Victoria Falls, Zimbabwe – At 5pm at the Victoria Falls border post, Margaret Tshuma – who has a 24-hour day pass to be in Zambia – is in a rush to return home to Zimbabwe before dusk.

This is not the first time Tshuma, 53, has travelled from her rural home in Diki village, 120km (75 miles) away, to cross into Zambia for the day. It has become a routine trip she makes monthly to buy medication for her husband who has scleritis – an inflammatory condition that affects the outer covering of the eye.

The prescribed medication is barely available on the shelves of pharmacies in Hwange district, where she lives. Of what is there, the high cost makes it inaccessible to many, she said.

“The same medication is expensive back home. If you add transport and medication costs altogether, it is still cheaper to come to Zambia. Also most times, some of this medication is not readily available which risks the patients’ lives,” said Tshuma.

Buying the medicines in Zimbabwe costs Tshuma about $85 a month, whereas just across the border in Livingstone she pays 320 kwacha ($13). Even with travel, it works in her favour, as a two-way trip from Hwange to Livingstone costs $14.

Zimbabwe’s economy has been hit hard by decades of economic crises and soaring inflation. Many basics are not as easily available or affordable, and Zimbabweans themselves have lost confidence in the local currency.

At the border, Tshuma follows a small queue, before officials check her luggage and papers without much trouble and stamp her 24-hour pass – a process that takes less than 10 minutes.

Speaking to Al Jazeera, Mike Muleya, a commuter bus operator who ferries passengers back and forth to the border area, said a significant number of people make the daily trip from Hwange – a community of some 21,300 people – to buy medicines or visit hospitals in Zambia.

“My first early morning trip from Hwange, I carry at least six to nine passengers going to Victoria Falls to cross to Livingstone. We chat along the way and I find that five to seven are going for medical-related trips,” he said.

“In the evening, on my last trip, I literally park near the border as they will be calling me to take them back to Hwange. In between, I will be carrying one or two, so it’s a big number [making the daily trip], given that it’s not me alone in the transport business.”

The cost analysis

According to a 2023 report by the local advocacy group Community Working Group on Health, most Zimbabweans do not have access to quality and affordable healthcare. The group has called on the government to prioritise primary healthcare to achieve universal health coverage.

Poor Zimbabweans who depend on state healthcare struggle significantly more to obtain treatment than wealthier citizens, who can turn to more expensive private services. In addition to difficulties in obtaining care, many complain of long queues at public hospitals – often requiring four to seven hours of waiting.

In Matetsi Ward 1 in Hwange Rural, 20km (12 miles) from Victoria Falls, Mercy Khumalo recounted the ordeal of taking her aunt to Zambia for treatment.

It was not an easy situation for the family, Khumalo said. Using their meagre savings and the money from selling a cow, they were finally able to get enough to afford to see a specialist at a private hospital in Zimbabwe. But after doing a cost analysis, they chose to go to Zambia instead.

“We had consulted locally and got some quotations from various specialists. Aunt was diagnosed with a brain tumour. Our neighbour told us that treatment was affordable and a pure public service in Zambia. We saw that, with the money we had, it will have been spent within a month at a private doctor locally; yet, in Zambia, we will save a lot as we monitor the situation,” she explained.

“Foreigners are allowed to use the public healthcare system in Zambia and are generally free as long as you have your passport and health records in order,” Natasha Chola Mukuka, a public health practitioner and student of medicine at Levy Mwanawasa Medical University in Lusaka, Zambia, told Al Jazeera.

Although specialists and surgery cases do attract a cost, Zimbabwean patients told Al Jazeera they find it more affordable than at home.

5 Miles Hospital still miles away

Matabeleland North province, home to Victoria Falls and Hwange, is historically marginalised despite it being a tourism hub that also houses the largest colliery and the biggest national parks. Locals bemoan the lack of tangible infrastructural development, including health facilities.

The construction of the 5 Miles Hospital – named for being 5 miles (8km) from Hwange Town Central Business District – gave hope to residents and villagers. However, when it was nearly complete in 2018, construction stopped.

“The government started to build some hospitals to demystify that the region is marginalised but the structures have remained white elephants for decades,” said Fidelis Chima, the coordinator of the Greater Whange Residents Trust.

“There is nothing to indicate that the hospital will open soon. We have waited for the longest time. People in Hwange depend on Hwange Colliery Company Hospital, but it’s a private facility and very expensive. The government wanted 5 Miles Hospital to be a district hospital, covering both Hwange and Victoria Falls,” added Chima.

Matabeleland North has a record of poorly equipped hospitals. Existing facilities also lack essential drugs and sufficient trained personnel, locals say.

In Hwange district, five hospitals provide services to a population of about 125,800.

But according to Hwange Rural District Ward 12 Councillor Jowani Chuma, four wards are serviced by one hospital, St Marys – a missionary facility run jointly by the government and the Catholic church where patients receive a combination of free and paid-for services.

Each ward, or subdivision of a district, generally has between 2,000 and 7,000 people. Chuma deems it fortunate that some parts of the district have St Marys, as most wards have no such facility.

“St Mary’s is better because most of the rural clinics are manned by hybrid personnel, with one or two government registered nurses while the rest are nurse aides or village health workers. In the absence of the senior sister, one is in the care of the inexperienced personnel,” said Chuma.

The electoral promise

During campaigning for the 2023 elections, the governing ZANU-PF party said Lupane Provincial Hospital in Matabeleland North – a large 250-bed facility – was set to become the biggest in the country upon its completion and ease pressure on referral hospitals in the southern region.

“The hospital will be the largest in all provinces in the country,” said President Emerson Mnangagwa while addressing party supporters at a rally in Binga.

Binga villagers, however, who live in the Zambezi Valley, cross to Zambia every day using canoe boats in search of medication and other basics. Unlike in Victoria Falls, Binga and Zambia are separated by the Zambezi River, and in the absence of a bridge, boats become a mode of transport.

The few functional hospitals from Lupane to Victoria Falls in Matabeleland North are either missionary or private, and both come at a cost for patients who use them.

Despite the government allocating $47 million for construction of the Lupane hospital in 2023 – and the government promising that the facility would be complete by the end of last year – most patients in the province are still referred to the Catholic-run St Luke’s for health services, while the critically-ill are referred to Bulawayo.

To date, people still travel long distances to seek basic treatment. Meanwhile, Matabeleland North, home to some 827,600 people, remains the only province in the country without a provincial hospital.

Averting smuggling

With the influx of people across the Zambia-Zimbabwe border every day, immigration authorities are tightening the requirements for people bringing medication into Zimbabwe.

They now require a prescription from a doctor that is stamped by a medical facility.

Previously, people would cross over to buy drugs without a prescription, a situation authorities say was creating a fertile ground for smuggling and unregulated medical drug businesses within Victoria Falls and Hwange.

“The border is busy on a normal day, mostly its people crossing for same day services … some are tourists,” said a security official at the border who requested anonymity as he is not allowed to speak to the press.

“But the bulk are vendors from Zambia and individuals from Zimbabwe going shopping which includes medical drugs. It’s not a lot, but for drugs, we now require a stamped prescription and we check the purchased drugs to reduce smuggling,” he told Al Jazeera.

The immigration officer in charge of the border was not readily available when asked for comment.

As Margaret Tshuma makes her way from the border to her home in Diki village, she knows she will be back in a few weeks. But she also looks forward to the day that Hwange has a district hospital and the Lupane Provincial Hospital is complete.

“This will save lives as it will cut distances to Bulawayo referral hospitals,” she said, adding that adequate facilities and steady affordable supplies of medicine nearer to home “will be welcome”.

“Otherwise,” she cautioned, “people will still trace medical facilities and medicine in Zambia if there are no prescribed drugs on the shelves.”