Edwin Mwase and Cardnus Chijongwe
The situation in the Harare Central Hospital maternity wing is so dire that soon after giving birth, either on the floor or, if one is fortunate, on one of the few available beds, mothers are whisked away to a separate room.
Unlike in the past when the wing had several post-natal monitoring rooms where patients could recuperate, now the unit is always full to the brim.
Instead, the unit previously used for purposes of injecting infants with anti-tuberculosis vaccine Bacillus Calmette-Guerin (BCG) has been converted to cater for post-birth cases, as the maternal population increases to disproportionate levels at the hospital.
“All is not rosy here. As you can see, I have just given birth and need to relax in a comfortable place. However, I had to be content with sleeping on the floor as there are shortages of beds,” said Mrs Locadia Takadii of Murehwa, as she breastfed her six-hour-old baby.
Mrs Takadii is one of the 17 mothers who have just given birth and have been transferred to the cramped room, to make way for new births.
The matron of the maternity section at the referral centre, Sister Gertrude Pedzisayi, said the hospital attended to 1 547 maternal patients and 1 276 births last month alone.
She said 57 followed procedure and registered while 327 were referrals.
About 867 others accounted for repeat visits.
“We now cater for cases of people as far afield as Mtawatawa, yet there are supposed to be at least three interjectory hospitals — council, district and provincial — before a maternal patient is brought to the main referral centre,” said Sister Pedzisayi as she took The Sunday Mail crew on a tour of the health institution.
She said they have now reserved the early labour ward for mothers who encounter complications, as part of efforts to contain the swelling numbers.
The maternity section has a capacity to cater for 180 people at any given time, but now houses close to 500.
Clinical director Mr George Vera said the “not-so-clear” directive by the Ministry of Health and Child Welfare to scrap maternity fees has resulted in the dire situation.
“There is an influx of maternal patients as a result of the purported directive which has resulted in the current congestion. However, there is no way we can turn away a person who is in labour,” he said.
Mr Vera said the hospital gets US$150 per normal birth from the Health Transition Fund, which, he said, was meagre compared to the required US$600.
The hospital also gets US$450 for every caesarean operation, yet close to US$1 000 was needed.
Sister Pedzisayi added that at least 158 midwives were expected to work according to shifts, but only 64 are available.
About 74 general nurses (non-midwifery) complete the staff complement.
The matron said they had a turnover of three people per bed in 24 hours and a nurse- to-patient ratio of about 1:25 compared to a normal ratio of about 1:4.
“We had shortlived happiness when 23 qualified midwives who recently graduated were seconded to our department, but we will be sending 44 non-midwifery staff back to the general hospital which is also
reeling from staff shortages,” she said.
“A nurse is supposed to monitor two patients in the delivery room, but it is not possible now since we have about three nurses dealing with about 70 cases per day, which is abnormal.”
Former Health and Child Welfare Minister Dr Timothy Stamps said scrapping maternity fees would adversely affect health delivery.
He said by offering free maternity services, Government hospitals and clinics would run out of resources.
“Even highly developed countries such as Sweden, for instance, have tried to offer this free maternity service, but it later backfired,” he said.
“Yes, we all agree that children are special, but under normal circumstances, quality service cannot be offered for nothing.
“With limited resources, offering free maternity services will only serve to worsen the maternal mortality rate.” Health and Child Welfare Deputy Minister Dr Douglas Mombeshora said his ministry was equally confused by reports of the scrapping of maternity charges.
“I do not know where the statement that maternity fees at Government hospitals had been scrapped emanated from, whether it is bad journalism or overzealous politicians, I don’t know,” he said.
“What we said, as a ministry, was we wanted to launch the initiative as a pilot project at selected institutions as feasibility studies were to be carried out before implementation.”
Dr Mombeshora said Treasury released US$6 million instead of US$10 million for the project.
He said Harare Central Hospital should be used as a centre of last resort.
He added that authorities were also working out the modalities to assist pregnant women, the elderly and children below the age of five under the Health Transition Fund.