Zim failing women on maternal mortality

HARARE - Reproductive health care was allocated a budget of a paltry $200 000 in the 2013 budget. As at June 3, not a single disbursement had been made.

HIV/Aids and TB awareness, which was allocated $205 000 in the spending plan, is yet to receive the funds from the fiscus.

This comes at a time when the maternal mortality rate is pegged at an alarming 525 deaths per every 100 000 live births, according to the 2012 census. HIV/Aids has also been
fingered as a key factor in maternal mortality.

The figures are a top line ripple amid concerns by health experts that the fatalities could have easily been prevented.

Although there has been a slight decrease in maternal deaths, which were previously pegged at over 900 per 100 000 live births, the figure is still too high, considering that Zimbabwe introduced a maternal and child care budget in 2012.

The funds directed towards maternal health have also been dwindling each year, a sad development that has seen women especially those in poor communities finding it difficult to
register for maternal services owing to a number of factors, key among them, high user fees.

The ministry of Health and Child Care on one hand says that this unfortunate situation is a direct result of inadequate funding.

“We submitted a budget of $712 000 000 for our requirements,” Heather Machamire, a finance director in the ministry of Health said.

“The resource envelope that we received was $337 005 000 inclusive of salaries, so the start of the budget allocated was already inadequate.”

Machamire was speaking during the half-year budget performance review facilitated by the parliamentary portfolio on Heath in conjunction with the Zimbabwe Women Resource Centre Network (Zwrcn) recently.

Machamire said the allocation received was only 47 percent of their  bid, which left a funding gap of 53 percent.

She said the disbursement so far is close to 20 percent, which is 30 percent below the ideal 50 percent for the half year period.

“However, if we further analyse this, we note that $2 625 746 of the $7 829 183 disbursed so far is not money that we actually received, but it went towards Zimra set-offs for utilities, B.O.C (a supplier of industrial gases and related equipment) and suppliers that we owe as a ministry,” Machamire said.

Ruth Labode, the chairperson for the parliamentary portfolio committee on  Health queried why the ministry made a plan on money that was not available.

“We knew from the beginning that the revenue coming in was not enough but we still went on to throw figures of money we did not have?

“As we move towards 2015, we should work on what is feasible,” Labode said

“Why have you not mentioned the Health Transition Fund? We know that Harare Hospital gets $6 million and why is it that chief executive officers of these institutions have open-
ended contracts? It is about time a ceiling was put on those contracts.”

Although the donor community has come in to assist government, most women in poor communities still face problems in registering for the services.

In 2012, maternal and child health was allocated $6 million but only managed to access $2,6 million.

However, the figure was reduced to $5 million in the 2013 budget.

UNFPA in 2012 received a grant of €9,9 millionwhich was used to revitalise Maternity Waiting Homes, a development aimed at increasing access to skilled attendance delivery.

A significant number of waiting homes were established in most rural centres, a positive development which could have contributed to the decline in mortality rate.

“Zimbabwe has witnessed an unparalleled decline in key maternal and new-born health status indicators and is off target in achieving MDGs 4 and 5,” UNFPA said in a paper titled
“Revitalising maternity waiting homes and related services programme.”

“Evidence from the Zimbabwe Demographic and Health Surveys (ZDHS) show that skilled attendance at birth, declined from 73 percent in 1999 to 66 percent in 2010/11, institutional delivery also went down from 72 percent in 1999 to 65 percent in 2010/11 and antenatal care coverage has declined from 94 percent in 2005/06 to the current 89 percent.” Itayi Rusike, chief executive officer of the Community Working Group on Health (CWGH) said it was imperative for the ministry of Finance to prioritise access to funds for the ministry of Health.

“While the mortality figure has decreased to 525 deaths per every 100 000 live births, there is a greater need to mobilise more resources to address the underlying causes, identify
the areas where most deaths are happening so that they can be resourced adequately,” Rusike said.

“Most maternal deaths are happening at lower community levels hence the focus of resource targeting should be at the lower level in order to stem the unacceptably high maternal mortality.

“This calls for the need to strengthen the primary level of care by providing more funding at this level.”

Rusike also bemoaned the lack of clear guidelines in user fees which resulted in public health institutions charging fees to augment their meagre resources from government.

“There are still a number of barriers to access and uptake of maternal health services; including delayed reporting, failure to recognise danger signs, high fees at district hospitals, first use of traditional healers, service barrier, communication facilities, inadequate transport, social barriers, lack of drugs and skilled staff,” he  said.

“The welfare of mothers would be greatly improved and maternal mortality rates could be reduced by providing more education on sexual and reproductive health issues which should include training on methods of birth control and sensitisation to promote greater understanding of the physical aspects of pregnancy and the risks of child-birth control and sensitisation to promote greater understanding of pregnancy and the risks of child birth.”

Tinashe Mundawarara, programme manager for Aids and Law Unit with the Zimbabwe Lawyers for Human Rights, said the government was reneging on its constitutional obligations with
regards to the right to health care as espoused in Section 76 of the Constitution of Zimbabwe.

He said government needs to adopt budgetary and other polices towards the full realisation of the right to health.

“You have a situation where the parent ministry of Health is allocated less than half of what they ask for  and in the end, 50 percent of this inadequate amount that would have been
allocated gets disbursed,” he said.

“In the end, the ministry of Health thus carries an enormous burden in discharging the State’s obligations for the provision of basic health care services especially in maternalhealth where you require more than a limping budget to deliver and maintain basic maternal health services.”

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