The Sunday Mail
Veronica Gwaze
The dread of contracting the coronavirus could be causing many people who ordinarily seek services at registered health facilities to go underground, raising fears they will not receive the best health care possible.
During the first three months of the year, for example, the number of women seeking antenatal care and delivering at registered institutions has markedly dropped from the same period in 2019, according to the Ministry of Health and Child Care.
In fact, in April alone the figure dropped by half from a year ago.
Overall, institutional deliveries fell by 20 percent in the January to March period, while home deliveries rose 6 percent.
“It is likely that the Covid-19 pandemic has contributed to reduced access and utilisation of healthcare services. There is need for further analysis of the actual cause though,” said Health and Child Care acting Permanent Secretary Dr Gibson Mhlanga.
“The majority of Zimbabwean women deliver within our health facilities. Those that deliver at home usually do so due to religious and socio-cultural norms. Sometimes, women lack the financial means or transport to get to the clinic or hospital.”
But there are some who believe high maternity registration fees being charged by some health institutions are discouraging.
Government-run public health centres do not charge expecting mothers.
But municipal clinics, which make up the bulk of health facilities around the country, are currently charging a maternity registration fee of not less than $600.
The ignominy facing expecting mothers is made worse by the fact that some midwives are demanding a bribe of at least US$5 to “guarantee special favours”, which often entail receiving special and preferential treatment.
Maternity registration fees are much higher at private health institutions.
Desperate women are now opting for home deliveries, which are considered to be relatively cheaper.
And this is unsettling to Government.
“Our policy is that all pregnant women should book and deliver at a health facility. We have observed from routine surveillance that the number of women attending antenatal care and delivering at our health facilities has declined when we compare 2019 and 2020, particularly for the month of April,” adds Dr Mhlanga.
Harare City Council corporate communications manager Mr Michael Chideme said clinics could not possibly survive without user fees.
“Considering the process of registration to delivery and the resources that are needed, council clinics cannot survive without getting anything in return. Government needs to cover that funding gap which was created when they scrapped maternity registration fees for clinics to give that service for free,” said Mr Chideme.
Any fees charged for “special favours”, he added, should be reported so that the corrupt elements could be weeded out.
Home deliveries are largely considered to be risky.
Maria Mureverwi, a midwife at a local hospital, said the raging Covid-19 even makes it riskier.
“This is a very complex procedure that needs caution. Child delivery should be done under sanitised conditions and the midwives need Personal Protective Equipment (PPE), something we do not have in backyards,” she notes.
Chitungwiza-based Vongai Gondo (30) of the Johane Masowe yeChishanu sect, who has been operating from home as a midwife for more than a decade, acknowledged that Covid-19 indeed posed a significant challenge for continued home deliveries. She has delivered more than six babies since the lockdown started on March 30.
“In the case of HIV, I do not deliver anyone who has not been tested, but with Covid-19 it is a different case altogether. I do not have screening equipment or better PPE, but I ensure that every patient has a mask and that we wash our hands with soap,” she said.
Pretty Mukubvu (58), a chief midwife at Mugodhi Apostolic Church, said demand for her services has increased since the lockdown.
“I do not charge my patients, so I use my own resources to purchase surgical gloves, cotton wool, razor blades and other items I need for this service. I believe God will protect us against Covid-19,” said Mukubvu, who uses one of her bedrooms as a maternity ward of sorts.
There is growing concern backyard deliveries could increase local transmission of the coronavirus, which has so far claimed six lives in Zimbabwe.
Returning residents and citizens, mainly from South Africa, make up the bulk of the imported cases. Chief co-ordinator of the national response to the Covid-19 pandemic, Dr Agnes Mahomva, said health authorities were constantly on the lookout and are also monitoring pregnant women in quarantine centres. As part of our surveillance, we have since requested teams on the ground to report on pregnant women and babies in quarantine. This is to ensure that they do not escape and that we are prepared to offer them the appropriate care they need,” said Dr Mahomva.
The taskforce is also exploring ways of safeguarding the health of pregnant mothers, babies and children in quarantine.
The country recently recorded its first case of a Covid-19 patient who gave birth, at Gweru Provincial Hospital, where she was in isolation.
The baby was delivered through caesarean section on May 28 in adherence to infection prevention and control (IPC) procedures. The success story is being used to model responses and management of similar cases.
“Zimbabwe has successfully concluded the delivery of its index case of a pregnant mother who tested positive for Covid-19,” a statement read.
While vertical transmission from mother to child is unlikely, evidence show the mother can transmit the virus to the baby after birth.
“What we are sure of is that mother-to-child transmission can happen after birth, hence the need to maintain strict hygiene practices such as hand washing, sanitising and wearing a mask when handling and feeding the baby,” explained Dr Mhlanga.
