Community Working Group on Health

Residents doubt city leaders’ new levy will help pay for more critically-needed ambulances

By Gamuchirai Masiyiwa

Shirley Celebrate Mkono sits with her daughters, Marcia Nokutenda Chimambo, 1, and Princess Anashe Chimambo, 3, at their home in Glen View. Following childbirth last year, Mkono experienced severe headaches and waited four hours for an ambulance to arrive. She is among many Harare residents skeptical of a new emergency services levy, citing corruption and poor delivery of public services.

HARARE, ZIMBABWE — A few days after giving birth to her youngest daughter in May 2024, Shirley Celebrate Mkono, a 34-year-old mother of four, went to her local clinic to seek help for persistent headaches. Nursing staff worried she could have uncontrolled hypertension, recalls Mkono as she cradles her daughter, now 1 year old.

“The attending nurse informed me that my blood pressure was extremely high and I could collapse at any point,” she says.

After a few minutes, Mkono agreed to call a private ambulance for US$30. Even so, she waited four distressing hours for help to come.

“If the clinic had an ambulance in sight, it could not have taken this long,” she says. “I could have died.”

Only four public ambulances serve Harare’s over 2.4 million people, far short of the 32 ambulances the city says it needs; it would take a fleet of 48 to bring Harare in line with international guidelines of one ambulance for every 50,000 people.

In February, the city council introduced a monthly emergency services levy of US$1 per household to fund additional ambulances for council clinics, collected as part of the monthly electric bill. However, the council’s poor track record in managing public funds has made residents and watchdog groups skeptical that the money raised will be deployed with transparency and accountability.

The local authority has been grappling with health care financing for a long time, says Reuben Akili, director of Combined Harare Residents Association. Akili says the emergency levy will only be effective if it is collected and spent locally to stop funds from being diverted.

“There must be a mechanism in place that ensures the money is ring-fenced to buy ambulances in places where that money was collected,” he says.

Mkono, who lives in the suburb of Glen View, is doubtful the levy will serve its purpose.

“There is a lot of corruption at the local authority. We pay for refuse collection about $8 per month, but they don’t carry the refuse. I remember I last saw a refuse truck in my area in October last year after the mayor visited our area,” she says.

Embezzlement is a persistent problem in local councils, as highlighted in a 2024 analysis of local authorities conducted by the Southern African Parliamentary Support Trust and a coalition of local nongovernmental organizations. Diversion of funds from critical services like health care and sanitation has contributed to a cycle of mistrust and disillusionment, where citizens are reluctant to pay toward public expenditures that don’t actually improve local services.
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“If the clinic had an ambulance in sight, it could not have taken this long. I could have died.”Shirley Celebrate Mkono

Akili says the scarcity of public ambulance services has led people who can afford it to use private taxis, which can cost US$10 to US$20.

In May 2024, President Emmerson Mnangagwa set up an inquiry into the opposition-led Harare City Council following reports of corruption and financial mismanagement. The inquiry revealed that the city council has misspent more than US$1 million, with executives spending over US$125,000 per year on holidays even as the city fails to provide adequate services.

Mkono questions why the local authority is adding another levy on residents who already pay user fees when they seek medical care in council clinics.

“They should buy ambulances with that money,” she says.

In a written update to residents on recently introduced levies, which also include a US$1 streetlight levy and US$1 water levy, Precious Shumba, director of Harare Residents’ Trust, says the new fees were never presented and discussed during the annual budget consultations the city council held across Harare in September 2024. Without an accurate, transparent and functional billing system in place, Shumba writes, the levies “add to a long list of revenue streams that have the potential to be abused by the cartels running the affairs of the City of Harare.”

Caroline Machivenyika accompanied her 17-year-old pregnant daughter to the local clinic in December last year. When they got there, her daughter was referred to a hospital because she was underage, but Machivenyika learned she’d need US$70 to get a private ambulance to take them; the city ambulances were unavailable.

“I only had US$50 on me; I explained my situation, and after an hour, a private ambulance arrived,” she recalls.

Transfers of expectant mothers and traffic collisions constitute the bulk of emergency incidents that require ambulance services in the city.

Like many other residents, Machivenyika has doubts about whether any funds raised through the levy will genuinely buy ambulances.

“We have lost trust in the local authority because the necessities that we are paying for are not being adequately provided. For instance, we only get water three times a week, but we pay for these services each month,” says the mother of four.

Caroline Machivenyika, right, with her mother, Esther Machivenyika, at their home in Glen Norah.

Caroline Machivenyika had to wait an hour and pay US$50 for a private ambulance because there wasn’t a public one available. Like many residents, she questions whether Harare’s new monthly emergency levy will lead to real improvements in ambulance service.

But she says residents’ unpaid bills are also an important reason the local authority struggles to provide adequate services.

“They are supposed to close access to water for houses with unpaid bills, but when council workers come, people pay $5 bribes and they leave. Others are not even moved because they do not have access to water daily and do not care even if their water meters are disconnected by the council,” she says.

Stanley Gama, head of corporate communications for Harare City Council, did not respond to several requests for comment.

Only one-third of African countries have emergency medical services, and most of them require patients to pay a fee.

Upon reaching the hospital, Mkono was cared for and sent home within 30 minutes. She got a prescription for a month’s worth of medication to take at home, and her condition quickly resolved.

Ambulances used to arrive promptly when there was a need, recalls Machivenyika’s mother, Esther Machivenyika, 75.

“I remember in 1995 when my husband got sick at home, we called in an ambulance and it did not take an hour to come through and he was immediately taken to the hospital,” she says as she shells peanuts.

In the 1980s, Zimbabwe had a strong ambulance system with well-trained personnel, including a public service in Harare. But decades of economic instability have left emergency services unable to maintain or procure modern equipment.

Now, Esther Machivenyika says a patient has to pay cash up front to get assistance.

“You can die while negotiating payment,” she says.

Even if people pay the emergency levy, she has no hope of a change in the situation because of what she sees as a culture of greed in public service.

“They are now seeing money as more important than a person’s health,” she says. “Even at health facilities, you have to pay a bribe to get good service from nurses.”

The article was first published in the Global Press Journal.

Pictures Credit: Gamuchirai Masiyiwa

Gamuchirai Masiyiwa is a Reporter-in-Residence based in Harare, Zimbabwe. An internationally acclaimed economic reporter, her award-winning work includes a Clarion Award for her innovative comic feature on Zimbabwean currency. Gamuchirai holds a bachelor’s degree in Political Science and a diploma in Journalism and Mass Communication from the University of Zimbabwe. She brings deep expertise and a fresh perspective to reporting on economic issues impacting her community.

A shortage of pathologists and a culture of corruption have made mortuaries sites of extortion and grief.

By Linda Mujuru

Emily Muchabaiwa comforts her sister-in-law, Antonette Chisango, as she mourns the loss of her husband. Muchabaiwa wasn’t satisfied with her brother’s postmortem results, and like many in Zimbabwe, they were left with more questions than answers in a health system plagued by corruption and understaffing.

HARARE, ZIMBABWE — Blessing Mucharambei’s uncle was just having lunch when he stood up, then collapsed. “[He] started bleeding from the nose,” she says, “and died on the spot.”

As far as his family knew, he had no health problems. As they struggled to make sense of the news, Chitungwiza Hospital — where his body had been taken to a mortuary — told them that a forensic postmortem would be required.

Zimbabwean law mandates postmortems for sudden or unexplained deaths, and public hospitals offer them for free. But there are only five qualified pathologists in Zimbabwe serving a population of close to 17 million people. The wait could stretch for days. And each day the funeral was delayed would add to the cost of hosting mourners, as some traditions require.

A police officer stationed at the hospital offered them a workaround. Instead of a forensic postmortem, they could do a general one — an option when no foul play is suspected, and quicker since it doesn’t require a specialist. But even that, he warned, could take days. He offered to fast-track the process for a US$30 fee. Desperate to bury their loved one, they paid.

“We couldn’t afford the time,” Mucharambei says. “We did it because we had no choice.”
A country in freefall

Postmortem bribes are just one element of a health system — and state — in freefall. Hospitals across the country are plagued by chronic underfunding, obsolete infrastructure and the mass emigration of medical professionals seeking better pay abroad. The government estimates that the country needs more than US$1.6 billion for its health sector to recover.

Underpaid and overstretched health workers have come to rely on informal payments as a means of survival, says Dr. Norman Matara, secretary general of the Zimbabwe Hospital Doctors Association. “People are trying to survive. But over time, corruption becomes part of the culture.”

He says it’s a common problem across hospital services, from the moment a patient is admitted. New mothers, for example, face extortion for birth cards meant to be free. A 2021 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.

In March, a nurses’ protest at Sally Mugabe Central Hospital — the largest referral hospital in the country — exposed how dire the situation is. It was the latest in a long history of strikes by health workers, who have repeatedly protested poor pay and deteriorating working conditions. But their actions are often met with intimidation. In June 2022, the government responded to a strike by passing a law banning health care workers from striking longer than 72 hours, with penalties of up to six months in jail for participants and organizers.

A hospital corridor leads to the mortuary at Parirenyatwa Hospital. Zimbabwe’s public health system faces a severe shortage of pathologists, leading to postmortem delays and widespread bribery. Families say they’re often pressured to pay unofficial fees to expedite the process or obtain basic information about their loved ones.

A manufactured problem

Pathology services are particularly strained, Matara says. The few available specialists are clustered in major hospitals, which creates opportunities for exploitation.

Few medical students choose the career, and those who do face an uphill battle. Training programs are underfunded, mentorship is scarce and working conditions at public hospitals are dismal.

But this is partly a manufactured problem, says Memory, a nurse at Sally Mugabe Central Hospital, who asked to use her middle name for fear of losing her job. Memory has worked at the hospital’s mortuary close to 20 years.

“There isn’t really a backlog but a fake one is created by police officers, the doctors and mortuary staff to pressure families into paying,” she says.

These services are supposed to be easily available, she adds. A Cuban doctor performs the forensic postmortems on Mondays, Wednesdays and Fridays, while the general ones are done daily. But families are often told there are delays. At times, they are asked to pay US$50 to skip it entirely, even when it’s required by law, or US$100 to expedite the process, Memory says.

“It’s a moneymaking scheme at the expense of grieving people,” she says.

Global Press Journal reached out to Sally Mugabe Central Hospital for a response to these allegations. They declined to comment.

Tendai Terrence Mautsi, the public relations officer at Parirenyatwa Hospital, the largest public hospital in Zimbabwe, says there are occasional delays with forensic postmortem cases, mostly due to demand. The hospital, he says, has responded by increasing forensic postmortem days from two to three. They’ve also cut the average waiting time from up to two weeks to just three days. To address the national shortage, Mautsi says, the hospital has partnered with Cuban doctors to fill the skills gap.

He acknowledges that corruption has plagued the process. But, he says, it’s part of a much bigger unravelling, and everyone has become complicit.

“At times you can’t find evidence,” he says. “When you want to investigate it, the patient is complicit. The service provider is also complicit.”

In the end, corruption harms people in need, says Tafadzwa Chikumbu, the executive director of Transparency International Zimbabwe. “For those who can’t afford to pay [a bribe], it means being left unattended,” he says, which erodes the integrity of public institutions.

The solution, he says, is to make ethical conduct — including fair hiring and honest service delivery — the standard.

Emily Muchabaiwa, in hat, Antonette Chisango and Keldon Muchabaiwa sit at their home in Harare. The sudden death of Emily Muchabaiwa’s brother — Chisango’s husband — was marred by irregularities, including the absence of a written report and the lack of a clear explanation from medical staff.

A cover-up?

Postmortem corruption means some families never find out what happened to their loved one. When Emily Muchabaiwa’s brother was found dead in Harare’s industrial area, his family was desperate for answers. The circumstances of his death weren’t clear, and the family hoped a postmortem at Parirenyatwa Hospital would offer closure.

Per standard procedure, a medical doctor or the pathologist should explain the results to the family, Matara says. There should also be a written report. But it was a police officer who delivered the results, verbally, to Muchabaiwa’s family. There was no official report.

“[He] told us my brother had died from tuberculosis and a cold in the lungs, but he struggled to explain the medical terms. Prior to all this, my brother had no signs of sickness,” she says.

The family was suspicious. Muchabaiwa says they believe the death involved foul play and the process was compromised. It would cost the family money to delay the funeral, so they buried her brother, who left behind a young son.

“We had no choice,” she says, voice trembling. “The postmortem failed us. Corruption failed us.”

The article was first published in the Global Press Journal.
Photos Credit: Linda Mujuru

Linda Mujuru is a Reporter-in-Residence for Global Press Journal in Zimbabwe, where she covers foreign direct investment and its effects on local communities. She holds an MBA from Midlands State University and Master’s and Bachelor’s degrees in Journalism and Media Studies from the National University of Science and Technology. Linda is one of Global Press’ most widely read and syndicated journalists and won the Community Champions Award from the Nonprofit News Awards for her story “Push for Gold Leaves a Toxic Legacy.”