Source: The Herald
Complaints by Harare Central Hospital that defaulting mothers are crippling operations by sneaking out without settling their fees are only the tip of an iceberg.

They point to the urgent need for Government intervention to address maternal health issues. The hospital is owed US$8 million in

maternity fees as some women allegedly leave without paying or indicating how they are going to pay in the near future.

The problem is not limited to Harare Central Hospital alone, but is affecting many Government hospitals and clinics.

It is important for the State to establish why these women sneak out without paying their dues.

Public hospital maternity fees are pegged at US$150 for normal delivery and US$450 for a caesarian section. The amounts are too high for most women considering that those who are referred to State hospitals are poor.

The bulk of the women who end up at Government hospitals are those who would have paid US$25 to register at their respective council clinics, but experience complications which require them to go to the referral hospitals like Harare Central.

They would have struggled to raise the US$25 to register and definitely cannot afford hospital fees. In most cases they would not have budgeted for the US$150.

Because the bulk of pregnant women cannot raise the fees, others have simply given up on the health system and deliver at home as they fail to raise the required hospital fees.

In most cases, the women who sneak out of hospitals are unemployed and therefore cannot afford to pay the maternity fees as they also have to cater for other necessities for the family such as clothing, food, rent and rates.

In other cases, the women are single, informally employed and need to get back home to raise the money and cannot afford an extra day in hospital.

Since most of these women are informally employed, they are not covered by medical aid schemes, putting them in a difficult position.

On the other hand, some men do not support their unemployed wives financially during pregnancy. This has resulted in most women going through the nine-month long journey alone.

For this reason, Government should speed up the process of abolishing maternity fees at Government hospitals to cushion women who cannot afford to pay.

Zimbabwe is yet to scrap user fees despite being one of the African countries which adopted the Campaign for Accelerated Reduction of Maternal Mortality in Africa last year.

The campaign challenged leaders to treat the issue of maternal health as urgent.

It is now more than a year since the office of Deputy Prime Minister Thokozani Khupe fund-raised US$100 000 for accelerated reduction of pregnancy-related deaths and complications, but the money has not been distributed.

According to the initial plan for the pilot project, the money was to be paid to Government hospitals in advance so that poor mothers would access maternity services without problems.

It is also important to note that while these women are facing financial difficulties, they should at least try to pay a small amount to ensure that hospital operations are not affected.

On the other hand, hospitals should not confiscate the women's belongings but negotiate for payment plans.

The hospitals must not demand cash only but can arrange payment plans. Some of these women can trade in household property like televisions which will be released upon payment.

Mothers can settle their dues by providing labour at the hospital once they are fit to work. They can clean or cut grass on hospital grounds or their husbands can do this on their behalf.

While the hospitals have been sending debt collectors to defaulters, it has not been an easy task as most people leave wrong addresses or would have relocated.

In recent months, some medical schemes have been advertising their products for the unemployed and the informally employed. Some of the monthly subscriptions for a family of six are as low as US$10.

It is critical for people to take up such initiatives and invest in their future to avoid problems with hospitals.

Government should also come up with a mandatory health policy which will be financed from the national fiscus.

Members of Parliament can even direct some of the money from the CDF towards maternal health to ensure that mothers get enough medical care at the local level.

For example, countries like South Africa have a National Health Insurance, a financing system that ensures that all citizens of South Africa (and legal long-term residents) are provided with essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.

The NHI service package only includes basic health care at all levels, from primary health care, to specialised secondary care, and highly specialised tertiary and quaternary levels of care.

Just like in South Africa the NHI will not include in their package luxuries like cosmetic surgery, expensive dental procedures performed for aesthetic purposes, trendy spectacle frames and medicines.

The Minister of Health and Child Welfare Dr Henry Madzorera should give direct attention to the issue of maternal health and save mothers the embarrassment of having to sneak out of hospitals as if they are criminals.

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