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.
But they can be bought under the table, if you know who to ask and are willing to pay.
Zimbabwe’s Child Health Cards, meant to be free to new mothers, are crucial documents that track babies’ growth, vaccinations and medical histories. Without them, each clinic visit becomes a reset button.
Inquiry into the child’s medical history starts from scratch. Since July 2024, the cards have disappeared from health facilities across Harare’s central hospitals and 42 council clinics — even though the card’s producers say they’re making enough to meet demand.
This artificial shortage has birthed a shadow market where clinic staff quietly sell this essential document to desperate mothers. This sort of nickel-and-dime bribery exposes deep cracks in ahealth care system that's already failing the most vulnerable people.
What started as a clandestine operation has become an open secret.
“When cards arrive at a clinic, they’re kept by the sister in charge. But it’s usually nurse aides or junior staff who sell them, working in cahoots with other staff members,” says Simbarashe James Tafirenyika, who leads the Zimbabwe Municipality’s Nurses and Allied Workers Union.
Someone who sells 100 cards can pocket around US$500, she says, and none of that money goes to the government of the council.
The going rate for the Child Health Card is US$5, say several mothers who spoke to Global Press Journal.
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.
Harare’s council clinics alone deliver more than 3,000 babies every month, with each mother left scrambling for documentation.
“I feel hurt,” Jowa says. “I want to know what vaccines my child has received and their purposes, but I just can’t get that information.”
A nurse aide assistant at one of the council clinics has witnessed this shadow market.
“If a nurse is selling, they ask the mother to be ‘skillful’ if they need the card,” says the assistant, who requested anonymity for fear of retribution. In Zimbabwe, “skillful” is a common euphemism for paying small bribes.
While the Ministry of Health and Child Care is supposed to supply the cards for free, Prosper Chonzi, the City of Harare’s director of health, admits supplies have been erratic for six months and that people have complained about being forced to purchase these cards. Clinic workers may be exploiting the known shortage and coordinating among themselves to sell the cards rather than providing them for free, he says.
