adminbirths.
The major maternity hospital in Harare, that at Harare Hospital itself, is in the unfortunate position that it battles to cope with even the slack periods and is totally overwhelmed in any rush.
This is totally undesirable.
Those responsible for planning the State maternity system have tried very hard to keep the number of babies delivered in high-end hospital maternity units to a minimum.
Most babies are supposed to be delivered in clinics, and only those mothers who may have complications delivering in a hospital.
Unfortunately not every mother goes through the pre-natal procedures that this system requires, and there is an understandable desire by some mothers to go to a hospital even if this is not necessary and an equally understandable desire by many manning clinics not to take chances, and refer the mother to a hospital if there is any doubt.
At the same time the State system has capped maternity fees to ensure that no baby or mother suffers simply because the family is not well-off, a laudable move that has pushed up hospital deliveries while slashing baby and mother deaths.
But this capping does mean that State hospitals have no hope of recovering more than a small percentage of the costs of their maternity units.
The Government has launched a Health Transition Fund to raise money from donors so its State hospitals can be properly equipped. This will obviously help.
Another big help was the advent of anti-retro virals, which in effect have stopped the appalling growth in the number of people needing hospital care.
Aids did overwhelm a hospital system which, by 1990, was coping and which had ended colonial inequalities.
But the upgrade of maternity facilities in Harare cannot start and end with the main referral hospital. It has to be right along the line, and has to take into account that as Zimbabwe develops economically the urban population will rise far faster than the population as a whole.
If all suburban clinics were adequately staffed and equipped, and if there were enough of them and if they were properly funded, then fewer mothers would need to be referred to a hospital.
If all mothers went for pre-natal check-ups, the system would find it easier to decide who did have to go to hospital for a delivery, relieving pressure on the
hospitals.
We need to remember that a suburban clinic bed costs a lot less to maintain than one in a major hospital, so allocating adequate resources to those will give more benefit for each dollar spent.
At the same time, however laudable, the capping of maternity fees is, we probably need a means test.
We need more than the present two steps of either a very cheap delivery with the State or a very expensive delivery at a private clinic.
The State could ask about the income of a patient and have a scale of charges, levying more on those with better incomes.
All State patients will almost certainly still require large subsidies, but clawing back even a few percent of the costs will make a huge difference.
We could even go a little further, with a temporary maternal medical aid scheme for couples planning their families.
In the modern world most couples do plan when to have children and it should be possible to work out some sort of scheme where they could pay instalments for a say a year and then move to either the private sector or a full-recovery State hospital and the mother and baby would have proper care regardless of any complications.
Even if only a small minority of mothers took up such a scheme, it would still mean the standard State system would have that fewer mothers to cope with, and even a modest relief of pressure would be a big help.
In other words, it appears that the intolerable problems facing Harare Central Hospital require a two-fold approach: reducing the numbers who actually need the facilities of a top-end hospital as well as upgrading and restoring the facilities at that hospital.
Online Reporter