Innocent Ruwende Senior Reporter
Harare City Council has rejected Government’s directive to scrap maternity fees at its clinics, arguing that its health services are underfunded, hence it cannot afford to forego this income without alternative funding. Councillors said Harare would only scrap maternity fees subject to the Ministry of Health and Child Care undertaking to fund the subsequent loss of income.

The scrapping of maternity fees will cost the cash-strapped local authority $1 million annually.
At a full council meeting on Thursday councillors were divided over the matter with some feeling that maternity fees were a barrier resulting in high infant mortality, while the majority voted against freeing the service arguing that the city did not have resources.

Councillor Peter Moyo said council should not continue making mistakes by conceding to such requests.
“The previous minister (Saviour Kasukuwere) left this council in a dangerous place, these type of directives should be rejected at all costs. Government wants people to access free services when they pay in their hospitals,” he said.

“We are struggling to recover from Government decision to cancel residents’ debts in 2013. People are being detained at Harare Central Hospital and Parirenyatwa Group of Hospitals for failure to pay.”

Cllr Herbert Gomba felt that the idea was a noble one because people were dying in homes as they could not access maternity facilities.

Following further discussions the matter was put to vote with those voting against the idea triumph- ing.
According to the recent minutes of the Education, Health, Housing and Community Services and Licensing Committee minutes, acting Health Services director Dr Clemence Duri reported that on February 6, 2018 the Acting Secretary for Health and Child Care wrote to the Acting Town Clerk advising on the need for city council clinics to scrap maternity fees.

“Maternity fees were known to the barrier to timely access to maternity services and this contributed to maternal and child morbidity and mortality. All Government run institutions had scrapped maternity fees as part of the ministry’s 100-day plan and in compliance to a long standing policy,” reads the minutes.

“The acting secretary’s letter referred to agreement that was there with the city. The only agreement that was there was a 1976 agreement that obliged the ministry to reimburse the city 50 percent of its recurrent and capital expenditure on health.”
Unfortunately, the Ministry of Health and Child Care had not been honouring the agreement and the last grant was received in 2011.

Dr Duri said in 2017 the city received $981 228 income from maternity fees, which is a significant amount.
He said the City Health Services were already underfunded and could there not afford to forego this income without alternative funding.

He said it was also important to note that the removal of maternity fees would result in increased demand.
“If this was not matched by a corresponding increase in capacity, especially increased staff establishment, this would severely compromise quality,” said Dr Duri.

“The acting director of Health services further reported that it was therefore essential that the city expeditiously negotiated a funding arrangement for maternity services with the Ministry of Health and Child Care before the maternity fees are removed.”
Following discussion council resolved to recommend that council notes that the scrapping of maternity fees will result in a loss of income of approximately $980 000 per annum based on 2017 figures.

The council also noted that then City Health services are already underfunded and the scrapping of maternity fees without alternative funding would cripple the delivery of health services.

“That council notes that the removal of maternity fees will likely result in increased demand that has to be matched by corresponding capacity improvements in terms of more human resources and other consumables,” reads the council minutes.

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