Victoria Falls, Zimbabwe – At 5pm at the Victoria Falls border post, Margaret Tshuma, who has a 24-hour pass to Zambia, is eager to get home to Zimbabwe before nightfall.
This is not the first time that Tshuma, 53, has left her home village of Diki, 120km away, to travel to Zambia for the day. It has become a habit for her to make the trip every month to buy medicine for her husband who suffers from scleritis, an inflammatory disease that affects the outer membrane of the eye.
Prescribed medicines are barely available in pharmacies in Hwange district, where she lives. The high price of available drugs makes them inaccessible to many people, she explained.
“The same medicines are expensive in my country. Adding to that the cost of transportation and medicines, it is still cheaper to come to Zambia. Also, most of the time, some of these medicines are not easily available, which puts the lives of patients at risk,” Tshuma said.
Buying medicine in Zimbabwe costs Tshuma about $85 a month, while across the border in Livingstone she pays 320 kwacha ($13). Even when travelling, this works in her favour, as a return ticket from Hwange to Livingstone costs $14.
Zimbabwe’s economy has been hit hard by decades of economic crises and soaring inflation. Many basic necessities have become less readily available or affordable, and Zimbabweans themselves have lost confidence in the local currency.
At the border, Tshuma stands in a small queue, before officers check his luggage and papers without much hassle and stamp his 24-hour pass – a process that takes less than 10 minutes.
Speaking to Al Jazeera, Mike Muleya, a bus driver who transports passengers in the border area, said a significant number of people make the daily journey from Hwange – a community of about 21,300 people – to buy medicine or go to hospitals in Zambia.
“On my first morning trip from Hwange, I carry at least six to nine passengers towards Victoria Falls to cross to Livingstone. We chat on the way and I find out that five to seven of them are on medical trips,” he said.
“In the evening, on my last trip, I literally park near the border because they will call me to take them back to Hwange. In the meantime, I will transport one or two, so it is a big number (to do the daily commute), given that I am not alone in the transport business.”
Cost analysis
According to a 2023 report by local advocacy group Community Working Group on Health, most Zimbabweans do not have access to quality and affordable health care. The group called on the government to prioritize primary health care to achieve universal health coverage.
Poor Zimbabweans who rely on public health care have a much harder time getting care than wealthier citizens, who can turn to more expensive private services. In addition to the difficulties in getting care, many complain about long queues at public hospitals, often requiring four to seven hours of waiting.
In Matetsi Ward 1 in rural Hwange, 20km from Victoria Falls, Mercy Khumalo recounted the ordeal she went through when she took her aunt to Zambia for treatment.
The situation was not easy for the family, Khumalo said. With their meager savings and money from the sale of a cow, they eventually managed to raise the money to see a specialist at a private hospital in Zimbabwe. But after doing a cost analysis, they chose to go to Zambia.
“We consulted local specialists and got quotes from several specialists. My aunt was diagnosed with a brain tumour. Our neighbour told us that the treatment was affordable and that it was a public service in Zambia. We found that with the money we had, it would have been spent in a month at a local private doctor. However, in Zambia, we will save a lot by monitoring the situation,” she explained.
“Foreigners are allowed to use the public healthcare system in Zambia and are generally free as long as they have their passport and medical records in order,” Natasha Chola Mukuka, a public health practitioner and medical student at Levy Mwanawasa Medical University in Lusaka, Zambia, told Al Jazeera.
Although specialists and surgeries come at a cost, Zimbabwean patients told Al Jazeera they found them more affordable than at home.
5 Miles Hospital is still miles away
Matabeleland North province, home to Victoria Falls and Hwange Falls, has historically been marginalized despite being a tourist hub that is also home to the world’s largest coal mine and national parks. Residents lament the lack of development of tangible infrastructure, including health facilities.
The construction of the 5 Miles Hospital, named for its proximity to Hwange Town’s central business district, gave hope to residents and villagers. However, as it neared completion in 2018, work was halted.
“The government started building hospitals to demystify the fact that the area is marginalised, but the structures remained white elephants for decades,” said Fidelis Chima, coordinator of the Greater Whange Residents Trust.
“There is no indication that the hospital will open soon. We have waited a very long time. The people of Hwange rely on the Hwange Colliery Company hospital, but it is a private facility and very expensive. The government wanted 5 Miles Hospital to be a district hospital, covering both Hwange and Victoria Falls,” Chima added.
Matabeleland North has a save Hospitals are poorly equipped. Existing facilities also lack essential medicines and adequately trained staff, residents say.
In Hwange District, five hospitals provide services to a population of approximately 125,800 people.
But according to Jowani Chuma, councillor for Ward 12 in Hwange Rural District, four wards are served by just one hospital, St Marys, a missionary facility jointly run by the government and the Catholic Church where patients receive a combination of free and paid services.
Each ward, or subdivision of a district, typically has between 2,000 and 7,000 residents. Chuma says it is fortunate that some parts of the district have St Marys, as most wards do not have such facilities.
“St Mary’s is a better option because most rural clinics are run by a mixed staff, with one or two registered nurses while the others are nursing assistants or village health workers. In the absence of the senior nurse, one of them is taken over by the inexperienced staff,” Chuma said.
The electoral promise
During the campaign for the 2023 elections, the ruling ZANU-PF party said the Lupane Provincial Hospital in Matabeleland North – a large 250-bed facility – would become the largest in the country once completed and ease pressure on referral hospitals in the southern region.
“The hospital will be the biggest in any province in the country,” President Emerson Mnangagwa said while addressing party supporters at a rally in Binga.
The villagers of Binga, who live in the Zambezi Valley, cross Zambia by canoe every day to get medicines and other essentials. Unlike Victoria Falls, Binga and Zambia are separated by the Zambezi River and, with no bridge, boats become a means of transport.
The few functioning hospitals in Lupane, Victoria Falls in Matabeleland North are either mission or private, and both have a cost to patients who use them.
Despite the government’s allocation of $47 million to build the Lupane hospital in 2023 – and the government’s promise that the facility would be completed by the end of last year – most patients in the province are still referred to St Luke’s Catholic Hospital for health services, while critically ill patients are referred to Bulawayo.
To this day, people still have to travel long distances to get basic healthcare. Matabeleland North, with a population of some 827,600, remains the only province in the country without a provincial hospital.
Preventing smuggling
With the daily influx of people crossing the Zambia-Zimbabwe border, immigration authorities are tightening requirements for people bringing medicines into Zimbabwe.
They now require a doctor’s prescription stamped by a medical facility.
Previously, people would cross the border to buy medicines without a prescription, a situation that authorities said created fertile ground for smuggling and unregulated drug trade in Victoria Falls and Hwange.
“The border is very busy on a normal day, most people are crossing for same-day services… some are tourists,” said a border security official who spoke on condition of anonymity because he is not authorized to speak to the press.
“But most of them are Zambian and Zimbabwean vendors who come to buy, especially medicines. It is not a lot, but for medicines we now require a stamped prescription and we verify the medicines purchased to reduce smuggling,” he told Al Jazeera.
The immigration officer in charge of the border was not immediately available for comment.
As Margaret Tshuma drives from the border to her home village of Diki, she knows she will be back in a few weeks. But she looks forward to the day when Hwange will have a district hospital and the provincial hospital in Lupane will be completed.
“This will save lives as it will reduce the distances to referral hospitals in Bulawayo,” she said, adding that adequate facilities and regular and affordable supplies of medicines closer to home “will be welcome”.
“Otherwise,” she warned, “people will continue to seek medical facilities and medicines in Zambia if there are no prescribed drugs on the shelves.”
