Mixed feelings over Health Transition Fund

The Ministry of Health and Child Welfare early last year received more than $5 million from a multi-donor programme to support the health system. The European Union is the main funder of HTF, which aims to eliminate user fees for women and children to save more than 30,000 lives. The funds are managed by the United Nations Children’s Fund.

A snap survey of three main central hospitals in Harare by The Zimbabwean and exclusive interviews with senior officials revealed that Parirenyatwa’s Mbuya Nehanda Maternal Hospital recently increased maternal user fees for normal delivery from $50 to between $80 and $150. Caesarean or theatre deliveries now range from $450 to $600 from $350 to $500.

Harare Central Maternity Hospital user fees for normal deliveries are pegged at $50 but can go up depending on number of days spent in the hospital. Medication and sundries are added as well as a bed fee of $15 per day.

Surprisingly, Chitungwiza Central Maternal Hospital, which used to charge for maternal health care, dropped its charges in July last year owing to the HTF.

Pregnant women and their husbands expressed confusion over the scrapping of user fees.

“When I booked my wife for antenatal care she was six months pregnant. The money is too much and I cannot afford it,” said a Mr Mapfumba of Chabwino Farm in Shamva, who had come to visit his wife at Mbuya Nehanda.

Amai Mapfumba said she was referred from Tope Clinic near toll-gate along Shamva Road where she had initially paid $10 maternity fee.

“I have been here for six days as my blood-pressure was very high. The fees are just too high and a lot of women are dying in rural areas,” she said. “They are charging $20 bed fee per day and now have been prescribed for a scan which is $25 here.”

Mapfumba said he pleaded with the doctors for his wife not to be admitted since he could not afford the $20 per day bed charges.

“I asked them to discharge her and she would come back when she is about to deliver, but they refused saying the law does not permit them to do so as they risk being prosecuted,” he said.

“They said if she delivers through a normal delivery I would pay $80 plus bed fee and for caesarean they said plus or minus $500.”

Another couple at Harare Central, who spoke on condition of anonymity, said they paid $70 for a normal delivery.

“She was admitted at 12noon and delivered at around 8pm two weeks ago but was discharged the following day. I paid $50 for her to be discharged,” said the husband who had accompanied his wife to collect a birth record.

“Initially I paid $25 at Mbare Edith Opperman Maternity. What surprises me is that we are told by the media that maternity is free of charge but when we come here we are asked to pay,” he added.

Parirenyatwa Chief Executive Officer Thomas Zigora said the hospital received both poor patients and those able to meet medical expenses.

“I do not believe that the fund you refer to could have been created to cover the user fees for every single patient, inclusive of private patients, medical aid and those with means to settle their fees.

“The extent to which funding from any source is adequate for purposes of assisting the hospital to meet the needs of its patients will depend on several factors, including the rate at which reimbursements are made for services rendered, the timeliness of disbursement and other such factors,” he said.

All hospital stay charges are quoted on the basis of a minimum hospital stay of seven days and the actual fee depends on a particular patient’s hospital stay.

“The hospital has processes to ensure that patients who may not be able to settle their bills on discharge, agree payment terms to clear their bills,” he said.

“Hospital debtors stood at $18 million at the end of 2012. The long or short of it is that someone must pay for the hospital to purchase the medical supplies required to provide patients with services,” he added.

Zigora said that government did not have the resources to fund the hospitals – yet when patients present themselves the hospitals are duty bound to provide services.

“So please tell us what else should we do?” he asked.

Harare Central Hospital Clinical Director George Vera said they received the HTF once and it had since elapsed.

“Yes, we were given some funds that covered a certain limit, the amount has since finished but it helped a lot,” he said without giving details. “The amount we were given was not enough to cover all expenses and we still have some liabilities,” added Vera.

“We are waiting for the full implementation of the programme but we usually get a lot of promises and sometimes it comes late. Sometimes we are told to use our money and they would repay us later but the thing is we do not have the money.”

Chitungwiza Central Hospital Principal Nursing Officer Miriam Mangeya said maternal health care had been given for free since July last year.

“We only take those referred from polyclinics or those who delivered here before. The Health Transition Fund is reimbursing us. Our charges for a normal delivery and theatre are $150 and $400 respectively, blood, medication, bed fees are solely for free,” she added.

She appealed for the Fund to be revised upwards as they were overwhelmed.

“Initially we used to have 400 deliveries per month and it has increased to 683 normal deliveries and 109 caesarean deliveries in December. We are appealing to government to increase our establishment as the number of our midwives is very low,” she said.

Minister of Health and Child Welfare, Henry Madzorera recently told The Zimbabwean that government had adopted a policy to scrap user fees but was yet to implement it completely.

“In 2012 only 18 districts benefited on the pilot programme benefited from the fund and women in those districts were already enjoying free services. We will see if we can expand it early this year depending on the funds available,” he said.