Africanews Health for all by the year 2000 has been a household slogan popularised by the Zimbabwe government since independence in 1980. But following the Ministry of Health's monthly budget of $Z23 million, the poor are finding it difficult to cope with hospital charges. The government's treasury department ordered the Ministry of Health and Child Welfare to reduce its annual expenditure by about one third. This raised eyebrows of some human rights organisations, mission hospitals, the rural and urban folk. The Zimbabwe Catholic Bishop's Conference reacted angrily to the directive, which it said contradicted earlier pledges by the government to maintain its partnership with the Church in running rural health institutions.
"The President during his tour of church hospitals committed his government's support for the financial provision of those hospitals. However, today we see that this committment far from being realised is being reduced," said Bishop Francis Mugadza. Equally disturbed by the announcement was the Catholic Commission for Justice and Peace (CCJP) in Zimbabwe and through its spokesman the CCJP said; "This cut represents a third of the already ridiculously low health budget of 1995/1996. This Commission believes that, this is a human rights violation of gross proportions, particularly in a country beset by HIV/Aids and at the very start of the malaria season." Father Oscar Wermter of the Roman Catholic Social Communications department who works with the urban poor in Chitungwiza, 25km from the capital Harare, says he has been approached by several residents appealing for financial assistance for their medical attention at the town council clinics. Overwhelmed by the residents, he accompanied them to the clinics to plead with the nurses. The patients had come to Fr. Wermter after failing to convince the nurses that they were poor and qualified for free treatment provided by the government's welfare department; "but that didn't help much because these were just a few people". "Yes, Roman Catholic priests help a great deal.
Normally the nurses cannot doubt them because of their position in society. But should they want guaranteed assistance, the priests go to the offices of the social welfare department." said Mr. John Mapika of Mabvuku, Harare. However, since free health was waived at the introduction of economic reforms five years ago, the normal procedure has been that; patients must visit the clinics or hospitals for assessment before they see the welfare officer for a written approval. Whereby they are required to submit it back to the clinics or hospitals for treatment in which there is no guarantee due to shortages of medicine. In most cases the clinics give prescriptions. Meaning that the patients have to return to the welfare office for further instructions. Sometimes the welfare office rejects applications due to shortage of funds. Because of the vicious circle people are subjected to, they are frequenting traditional healers in large numbers, whose conditions of payment suit their financial standing. But Mrs. Cynthia Ngoma of Harare was not too pleased when she was turned away trying to get her son treated. "The sister told me she would come home and investigate my poverty before she accepts my story. Because my son was suffering, I had to run around and borrow some money from friends." "The Sister sent a nurse three months later during my absence and the story I heard was that because I owned a television set, a radio set, and nice kitchen utencils, I was not qualified for assistance.
The message I received from my neighbours was that, whenever I am faced with sickness, I must sell some of my possessions to raise money for clinic fees. These days you have to be known by somebody otherwise nobody follows the rules. It does not matter how you qualify, you have to be known." said Mrs. Ngoma. Due to the economic harships, not only unemployed people require free medical care. Employed people are required to produce payslips to prove they cannot afford the charges. On average, patients are charged about $Z30 for anybody earning more than $Z400 per month. But the system is not very effective because the charges are normally spent as consultation fees. In some welfare offices, applications of patients seeking the services of healers are also processed as long as they are registered. What worries thousands of people is that the money is not forthcoming and both healers, and the welfare department turn down applications. The health problem is also puzzling mission hospitals and the Catholic Development Commission (CADEC) is one of the organisations that have been hit hard. "While mission hospitals have been built by the churches with their own funds, mostly from overseas donors, they rely on government to pay for the running costs. But the hospitals have to buy these things first and claim a refund later.
Quite often claims are not allowed. Where then, is the hospital going to find money for such purchases? At any rate, since the hospital pays first only to be refunded much later, there must be a sizeable revolving fund. But many hospitals cannot afford to pay out large sums of money and then wait for weeks and months for reimbursement by the government. So they just do not buy many things even though they are absolutely necessary, which leads to the absurd situation. Even though our mission hospitals are underfunded, the provincial medical offices sometimes send unclaimed money back to Treasury. But of course our hospitals and their rural patients need every penny,"says Ms Christian Mtize, CADEC's health co-ordinator. Following the reduced financial allocations coupled with an increase in the demand for medical care, doctors working in the rural areas have an added responsibility, thus making a lot of sacrifices and learning to do without special allowances accorded their counterparts in urban hospitals. There are 106 mission hospitals in Zimbabwe, more than 50 of which are under the authority of the Roman Catholic Church.
And observers are concerned that health for all might not be attained as the deadline is four years to come.
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