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Results-Based Financing in Zimbabwe: Empowering women by driving access to quality healthcare

7th March 2019

From left to right:Caroline Mubaira, HDF-RBF Deputy team leader; Sister Matimba, Matron at Bikita Rural Hospital, Marie-Jeannne Offosse, HDF RBF Team leader and Muchaneta Mwonzora, Crown Agents Country Director

In the dead of night when the community’s activities have ceased, and when Esther’s three young children are safely in bed and fast asleep, she and her husband slip cautiously into the darkness and make the short but precarious trek to the antenatal clinic that remains open after hours.

It’s a matter of life and death, since she has lost two children during home births and knows that having her baby at Kunaka Rural Hospital under the supervision of dedicated nurses is the best possible start in life to give her unborn child.

As members of the Apostolic Faith community, which forbids women and young girls from accessing health services, there is a high risk that Esther Guvava and her husband will be ostracised from the community if they were ever found out.

Some Apostolic Faith members do not believe in accessing conventional medicine or health services offered by hospitals.

Fully aware of the stigma that women like Esther might face, the nurses at the rural hospital in Seke go the extra mile to educate the mothers of the Apostolic Faith. Secret registers have been opened offering family planning, antenatal services and immunisations, and the nurses treating them work for longer hours at night to help save their lives and those of their children.

This is just one example of the how the Results-Based Financing programme in Zimbabwe is prioritising women’s health in a bid to reverse worrying maternal mortality rates, which currently stand at 433 mothers out of 100,000 live births.

The programme, delivered jointly by UNICEF, the Zimbabwean Ministry of Health and Child Care, and Crown Agents, finances interventions to reduce maternal and neonatal deaths and strives to empower women to take on leadership and decision-making roles at all levels across the health sector. It does this by transferring funds to health providers on the condition that measurable action will be taken to achieve defined health system performance targets.

Service quality, service utilisation and improving staff morale are key to delivering Universal Health Coverage, while prioritising women’s health and therefore saving women’s lives aligns with global Sustainable Development Goals on gender.

According to the World Health Organisation 800 women die daily ‘due to complications of pregnancy and childbirth, including severe bleeding after childbirth, infections, hypertensive disorders and unsafe abortions’. Ninety-nine percent are in developing countries and half of these occur in Sub-Saharan Africa.

Health facilities across several districts in Zimbabwe have seen marked improvements, and in many instances Zimbabwean women have impressively forged these themselves, empowered by the RBF programme’s emphasis on gender equality.

Laina Mageza, Ambulance Driver

They have taken on leadership positions as Provincial Medical Directors and via Health Centre Committees, while new Community-Based Organiser posts have diversified career opportunities in health, extending beyond women’s traditional roles as nurses. Zimbabwean women have challenged gender norms by becoming ambulance drivers and female workers in rural settings have volunteered their manual labour by fetching water during the construction and renovation of health facilities.

RBF and Women in Crown Agents Zimbabwe
The RBF programme in Zimbabwe is led and implemented by team leader Marie-Jeanne Offosse in collaboration with deputy team leader Caroline Mubaira. Women constitute 53% of all Crown Agents Zimbabwe staff and is headed up by Country Director Mrs Muchaneta Mwonzora. Reflecting back to 2014 when she was asked to roll out RBF in 42 districts across the country, Mrs Mwonzora said:

‘This was an exciting proposition for us given the objective of reducing maternal and infant mortality. This spoke strongly to the grandmothers, mothers and young women in the organisation, many of whom have roots in rural areas and have grown up understanding the challenges of accessing affordable healthcare. Each one of us can recall a sad story about women and child birth, but here was an opportunity to write a happy ending.’

Learn more by downloading the RBF programme’s latest publication: Gender at the Core: Results-Based Financing for Women’s Healthcare in Zimbabwe. In it you will find the stories of the inspirational women and men working to improve healthcare services for women, as well as the uplifting stories of those who have benefited from the programme.

‘If you set your mind on it, you can achieve it!’ says Sister Matimba, who believes that a lack of self-belief is the most potent factor holding women back.