By Edinah Masiyiwa
I was visiting Binga District Hospital in Binga, Matabeleland North province as part of a team that was doing a review of the HIV programme when a woman in the middle of a complicated labour took a turn for the worst. The woman was fully dilated (cervix had opened fully to allow delivery), but the baby’s head was too big to go through the woman’s pelvis. The hospital decided to transfer her to another facility 300km away for care. I am a midwife, and I knew that delay in care could have easily killed her. Fortunately for the woman, a doctor who was visiting with my team came up and offered to assist. He took the woman to the operating theatre, resulting in saving the lives of her and child.
It is easy to save lives. But to do so, we need a strong and motivated health force. We need modern facilities and working equipment.
Today, Zimbabwe’s health work force is demoralised and have no resources to use in their work. Just months ago, nurses threatened a work slowdown, to show up just two days a week. It was a desperate attempt to negotiate a salary increase substantial enough to cover the basics of food and transportation to work. Now, doctors are on strike, also hoping for a living wage and decent work conditions. And, increasingly, we hear reports of women dying in labour.
As a result, the progress that we have made as a country in lowering maternal and infant mortality is at risk and the very fabric of our health care system is ripping. One of the main strategies for reducing maternal mortality is to improve access to skilled attendance at delivery; including emergency obstetric care. Where we are now women are delivering without skilled health workers because of the prevailing strike by doctors. It is, therefore, time for the government to fundamentally re-evaluate the priority it places on the lives and health of the Zimbabwe people. We need skilled personnel to deliver women.
As a midwife, I know first-hand that maternity wards are short-staffed. Nurses are now stretched to the limit. They are exhausted, stressed and prone to making mistakes during patient care. The Zimbabwe National Health Strategy 2016 -2020 has reported that the vacancy level for midwives is an astounding 89%. The same strategy states that there is need for a long-term strategy for retaining health staff.
But the government appears to be doing the opposite. Most obvious is its failure to allocate 15% of its national budgets to improving the health system. It made this commitment 18 years ago when signing the Abuja Declaration. Yet, in 2018, only 8,3% of the budget was allocated to health.
Clearly, this is not enough.
Yes, government’s budget is stretched thin. The country is in crisis. Its currency is unhinged and inflation is out of control. Up to 5,5 million people could be at risk of starvation before the year is through. And with mounting malnutrition and hunger will come an ever-worsening health crisis in — which women and their babies will suffer most. In fact, pregnant women are once again finding that they have nowhere to go to safely deliver their children.
In late September, a woman died in labour while nurses in one of the biggest maternity hospitals ignored her. Two lives were lost, baby and mother.
Any woman who has given birth can imagine the pain that this woman went through as she called for help that did not come. A preliminary report later found that the ratio of patients to nurses was twice as high as recommended, and wards designed to accommodate 10 patients housed 17.
How can it be that we have raised awareness on the importance of booking and delivering at a health institution — which was and objective of the Zimbabwe National Health Strategy — but we have such cases where women are dying in hospitals due to lack of care? The woman who died at Mbuya Nehanda Hospital had booked on time, and came to hospital on time. She died due to negligence.
Now, such failures are leading women to stay away from health clinics. Even in the Harare City Council clinics, fewer women are choosing to give birth in hospitals. Too often, when women do show up for a maternal health check-up, they are sent home without being seen by a health provider. This will undoubtedly result in unnecessary deaths, as dangerous conditions during pregnancy, such as high blood pressure, go untreated.
To reverse this free-fall in maternal and child health, the Ministry of Finance must conform to the Abuja Declaration, and allocate a full 15% of the national budget to the Health and Child Care ministry. This will alleviate the human resource challenge facing health institutions. It is the first point to address the financial challenges being faced by the health delivery system. It will allow all health workers — whether midwives, nurses or doctors — to be fairly compensated. It can help stop the drain of health care workers from where they are most needed.
In its own allocation of funds, the Health and Child Care ministry should be gender sensitive, allowing more money to be allocated for maternal health services. We cannot continue to see our women die from preventable causes. This national problem should be addressed with the urgency it deserves.
l Edinah Masiyiwa is a women’s rights activist. Currently she is the executive director of Women’s Action Group and a 2019 Aspen Institute New Voices fellow.