This
story
was
originally
published
by
Global
Press
Journal.
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.
“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.
Gamuchirai
Masiyiwa,
GPJ
Zimbabwe
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.”
Kathryn
