It was a jovial moment for women who had delivered their babies under the World Bank’s Results Based Funding (RBF) programme at Home Eden Clinic in Mazowe district of Mashonaland Central early last week.
The programme, which started in 2011, was initiated after realising that too many women and children were dying from birth–related complications that could have been corrected.
The fund, which was officially launched at the clinic, also benefits children from the time they are born until they are five years old.
A 26–year–old woman could not hide her excitement as she testified how she had benefited from RBF.
“When I had my first baby about six years ago, I struggled to get money to attend antenatal clinic and also money to pay vaccinations for the childhood diseases,” she said.
“But here I am joyfully holding my bouncing second baby that was delivered here at Home Eden Clinic for free. It is such a great relief for many women and babies who would have otherwise died during or after delivery due to lack of access to a medical institution.”
Some of the diseases babies get immunised from include diphtheria, measles, polio, rubella, tetanus and whooping cough (pertussis).
Another 23-year-old woman who held her suckling baby said so many women and children in Mazowe District had died during childbirth conducted by traditional midwives in their homes.
“This is a great achievement for all mothers to be. I live in Concession and I also paid for antenatal clinic visits for my first child, but with this RBF programme, I will have my child vaccinated against childhood diseases and also get family planning pills for free. This is a milestone achievement for us women,” she said.
Zimbabwe’s performance in key health indicators have been lagging behind on Millennium Development Goals (MDGs) to reduce both infant and maternal mortality. The country’s maternal ratio stands at 960 deaths per 100 000 live births against the MDG target of 174. Infant mortality is a staggering 57 deaths per 1 000 live births against an MDG of 22.
The World Bank provided funding to the health sector following a request from the government to contribute in improving maternal and child health indicators. The bank initially provided a grant of $15 million in July 2011, and an additional $20 million was granted this year.
The fund has also spread to 16 other districts countrywide where it has provided subsidies directly linked to performance in the form of quantity and quality service at rural primary health care centres and secondary level hospitals.
The World Bank has extended its funding to urban areas like Harare and Bulawayo to help expand health coverage to poor families.
Other areas that are benefitting from the RBF include Binga, Nkayi, Kariba, Chegutu, Mutare, Chipinge, Mwenezi, Chiredzi, Mutoko, Chikomba, Gokwe, Gweru, Gwanda, Mangwe, Zvishavane, Marondera and Centenary.
The RBF has managed to address some of the problems hindering full access to maternal health services by removing user fees and advocating for the improvement of enabling resources at 391 health facilities across Zimbabwe.
According to records from Zimbabwe’s Ministry of Health and Child Care between 2011 and 2013, the number of new outpatient visits to health centres in districts covered by the project went up by more than 90%, up from 151 000 to over 292 000.
This compares with a markedly lower increase of just 16% in districts not covered by the health project.
“The immediate objective of this grant is to help reduce Zimbabwe’s tragically-high rates of maternal and child mortality and to bring good quality service-
oriented healthcare within the reach of poor families,” Nginya Mungai Lenneiye, World Bank Country Manager for Zimbabwe said.
“In the long run, the health and survival of mothers and children are critical factors to the social and economic progress of any country.”
The number of normal deliveries supported by RBF rose by 40%, from 2 300 in March 2012 to nearly 3 200 in June 2013.
During the same period, number of women receiving at least four ante-natal checkups increased more than threefold, from 3 100 to 9 670. Number of women receiving at least two post-natal checkups also increased from 1 240 to 5 300.
These significant improvements have contributed to government’s objective of promoting better reproductive health and preventing avoidable deaths and lost income in Zimbabwe’s poorest families.
With the new funding, the project now aims to provide 93 000 more pregnant women with four or more ante-natal care visits, nearly doubling its targeted coverage, and to fully immunise 33 500 more children.
As part of its expansion into urban areas RBF through the Health Sector Development Support (HSDP) Project will use vouchers to help poor families’ access essential mother-and-child services. It will also adopt the same performance based approach that is delivering results in the rural areas.
“Access to maternal and child health has been a challenge in Zimbabwe, partly because poor families could not afford to pay the out-of-pocket costs for services,” said Olusoji Adeyi, World Bank Sector Manager for Health, Nutrition and Population for Eastern and Southern Africa.
“This programme is reducing the high cost of health services, which is a barrier to accessibility, while expanding the use and improving the quality of essential health services.”
The World Bank’s effort is supported by the United Kingdom and Norway. Under the technical and policy guidance of Zimbabwe’s Ministry of Health and Child Care and technical support from the World Bank, the implementing agency for the project is Cordaid—a non-governmental organisation with a global and regional experience in managing results-based activities in the health sector.
“We are here today to celebrate the achievements made since July 201 by the government of Zimbabwe with funding from the Word’s Bank Health Results Innovative Trust Fund. We acknowledge DFID and Norway for their generous support to the people of Zimbabwe through their contributions to the Health Results Innovation Trust Fund,” said the principal director, Preventive Services in the Ministry of Health and Child Care Dr Gibson Mhlanga.
Across Sub-Saharan Africa, many countries, including Rwanda, Burundi, Nigeria and Kenya, to name just a few, are shifting their focus from inputs to health results by rewarding health facilities for performance and motivating health workers.
“This trend is showing encouraging results and making a real difference to people across the continent,” Dr Mhlanga said.
Former Deputy Prime Minister Thokozani Khupe (MDC-T) has in the past year advocated for scrapping of user fees for women seeking maternity services describing childbirth as a national duty. She argued that if women decided not to refuse to fall pregnant, there would be no nation to talk about.
“We all came from a woman’s womb and if women in Zimbabwe were to stand up and say no woman must fall pregnant, what do you think will happen in the next 15 to 20 years?” she asked. “This country would come to a standstill.”
The launching ceremony was attended by Paramount Chief Makope, Raymond Kazembe Mazowe West MP, various government, Cordaid and EU officials.