New Public Health User Fees A Threat To Universal Health Coverage

UNIVERSAL Health Coverage can be summarised in two key terms. These are financial protection and quality service coverage.

By Kudakwashe Pembere

The new hospital user fees have a lot of detrimental implications to the health and wellbeing of this country. Government’s role is to create a level playing field while more importantly, protecting the citizens.

Zimbabwe is a nation exemplary in making commitments towards improving health delivery system yet fulfilling them seems to be something taken lightly.

Supposed to have a happy new year were Zimbabweans whose festive spirit was dampened by the new hospital user fees. The hospital user fee increase in Zimbabwe ushered in an unforeseen ‘January disease’. Accessing health care is now a preserve for the wealthy and a luxury in Zimbabwe. From being a human right to a privilege, the Zimbabwean Government has made made health meant for all.

A healthy nation is a wealthy nation. Government should commit to its responsibility of looking after its people’s physical and mental wellbeing. Zimbabwe since independence has been making promises and commitments for its people to have affordable and quality healthcare at minimal costs. That there will be health for all for Zimbabweans remains a utopia with policy inconsistency displayed by authorities. The ambitious target for Zimbabwe to attain the middle income status by 2030 with signs showing through this user fee regime, against the health for all goal in UHC prove Government is not serious.

Universal Health Coverage is best defined as quality health access for everyone at little or no costs.

National strategies to guide the country into making sure no one is left behind have been published in particular the 2016 to 2020 document by the Health Ministry with a payoff line ‘Equity and Equality in Health, Leaving No One Behind.’

The Health and Child Care Minister Dr Obadiah Moyo is on record ensuring that primary health care comes at the fore. In February last year, he ensured that 1792 health posts were unfrozen to beef up the quality component.

The Minister envisions ‘superpecialist’ health facilities for the country where severe health complications are dealt with while other complications can be addressed at district hospitals.Yet, the Zimbabwean government is backtracking on its promise of health for all.

Zimbabwe is struggling to meet the 15 Abuja declaration target where  15 percent of the budget is supposed to be directed towards health expenditure. Health economist, Dr Prosper Chatambara has described Zimbabwe’s situation a grossly inadequate ZW$41 per capita per person.

October last year saw the nation again showing political will on attainment of universal health coverage. But two days into New Year, a somersault on this commitment came as a shocker not only to public health advocates but the nation at large.

Government then tripped on its commitment. Permanent Secretary in the Ministry of Health and Child Care (MoHCC), Dr Agnes Mahomva announced the new government hospital tariffs effective January 1, 2020.

In a statement, Dr Mahomva said the move was reached after taking into consideration the plight of the general populace, as well as the inflationary environment currently prevailing.

The Ministry of Health and Child Care has reviewed hospital fees with effect from 1 January 2020. This was announced by the Permanent Secretary in the Ministry, Dr Agnes Mahomva in a statement on Tuesday.

From not being asked to pay anything in rural district clinics, consultation fees for adults were increased from ZW$12 and ZW$24.

“At Parirenyatwa Hospital, adults will pay $200.00 while children below the age of 5 will pay $100.00 in the General Ward, while at Central Hospitals the fees will be $160.00 & $80.00, at Provincial Hospitals – $120.00 & $60, and at District/General Hospitals the fees will be $80.00 & $40.00 for adults and children respectively,” read the document.

Maternity fees were reintroduced after being scrapped in 2017. The reduction of maternity fees increased health seeking behaviour among pregnant women. Zimbabwe according to the latest Multiple Indicator Cluster Survey (MICS) over the past five years saw a 22 percent reduction in maternal mortalities from 614 per 100 000 live births to 462 per 100 000 live births.

“Ante-natal, General Ward per day: Parirenyatwa Hospital – $200.00; Central Hospitals – $160.00; Provincial Hospitals – $120.00; District/General Hospitals – $80.00 Post-natal, General Ward per day: Parirenyatwa Hospital – $200.00; Central Hospitals – $160.00; Provincial Hospitals – $120.00; District/General Hospitals – $80.00. Caesarian: Parirenyatwa Hospital – $2 500.00; Central Hospitals – $2 500.00; Provincial Hospitals – $1 500.00; District/General Hospitals – $1 000. Normal Vertex Delivery – Parirenyatwa Hospital – $600.00; Central Hospitals – $600.00; Provincial Hospitals – $360.00; District/General Hospitals – $240.00,” read the prices to see many women preferring either home births or private health institutions or local authorities.

The new hospital user fees repel health seeking behaviour in the population at a time when life expectancy among Zimbabweans is improving. Most of the gains and positives achieved will be eroded.

Between 1990 and 2018, Zimbabwe’s life expectancy at birth increased by 3.1 years. World Health Organization (WHO) Zimbabwe National Programs Officer for Family and Reproductive Health Dr Trevor Kanyowa told this publication that life expectancy has continually risen and is currently estimated at an average of 61 years compared to an average of 57.5 years in 2015. The adult mortality rate per 1000 people for females was 300 while men were at 362 per 1000 people in 2018.

CWGH executive director Itai Rusike opines the approved hospital user fees as the most unequal way to fund a health system as  the sick suffers a higher burden.

“Zimbabwe should pursue efficient health financing policies, to respond to unmet needs and to eliminate financial barriers to access, reduce out-of-pocket expenditures leading to financial hardships and ensure financial risk protection for all throughout the life course, especially for the poor and those who are vulnerable or in vulnerable situations. UHC means every individual and community receive the full spectrum of care they need, from health promotion to prevention, treatment, rehabilitation, and palliative care,”he says.

Adds Rusike, [pullquote]“The new hospital user fees will kill the health seeking behaviour as people will get sick and die at home because of the fee barrier. We understand that the hospitals are facing severe cash constraints.[/pullquote]

“However, we are concerned that the approved hospital user fees are way beyond the reach of the general public who do not have any medical insurance cover, lack any safety net, are earning salaries below the poverty datum line and hence depend on the public health institutions to access health care services.”

The CWGH Director said most poor people depended on public health services. He said pregnant mothers will be the most affected lot by the new hospital user fees.

“The cost of health services in public institutions has gone beyond the reach of many with the impact being felt seriously in maternity especially for those in need of Caesarean services. The low-income population can no longer afford to get ill, because they cannot afford expensive curative services,” says Rusike.

Public health advocate Tariro Kutadza says this policy flip-flop is confusing the communities.

“For the past 10 years the discussion was to scrape user fees in public institutions. The signing of UHC in September was a step towards affordable primary health care. Surprisingly 3 months down the lane user fees is increased. This is a confusing situation .We not consistent with the information we relay to communities. Is UHC a drama or a dream that should come true at any given time in Zimbabwe?” she quizzes.



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