- Women not booking at ANC facilities early leading to complications
- Exodus of healthcare staff leads to poor quality of care for pregnant women
THE number of babies dying during birth, moments before birth or a few weeks before and after being born has been going up over the past five years in Zimbabwe largely due to a myriad of factors ranging from failure by pregnant women to book at the ANC on time, infection of babies before, during and after birth as well as declining quality of care in health facilities.
By Michael Gwarisa
The MICS Reports of 2014 and 2019 indicate that all Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH) indicators have been performing well except Facility Neonatal Mortality Rate
While Zimbabwe aims to achieve a value of 12 deaths per 1000 births in the year 2030, the country’s Perinatal Mortality is actually going up. Perinatal Mortality was 29 per 1000 in 2017 and in 2021, it was at 30. Fresh stillbirths have also been increasing with 5 per 1000 having been recorded in 2017. In 2021, 7 stillbirths per 1000 births were recorded.
Briefing Journalists during a media sensitization meeting on the on the Zimbabwe Health Sector Development Support Project (ZHSDS) Additional Financing Five (AF V) and the achievements that have made over the years in the Results Based Financing (RBF), Dr Marvin Venge, the Acting Deputy Director Reproductive Health in the Ministry of Health and Child Care (MoHCC) said there has been a sharp decline in the number of women booking with the Antenatal Clinic and this has exposed more unborn babies to complications and infections leading to mortality.
“Causes of stillbirths, we have pre-maturity where babies are being born before they reach their full term that is 37 plus weeks. This emphasizes that mothers should actually visit their Antenatal Clinics so the complications of pre-maturity can actually be managed,” said Dr Venge.
Birth asphyxia as well as neo-natal sepsis are some of the leading causes of stillbirths in Zimbabwe. Perinatal Mortality Rate and Fresh Stillbirths Rate have also been going up. A Perinatal death is a stillbirth or neonatal death of a baby of 20 or more completed weeks of gestation while a fresh stillbirth is defined as the intrauterine death of a fetus during labor or delivery.
Dr Venge also bemoaned the rise in perinatal mortality saying, “Our Perinatal Mortality rate has not been that well. This is very important, the reason why this is very impotent is because it speaks to the quality of care that our women are actually getting during the delivery period and the seven and 28 days after the baby has been born. This tells us that in terms of our quality, we are not yet there.”
According to Dr Venge, there was a decline in ANC bookings in the first half of 2022 when compared to previous years and this was not good for neo-natal health. Total bookings declined by 2% and bookings below 16 weeks gestation by 4% between the first half of 2021 and that of 2022. The number of deliveries in health facilities increased by 4% between the first half of 2021 and that of 2022. Home deliveries fell by about 22% in the same period.
Meanwhile, to avert numerous maternal and child health challenges facing urban and rural health institutions, the Ministry of Health and Child Care (MoHCC) and Cordaid are implementing the Results Based Financing for healthcare model (RBF) through technical support from the World Bank (WB). The RBF introduced the Urban Voucher Component where pregnant and expecting women from vulnerable backgrounds get assistance throughout their pregnancy up to the time they give birth.
Dr Celstino Bhasera, the Global Fund Grants Coordinator (TB and Malaria) said the RBF has helped in the institutionalization and decentralization of maternal, family and child health services.
“The RBF was designed to support the national health strategy and policy. The user fee was to be removed, the quality of care had deteriorated and we had to rebuild. The focus was with maternal, family and child health at first. The prioritized package of service was directly linked to the burden of disease for mothers, new born and children under the age of five. The urban voucher was the introduced to cater for those who were poor in the urban settings,” said Dr Bhasera.
He added that while certain indicators were not looking good, there has been great improvement in the coverage of maternal and child health services and in the quality of selected ANC services as well as improvements in the uptake of vouchers. The RBF has been effective around cost effectiveness and strengthening of maternal and child health services.
In a speech read on behalf of the health ministry Permanent Secretary, Dr Jasper Chimedza by Dr Stephen Banda, the director policy and planning in the ministry of health, he said, “Based on successful implementation and positive results, the Government of Zimbabwe decided to institutionalize RBF in the health sector. To demonstrate government commitment, Treasury is fully financing RBF subsidies for 18 rural districts, which were previously supported by the world bank under the HSDSP. I would like to acknowledge other development partners who are financing the 42 districts through the Health Development Fund (HDF).”
In 2020 the HDF contributed a total of USD12 million to the RBF programme. The RBF programme was extended to support an urban component and demand-side maternal health voucher scheme that targets the poorest households to reduce financial barriers to accessing high impact Maternal and Child (MCH) services while improving the quality of health services in Zimbabwe’s two largest cities (Harare and Bulawayo). To date, through the Urban Voucher component of the program a total of 35 facilities have been contracted to provided services to our poor pregnant women in the two cities.
The Government of Zimbabwe also availed resources for the national COVID-19 response.
