I’ve just returned from Zimbabwe, a country that has remained under the radar in recent years but is visibly strained by over a decade of economic hardship. Nowhere was this more visible than in the rural areas I visited as part of my work there and where many people’s everyday lives are a constant uphill struggle.
Budgeting for health
In my first week, I attended a World Health Organization budget advocacy workshop in Harare, which sought to develop the skills of health practitioners to influence the country’s budget allocations for health.
It provided an interesting insight into the lack of national prioritisation for health – and the lack of resources and redistribution of wealth. Importantly, it created a useful space for advocates and policy-makers to network, share information and work on finding solution to the many challenges they face.
Zimbabwe’s budget allocations for maternal newborn and child health (MNCH) only make up a small percentage of the total health budget. They’re a far cry from what’s needed to provide basic healthcare – let alone ensure that pregnant women and children under five have access to the free services they’re entitled to under the national health strategy.
Free services for pregnant women and children
The country’s maternal mortality rate is alarming. It’s actually worse than a decade ago. Every year, an estimated 3,000 women die in childbirth – that ’’s eight women a day!
Child mortality meanwhile is improving – but very slowly. Newborn mortality stands at 57 per 1,000 live-births and under-five mortality at 84. Why this is the case became apparent when I left the capital and travelled, with Save the Children colleagues, to a remote village in the Guruve district.
When we reached the Gota clinic, we were greeted by a fairly large group, mostly men, including the local councillor, community nurse, Health Centre Committee (HCC) representatives, health literacy facilitators and community monitors to discuss the work taking place here to increase demand for free MNCH health services. We sat under the big tree to shelter from the midday sun and listened to the community nurse present the latest results.
As one of the worst performing clinics in the district, everyone here was pleased to report substantial progress in the number of safe deliveries over the previous year. But while more women are attending the clinic and relationships between the community and the clinic have improved, all is not well.
The project has raised expectations, but health workers haven’t been able to meet the growing demand.
In addition, the infrastructure is inadequate. With no electricity or running water, the clinic is struggling to handle additional patients.
Different clinic, same challenges
The next day, I visited the Mwanza clinic in Chikwaka, with our partner organisation, Community Working Group on Health (CWGH). The HCC here has been active for over a decade and it shows. The clinic is bigger, better equipped and more adequately staffed.
As I get shown around, a woman arrives on the back of a pickup truck. She is in labour and about to give birth. Four women, patients, rush over and literally drag her out of the truck straight into the delivery room.
Health worker’s plight
The visit continues, followed by a meeting with community members, where we discuss the successes and challenges of the project and the environment in which they operate. They have made great strides in ensuring more women know what services are available to them but, here too, provision is not a given.
The village health worker I spoke to is the only one for the five surrounding villages. She’s in high demand, usually 24 hours a day, and often walks at least 10km a day. But she gets paid just US$14 a month – less than half of the symbolic ‘$1 a day’ measure of the world’s poorest people. And that’s when she actually gets paid.
No wonder so many health workers in developing countries desert the profession in the hope of earning a living wage.
Glimmer of hope?
On the way back to Harare, I kept thinking about Eunice – who I’d met in the clinic in Chikwaka clutching her newborn girl. The look of relief in Eunice’s eyes that they were both safe – at least for now – was etched on my memory.
I was therefore heartened to hear that the Ministry of Health is developing a Universal Health Coverage policy. But after my short time in Zimbabwe, I’m aware that in a country facing so many hurdles, raising the necessary revenue to achieve ‘health for all’ will not be an easy task.