Background on the issue of user fees

The cause of high HIV transmission are multifactorial

In November 2020 Zimbabwe daily reported that 6 000 children are born with HIV in Zimbabwe annually: . Of these, 29% are not on ART and 30% of those not on ART are lost each year. These children are dying mainly because of delays in diagnosis and failure to access paediatric ART. The Zimbabwean eMTCT Program has not been performing very well. Despite the introduction of Option B+ in 2014, the HIV Maternal to Child transmissions remain high (6.39% in 2015 going up to 6.74% in 2017) and there are no signs that it will come down to the target of <5%. The challenges contributing to this are across the continuum of antenatal and postnatal care. Despite the high ANC coverage, some expecting mothers do not reach the minimum four ANC visits. Some might test negative in their first ANC visit but seroconvert during the course of the pregnancy. Because they do not come for subsequent visits, they are missed and not put treatment. There is also the barrier of User Fees charged by local authorities. These have caused most pregnant women to only come to the health facility for delivery. At Mpilo, the ANC is overwhelmed by expecting mothers who are coming from Local Authorities Clinics because they do not have the required User Fees.

According to Dr Mushavi, the National EMTCT Coordinator, the cause of high HIV transmission are multifactorial. According to her, though 93% of women attend at least one ANC Visit, most of these attend around 26 – 27 weeks of pregnancy, which is late. User fees is one of the reasons for late booking because the pregnant women will spend time to put together the required ANC fees. This mostly affects women in the urban settings where there are mostly Municipality run clinics. In the rural areas, there are government facilities that offer free Maternity services. The challenge for the pregnant women in the rural areas is access to health facilities due to long distances and poor transport networks. She also brought up an issue of culture and religion playing a role. Some religious groups in Zimbabwe (“the white garment churches”) do not believe in going to health facilities for care.

The user fees have become a barrier considering the economic situation in the country and household income. Most people in Zimbabwe are informally employed. Because of the Covid-19 related lockdowns, the situation is getting worse for most households. This makes it very difficult for a pregnant mother to prioritise ANC when children go hungry. Find below some of the user fees charged at local authority clinic:

City of Harare Clinics
Target Group First Visit (USD)  Second & subsequent Visits (USD)
Pregnant Mothers $25 Free
Adolescents $5 $10 (Doctors)
Children under 5 $3 $5 (Doctors)


City of Bulawayo clinics
Target Group First Visit (USD)  Second & subsequent Visits (USD)
Pregnant Mothers 19 USD FREE
Adolescents 4 USD 4USD
Children under 5 FREE FREE


City of Mutare Clinics
Target Group First Visit (USD)  Second & subsequent Visits (USD)
Pregnant Mothers 10.00 Free
Adolescents 0.91 0.60
Children under 5 Free of charge Free of charge


Please note that these three cities are just samples but user fees are paid for all the Local Authority clinics.

Local authorities are supposed to get budgetary support from the Central Government but they have not been getting it. This is attributable to the political fights between the ruling party and the main opposition party. The opposition controls most of the Urban Local authorities/municipalities and the ruling governing party is not willing to provide the resources to the local authorities lest they succeed and in turn continue to be voted for in the elections. So tackling the user fees issues is more complex because the local authorities say user fees are their sources of revenue.

There are no recent studies done on effects of user fees on maternal health services. Unfortunately, there is not much media coverage on the issue.


Prepared by:


Dr Enerst Chikwati



AHF Zimbabwe

Post published in: Featured

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