Council clinics ignore govt directive

HARARE - A number of council clinics are still refusing to attend to pregnant women who are not registered with them notwithstanding the existence of a directive issued by government late last year.

In December 2017, President Emmerson Mnangagwa’s administration scrapped user fees for children under the age of five years; all maternal cases and for senior citizens above the age of 65 years.

That same month, a memorandum was generated to all district medical officers, medical superintendents and chief medical officers, rural district council chief executive officers and town clerks, advising them that the policy was now a requirement.

A survey by the Daily News on Sunday has however, shown that unregistered pregnant women seeking to deliver at their nearest healthcare facilities are still being turned away in spite of the directive.

A case in point is St Mary’s Clinic in the dormitory city of Chitungwiza where residents spoke of women being turned away because they were not registered with the health institution.

One resident who spoke to this publication said pregnant women should be allowed treatment even when they do not have money to pay for the service as their condition was a matter of life or death.

“Last week, a woman was turned away at the clinic by some rude nurses because she was not registered there. They told her to go to Chitungwiza Central Hospital where she could get free treatment. Unfortunately, for the woman her time was due and she ended up delivering her baby by the clinic’s entrance,” said the resident.

Chitungwiza Town Council spokesperson, Lovemore Meya, said the local authority was still charging user fees for the three groups, arguing that only until when they get a clear directive from the ministry of Health will they scrap the requirement.

“There has been no official comment from the ministry. We are still making frantic efforts to get a clear position on the matter regarding the user fees. However, at present they (user fees) are still in place,” Meya said.

A survey by this reporter showed that this is not just limited to Chitungwiza alone.

Pregnant women at several council clinics are still obliged to pay user fees and provide other ancillary requirements such as gloves, surgical razor blades and umbilical cord clamps, while those over 65 also expected to pay for medical services.

The development shows that Zimbabwe still has a long way to go to eradicate maternal mortality.

Despite the decrease in maternal mortality worldwide, Zimbabwe still remains one of the countries with the highest incidences.

At least 242 pregnant women died in 2017, up from 124 incidents recorded in 2016.

Zimbabwe’s maternal mortality rate stands at 614 deaths per 100 000 live births –one of the highest in the region.

According to the Zimbabwe Demographic Health Survey (ZDHS)’s 2015 report, at least one in every 15 live births die before reaching the age of five.

The report further stated that the level of under- five mortality is 69 deaths per 1 000 live births.

A maternal death is any death reported as occurring during pregnancy, childbirth, or within two months after the birth or termination of a pregnancy.

According to reports, the estimate of the maternal mortality ratio for the seven-year period preceding the 2015 ZDHS report was 651 deaths per 100 000 live births; that is, for every 1 000 births in Zimbabwe, there were about seven maternal deaths.

Observers, however, say the number could be higher since some cases are never reported, considering that Zimbabwe records between 500 000 and 700 000 pregnancies every year.

In Zimbabwe, owing to the persistent economic hardships, several people are living on less than a dollar a day and cannot afford basic health care.

The provision of health care is extremely expensive when compared to what obtains in the sub-region, and most of the drugs are unavailable.

While waiting shelters have been established in some rural areas for pregnant women to be closer to healthcare facilities, some women still fail to access the facilities because of the long distances involved, leaving them to give birth at home in unsanitary conditions.

Zimbabwe Association of Doctors for Human Rights executive director, Calvin Fambirai, said the insistence on payment of user fees shows that there is no concordance between the political narrative and the administration of health.

He said while the Mnangagwa’s administration is giving indications of free and improved access to maternal health services, the system is not responding.

“What it then points to is that no attendant funding was channelled to the said facilities in line with the policy directive. As we have stressed before, it is basic that any policy narrative should be supported by a budget. In the absence of funding promises of free access to maternal healthcare remains a mirage to the pregnant and would-be mothers,” Fambirai said.

The Zimbabwe Local Government Association (Zilga), however, believes that while the directive may have been passed, councils do not have the requisite budgets to support it.

Zilga president, Killer Zivhu, said it was important to note that most local authorities pay their own medical personnel and buy their own drugs without governmental support and it would be unfair to deprive them of a revenue source that sustains their operations without providing subsidies to keep them going.

“Let us remember that in 2013 when government wrote-off those debts they did not do the same thing for what councils owed to others. That left many local authorities bankrupt with some even being hauled before the courts,” he said, referring to a populist directive by former president Robert Mugabe’s administration in 2013, ordering power utility Zesa Holdings and councils to write-off debts owed to them by residents.

The 2013 directive resulted in councils failing to deliver services to their residents.

Said Zivhu: “Similarly, this directive cannot be effected without a proper budget. If the directive was there, it should be cascaded down to councils with support”.

In February 2013, under the Government of National Unity, then Health minister Henry Madzorera scrapped user fees for the pregnant women, children under the age of five and senior citizens over 65 years.

The move, which was expected to help the country achieve the Millennium Development Goals, was prompted by a $17 million donation from the European Union.

Nonetheless, it was never implemented.

Last year, as part of his 100 day plan, Mnangagwa scrapped all user fees for pregnant women, children under the age of five and senior citizens over 65 years.

According to a December 2017 memo copied to all district medical officers, medical superintendents/chief medical officers, rural district council chief executive officers and town clerks, the policy was now a requirement.

“With the coming in of the new dispensation, Cabinet has approved a 100-day plan which everyone has to work towards achieving. One of the issues in the 100-day plan, which requires attention, is the removal of all forms of payment for non-paying groups.

“The following groups are supposed to be treated for free: a) children under the age of five years; b) all maternal cases; c) senior citizens above the age of 65 years.

“These groups are not supposed to pay any consultation fees, card fees, table money, administration fees or whatever name the fee might be called. You are therefore expected to advise all your institutions to remove these fees with immediate effect. DMOs (District Medical Officers) are being reminded that the first progress report is due on 25 January,” the memo reads.

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