Fees for pregnant women, under 5s and over 65s must be eliminated in rural Zimbabwe, says health minister

A policy scrapping user fees for pregnant women, children under five and those over 65 must be enforced, particularly in rural areas, Zimbabwe’s Minister of Health and Child Welfare Dr Henry Madzorera has said.

By Robert Tapfumaneyi

A policy scrapping user fees for pregnant women, children under five and those over 65 must be enforced, particularly in rural areas, Zimbabwe’s Minister of Health and Child Welfare Dr Henry Madzorera has said.

Speaking in Harare, Dr Madzorera said ten women die every day in Zimbabwe as a result of complications during pregnancy. But no woman should die while giving life.

He added: “User fees are one of the most important barriers preventing Zimbabwean women and children from accessing healthcare and fulfilling their right to health services. We have now created an adequate pool of resources that will allow us to eliminate user fees, starting with the clinics in rural areas, which typically suffer the most inequity in terms of access to quality care.”

Since the late Nineties, the Ministry of Health and Child Welfare has said that user fees should not be charged for pregnant and lactating women, children under 5 years and people more than 65 years. However, efforts to monitor and enforce the policy have been complicated by health facilities having insufficient resources to cover their running costs in the absence of user fees.

In line with Zimbabwe’s 2009 to 2013 national health strategy, and in an effort to reach the millennium development goals on health, the government says it is once again committed to achieving free access to healthcare for these groups.

The Ministry of Health and Child Welfare has also been in the process of strengthening health facilities to cope with the likely increases in demand once the scrapping of these fees is enforced. With support from development partners, essential medicines and equipment are being provided to every rural health facility in the country. Medical staff are being trained in maternal, newborn and child health and are being retained and motivated through the country’s Health Worker Retention scheme.

“Human resources are the heartbeat of our health system. An appropriately trained, skilled and well-motivated workforce is a critical component required for the efficient delivery of health services, including pregnant women and children. The Ministry of Health and Child Welfare has therefore given human resources high priority in order to increase access to trained human resources and to achieve both the national health and millennium development goals,” Dr Madzorera said.

He added that health workers need to earn a living like all professionals and deserve conducive working conditions as they are not only dedicated, highly skilled and hardworking but will often work in isolated areas with no access to urban amenities.

Supporting delivery of targeted, high-impact interventions for maternal, newborn and child health is a priority, and requires adequate numbers of trained health professionals, particularly midwives. However, Zimbabwe has experienced a high attrition rate of experienced and skilled health professionals over the last thirty years. Health professionals have continued to leave in the face of an increasing disease burden and related workload, and people are continuing to die.

In an effort to maintain a skilled health workforce, medical staff in Zimbabwe have been receiving a retention allowance from the Global Fund for AIDS, Tuberculosis and Malaria. The agreement between the Zimbabwean government and the Global Fund was that the latter would reduce its contribution by 25% every year and that the government would then make up the difference in order to maintain health worker allowances overall. But unfortunately the economy in Zimbabwe has not yet picked up sufficiently to enable this to take place.

The Health Transition Fund (HTF) has now received 17.1 million USD from the European Commission to provide financial support to maintain retention allowances at their current levels. These allowances continue to be received by health workers across Zimbabwe through the Health Workers Retention Scheme.

Zimbabwe has 21 schools for midwifery training, and in 2012, 726 midwives commenced training. However, there have been particular challenges in recruiting tutors responsible for training new midwives and ensuring all women have access to a skilled medical attendant at birth in order to keep both mother and baby alive. For this reason, an extra, short term allowance has been allocated through the HTF for midwifery tutors and midwives.

There has been an unacceptable leadership vacuum within the health sector as many managers have been recruited to work elsewhere. A critical allowance is also being paid to selected managerial positions that will help to ensure the objectives of the national health strategy are met. These positions get a government salary and an allowance from the HTF but not the retention allowance.

Past and current experiences clearly indicate that without adequate human resources for health it is impossible to improve access to quality health services. People are the most important resource in any health service. Other resources such as funding, equipment and materials may be available but without the human resource component they will be useless, and the health of the nation will not improve.

Dr Madzorera praised health workers who he said have “continued to serve dedicatedly [sic] with minimal remuneration.”

He added: “The Ministry of Health and Child Welfare will continue working very hard to ensure there is a happy workforce in the right place, with right tools for the trade to provide the right care for all Zimbabweans.”