Paying close attention to her baby’s sudden movements, Rumbidzai waits patiently for the arrival of her third child. Ahead of her labour, Rumbidzai is staying in a maternity waiting home in Msambakaruma, Zimbabwe on the health clinic site. This is the first time she will have given birth away from home but knows that being at the clinic, under the supervision of dedicated nurses, gives her unborn child the best possible start in life.
“I delivered my first child in 2003 at home because I was faced with factors that steered me away from attending the clinic,” says Rumbidzai. “I’d have had to walk over 20km just to reach the site, and on top of that, back then there were high fees to have an institutional birth.” Some women in Zimbabwe are also forbidden to use health services by their local communities or for religious reasons. Yet, Rumbidzai is aware now of how risky her home birth could have become.
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 for Zimbabwe, mortality rates stand at 462 mothers out of 100,000 live births.
The construction of maternity waiting homes is just one example of how the Results-Based Financing (RBF) Programme in Zimbabwe is prioritising women’s health in a bid to reverse these worrying maternal mortality rates. The programme, which is delivered jointly by UNICEF, the Zimbabwean Ministry of Health and Child Care and Crown Agents, finances health 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.
Encouraged by the Results Based Financing initiative, the maternity waiting homes concept was developed by Zimbabwean health workers in partnership with Health Care Committees to encourage more women to opt for safe institutional births. RBF works through, and builds upon, existing health structures, and therefore the lodgings were constructed on already established health facility premises. The close proximity to the clinic means that mothers can be closely monitored by health experts and easily get support should complications occur.
In the third trimester of pregnancy, mothers call in to book a room at the facility. This overcomes geographic and seasonal barriers preventing many from attending the clinics, such walking long distances in rainy season.
Another major draw of these homes has been the spacious rooms and the free services offered, which were described by one guest as “Kanyi pindwe,” Ndau translation meaning “better than at home”! These services range from health care, such as psychological support ahead of birth, to classes which teach the women life skills, such as sowing. This training helps pass the time during their stay and provides an opportunity to interact with other expectant mothers.
Nutrition gardens are also planted outside the lodgings and the homes are equipped with cooking essentials. “This minimises the burden on the women to bring their own food during their stay” says Mr Samatanga, the Health Care Committee Chair at the Msambakaruma clinic where Rumbidzai gave birth.
The Results-Based Financing Programme works to strengthen national and local health systems, making them more sustainable and more robust to change. Initiatives under the programme have therefore proved essential during the Covid-19 pandemic in Zimbabwe. Medicines have become difficult to access as many local pharmacies have reduced their hours since the outbreak. Lockdown measures and travel restrictions are also making it difficult for Zimbabweans to get to the critical support they need. Across 42 districts, all RBF health facilities have been able to adapt to the challenges of the pandemic and quickly implement measures to prevent the spread of the virus, including social distancing and temperature checks. They have thus been able to continue operating and serving the public.
The pandemic has not put a halt on the number of babies being born, and therefore it has been imperative that women’s maternal health has continued to be prioritised throughout. Despite all the uncertainties brought about by Covid-19, well organized arrangements, such as the waiting home pick-up scheme and the lodgings on the clinic sites, are enabling women like Rumbidza to continue to gain access to the skilled medical care they need to safely give birth to their babies.