then transferred to Masvingo Provincial Hospital where I delivered my child through caesarian section. I had to go through blood transfusion to replace the lost blood and one sachet of blood costed US $100 each and was prescribed 3,” she said.
Another woman Nyasha Mutengiwa said there were no adequate equipment and material in maternal health facilities making it expensive for waiting mothers to access the service despite it being said is free.
“There seem to be no or inadequate equipment in hospitals because some of the examinations that requires equipment you are told to go and get them somewhere else where you have to pay for the service.
“What is the use of an ultrasound scan at Masvingo Provincial Hospital, when I was asked to go and get a scan elsewhere where I had to pay? Why can’t nurses at Mazorodze clinic refer us to Masvingo Provincial Hospital to get free scans and bring them back,” Mutengiwa said.
A random observation in the city pharmacies shows , the basic delivery kit costs around US$30 where four packs of surgical gloves cost US$6, 500g cotton wool costs US$14, cord clamps US$1, methylated spirit US$2, latex gloves US$2, and tetracycline US$2 which the brings the total cost to about US$27.
The situation is also bad in council clinics where expecting mothers are often anticipated to buy supplies required for birth delivery with Masvingo City Health Director, Suzanne Madamombe confirming the service was free but the clinics sometimes run out of supplies passing on the cost to the pregnant women and girls.
“No money is paid if you are a known pregnant person. Clients are given the list of these items as NatPharm does not supply these items at times and our stores department will be out of stock,” said Madamombe.
Many women, especially in rural areas, have limited access to healthcare facilities. This often forces them to opt for home births, which can be risky due to lack of skilled birth attendants.
There are usually no waiting shelters at the health facilities especially in rural and marginalized communities. These shelters provide a place for women to stay during the last weeks of pregnancy, ensuring they are close to medical facilities when they go into labor.
One village community health worker in Zaka said it was difficult to get transport to rush an expecting mother to the hospital during emergencies in their areas.
“In our community its difficult to get a car, to rush women to the hospital when she’s in labor and if we can’t get a car, we are forced to use a scotch cart or at times the expecting mother is forced to walk for a long distance to clinic,” said Tariro Nduna.
Another woman from Zaka said she delivered in a cart and the baby died before reaching the clinic saying there were few waiting shelters in Zaka forcing them to go the clinic when we are due.
“Here in rural areas there are few waiting shelters and in most cases we are to be rushed to the clinic when we are in labor. Two years ago I delivered my baby in a cart on my way and the baby died before reaching the clinic. This year I’m pregnant and expecting to deliver in September and I’m afraid as to what will happen,” said the woman.
My Age Zimbabwe, a youth led organization that champions youth leadership participation, gender equality and health rights of adolescence and young people, communications and advocacy officer Veeslee Mhepo said most of the problems young girls and women were facing during birth were due to inadequate funding and lack of resources at government hospitals.
“22 percent of young women in Zimbabwe’s 20–24 age groups have given birth under difficult circumstances. Due to expensive medical expenses, cultural beliefs, and inadequate funding and resources at government hospitals, many pregnant women and girls in Zimbabwe choose to give birth at home.
“Home births can increase a woman’s chance of getting potentially fatal birth-related injuries, such as obstetric fistula, particularly in young women who might not have access to knowledge about the condition’s causes and treatment. Obstetric fistula treatment and prevention in Zimbabwe is hampered by a number of factors, including cultural norms, a lack of knowledge, and financial limitations,” said Mhepo.
According to World Health Organization (WHO) a minimum healthcare spending is $86 per person, yet in Zimbabwe the budget allocates around $20 per person. This breeds a lot of problems for the healthcare system.
The healthcare system in Zimbabwe is underfunded and under-resourced. This usually results in overcrowded maternity wards, equipment shortages, and inadequate medical supplies which can lead to incorrect risk assessments and treatments.
According to the country’s 2024 budget, ZWL $6, 3 trillion was allocated to the health sector seeking to improve health outcomes and reduce the need to seek medical treatment outside the country. The allocation was also meant to consolidate recovery of public health sector services, such as adequate drugs and medical supplies.
Zimbabwe has been rated among countries with the worst maternal death ratios with some of the reasons behind the sorry situation in the country being the high cost of accessing the ‘free services’ which has shut most expecting mothers away from health facilities on this most important period of their lives resulting in many deaths.
Statistics from ZIMSTATS 2022 Preliminary Results of the 2022 Housing and Population Census have revealed that the estimated mortality rate in Zimbabwe is 363 per 100 000.
Reasons behind the high mortality rate include poor health seeking behaviours among expecting mothers who have complained that despite the service being deemed free by government, it had become expensive as government health facilities are underfunded and under resourced against the prevailing economic conditions which makes it impossible for the greater part of the population to seek services at private facilities.
