City Of Harare | Urban Voucher system restores maternal health dignity in Mbare

MBARE, Harare's oldest suburb is where the hustle and bustle of the city is. Driven by the need to deflect poverty among families, many industries such agricultural produce, steel making to mention but these are thriving. Despite these appearances,reality on the ground is that most residents are still living in extreme poverty. This suburb made headlines in 2019 when a backyard midwife became famous for home deliveries. Maternal health is an indicator to national development and with this being under Sustainable Development Goal 3, it should be prioritised. Zimbabwe through the Results Based Financing facility managed to avert many maternal deaths. With the emergence of COVID-19, its impact was not felt due to lockdown restrictions which resulted in maternal deaths rising. Coupled with the COVID-19 effects, low health seeking behaviour among pregnant women, high costs of antenatal care could be attributed to the high maternal mortality particularly in urban areas. Who knows? Had it not been for the RBF intervention, Shyleen Kandamuviri(34) could have succumbed to ante or post natal complications given she says she barely attended antenatal visits. She explained how she got assistance through the RBF program. “I came from a very disadvantage family both my husband and I we do not work and I could not even afford to access finances for me to book my pregnancy this led me to delay my anti natal booking till I got to 8 months but luckily I got help from workers who assisted me I managed to qualify and accessed the voucher,”she said. She hopes this program continues for the benefit of other expectant mothers. “I got all the assistance I needed in the labour ward till delivery. All I can say I am thankful about the RBF program, my child is turning 3 this year, I wish they can keep continuing with the program so that others who will come after me who are as vulnerable and poor as I am will continue to benefit in accessing safe maternal health care,” said Kandamuviri. Panashe Muvhiringi (23) found antenatal care visits costs unbearable. “I am married and my husband and I do not work. I was approached by a community health worker who came to my house and asked me if I had gone for my ANC booking and unfortunately I had not done so and I told them I did not have any money. They assessed me if I could qualify for the UV program and I did manage to get my name into the program. I am on 4 months pregnant now and its my first. I have the voucher, today I came for my second ANC check-up, I wish the RBF program continues to help the poor pregnant women who cannot even ever see or dream themselves to have a baby delivery at clinic or hospital facility,” said Muvhiringi. The Urban Voucher (UV) component of the Results Based Financing program provides free Maternal Newborn and Child Health (MNCH) services for the poor in two pilot areas: Mbare and Hopely Wards. Mbare Edith Opperman Clinic Sister In-Charge Juliet Gura extoled the Urban Voucher component of Result Based Financing program saying it improved the quality of service while boosting staff morale which are key in delivering maternal health care for the women in line with the Sustainable Development Goals on gender and health. “It has been an exciting journey for us as we have seen an improvement, a decrease in maternal death and neo natal death, the Urban Voucher ( RBF) program has helped us a lot as it offers multifaceted benefits, before the program many women were giving birth in their homes hence we were having many home deliveries in Mbare, which led high numbers of maternal and neonatal death, so when this program came we saw that there was a rise in anti-natal bookings it resulted to rise in institutional deliveries," she said. The RBF focal person for Bulawayo and Harare Dr Collen Nyatsambo said the platform has brought relief to women among the 58% in the city living below the poverty datum line who are subjected to catastrophic out of pocket expenditure when accessing health care services. “We started with few clinics in both cities phase 1 of RBF started in 2014 and ever since we have been scaling it up to the extent that from the five sites in Harare and six in Bulawayo we actually added 12 more sites and now we have 23 sites,” said Dr Nyatsambo. He highlighted that regardless of positive progress having 64 percent to 91 percent of our women are utilising their first ANC visit vouchers, there are also other challenge are also encountered. Dr Nyatsambo added that since the inception of the Urban RBF voucher system they had a remarkable number of successes. “It has increased of access to care especially for the bottom 20 percent of our people who probably would not have been able to access health care in our units because of poverty. “We have adopted the health centre committee concepts which we did not have, it is now a bridge between the clinics and the community and we are implementing it in all our clinics, we also have autonomy of the health centre committees. “In terms of the program performance key indicators 4 percent are coming before the 16 weeks of pregnancy and this has been a kind of a source of concern on what we should do to cover this gap it is a battle between cultural beliefs and initiatives that we as the two cities we should put in place” he said. World Bank Country Director for Tanzania, Malawi, Zambia and Zimbabwe Mara Warwick lauded the teams implementing the UV system in Zimbabwe. " A couple of days ago we celebrated International Women’s Day and we talk about it we talk about empowering women but what we have seen today it is International Women’s Day because what we have seen is a group of people all of you working together to empower women of this community, I think there is nothing more empowering for a women than to be able to access maternal health care, to be able to make sure her baby is health that she has education needed to be able to able to carry that health forward with the baby, you are women empowerment in practise and I am very impressed by how everybody has is working together for this community,” she said. "Some of the challenges that women face are due to the unprecedented COVID-19 pandemic in the last two years. Unfortunately, like many other countries, the pandemic has not spared Zimbabwe, resulting in macro-economic challenges and disrupting the provision of essential services, particularly for women and children,” Ms Warwick said that the Government of Zimbabwe has already shown commitment to RBF through increasing financial contribution to the approach over the years. “Let me take this opportunity to thank all the stakeholders in implementing this Project, I have been impressed by the collaboration between the health facility and the community through the community health workers and the Health Centre Committee, I especially commend the commitment by the health care workers, given their additional workload and additional occupational risks that they face due to the COVID-19 pandemic. “I greatly appreciate the leadership provided by the Ministry of Health and Child Care and the City Health Authorities and the productive collaboration with CORDAID, the Project Implementing Entity I also wish to express my heartfelt appreciation to the beneficiaries for having confidence in the Project and utilizing the services at their disposal, taking care of their health and their families despite particularly challenging circumstances,” she noted. Catholic Organisation for Relief Aid (Cordaid) team leader Dr Endris Seid said the program has helped poor pregnant women to have safe deliveries. "Through the noble and innovative approach it has been possible to support the poor pregnant women to have safe delivery by removing financial access barricade so that they can have health mother and babies, (UV) program bring peculiar features by involving different actors from identification of potential beneficiaries by community health worker, assessment by social workers and provision of service by Ministry of Health and Child Care and City Health Staff,” said Dr Seid. The program also helped to revamp health centre committees playing important leadership and guidance roles in the community. It has provided an opportunity for the District and Provincial health teams to conduct quality maternal health provision in a structured manner. “We are now at a stage where the Urban Voucher program is being scaled up through the support of health sector, developmental support project and a significant co-financing by the Government of Zimbabwe. We will continue provide technical help to the cities to realise institutionalisation and sustainability as the projects end next year April,” Said Dr Seid.