RBF’s Urban Voucher Reduces Maternal and Neonatal Deaths In Harare

THE Urban Voucher (UV) component of the Results Based Financing (RBF) program, which is being implemented through funding and technical support from the World Bank (WB) has resulted in a decline in maternal and neonatal deaths due to increased uptake of services by pregnant and expecting women.

By Michael Gwarisa

The RBF project was introduced by the government of Zimbabwe in 2011 and is financed by the Global Financing Facility and the Health Results and Innovation Trust Fund. In the earlier phases, the  Project aimed to accelerate access to quality maternal and child health services using an RBF approach and was rolled out in 18 rural districts given the poor health outcomes for women and children in rural areas before it was expanded to urban health facilities.

Mbare Polyclinic is the only Polyclinic in the southern district of Harare that is benefiting from the RBF program. It is also the only clinic amongst the 10 clinics in the district which offers maternity services and serves a population of 200 000 mainly people from Mbare and beyond its catchment area in areas such as Epworth, Waterfalls among others

Speaking during a site visit of Mbare Polyclinic by the World Bank Country Director for Eastern and Southern Africa, Mara Warwick, Mbare Polyclinic Sister in Charge, Sister Juliet Gura said the prevalence and incidence of maternal and neonatal deaths have been greatly reduced since inception of the RBF Urban Voucher program.

This Polyclinic was lucky to have the urban voucher program which is looking at the vulnerable people of Mbare and beyond. With this program, we saw that there was an improvement in everything because we got a number of benefits from this program.

“Before the program, we were having many home deliveries in Mbare and also we were having many maternal deaths and neonatal deaths. When this program came, we saw that there was a rise in Antenatal (ANC) bookings and we saw that there was a rise in institutional deliveries and we witnessed a decline in maternal deaths and neonatal deaths,” said Sr Gura.

Mbare Polyclinic offers both preventive and curative services. It also offers maternity services such as ANC, delivery and Post natal care. On Antenatal Care, the clinic serves not less than 40 pregnant women in a day, that is those who come for their first antenatal visit. In the labour and delivery wards, about 20 women are served per day.

This program started in 2014 at Mbare Polyclinic, before being paused briefly in 
2018 and then resumed in 2019.

Speaking during the same event, Global Fund Grants Coordinator (TB and Malaria), Dr Celstino Bhasera said following the successful implementation of the program in both rural facilities and Mbare Polyclinic, plans are already underway to roll out the program to more urban health centres.

“You will all be aware that this project came in to alleviate poverty constrains in terms of maternal and child health issues. It has brought in a lot of relief and has strengthened the way we do our work. We have experienced the impact of this intervention and as we roll it out and increase the number of facilities, I am sure we are going to see more,” said Dr Bhasera.

The RBF Urban Voucher project started as a pilot and is currently at a phase where it’s being scaled up to a total of 35 facilities which will be contracted under the current funding.

Giving her remarks after touring the facility and its services, Mara Warwick, the World Bank Country Director (Tanzania, Malawi, Zambia and Zimbabwe) said, “…the Project demonstrated positive results from the very early years of implementation, leading to the RBF approach being scaled up to the remaining 42 Districts in 2014 with funding support from other development partners.

“During the scale-up of the rural RBF, there was also growing evidence of women and children in urban communities facing similar challenges in accessing maternal and child health services, mainly due to financial barriers as they could not afford the costs of these services.”

She added that the concept of an Urban RBF emerged with the RBF approach being modified to fit an urban context.  This Urban Voucher Program is demand-driven, targeting poor pregnant women with a package of maternal care services ranging from prenatal care, institutional delivery to postnatal care in selected facilities in Harare and Bulawayo.

Meanwhile, the RBF Urban Voucher project is being implemented by the Catholic Organization for Relief and Development Aid (CORDAID). Giving his remarks, CORDAD Team Leader, Dr Endris Mohammed Seid applauded the partnership and oneness that was shown by government and all involved partners in implementing the project.

“We as CORDAID are very grateful for the opportunity given to us and the trust given to us by the World Bank and the Government of Zimbabwe to serve as the project’s implementing entity. Through the guidance and support given to us by the Ministry of Health and Child Care, World Bank and the City Health Department, we have been able to make tremendous progress in achieving intended results of the projects.

“Through this noble and innovative approach, it has been possible to support the urban poor pregnant women, to have safe delivery by removing the financial access burden so that we can have a healthy mother and baby. The urban voucher program brings a peculiar feature by involving different actors from identification of potential beneficiaries by Community Health Workers (CWHs), assessment by Social Workers and provision of service by ministry of health and City Health Staff,” said Dr Endris.

 

 

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