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Government
should improve maternal and child healthcare
Sibusisiwe
Ndlovu-Bhebhe
March 05, 2012
Child mortality
and maternal health remain a challenge for Zimbabwe and indeed most
developing countries despite the explicit call to focus on these
critical areas through millennium development goals number four
and five which call for steps to be taken towards the reduction
of child mortality rates and improvement of maternal health care
service provision. According to the World Health Organisation (WHO)
of the 3.1 million deaths that occurred in 2010 amongst newborns,
a quarter to half occurred within the first 24 hours after birth.
WHO also states that labour, birth and the immediate postnatal period
are the most critical for newborns and maternal survival and argues
that in many low and middle income countries, mothers and new born
babies do not receive optimal care during these critical periods.
It is therefore important to understand that a failure to provide
the best care for both a mother and her new born soon after delivery
is a risk on both their lives. The reported detention of mothers
and their children at Mpilo Hospital for failure to pay their full
hospital fees (Chronicle 17 January 2012) is disturbing in light
of the fact that not only does it deny the mother and child the
opportunity to bond in a healthy and conducive environment that
allows them to regain their strength, but it also places the mother
and in turn the baby under immense mental strain. While hospital
officials have denied ever having detained anyone for not paying
their bills, some victims who spoke to the press and this writer
have confirmed that this is an on-going issue which while not in
hospital policies has been effectively applied for years to get
mothers to settle their bills with the institution.
According to the media reports, new mothers are asked to provide
their own food and bedding if they have not paid their fees. It
is quite obvious due to the strain of delivery that new mothers
and their babies need all the support they can get to fully recover.
Asking these mothers therefore to make their own food provisions
and sleeping arrangements in a common room may be a difficult task
due to the special care and attention needed. Placing them in one
room with no guarantee of bedding and food may leave these children
at risk of malnutrition and catching diseases like pneumonia amongst
others.
This is sad considering that the government announced late last
year that it had secured $430 million in funding to support free
maternal health care at public hospitals. The fund was reportedly
secured through the European Union (EU), UNICEF, and other donor
agencies and well-wishing countries. These efforts have also been
backed by other donations made early this year by the Deputy Prime
Minister Thokozani Khuphe who facilitated the rehabilitation of
critical equipment at Mpilo, including the institution-s incinerator.
It is unfortunate that these efforts and positives have not yet
trickled down to the ordinary beneficiaries who are still being
detained for none payment of fees. Added to this, the fact that
these mothers are being forced to leave their children-s birth
records before they can be discharged, is in itself a violation
of the child-s right to identity and full existence.
According to the National Action Plan on Orphaned and Vulnerable
Children (OVC), birth records cannot be withheld by any hospital
as this deprives the child of important documents like birth-certificates.
Patricia Tshabalala of Vulindlela Orphanage also weighs in and states
that of the 500 plus children she takes care of, a large majority
does not have birth certificates because these were withheld by
health institutions for none payment of fees. Enquiries made with
the Zimbabwe Lawyers
for Human Rights (ZLHR), revealed that a hospital contract in
this case is between the mother and the hospital and does not include
the child. Therefore, withholding the child-s birth-record,
and detaining the child with the mother is tantamount to violating
the child-s rights while at the same time depriving them of
a healthy environment to develop in the first few days of their
lives. It must also be noted that detaining the mother and child
for none payment in exclusion of the father indirectly presumes
that the mother is the only one responsible for the existence of
the new born.
It is interesting that Mpilo has so far failed to use the same mechanisms
it uses for its other services in this instance. For example, ambulance
fees are placed on the water charges bill forcing the patient to
pay the debt when paying for their water bills. Is it not possible
to also include these charges in the rates bills even if these are
not under council-s services. It would be better to give the
new mothers an option of payment plans which will allow them to
pay off their arrears without exhausting all of their financial
sources of income and compromising the new born-s health.
While taking them to the debt collectors would be an extreme method,
at least the hospital would be guaranteed of interest being charged
on overdue amounts while someone else puts the pressure on debtors.
It will also allow the mothers to go back home and find means of
paying the debt while taking better care of their babies than when
they are stuck in a hospital ward. Nevertheless it must also be
made clear why it is so expensive for mothers to give birth at government
hospitals. If council clinics can charge US$30 for the same service
that the hospital charges up to US$200 for, then the extra special
services being offered by the hospital must be made clear to the
patients.
It is also important that the government of Zimbabwe and respective
institutions take serious steps towards being part of the solution
than part of the problems that stand in the way of fully meeting
the MDGs by 2015. Instead of harassing new mothers, health institutions
must instead put such pressure on the Ministry of Finance to release
the funds promised in the 2012 budget
statement.
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