Free maternity services require solid funding

THE heavily pregnant woman lying on the floor in a maternity ward at Harare Central Hospital stretches out her hand to greet First Lady Auxillia Mnangagwa.
An unidentified expecting mother at Harare Central Hospital (right) has to make do on the floor due to shortage of beds in the maternity wing
For the briefest moment, the woman forgets about the hard, cold and uncomfortable surface and basks in the glow of being in the presence of “greatness”.
A wide grin splits her youthful face and she nods her head as the First Lady whispers some congratulatory words.
But once the colourful parade and its entourage has moved on, reality sinks right back in and once again the pregnant woman and her colleagues in the overcrowded maternity ward crouch back into their makeshift beds on the floor.
Harare and Parirenyatwa hospitals’ maternity wards, just like in most public health facilities across the country, are swamped with patients and many have resorted to sleeping on the floor.
This follows the scrapping of maternity user fees in accordance with the government policy.
During a tour of Harare Hospital’s maternity wards on the side-lines of the handover of the refurbished maternity wards by the First Lady recently, there was quite a huge number of women using floor beds.
This sad scenario apparently has become the norm in public hospitals.
Harare Hospital has a carrying capacity of around 100 women, but is currently being stretched to accommodate between 150 and 200 women. This also means pressure on the ablution facilities.
The government’s policy on free maternal health has seen a lot of women seeking help at the country’s major referral centres, Harare Central Hospital and Parirenyatwa.

Council clinics are still charging maternity fees and so many women will end up at government health facilities which are offering these for free.
A tour of Parirenyatwa also revealed the same problems. Maternity wards are full to capacity with many women using makeshifts beds.
“We handle births exceeding 20 in one night and this weighs heavily on the staff that have to work extra to contain the situation,” said a nurse who declined to be named.
She said the staffing levels had not increased and the wards had not expanded to cater for the overwhelming number of women.
“This will ultimately compromise services because the staff will be exhausted from handling so many women.
The women, however, had mixed reactions. Some were quite happy to even have the floor bed as long as they were not paying for it.
“I did not have the maternity fees for the council clinic where I stay so I came here to Parirenyatwa,” said a young first-time mother showing off her baby.
However, others felt that it was dehumanising to sleep on the floor and if they had a choice they would not agree to the set up.
The hospital’s public relations manager Linos Dhire said indeed the maternity wards were overstretched but they could not turn away pregnant women.
“The floor beds have been adopted to manage the ever increasing number of pregnant women who come for the free services. It is a good policy, only that the space is not big enough,” he said.
Community Working Group on Health director Itai Rusike said the abolishment of user fees should be backed up by provision of adequate resources.
“The blanket removal of user fees for pregnant women without clear vetting mechanisms for those that can still afford to pay presents a high risk of suffocating the public health delivery system,” he said.
Rusike also said government may need to seriously look at the long outstanding issue of building district hospitals in major cities to decongest the central hospitals.
“Resources must trickle down to the primary care level to avoid the assumption that the higher levels are better funded and better equipped,” he said.
“Unfortunately, it is not clear on how the ministry is going to fund the gap as pregnant women and under five children constitute the majority of the patients.”
Since 2009, the Health ministry has not been allocating significant resources for maternal and child care services.
This has created an over reliance on donor pools which are not sustainable.
Rusike said the free user fee policy for pregnant women and children under five should not just be political rhetoric.
“The health broken institutions need support with resources from the national budget. We need to protect the dignity of patients once they are admitted in our health institutions,” he said.
Speaking on the issue, Fungisayi Dube from the Citizens Health Watch said the policy was not practicable.
“It cannot be operationalised. It is sad and I do not think there is an effort to change things yet.”