Articles

Government should improve maternal and child healthcare

By Sibusisiwe Ndlovu - Bhebhe

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 toregain their strength, but it also places the mother and inturn 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 newborn.

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 newborn'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.

Sibusisiwe Ndlovu - Bhebhe is the Gender Officer at Bulawayo Progressive Residents Association (BPRA). She writes in her personal capacity. She can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it.

 

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