In Zimbabwe's high-density urban areas, such as Dzivarasekwa in Harare, the Health Sector Development Support Project (HSDSP) is working to improve maternal and neonatal health outcomes. Shorai Sande, a pregnant resident of this under-resourced community, exemplifies the challenges many face due to limited access to healthcare services. Through the Urban Voucher Program, part of the HSDSP, over 80,000 women, including Shorai, have received essential antenatal care, leading to healthier pregnancies and safer births. This initiative has resulted in 35,000 safe deliveries and has helped reduce maternal and neonatal mortality rates.
The HSDSP, supported by the World Bank through what is now known as the Global Financing Facility (GFF), began in 2011 in collaboration with Zimbabwe's Ministry of Health and Child Care (MoHCC). It aims to enhance the availability and quality of care in underserved urban areas by improving the performance and management of health facilities. The declining quality of care in hospitals has significantly contributed to maternal deaths, with central and provincial hospitals implicated in 57% of such cases. To combat this, a quality-focused, results-based financing (RBF) pilot project was introduced in 2022 to enhance care quality.
The RBF approach in Zimbabwe correlates subsidies to health facilities' performance, thus incentivizing quality improvements in maternal and child health services. Resources generated from these subsidies have been used to procure necessary equipment and provide incentives for health workers. "In 2023, a year after the hospital joined the project, we had seven maternal deaths, down from 11 and 32 neonatal deaths compared to 51 from the previous year," stated Mrs. Choruma, Matron at Marondera Hospital. Her hospital utilized project subsidies to acquire equipment critical for handling and tracking health indicators, such as post-partum hemorrhage and pre-term births.
Sally Mugabe Hospital, Harare's busiest obstetrics facility, also benefited from similar support. Dr. Munyaradzi Nyakanda, Head of Obstetrics at Sally Mugabe Central Hospital, noted the importance of allowing facilities to choose their procurement needs, adding, "we decided to procure Intensive Care and Theatre equipment, including ultrasounds for our fetal medicine unit, which is our busiest department at the hospital."
RBF initiatives in rural areas began in 18 districts and have since been expanded with support from other development partners. This expansion led to facility refurbishments, improved service delivery, and enhanced community engagement. Village Health Workers (VHWs) played a crucial role in increasing healthcare service demand and coverage. Irene Goba, a VHW from Dora District, Mutare, highlighted her role in advising pregnant women, saying, "we educate them on the importance of getting tested for HIV."
To ensure the program's longevity, Zimbabwe's government has incorporated RBF into all rural districts as a health financing strategy, striving to maintain the substantive achievements in maternal and child health care.