b'IMPACT STATEMENT 2021Strengthening maternal healthcare in ZimbabweMaternal mortality must be declared a national disaster deserving urgent national attention.Dewa Mavhinga, Human Rights Watch ResearcherThe early 2000s saw rapid economic decline and political instability in Zimbabwe. Coupled with a reduction in government budgets, this had significant effects on the provision of healthcare services across the country. Severe shortages of healthcare staff and ill-equipped hospitals affected the delivery of quality maternal care, and by 2015 an estimated 3,000 women were dying each year from childbirth. Women living in poverty in rural areas suffered the most, with many unable to access quality obstetric care.In the remote area of Katerere in Nyanga, Manicaland Province, Bernadette Sobuthana remembers with pain how her mother passed away whilst delivering twins when she was just four years old.Bernadette is driven by the desire to help improve I was told that my mother complained of a severematernal healthcare so that no woman dies headache and was vomiting profusely, but comingneedlessly during childbirth. One woman who dies from a poor background meant her only method ofwhilst giving birth is one too many has become her transportation to the hospital was via a scotch cart.mantra. Following this passion has led Bernadette to By the time she had travelled the 25kms to the facility,the Crown Agents managed Results Based Financing the doctors were unable to save her.(RBF) Programme, where she is now the Projects Her mothers death cast a shadow over every aspectDevelopment Manager.of Bernadettes life. It had a ripple effect on myRBF works alongside Zimbabwes Ministry of Health family, she says. Not only was I left to care forand Child Care (MoHCC) to enable the delivery of high myself, but I was labelled as a maternal orphan andimpact maternal, newborn and childcare services. bullied at school. However, this did not deter her fromThis programme is critical to achieving MoHCCs goal thriving in her education. Her curiosity to understandto reduce the countrys maternal mortality rate, and is what caused her mothers death led her to accept acurrently operating in 42 rural districts, encompassing place at nursing college, where she was celebrated as849 rural health facilities and 67 hospitals.the best theoretical and practical nurse in her class. Under the RBF model, incentives are given to service providers for the results they obtain. Health facility staff and health centre committees have the RBF has supportedautonomy to decide how these funds are utilised to healthcare effortsimprove results. In some districts, RBF funds have been used in the construction of Waiting Mothers that have led to Homes near the health facility, so that expectant a 29% reduction mothers dont have to travel such long distances to give birth. At the primary care level, user fees have in Zimbabwesbeen removed to enable more people to access maternal mortalitycrucial health services. We have seen tangible results through the RBF rate since 2015* approach, Bernadette says. At the start of the programme, indicators for quality care at the health centre level were at 63% but are now well above 88% across all districts. Maternal mortality rates have also *http://ghdx.healthdata.org/record/zimbabwe- reduced significantly, dropping 29% since 2015, while multiple-indicator-cluster-survey-2019 infant mortality has fallen by 6%. 16'