BY GAMUCHIRAI MASIYIWA

Summary: The quiet return of maternity fees and the black-market sale of essential documents put extra burdens on mothers as they struggle to navigate a broken system.

First-time mother Connie Jowastands with her 3-month-old baby nestled against her back, chatting with other mothers in line. Like many women at this crowded clinic in Harare’s Mabvuku suburb, Jowa is trying to get a Child Health Card, which was unavailable when she gave birth at a public hospital, and was still out of reach at her local clinic. Health cards are mysteriously out of stock.

But they can be bought under the table, if you know who to ask and are willing to pay.

Zimbabwe’s Child Health Cards, meant to be free to new mothers, are crucial documents that track babies’ growth, vaccinations and medical histories. Without them, each clinic visit becomes a reset button. Inquiry into the child’s medical history starts from scratch. Since July 2024, the cards have disappeared from health facilities across Harare’s central hospitals and 42 council clinics — even though the card’s producers say they’re making enough to meet demand. This artificial shortage has birthed a shadow market where clinic staff quietly sell this essential document to desperate mothers. This sort of nickel-and-dime bribery exposes deep cracks in a health care system that’s already failing the most vulnerable people.

What started as a clandestine operation has become an open secret.

“When cards arrive at a clinic, they’re kept by the sister in charge. But it’s usually nurse aides or junior staff who sell them, working in cahoots with other staff members,” says Simbarashe James Tafirenyika, who leads the Zimbabwe Municipality’s Nurses and Allied Workers Union.

Someone who sells 100 cards can pocket around US$500, she says, and none of that money goes to the government of the council.

The going rate for the Child Health Card is US$5, say several mothers who spoke to Global Press Journal.

Medical Histories on Scraps of Paper

When the system works as designed, every mother receives a Child Health Card when her baby is born. Now, most mothers must track their infants’ medical histories on scraps of paper.

Harare’s council clinics alone deliver more than 3,000 babies every month, with each mother left scrambling for documentation.

“I feel hurt,” Jowa says. “I want to know what vaccines my child has received and their purposes, but I just can’t get that information.”

A nurse aide assistant at one of the council clinics has witnessed this shadow market.

“If a nurse is selling, they ask the mother to be ‘skillful’ if they need the card,” says the assistant, who requested anonymity for fear of retribution. In Zimbabwe, “skillful” is a common euphemism for paying small bribes.

While the Ministry of Health and Child Care is supposed to supply the cards for free, Prosper Chonzi, the City of Harare’s director of health, admits supplies have been erratic for six months and that people have complained about being forced to purchase these cards. Clinic workers may be exploiting the known shortage and coordinating among themselves to sell the cards rather than providing them for free, he says.

“We can’t rule that out,” he says.

The card shortage coincides with the quiet return of maternity fees in public hospitals. Though not officially announced, hospitals have begun billing mothers after delivery — a policy change the government would neither confirm nor deny.

High Inflation, More Corruption

Between 2011 and 2024, more than 1 million pregnant women in the country delivered babies for free at health care clinics, under a scheme called results-based financing. Maternal mortality rates dropped during that time.

But these gains, partly achieved through better access to safe delivery services, face new hurdles as budget constraints and economic pressures reshape the health care landscape.

Even in 2021, a study from Transparency International Zimbabwe surveyed over 1,000 people in Zimbabwe and found that 74% had been asked to pay a bribe while trying to access health care services. A feeling of being underpaid amidst a deteriorating economy and high inflation was a key driver among health workers who solicitated bribes, which has been a rising trend, according to the study.

“The motivation for earning an extra income is strong especially in countries with a high rate of inflation,” the study states.

Zimbabwe’s health care system faces chronic challenges, including an exodus of health workers to other countries, inadequate funding, drug shortages, obsolete infrastructure and more. In 1991, the government introduced user fees across public institutions as part of an economic structural adjustment program. The government abolished the fees in 2011, only to partially reinstate them around 2013.

Prudence Hanyani, a community activist in Harare, says the reintroduction of user fees in public hospitals will burden women who already shoulder extra costs, like paying for midwives, so they can get better treatment when giving birth.

“Maternal health services should be free,” she says, “because giving birth is a service for the nation that contributes to the country’s population.”

Mothers Pay the Price

Valerie Shangwa, who gave birth four and a half months ago at a private maternity hospital, still has no card for her daughter.

“You know how difficult it is to keep a paper,” she says. “When nurses ask about last month’s weight, you end up guessing, and that distorts the whole record.”

Charlton Prickise, technical director at Print Flow, says his company sells Child Health Cards only to government-authorized health facilities and faces no shortages.

“The shortages mean health facilities simply aren’t coming to get them,” he says.

Though Print Flow hasn’t detected leaks, Prickise recalls finding other versions of this card on the market two years ago, possibly from a nongovernmental organization. Print Flow isn’t the sole supplier of the cards, and they haven’t received any government orders recently.

In a written response to Global Press Journal, Donald Mujiri, spokesperson for the Ministry of Health and Child Care, said the shortage of Child Health Cards is due to supply chain inefficiencies and insufficient donor funding. The cards, he says, are procured with government funding and aid from supporting partners such as the United Nations Children’s Fund. Nevertheless, Mujiri says, the ministry needs to strengthen the supply chain management system at all levels and proactively mobilize resources for procuring the cards.

Meanwhile, mothers wait — or pay the price. Faith Musinami, 26, delivered her daughter in July 2024. An orderly told her the clinic only had cards for boys, but if she wanted, they could organize one for US$5. Musinami had not budgeted for the cost. She sacrificed the last penny she had.

This story was originally published by Global Press Journal.

BY LINDA MUJURU

At Mbare marketplace, a major trading hub in Zimbabwe, plastic bags are everywhere. Vendors stack them at the ready for customers, who tote their purchases home and often discard the bags after a single use. Many of these plastic bags are either imported from China or sold by local Chinese companies, and fail to meet Zimbabwe’s standards for plastic packaging.

“We know this type of plastic isn’t allowed, but we sell it anyway. It’s cheaper, and there is a huge demand for it in the market,” says Tichaona, a local plastic bag vendor who sources his bags from a Chinese company in Harare. He provided only his first name for fear of arrest.

In some cases, plastic bag buyers don’t even know that the bags are thinner than is legal, says one employee at Colour Maximal, a Chinese-owned plastic manufacturing company in Harare, who asked Global Press Journal to protect his identity for fear of losing his job.

“We know what the quality should be, but we never produce it,” he says. “Customers are told these plastics meet the 30-micron requirement, but that’s simply not true.”

Zimbabwean law bans the production and distribution of plastic packaging thinner than 30 microns (a unit of measurement to describe plastic thickness), except for bread packaging, which must measure at least 25 microns. However, the country faces an influx of inexpensive plastic imports from China, coupled with a rise in Chinese-owned manufacturing firms, which now dominate the plastic industry.

Many of these importers and manufacturers exploit weak law enforcement to produce plastics that measure lower than the standard, exacerbating a pollution crisis that’s already critical.

“[They] don’t care about quality. Their products are cheaper. People can just walk in and buy in bulk,” says Donald Marumbwe, who has worked in the plastic manufacturing industry for over 30 years.

Global Press Journal collected samples from Colour Maximal and independently tested them. All samples were thinner than the required 30 microns. Some bags measured were just 20 microns.

Global Press Journal also measured bread bags from Mbare marketplace, which, according to the regulations, should range between 25 to 30 microns. Some of those bags measured as thin as 6 microns.

Thin plastic bags, often used just once, can take thousands of years to decompose, turning into harmful microplastics that threaten wildlife and enter the human food chain. Thicker plastic is likely to be reused and recycled, reducing environmental impact.

But thin plastic is cheaper to make, says Tatenda Murwira, a manager at Colour Maximal. It’s the reason his employer manufactures this kind of plastic, despite the law. “We’re profit-oriented,” he says. “It’s all about saving materials and keeping prices competitive.”

In the end, it’s Zimbabweans who suffer. A significant portion of plastic waste — approximately 18% of the country’s total waste — isn’t disposed of properly. It has clogged rivers, littered streets, and, worse, been linked to deadly flash floods and animal deaths due to ingestion. Since 2010, plastics, both locally produced and imported, have caused the deaths of about 5,000 animals.

Amkela Sidange, the environmental education and publicity manager at Zimbabwe’s Environmental Management Agency, says they conduct routine inspections to prevent the manufacturing and distribution of plastic that doesn’t meet requirements. Those caught violating the law face fines that could reach 500 United States dollars.

But Murwira, the manager at Colour Maximal, says that while officials from the environment agency have visited the company, which has been operating for more than a decade, they’ve never inspected the factory. “They never check the quality of our products,” he says.

Once the packaging gets into the market, it’s hard to trace back to the manufacturer. “[The companies] don’t put their names on the packages because they don’t want it traced back to them,” Marumbwe says.

None of the plastic bags Global Press Journal examined at Mbare marketplace had a manufacturer’s name on them.

Although South Africa is the main supplier of materials used to produce most of the plastic packaging circulating in the country, these imports are on the decline while imports from China are on the rise. In 2012, Zimbabwe imported 10.9 million dollars’ worth of plastic raw materials from China. By 2023, that number had increased fivefold to 54.8 million dollars, according to data from Trade Economics.

“We’re profit-oriented. It’s all about saving materials and keeping prices competitive.”

Tatenda Murwira, a manager at Colour Maximal

China is also a major player in Zimbabwe’s manufacturing sector, largely thanks to former President Robert Mugabe’s push to strengthen ties with East Asian countries. Mugabe famously described China as “our second home, a part of us” in 2006. By 2015, China was Zimbabwe’s biggest foreign investor, and its hold over key sectors, including mining and manufacturing, has grown.

The investment has promoted growth, but it’s also come with challenges, including environmental degradation.

Chinese-owned companies’ disregard for regulation is indicative of a larger problem, says Gift Mugano, a professor of economics at the Durban University of Technology, in South Africa.

“They are in bed with the politicians. [The] Chinese work with people in high offices, so they’re kind of covered, and they don’t respect the environmental laws,” Mugano says.

It’s a widespread problem in Africa, where dependency on such investors is common, he says. In Zimbabwe, the situation is even worse because the country is mired in debt, which makes it susceptible to influence from one of its primary investors.

“[It’s] a new wave of neo-colonialism,” Mugano adds.

Zimbabwe has made several attempts to address its plastic problem, including a 20% tax on plastic bags, which went into effect in January. But companies routinely dodge that tax, just as they’ve avoided the plastic bag regulations, says the ColourMaximal employee who spoke on condition of anonymity.

“At the end of 2024, Zimbabwe Revenue Authority representatives visited our offices, threatening to shut us down for nonpayment of taxes,” he says.

Murwira, the manager, says Colour Maximal is fully tax compliant.

Global Press Journal visited a plastic-packaging production company formally registered as Liwei Wang but currently trading as Multiple Star. Upon inquiry, factory representatives said that their plastic bags measured only 20 microns, short of the standard.

On display at the site was an expired 2024 tax clearance certificate.

Global Press is an award-winning international news publication with more than 40 independent newsrooms in Africa, Asia and Latin America.

BY LINDA MUJURU

Natasha Gwashure watches as tuberculosis ravages her 1-year-old son Anashe’s frail body. He has been ill for more than a month. Gwashure struggles to accept the diagnosis. Her only solace is that they have access to free medication.

“Without this support, the chances of defaulting on treatment because of monetary constraints would have been significantly higher,” she says.

For years, the United States Agency for International Development has stood at the front lines of Zimbabwe’s TB battle, providing critical support for detection, treatment and prevention. But this lifeline now hangs in the balance as a US executive order threatens to undermine years of progress, potentially forcing patients, like Gwashure’s son, to abandon lifesaving treatments.

TB is a particularly vicious illness. Left untreated, the mortality rate is about 50%. It spreads easily, when an infected person coughs or sneezes, or even sings or speaks.

US President Donald Trump issued an executive order on Jan. 20, his first day in office, to suspend nearly all international aid. That includes USAID programs, which administer lifesaving health and other services around the world.

The recent funding freeze leaves a huge gap in Zimbabwe, where nearly all funding for TB treatment comes from international donors. Just 4% of that funding is domestic.

In 2024, USAID allocated 7 million United States dollars for TB treatment, screening and other necessary interventions in Zimbabwe. Despite decades of medical advances, tuberculosis still rampages across the globe. TB affected 10.8 million people in 2023; 1.3 million of those were children.

In Zimbabwe, the battle against TB reveals a health care system struggling to keep up. In 2021, just a little over half of an estimated 30,000 new infections received treatment.

The human cost of scrapping USAID programs is already evident here. Hospitals that once benefited from US-backed health programs now face mounting pressure as health workers supported by these initiatives have been forced to stop working.

A local nurse, who requested anonymity for fear of retribution, says it’s strained an already overextended health care system. She says that nurses previously funded by USAID-backed organizations, who primarily cared for patients with HIV, TB and other diseases, have stopped reporting to work. And what used to be handled by a full team of nurses is now falling on just a handful.

The freeze has begun dismantling Zimbabwe’s TB care network. New Start Centre — once a cornerstone facility, providing essential CD4 count testing, TB screening, diagnosis and counseling — has already gone dark, its doors closed as funding runs dry.

Noah Taruberekera, executive director of Population Solutions for Health, which has relied on USAID support for these centers, acknowledges the dire challenges now confronting patients and health care providers. He says he is not authorized to share additional details.

The funding crisis ripples beyond TB control, casting a shadow over HIV programs — a critical concern since TB preys particularly on those with HIV. While effective antiretroviral therapy can reduce the risk of developing TB, ongoing screening and preventive measures are vital for those with HIV.

HIV co-infection affects 68% of TB cases in Zimbabwe, but the national government covers only 7% of the required TB budget. International donors contribute 60%, leaving a significant funding gap.

Despite the mounting challenges, Dr. Fungai Kavenga, deputy director of TB and prevention control in the government’s Ministry of Health and Child Care, remains hopeful.

“If donor support diminishes, I am confident that the government of Zimbabwe can still ensure a steady supply of treatment for TB patients,” he says.

But Barbara Samu, a TB patient receiving care at Beatrice Road Infectious Diseases Hospital, underscores the critical role of donor support. She received free medication because USAID supported the hospital.

“I can’t even begin to imagine where I would find the money for treatment,” she says. “I would be facing a death sentence.”

Global Press is an award-winning international news publication with more than 40 independent newsrooms in Africa, Asia and Latin America.