User-Fees, A Barrier to Treatment 

 

By Edward Makuzva 

In Zimbabwe Anti-retroviral Treatment (ART), is over 90 percent donor-funded

by the Global Fund, PEPFAR, the Melinda

and Bill Gates Foundation, the United

Kingdom’s Department for International

Development (DFID), and other partners.

The Government of Zimbabwe has domestic resource funding, the AIDS Levy, which is three percent of a formally employed worker pooled in the National AIDS Trust Fund (NATF).

Through these funding mechanisms, ART

is given free of charge in public hospitals.

However, some centers charge what they term User-Fees for administration purposes.

The Zimbabwe HIV and AIDS Activist Union Community Trust,(ZHAAUCT), left no stone unturned in the Community Led Monitoring (CLM) mission to Manicaland in exposing the unjustified

User-Fees.

Speaking to the Secretary General for ZHAAUCT, Angeline Chiwetani, the issue

of User Fees stuck out like a sore wound.

“We had Community Health Advocates from the areas we worked in.

 

The issue of User Fees was a constant pain in all the discussions we had at

health facilities in Manicaland Province for clients accessing ART in the City of Mutare Council Clinics.

“We worked in Mutare Urban and Makoni

Districts. We covered Mutare urban councilrun clinics, and rural authority clinics in Makoni.

“User Fees ranged from US$1, US$2 or US$5 in facilities run by Mutare City Council. The user fee was a barrier to accessing services for many who can not afford the required fees.

ZHAAUCT requested the clients who had paid to take pictures of the receipt, as evidence.

“Imagine a family with both parents and two children on treatment. They need US$20, it is too much, it’s expensive, beyond their reach,” said Chiwetani.

“The fact that the centers were only issuing out refills for a month’s supply even to clients who are stable worsened the situation. This meant that the client would incur the cost of transport and user fees monthly. It is a situation that is unsustainable for most of the community

members. ART issued to PLHIV at these clinics is made available through the support from donors such as PEPFAR.

“We had a series of meetings with the

authorities, and we had all the evidence.

People had been paying for 15 years, and there were people who defaulted and would come to collect when they

get the cash. The community felt they were purchasing ART.

Other patients transferred themselves and walked to rural areas to get free treatment,” bemoaned Chiwetani.

“We had meetings after meetings, and with evidence mounting, the authorities

acknowledged that the fees were meant for administration purposes. A circular was written to all centers directing facility administrators to scrape the User Fees. It was a joyful moment for us and people living with HIV. People are now getting their medication for free. We comntinue to monitor the situation to ensure that these CLM advocacy gains are not lost.

“Engagement with ZNNP+ helped, as the

mother body, they were aware of these issues for years. They were happy that the barrier finally crumbled,” concluded Chiwetani.