HARARE, ZIMBABWE — First-time mother Connie Jowa stands 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.
However, they can be acquired discreetly, provided you know whom to approach and are ready to cover the cost.
The child health cards provided at no cost to new mothers in Zimbabwe serve as essential records tracking infants' development, immunizations, and medical backgrounds. In their absence, every clinic visit would essentially start from scratch without this documentation.
The investigation of the child's medical background begins anew. Starting from July 2024, these record cards have vanished from healthcare centers throughout Harare’s main hospitals and at 42 local council clinics—despite assertions from the manufacturers that they are producing sufficient quantities to satisfy the demand.
This fabricated scarcity has led to an underground marketplace wherein hospital employees discreetly peddle this crucial paperwork to frantic mothers. Such petty bribes highlight severe fissures within a health care system that is already faltering in support of those who are most susceptible.
Initially a covert endeavor, this has now turned into widely known information.
"When the cards reach the clinic, they are typically held by the head sister. However, it's often nurse aids or less experienced staff members who end up selling them, collaborating with other employees," explains Simbarashe James Tafirenyika, who heads the Zimbabwe Municipality’s Nurses and Allied Workers Union.
She mentions that someone selling 100 cards could earn approximately US$500, adding that this income doesn’t go to the local council’s government.
Several mothers told the Global Press Journal that the cost of the Child Health Card is around $5.
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.
The city of Harare's municipal health centers alone assist over 3,000 births monthly, leaving each new mother to compete for necessary paperwork.
I am feeling wounded," Jowa states. "I wish to understand which vaccinations my child has been administered and their respective purposes, yet I am unable to obtain this information.
A nursing aid at one of the municipal health centers has observed this underground marketplace.
"If a nurse is involved in sales, they request the mother to act 'skilled' when needing the card," explains the assistant, seeking confidentiality due to concerns about retaliation. In Zimbabwe, "skilled" often serves as a colloquial term for offering modest bribes.
Although the Ministry of Health and Child Care is meant to provide the cards at no cost, Prosper Chonzi, who serves as the City of Harare’s director of health, acknowledges that deliveries have been inconsistent over the past six months and individuals have reported being compelled to buy these cards. He suggests that clinic staff might be taking advantage of this scarcity and collaborating with each other to sell the cards instead of distributing them freely as intended.
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