Economic hardship means many health facilities are denying women access to free maternal healthcare. (Aaron Ufumeli)

Long queues tell Zimbabwe's story of economic crisis and failing healthcare

Tawanda Karombo, Adri Kotze
Many people can no longer afford hospital treatment and medication, and the number of those with medical aid has fallen by a third.

Arnold Gambe (76) is near the back of the snaking queue in Harare. He has stood here every day for the past week to get his government pension from the People's Own Savings Bank.

Each morning, he comes from his home near Juru, about 50km north of Zimbabwe's capital, to try to get the stipend. He needs it to buy painkillers: he has back problems.

His orphaned eight-year-old grandson, who is HIV positive, fell ill a month ago. He has chest pains and difficulty breathing. So Gambe also has to buy the boy medicine.

But, with the country's economy in meltdown and running out of dollars, Gambe is just one of the many Zimbabweans who has been struggling to get cash. Banks often run out, but when they do have dollars, they impose strict limits of $500 a week or $200 a day.

"You go up and down to Harare and come back empty-handed," he says. "Some people sleep outside the banks as they can't afford to travel back."

The economic crisis has fuelled a wave of street protests, a national stayaway and a social media campaign against President Robert Mugabe's government.

The importation of many basic commodities has been banned and civil servants, including nurses, went on strike when the government could not pay their salaries.

Stocks and services in short supply
Zimbabwe's health service has been hit hard. Ninety percent of healthcare institutions don't have essential medicines in stock, according to Mercy Bosha, the programmes manager of the watchdog body Citizens Health Watch (CHW). CHW's evidence indicates that antibiotics and medicine for common conditions such as hypertension, asthma and diabetes are often out of stock.

Although antiretroviral (ARV) drugs are free in public healthcare institutions, there have been sporadic shortages, with patients on the third line of treatment most affected.

"Patients are asked to buy from private pharmacies," Bosha says. "Some government hospitals even have privately run pharmacies within the hospitals."

Most hospitals are running at less than 30% capacity.

In the waiting area in Harare Central Hospital, Espinah Matsanda (66) shrugs. Last year she was injured when the taxi she was travelling in plunged into a ditch.

"At first, I thought I would just be treated for the minor injuries from the accident and discharged but the doctors discovered that I had diabetes and high blood pressure," Matsanda says.

She goes to the hospital for her monthly and sometimes bimonthly reviews.

"I sometimes have to borrow money to travel to Harare and pay it back when I get money from my children who work in South Africa. It has been difficult for me trying to make ends meet in this difficult economy as the hospitals don't have medication and I have to buy my drugs from private pharmacies for about $60 every month," Matsanda says.

Pledges of free maternal, child healthcare fail to materialise
She and many others should not have to pay for medicine or treatment. Last month Health and Child Care Minister David Parirenyatwa confirmed that children under five, pregnant women and those over the age of 65 are entitled to free healthcare. But he admitted this did not happen.

"I have observed that, in some hospitals and clinics, they have what we call a 'card fee,' which is illegal," Parirenyatwa told Parliament.

Zimbabweans have long complained that medicine is more expensive than in neighbouring countries, and last month parliamentarians condemned the exorbitant fees charged by both government and private hospitals.

James Maridadi, of the Movement for Democratic Change-Tshivangirai party, reportedly claimed that a yellow fever vaccination could cost $66 in Zimbabwe but only $24 in Kenya.

Anecdotal reports in local newspapers have suggested that Zimbabweans in the north of the country have to "run with cooler boxes" to Zambia to buy blood for sick relatives because it is much cheaper there.

In Zimbabwe, fees vary and appear to be decided on in an ad hoc manner.

Bosha says a seven-day course of the commonly used antibiotic amoxicillin can cost up to $7 and a monthly supply of ARVs between $40 and $50. An HIV viral load blood examination, which is needed to determine whether patients are responding well to ARVs, can cost up to $30 at a private laboratory. Most public healthcare institutions don't offer this service.

No money, no care
Most sick Zimbabweans simply don't have enough money for proper care. Nearly two-thirds (35.4%) of ill people nationally do not seek medical treatment because they can't afford it, according to the Zimbabwe Interim Poverty Reduction Strategy Paper 2016-2018, which was released on June 20 by the Ministry of Finance and Economic Development.

Most Zimbabweans are not formally employed (the unemployment rate is estimated to be as high as 95%, but there is little reliable data available) and don't have bank accounts or bank cards.

The squeeze is also being felt by the country's formally employed and well-off.

Private doctors have been demanding cash up front from patients with medical insurance, accusing medical aids of not paying them on time or not enough. This has led to a long stand-off with the government, which was only resolved last week after the doctors caved in.

Last year, the Association of Health Funders of Zimbabwe reported that medical aid membership fell by 31% from 600 000 in 2007 to 400 000 in 2014. These numbers are thought to have declined even further as the economic turmoil has worsened. Jane Muita, the United Nations Children's Emergency Fund's representative in Zimbabwe, says there is limited funding for health programmes. "If the cash shortages persist for a long time, that is when we are going to see some real challenges, even when people have money in their banks," she predicts.

Gambe's fruitless trips to the bank have driven him to desperate measures. Determined not to let his grandson go without medicine, he sold his livelihood last month.

"I ended up having to sell my oxen for $220, which is below the real market value of about $350 because I had to make sure we secure medication for the boy," he says.

But that money has now run out and Gambe is back in the banking queue in Harare. With no more oxen to sell and no indication whether he will be able to get his pension, Gambe is running out of options. "It is terrible to see him in pain. He needs all the care I can get him. There is no one else who can look after him."

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