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Zimbabwe Briefing - Issue 94
Crisis in Zimbabwe Coalition (SA Regional Office)
October 03, 2012

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Maternal Health: One Step Forward, Two Steps Back

To some of us who are in human rights work the move to scrap maternity fees from all provincial and central hospitals countrywide to ease pressure on underprivileged expecting mothers was a plausible effort from central government. However what had seemed like a moment worth celebrating for many Zimbabweans can be a pie in the sky if we fold our hands.

Human rights activists have for long been advocating for the government of Zimbabwe to respect, protect and fulfil the right to health and particularly maternal health through increased access to health care facilities by pregnant mothers. Maternal and child health care is a key element of the right to health. This is in sync with the human rights principles and the Campaign on Accelerated Reduction of Maternal mortality in Africa (CARMMA) under the theme "Zimbabwe Cares: No Woman Should Die While Giving Life!" launched in 2010 and spearheaded by the Hon. Deputy Prime Minister, Thokozani Khupe. The programme feeds into Zimbabwe's MDG target for the maternal mortality rate of 174 per 100 000 live births.

Faced with a high rate of maternal mortality and the need to respond effectively to the growing concern, the Ministry of Health and Child Welfare scrapped user fees for pregnant women starting July 2012. According to the Zimbabwe Demographic Health Survey (ZDHS 2010-2011), the country has a Maternal Mortality Rate (MMR) as high as 960 deaths per 100 000 live births. An upward trend can be seen as statistics from the 2010 Millennium Development Goals status report that show that in 1994 the MMR was 283 per 100 000 live births, rising to 695 in 1999 before declining to 555 between 2005 and 2006 and 725 deaths per 100 000 live births in 2007 according to the Zimbabwe Maternal and Perinatal Mortality Study (ZMPMS, 2007).

The Ministry of Health embarked on what can be called a noble initiative in terms of increasing access services but whose undertaking and implementation manifest the failure by the ministry to carry out a feasibility study to determine the extent of the problem and its capacity to respond effectively. In a clear act of poor judgement and desire to score political gains, the Ministry officials in their wisdom failed to act appropriately.

The Ministry was and is aware that in the 2012 National Budget the Minister of Finance Hon. Tendai Biti allocated only US$345, 6 million which amounts to 8.6% of the total national budget and more than 6% below the Abuja Declaration recommendation of 15% of the total budget. The 8.6% would only allow for around $ USD19.70 per capital income which falls short of the minimum WHO guidelines of USD34 per capita income.

As policy makers and implementers the government is aware that the high mortality rate has been accelerated by failure to afford medical care by the majority of women. They are also aware of the carrying capacity of state health institutions and the staff levels, particularly, the midwives and inadequate financial resources. With that in mind the government officials should have taken an incremental route instead of the radical policy shift since such policy changes required radical changes on the grant.

From the day of the policy inception, Harare Central Hospital maternity wing is reported to have failed to cope with the surge in numbers of pregnant women as it can only accommodate 180 people at any given time, but had become over-stretched after admissions began averaging 70 per day. Such is a clear case of a possible implication that was not well thought of. Further to that, the Ministry officials were quite aware when they made the decision that staffing levels are compromised at most if not all state health institutions. According to the UN-FPA in the ZDHS (2012-2011) only 22 percent of posts for midwives were filled. With such a scenario imagine the quality of services that will be offered when the expected average figures are surpassed. What boggles one's mind is why someone entrusted with the nation's health would pursue a policy that is counterproductive without assessing all imperatives and which in all respects lacks a semblance of sustainability. Be that as it may, the temporary policy shift exposed the government and the nation at large to the inadequacies of the health vote and the need to increase the health allocation in subsequent years. The government should make the health sector a priority. If the government work with 15% in line with the Abuja Declaration as a benchmark policy makers should be able to cover ground in the progressive realisation of the right to health. Right now the debate and focus is being limited to the failure of the government to meet the international targets as the primary cause of the government's failure to provide adequate health care to pregnant women.

The GNU has been extravagant with resources in splashing huge sums of money in purchasing luxury and top of the range vehicles. The inclusive government also gobbled US$45 million in foreign travel in 2011 alone according to Minister Biti. This is all at the expense of service delivery. In this light, as health rights activists who were active in push-ing for the right to health in the new constitution, we are buoyed by the possibility of the right being enshrined in the New Constitution of Zimbabwe. The Copac draft enshrined the right to health in the Bill of Rights in Chapter 4 Section 28. The move is positive. From this desire is to up our tempo using the constitution to demand the respect, protection and fulfilment of the highest attainable standard of physical and mental health for all Zimbabwean.

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