As Zimbabwe's economic woes continue to load a mounting burden on an already weakened health delivery system, recent hikes in doctor's fees have now moved even basic medical care beyond the reach of most.

"Because of the constant rise in medical costs and the sorry state of the economy, access to healthcare is becoming a pie in the sky for the poor," Murisi Zwizwai, member of parliament for the main opposition Movement for Democratic Change party, told IRIN. "Healthcare is now almost the preserve of the rich."

The Association of Healthcare Funders of Zimbabwe, an independent organisation that sets medical costs with the approval of government, recently announced new consultation and laboratory test fees, adding to the financial squeeze that most Zimbabweans feel.

According to the state-run Herald newspaper, doctors' consultation and laboratory fees have increased 10-fold in some cases. "General practitioners are now charging between Z$3 million [US$2.3] and Z$5 million [US$3.85] a visit, up from Z$500,000 [US$0.38] in June. Physicians and paediatricians are now charging an average of Z$8 million [US$6.5] per consultation,” the Herald said.

Zwizwai, who is also a member of the parliamentary committee on health and child welfare, said "the increases, steep as they are, might be justified in order for those that provide health services to remain viable, but the tragedy is that the sick, particularly those that belong to the 80 percent of people living on less than a [US] dollar a day, have been dealt a body blow."

Zimbabwe's economy is buckling under the highest inflation rate in the world - nearly 8,000 percent - unemployment levels of 80 percent, and acute shortages of basic foodstuffs, fuel and electricity. The public health system has been crippled by a lack of foreign currency, making it unable to replace ageing hospital equipment and essential drugs, while many medical personnel have left for better-paying jobs abroad.

"The poor now have no option but to trek to government hospitals and clinics, but then these institutions are overwhelmed and suffer severe shortages of drugs, nurses and doctors," Zwizwai commented.

"While there is a need to factor in costs in delivering services, there is nothing that supersedes the value of life," he added, referring to a number of institutions that have started refusing care to patients who do not have the cash to pay for treatment upfront.

Most vulnerable bear the brunt

"Vulnerable families, such as the ones that are headed by children owing to a variety of reasons but mostly orphaning through the HIV/AIDS epidemic, have been presented with a serious challenge in the wake of the rise of medical expenses," Zwizwai said.

Estha Mugoni 17, who lives in the capital, Harare, became a 'parent' and the family's only breadwinner last year after her father died in an accident at a factory and her mother left with another man. She now looks after two sisters and the youngest, 10 years old, recently developed a tumour in her abdomen that requires specialist attention. Mugoni's cleaning job means the treatment is well beyond their financial reach.

"I am at a loss as to what I should do. I am struggling to fend for my sisters on the salary that I receive. We cannot have enough food and we have all stopped going to school because money is hard to come by," Mugoni said. "Since I cannot raise the money that is needed for a major operation, I have resigned myself to watching my sister die slowly."

After visiting the social welfare department on several occasions to ask for help, Mugoni realised her family's story was not unique: the underfunded department had long waiting lists of needy people to tend to before it would be their turn.

Josphat Mapanda, 45, a teacher earning Z$14 million (US$10.77) a month, half of which goes to pay his rent in Harare, said hospital officials had kept his wife in detention for three weeks when she could not pay for medical treatment she received after suffering a miscarriage.

He told IRIN he would now have to avoid hospitals and visit a traditional healer if he or a member of his family fell ill. "Drugs have been beyond our reach for a long time, and I have seen many relatives and friends die because of that, but it seems the recent rise in medical fees is the final nail."