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Medical migrants head south
August 05, 2009

For almost a decade Zimbabwe's main international bus station, Roadport, in the capital, Harare, has been a bustling hive of people travelling to neighbouring South Africa: informal cross-border traders going to buy goods, others leaving in search of work and a better life. Now they have a new travelling companion - anyone in need of reliable, affordable medical attention.

"I'm going to deliver my first-born child in Pretoria [South Africa] because it is no longer possible to do it here," said Sophia Chibondo, 25, sitting on a bench next to her anxious husband.

"Being unemployed, and with my husband struggling to keep the family going, we found it wiser to go and seek help from a South African [public] hospital," she told IRIN. "Maternal costs at local clinics and hospitals are just too much, and we cannot afford them."

Thousands have fled Zimbabwe's economic meltdown, food insecurity and political turmoil, but the almost total collapse of the national health system has seen standards plummet and prices rocket, and the Chibondos are now part of a growing group of migrants looking for better, more affordable health care.

South Africa's Department of Home Affairs (DHA) announced in April 2009 that it would introduce a special dispensation permit allowing Zimbabwean nationals to remain in the country legally for up to 12 months, but this is still being considered by cabinet.

In the meantime, a 90-day 'visa-free entry' into South Africa for Zimbabweans is already in effect.

In June 2009 a report by international relief NGO Médecins Sans Frontières (MSF) warned that the adoption of a more "liberal immigration policy" for Zimbabweans was placing greater burdens on South Africa's already stretched health care system.

"Consultations in our Johannesburg clinic have almost tripled in the last year, a telling sign of the extent to which Zimbabweans are consistently denied access to even the most basic health care services necessary for their survival," Eric Goemaere, Medical Coordinator at MSF in South Africa, said at the launch of the report.

Overpriced and substandard

Private hospitals in Zimbabwe still maintain high standards, but at a premium: a pregnant woman would be expected to fork out well over US3,500 for gynaecologists, paediatricians and anaesthetists, besides money for food, drugs and accommodation for mother and child.

Government health institutions are far cheaper but lack trained staff, drugs and equipment. In South Africa, Chibondo said, she would pay less than US$70 for all the services up to delivery, and she could shop for baby care products and clothes at a fraction of what they cost in Zimbabwe.

"Patients prefer to cross the border [to South Africa] because it is cheaper there, and there are higher levels of care," said Primrose Matambanadzo, director of the Zimbabwe Association of Doctors for Human Rights (ZADHR).

"People also still don't have confidence in [Zimbabwean] public health institutions due to the health crisis that ... has affected the country for many years," she commented.

"It is the responsibility of government to ensure a reliable health system, and as long as signs of the crisis linger, Zimbabweans will continue trekking to other countries to get medical attention; a situation that is regrettable."

Most of Zimbabwe's public health centres closed last year as employees protested over poor salaries and working conditions during a severe cholera epidemic that began in August 2008 and claimed the lives of more than 4,200 people out of about 100,000 known cases.

Public health facilities reopened in February 2009, when donors made money available for allowances that brought striking nurses and doctors back to work.

Health minister Paul Madzore recently admitted that a lot needed to be done to kick-start a health system severely affected by the migration of thousands of doctors, nurses and other skilled personnel.

"You often hear of doctors causing the deaths of patients due to negligence. It is therefore not surprising that our patients are avoiding local hospitals," said Matambanadzo.

Chibondo had visited the facility where she would be having her baby several times for prenatal examinations. "I am encouraged by the quality of service at the hospital and the professionalism of the staff - rare things to find in Zimbabwe," she said. Her elder sister had also given birth there.

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