“Health system is on its knees.”
Recently I read an article about a woman who delivered twins at one of the Harare City Council clinic’s gate because the clinic had been closed. I shuddered to think how much worse it may get unless the new national health leaders redirect some resources toward maternal health services immediately.
Right now, the reality is the focus for health delivery is fully on COVID-19. There is a daily situation report on the epidemic and a special news segment to talk about COVID-19 on national television. Other health needs are being deprioritized or ignored, including sexual and reproductive health and rights (SRHR). Evidence of this is that only six polyclinics are functional in the whole of Harare.
This unequal resourcing is true in many parts of the world. A publication by Plan International noted that resources are being redirected away from vital SRHR services in favour of other COVID related responses. A survey conducted by the International Planned Parenthood Federation (IPPF) among its members similarly revealed that the COVID-19 pandemic is having a major impact on the delivery of sexual and reproductive healthcare around the world. The report highlights that 5,633 static and mobile clinics and community-based care outlets have already closed because of the outbreak, across 64 countries.
Zimbabwe has not been spared from the challenges brought about COVID 19 as its health delivery system continues to deteriorate, including in the area of maternal health.
This is such a shame when the country was celebrating the reduction of maternal mortality from 614 to 462 deaths per 100 000 live births at the beginning of the year. This was really a step in the right direction as it echoed Zimbabwe’s commitments made at the International Conference on Population and Development in Nairobi, Kenya, last year where the country committed to half maternal deaths from 614 to 325 by 2030. Measures that were put in place to reduce maternal mortality included the scrapping of user fees in public hospitals and delivering babies under the supervision of skilled birth attendants.
However, with the coming of COVID 19 and the continued strikes by doctors and nurses this commitment might remain a dream for Zimbabwe. Rashida Ferrand, director of the Zimbabwe–London School of Hygiene & Tropical Medicine Research Partnership, based at Parirenyatwa Hospital in Harare, had this to say about the nurses and doctors’ strikes that have been ongoing since 2019, “This has affected all health-care services…obstetric, dialysis, acute medical and surgical, and chronic HIV care.”
She goes on to say the “Health system is on its knees.”
This is the truth about the health system in Zimbabwe as hardly a day passes without an announcement of a death which could have been avoided if our systems were stronger.
The situation specifically in maternal health has resulted in women’s babies being delivered by untrained personnel outside the health delivery system. The policy of free maternity health services is no longer applicable as women are having to pay for services — and this is financially out of reach for many.
Because so few medical resources and personnel are available, desperate mothers-to-be are turning to other avenues for help. In an interview I had with mbuya Gwena, a woman who has become a well-known untrained midwife, she told me that she has delivered 65 babies since January this year. She narrated how she was afraid to deliver a baby who was breech (where a baby presents with buttocks first), but felt she had no choice but to try to deliver the baby anyway. Many traditional midwives are conducting deliveries without any training or resources to carry out the work. This is a situation which is unacceptable.
I am however encouraged by the fact that now the Ministry of Health and Child Care now has a new Minister and a new Permanent Secretary. The Minister is the Vice President who has the power to change the focus on maternal health in the country. I, therefore, call upon the newly appointed minister to give attention to the plight of pregnant women in Zimbabwe and ensure that the Reproductive Health Department and the nursing services are given the attention they deserve. The starting point is to allocate 15% of the national budget for health for non COVID 19 health issues. The ongoing strike by nurses and doctors should be addressed as a matter of urgency. This way we will reach our target of halving maternal mortality ratio by 2030.
Zimbabwean women’s and girls’ voices must be heard.
Edinah Masiyiwa is a women’s rights activist. She is the Executive Director of Women’s Action Group and an Aspen Institute New Voices Senior Fellow.