Patients Dump Urban Healthcare for Rural, Mission Hospitals

WHEN Tobias Nzira recently tested HIV-positive after visiting a New Start Centre he never thought he would encounter difficulties in seeking treatment for opportunistic infections in the capital.


After receiving counselling at the centre, he had vowed to live positively and pursue his dreams.

Nzira was told at the centre to undergo a CD4 count to determine whether or not he should be put on the life-prolonging antiretroviral (ARV) drugs.

With most opportunistic infections clinics having shut down last year after health workers embarked on an indefinite strike, Nzira’s only hope was Howard Mission Hospital in Chiweshe, Mashonaland Central.

The clinics at Parirenyatwa, Harare and Chitungwiza hospitals provided services to people living with HIV and Aids.

Colleagues told Nzira that if he visited the hospital he would be immediately put on the ARVs programme at affordable cost if his CD4 count is below normal.

Nzira is not the only one who has joined the great trek to rural mission-funded hospitals, but hundreds of urbanites across the country have also joined them as health delivery at public hospitals is almost non-existent, while fees at private institutions are beyond the reach of many.  

With medical aid no longer accepted by private hospitals, patients like Nzira now rely on rural mission hospitals that are donor-funded like Howard, All Souls in Mutoko, Mutambara in Manicaland, Father O’Hea in Zvimba, Karanda in Mashonaland Central and Silveira in Masvingo.

Public and private hospital fees are now paid in foreign currency and most people living with HIV and Aids cannot afford to pay.

According to UNAids, Zimbabwe has a severe generalised epidemic of HIV and Aids with an overall adult (15-49 years) HIV prevalence rate of 15,3%.

An estimated 1,3 million adults and children were living with the HIV infection in 2008 and of those 680 000 were women of childbearing age.

The organisation said access to HIV and Aids care and treatment is threatened by the political and economic situation, which has caused a number of difficulties in HIV programmes.

A spokesperson for an HIV and Aids organisation said most of these mission hospitals are funded by the Global Fund and are better equipped than urban institutions.

“For example, Mt Darwin Hospital has three doctors, two lab technicians, two nurses and two pharmacists who are paid by the global fund,” the spokesperson said.

“The doctors are paid well and you would find that many of these hospitals are well stocked in terms of medicine. That is why many people are flocking there.”

That is the reason why Nzira preferred Howard Mission Hospital. His medical aid, like those of many Zimbabweans, had become invalid and further constrained the health delivery system.

Recently, medical aid companies have attempted without success to persuade their clients to subscribe in foreign currency.

Doctors’ consultation fees now range between US$30 and US$50 and almost all of them have since stopped accepting medical aid and are demanding up-front payment in foreign currency.

This move has effectively blocked access to health care for most Zimbabweans.

Doctors and medical aid societies have been squabbling over fees for years, while subscribers accused both of unilaterally imposing self-determined fees and subscription structures on them.

The doctors have lost trust in health insurance companies as some of them have over the years failed to pay them on time.

Paul Chimedza, former president of the Zimbabwe Medical Aid Association (Zima), said in this day of hyperinflation it was irrelevant to have medical aid.

“Zimbabwe is surviving under abnormal conditions and people are not talking about medical aid anymore,” Chimedza said. “Most doctors and service providers are now dealing with the patients directly. Doctors want money up-front just like a supermarket where you have to buy the product first before making use of it.”

He said medical aid societies were still on the road to creating foreign denominated models for subscribers, and were still to gain acceptance in the health sector.

Chimedza added: “Doctors are still hesitant to take medical aid. Even when things were normal doctors had always had serious problems with medical aid societies. They would fail to pay a third of the medical bills.

“If one has US$100 it would be prudent to just save the money somewhere and make use of it if one wants to go to the doctor. The problem is that people might subscribe and when they visit their doctors they would be told that we do not accept medical aid and in the end they lose both ways.”

He said the other option was for companies to form partnerships with doctors and pay them monthly subscriptions for their workers’ healthcare.

“This is a much more guaranteed procedure to get a service,” he said.

A staffer at Premier Service Medical Aid Society who preferred anonymity said their organisation was still negotiating with doctors over charging in foreign currency.

“There hasn’t been a proper plan put in place to strategise the payment in foreign currency with the doctors. For Excel Plan, the subscription at the moment for 20 units per one person per month is set at US$2 while for the Pinnacle plan, which is the highest scheme, a person has to pay US$4 monthly,” he said.

He, however, said these payments were not viable.

“What might be encouraged is for people to keep their accounts and in the long run when things are okay things might work out. Otherwise it is disaster,” he added.

A snap survey conducted by the Zimbabwe Independent this week found that most hospitals and private clinics no longer accept payments through medical aid.

Avenues Hospital said they would not accept medical aid if it were paid in local currency. “We no longer accept medical aid, especially if paid in Zimbabwe dollars. It has to be in foreign currency. Payment (in foreign currency) depends on

how much you pay monthly at the aid society,” said a lady at the reception.

A dental surgeon in Eastlea said he no longer accepted medical aid and was accepting payments in US dollars only.   

BY WONGAI ZHANGAZHA