Zimbabwe is one of the countries in the world with free treatment policy for tuberculosis (TB).
However, the country’s TB mortality rate remains high with the country ranked fourth in the world. It has emerged TB patients on treatment are defaulting because they cannot afford the consultation charges by hospitals and clinics.
A snap survey by NewsDay showed most private clinics and missionary hospitals in the country are shunning the government’s free treatment policy on TB and patients are struggling to raise the exorbitant consultation fees.
Some of the patients said they knew of the government’s free treatment policy, but when they were charged consultation fees they had to comply because they wanted to be treated.
“I know the government subsidised for the treatment, but the private clinics are charging $20 for consultation. For the past three months I was on treatment I have been forking out money for these consultations,” Tererai Maunga, a TB patient, said.
Another patient said he defaulted because he could not afford the charge and this has had dire consequences as he is now drug resistant.
“I never knew the treatment was for free. I defaulted and doctors are saying the disease is now drug resistant,” he said.
Reports showed most government hospitals were offering free treatment, but because of lack of information, most patients ended up going to private clinics.
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“The truth is I didn’t know there is a government policy like that. I think the relevant authorities should improve on their information dissemination because many people die in ignorance,” said Michael Magorimbo, who had come to visit a hospitalised relative.
Patients in rural areas are the biggest victims as they could not foot the consultation fees. Some patients in Bikita said Silveira Mission Hospital was charging $4 for consultation, but for most rural folk to raise the money is an uphill task.
“In urban areas $4 is not much. But here we are struggling to raise it, especially this year where we witnessed drought,” said one Bikita resident.
Deputy director of Aids and Tuberculosis programmes in the Ministry of Health and Child Welfare, Dr Charles Sandy, said failure by the government to “shepherd” its policy was the major reason why some hospitals are violating the government’s policy and get away with it.
“Provincial health offices should supervise how hospitals are doing, so hospitals are taking advantage of loopholes. We have been found wanting in this area and we need to support the supervision,” said Sandy.
He, however, warned hospitals against transgressing laid down policies saying the government will read the riot act.
“The hospitals should stop charging fees on supposedly ‘free treatment diseases’. Though there are no sanctions or fines for the transgressors, the government will soon read the riot act on hospitals who continue with the practice,” he said.
He noted chief culprits were mission hospitals in the country’s remote areas. “Many hospitals — chief among them mission institution like Mashoko Hospital, St Albert’s and Silveira Mission — were charging the consultation fees on what is supposed to be free treatment,” said Sandy.
Tuberculosis is a curable disease, but according to the statistics from the Ministry of Health and Child welfare, the disease is claiming more than 83 000 people annually with two thirds of the sick not treated. Zimbabwe had an infection rate of about 47 000 per year.
To fight TB, Sandy said his Health ministry department was decentralising care — especially in rural communities — and distributing motorcycles to ensure rural health staff can reach people who cannot get to hospitals.
Tuberculosis is a major public health problem in Zimbabwe — ranked 17th on the list of 22 high-burden TB countries in the world.
According to the World Health Organisation’s Global Tuberculosis Control Report 2009, Zimbabwe had an estimated 71 961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100 000 population. The number of new reported TB cases in Zimbabwe declined 2,6% between 2006 and 2007.
However, the DOTS (the internationally recommended strategy for TB control) case detection rate declined from 46% in 2002 to 27% in 2007. The treatment success rate also declined from 71% in 2001 to 60% in 2006.
These declines reflect the deteriorating sociopolitical context, which has a direct impact on health service delivery in Zimbabwe.
