Desperate Zimbabweans get in debt to pay for lifesaving blood transfusions

Bulawayo,
Zimbabwe
– When
Lloyd
Muzamba
was
critically
injured
in
a
car
accident
on
the
Harare–Bulawayo
highway
in
2023,
he
needed
an
urgent
blood
transfusion
to
save
his
life.
Despite
being
admitted
at
Mpilo
Central
Hospital,
the
biggest
public
health
facility
in
Zimbabwe’s
Matabeleland
region,
a
shortage
of
supplies
meant
the
doctors
didn’t
have
enough
for
him.

In
desperation,
Muzamba’s
family
turned
to
their
only
other
option
–
a
nearby
private
hospital
that
sold
them
the
three
pints
of
blood.
But
at
a
cost
of
$250
per
pint,
Muzamba
–
who
earned
a
$270
monthly
salary
and
had
no
savings
–
could
not
afford
it.

With
time
running
out,
the
family
had
to
make
a
plan.
Eventually,
Muzamba’s
uncle
sold
a
cow
for
$300
and
asked
other
relatives
to
contribute
the
balance.

Two
years
on,
the
now
recovered
Muzamba
says
the
incident
has
left
him
psychologically
wounded,
as
he
worries
about
other
emergencies
when
people
may
need
lifesaving
blood.

“Three
pints
can
be
a
small
number;
others
might
need
more
than
that.
But
due
to
the
costs
involved,
it
becomes
life-threatening,”
said
the
35-year-old,
who
works
in
a
hardware
store
in
Bulawayo.

“I
could
not
get
the
blood
without
paying
or
making
a
payment
plan.
It
was
a
painful
experience
for
an
ordinary
Zimbabwean
like
me.”

Muzamba’s
is
not
an
isolated
case.

With
ongoing
currency
woes,
rising
costs
of
living
and
high
levels
of
poverty,
desperate
Zimbabweans
in
need
of
care
face
life-threatening
delays
due
to
financial
barriers.
This
includes
blood
shortages
–
despite
supplies
being
free
in
public
health
facilities.

Tanaka
Moyo,
a
mother
of
two
in
the
capital
Harare,
also
experienced
the
stress
of
needing
to
pay
for
emergency
blood
supplies
during
the
delivery
of
her
second
child.

After
excessive
postpartum
haemorrhaging,
the
38-year-old
street
vendor
needed
four
pints
of
blood.

Together
with
her
husband,
a
security
guard,
she
had
struggled
to
raise
money
for
the
birth
of
their
child.
The
sudden
need
for
a
blood
transfusion
was
a
shocking
unplanned
cost.

“My
husband
ran
around
and
borrowed
money
from
a
microfinance
institution.
The
interests
are
steep
and
conditions
stringent,
but
he
had
to
act
quickly,”
said
Moyo.

“At
the
hospital,
they
insisted
the
blood
was
free
–
but
it
was
not
available.”

Plaxedes
Charuma,
a
gynaecologist
in
Bulawayo,
says
“postpartum
haemorrhage
is
the
leading
cause
of
maternal
mortality”.
The
prevalence
of
the
condition
means
that
hospitals
should
always
have
supplies
on
hand
to
deal
with
maternal
blood
loss
emergencies
that
arise,
health
experts
say.

According
to
the
Community
Working
Group
on
Health
(CWGH),
a
network
of
civic
health
organisations
in
Zimbabwe,
the
country
faces
a
high
demand
for
blood
transfusions,
and
those
most
affected
are
pregnant
women.

“About
half
a
million
pregnancies
are
expected
in
Zimbabwe,
and
in
some
of
these,
there
is
excessive
blood
loss,
requiring
transfusion
of
at
least
three
pints
of
blood,”
said
Itai
Rusike,
CWGH’s
executive
director.

“Maternal
mortality
in
Zimbabwe
remains
unacceptably
high,”
Rusike
told
Al
Jazeera.
“Timely
blood
transfusion
prevents
maternal
deaths,
which
in
Zimbabwe
stands
at
212
women
dying
per
every
100,000
live
births.”

‘Free
blood
for
all’

Generally,
there
are
two
major
types
of
blood
transfusions:
allogeneic
and
autologous.
Autologous
transfusion
refers
to
self-same
blood
donation
by
an
individual
for
their
own
use
later.
Allogeneic
transfusion,
which
is
the
most
common
in
Zimbabwe,
involves
administering
blood
donated
by
one
person
to
another
who
matches
their
blood
type.

The
National
Blood
Service
Zimbabwe
(NBSZ)
is
the
body
that
oversees
blood
donation
and
distribution
in
the
country.
It
operates
as
an
independent
not-for-profit
entity,
but
it
is
mandated
by
law
to
collect,
process
and
distribute
blood
throughout
Zimbabwe.

While
the
Ministry
of
Health
and
Child
Care
is
permanently
represented
on
its
board
of
directors,
NBSZ
functions
independently
of
hospitals
and
government
health
institutions.
It
is
not
present
in
every
facility,
but
maintains
decentralised
distribution
from
five
regional
centres:
Harare,
Bulawayo,
Gweru,
Masvingo
and
Mutare.

Historically,
patients
in
Zimbabwe
paid
for
blood,
but
over
the
years
the
government
worked
on
lowering
costs
–
from
$150
a
pint
in
2016
and
prior
to
$50
by
2018.

The
government
then
went
a
step
further
in
July
that
year,
deciding
that
blood
would
be
made
free
at
all
public
health
institutions.

“The
free
blood
for
all
move
is
going
ahead
as
planned
and
mechanisms
have
already
been
put
in
place
to
finance
the
move,
and
come
July
1
[2018],
blood
will
be
available
for
free,”
said
then-Minister
of
Health
and
Child
Care
Dr
David
Parirenyatwa
during
the
June
2018
World
Blood
Donor
Day
celebrations.

However,
despite
the
policy,
hospitals
continue
to
face
shortages.

This
May,
there
was
a
critical
lack
of
blood
in
public
hospitals,
a
situation
that
threatened
the
lives
of
thousands
of
people,
the
Ministry
of
Health
and
Child
Care
said
in
a
statement.
Al
Jazeera
contacted
ministry
spokesperson
Donald
Mujiri
to
ask
about
the
shortage
and
the
implementation
of
the
free
blood
policy,
but
he
did
not
respond
to
our
requests
for
comment.

NBSZ,
meanwhile,
said
that
May’s
shortage
was
due
to
operational
and
systemic
challenges
that
disrupted
its
ability
to
carry
out
routine
blood
collection
activities.

“Without
timely
financial
support,
we
faced
constraints
in
mobilising
outreach
teams,
securing
fuel,
and
procuring
essential
supplies,”
Vickie
Maponga,
NBSZ
communications
officer,
told
Al
Jazeera.

“Additionally,
the
crisis
was
exacerbated
by
a
seasonal
dip
in
donations,
particularly
from
youth,
who
make
up
over
70
percent
of
our
donor
base.”

These
shortages
regularly
result
in
patients
on
the
front
line
needing
to
buy
blood
at
private
clinics.
In
most
cases,
the
patient
is
physically
transferred
to
the
private
facility
for
the
transfusion,
where
they
pay
the
costs.
In
some
cases,
the
patient
pays
and
the
private
hospital
sends
the
blood
to
them
in
the
public
hospital.

Crucial
blood
donations

The
World
Health
Organization
(WHO)
aims
to
ensure
that
all
countries
practicing
blood
transfusions
obtain
their
blood
supplies
from
voluntary
blood
donors.

The
NBSZ
told
Al
Jazeera
that
a
sustainable
blood
supply
in
Zimbabwe
depends
on
cultivating
a
culture
of
regular,
voluntary
donations,
particularly
among
the
youth
and
underserved
communities.

The
service
has
a
mobile
outreach
model,
through
which
it
brings
blood
donation
drives
directly
to
schools
and
communities.
To
further
engage
the
youth,
Maponga
said
they
also
started
a
club
that
“encourages
young
people
to
commit
to
donating
blood
at
least
25
times
in
their
lifetime”.

“We
also
integrate
blood
donation
awareness
into
school
programmes
and
partner
with
tertiary
institutions
to
maintain
continuity
post-high
school,”
she
said.

Ivy
Khumalo,
32,
is
one
of
those
who
has
been
donating
blood
since
she
was
in
high
school.
But
she
says
the
lack
of
blood
donation
centres
around
her
now
limits
her
ability
to
give
as
an
adult.

“As
a
school
child,
it
was
[first
started]
as
a
result
of
peer
pressure,
but
I
found
it
fascinating,”
Khumalo
said.
“It
was
only
when
I
was
an
adult
that
I
made
a
personal
decision
to
continue
donating
out
of
love
to
save
life
and
help
those
in
need.”

But
since
moving
from
Bulawayo
to
Hwange,
she
said,
donating
blood
has
become
expensive
as
the
nearest
centre
is
in
Victoria
Falls,
over
100km
(62
miles)
away.

NBSZ
says
it
routinely
deploys
mobile
blood
drives
around
the
country.
It
also
says
it
offers
donors
incentives.

“Regular
donors
who
meet
specific
criteria
such
as
having
made
at
least
10
donations,
with
the
most
recent
within
the
past
12
months,
qualify
for
free
blood
and
blood
products
for
themselves
and
their
immediate
family
members
…
in
times
of
medical
need,”
explained
Maponga.

However,
for
keen
donors
like
Khumalo,
the
effort
to
reach
a
far-off
donation
site
is
a
barrier
to
entry.

“In
such
circumstances,
it
is
no
longer
a
free
donation
as
I
spent
money
going
there.
In
the
end,
most
of
us
decide
to
stay
home
despite
the
passion
for
blood
donation,”
she
said.

CWGH’s
Rusike
says
the
NBSZ
and
Ministry
of
Health
and
Child
Care
must
urgently
devise
innovative
and
sustainable
ways
to
increase
the
number
of
eligible
blood
donors.

“The
government
should
utilise
the
Health
Levy
Fund
of
5
percent
tax
on
airtime
and
mobile
data
as
it
was
set
up
to
specifically
subsidise
the
cost
of
blood
and
assist
public
health
institutions
to
replace
obsolete
equipment
and
address
the
perennial
drug
shortages
in
our
public
health
institutions,”
he
said.
“That
money
should
be
ring-fenced
and
used
for
its
intended
purpose
in
a
more
accountable
and
transparent
manner.”

Promises
and
shortages

Authorities
say
that
as
of
mid-2025,
Zimbabwe’s
national
blood
supply
is
showing
good
progress,
and
NBSZ
has
already
collected
over
73
percent
of
its
half-year
target
(the
2025
annual
target
is
97,500
units).

The
blood
service
also
says
the
Ministry
of
Health
and
Child
Care
plays
a
central
role
in
both
subsidising
and
overseeing
the
cost
of
blood
within
the
public
health
sector.

“Since
2018,
this
[free
blood
policy]
is
made
possible
through
a
government-funded
coupon
system,
which
absorbs
the
full
cost
of
$250
per
unit,
resulting
in
zero
cost
to
the
recipient
[in
public
hospitals],”
said
Maponga.

The
NBSZ
maintains
that
it
operates
on
a
cost
recovery
basis.
It
says
the
entire
chain
of
collecting,
processing
and
distributing
a
pint
of
blood
costs
$245.
The
agency
charges
$250,
making
a
$5
profit
per
pint.

However,
prices
at
some
private
facilities
can
reach
as
much
as
$500
per
pint,
Zimbabweans
say.
This
has
sparked
heated
debate
on
social
media,
as
the
high
cost
remains
far
out
of
reach
for
many
people.

“NBSZ
does
not
have
regulatory
authority
over
how
those
institutions
price
their
services
to
patients,”
said
Maponga,
explaining
that
while
blood
itself
is
donated
freely,
the
journey
from
“vein
to
vein”
involves
a
complex
and
resource-intensive
process.

Observers,
however,
say
more
can
be
done
to
lower
the
costs
of
blood
transfusions.

“At
closer
look,
the
whole
chain
of
blood
transfusion
can
cost
less
than
$150
by
strategically
deploying
available
resources,
use
of
financial
donor
stakeholders
like
corporates,
and
also
holding
the
government
accountable
to
fund
the
whole
process,”
said
Carlton
Ntini,
a
socioeconomic
justice
activist
in
Bulawayo.

The
issue
of
free
blood
in
the
public
hospitals
is
noble,
Ntini
said,
but
without
full
implementation,
it
remains
a
false
hope
and
only
benefits
the
“lucky”
few,
as
shortages
are
the
order
of
the
day.

“In
reality,
any
amount
above
$50
per
pint
of
blood
will
still
be
high
to
Zimbabweans,
and
it’s
a
death
sentence,”
he
said.

Meanwhile,
for
patients,
the
cost
of
essentials
only
adds
to
an
already
stressful
situation.

Muzamba
was
fortunate
in
that
his
family
did
not
claim
back
the
money
they
gave
him
for
his
blood
transfusion.
But
Moyo
and
her
husband
struggled
to
settle
their
$1,000
loan
debt,
which
escalated
to
$1,400
after
interest.

“It
psychologically
drained
me
more
than
the
physical
pain
as
I
wondered,
‘Where
would
I
get
such
money
in
this
economy?’”
said
Moyo.
“The
government
must
own
up
to
its
promises
–
it’s
not
only
about
being
free,
but
must
be
accessible.”