Women carry burden of health sector graft

HEALTHCARE

ENERESI Runesu (not real name) looks distraught as she waits for her turn to register for antenatal care service at St Mary’s clinic.

The mother of two, is expecting her third child and has been seated on the bench with a few other women who are seeking similar services at the council-run clinic. No one from the health centre’s staff seems to be willing to assist her.

Runesu looks dejected and impatient after seeing some people coming into the clinic and getting assistance while she sat for close to three hours without any help.

“One of the staff members, who is not a nurse, asked me if I had ‘something’ to facilitate my registration and I told her that I did not have money,” Runesu said.

“She told me that it would be difficult to get the service unless I hand over something to her.

“I can now see why I have been seated here for long while other people are getting help.”

Runesu said she will have to go home and would only come to the clinic if she gets the money from her vending business.

“This means I will have to delay antenatal care service registration and I am not sure about my health since I feel abdominal pains here and there,” she said.

“I didn’t expect to pay ‘something’ because the last time I delivered my child four years ago here, I never paid this ‘something’.”

Runesu is among a myriad of women in the country facing some of the biggest challenges in realising their sexual and reproductive health rights due to stigmatisation and economic weakness.

According to a recent report by the Zimbabwe Women Against Corruption Trust (ZWACT) titled Health Sector Corruption, corruption in public health institutions is so widespread that almost all officials are involved in one way or the other.

The report said 68% of officials in public health institutions are involved in corruption.

“I noticed that everyone at the clinic is involved in corruption at the clinic,” Runesu said.

“You could tell that something is amiss and these people work as a team.”

Runesu, just like the majority of women and girls in Zimbabwe seek sexual and reproductive health rights and maternal health care services in public health institutions such as local clinics and hospitals.

“I came to the clinic because it is very close to my place of residence,” she said.

“If you go to the hospital they will refer you back to the clinic, saying it was more of a referral centre.”

Runesu fears that if she does not get early antenatal care services, she might have complications with the delivery.

A clinic staffer, who spoke on conditions of anonymity, concurred that corruption was rampant at St Mary’s and three other clinics run by the Chitungwiza Municipality.

“It’s true people are made to pay ‘something’ to facilitate their assistance,” she said.

“It’s happening all over the country.”

The UN report on the right to health documents that corruption at the service delivery level is often caused by deeper structural problems that are beyond the control of underpaid and overworked front-line service providers.

According to the health sector corruption report, corruption in the sector takes many forms with the most common form being abuse of office (24%) followed by favoritism (20%) in which health personnel favour their relatives, friends and compatriots.

Misuse of government resources (14%), bribery (20%), tribalism/nepotism (11%) and sextortion (7%) are other forms of corruption, according to the report.

Investigations carried by this publication at the four Chitungwiza Municipality-run clinics showed that bribery was widespread.

“Some patients offer to pay bribes so that they are attended to quickly,” said a health worker at Zengeza 3 clinic.

“We usually have long queues and some people opt to jump queues by paying bribes.”

ZWACT director Sandra Matendere said corruption impacted negatively on the well-being of women, particularly their health.

“Corruption in general and specifically in the health sector is a major driver of health and gender inequalities as it disproportionately affects the poor, disadvantaged and marginalised populations especially women in accessing sexual and reproductive rights as well as maternal rights,” Matendere said.

“Whilst corruption affects all sectors and has deleterious effects on the political, economic and social development, its impact on the health sector is dire and can lead to the difference between life and death.”

Matendere said ZWACT’s work was meant to inform government to come up with policies that help improve and respond to corruption within the health sector with a particular emphasis on the access by women of sexual and reproductive health rights and maternal health services.

Public health expert Johannes Marisa attributes Zimbabwe’s healthcare system’s decay to high levels of corruption.

“A lot of problems in the country’s health sector can be traced to corruption; infrastructure decay, shortage of drugs and equipment among other things are a result of corruption within the health sector,” Marisa said.

“As you know, tender procedures are flouted; briefcase companies are given tenders to supply essential equipment and drugs, which has repercussions on the health care system.

“It is said the country loses around US$2billion annually through corruption and that money could be used to buy drugs and equipment as well as develop hospital infrastructure..

“You will realise that vulnerable people like women and the poor are thrown into the deep end and they cannot access critical health facilities such as theatres because they don’t have money to bribe.”

Marisa said corruption was the major reason why the country is having high mortality and morbidity rates.

Zimbabwe last year scored 24% in the corruption perception index compiled by Transparency International Zimbabwe and was ranked 157 out of 180 countries in terms of fighting corruption.

Development expert Takemore Mazuruse said corruption in the health sector has devastating effects on women and girls seeking critical services like sexual and reproductive health.

“Corruption undercuts the health delivery system of a country,” Mazuruse said.

“Women, particularly those seeking sexual and reproductive health rights are the most affected.”

Chitungwiza Municipality director of health services Tonderai Kasu could not be reached for comment.

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