Tavern Of Life: Concession Pub Transforms Into Vibrant Clinic

For decades, Dandamira bar in Ward 15, Concession, Mazowe District, had served wise waters to thirsty revellers from within the community and passers-by. Pleasure managers and those who grew up in the area during the Tavern’s heyday confess that the pub would even eclipse some morden urban joints.

By Michael Gwarisa

Despite the flowery history the building holds, its clients from Dandamira and other surrounding wards were struggling to access basic healthcare services. For several years, people from the community would walk or travel 7 Kilometres to Concession District Hospital for health services, including services such as maternal and child health services, Antiretroviral Therapy (ART) refills, Family Planning among others.

Due to the long distance, home birth deliveries and maternal health complications were rife as pregnant women in the Concession community would struggle to visit the Antenatal Clinic (ANC) for pregnancy bookings. Those whose pregnancies had complications would take  long to get assistance. The World Health Organization (WHO) recommended distance between a community and the nearest health facility is 5 km.

Mazowe District has 39 health facilities, with an estimated population of 352,000. Of the 39 health facilities, the district has got three hospitals, 35 Clinics, and one rural Hospital. The district has three urban communities, namely Tsungubvi, Mvurwi, and Concession. However, Mvurwi and Tsungubvi had clinics but Concession, on the other hand, didn’t have any primary healthcare facility.

After realizing the gap, in 2019, the community in Concession identified a Bar in Dandamira, a high-density suburb, which they later converted into a now vibrant Clinic. The clinic has been operating since then. Before that, long queues would form at Concession District Hospital, which is a Secondary Healthcare facility as the facility served patients from Dandamira and all suburbs in Concession and surrounding areas.

This place used to be a bar. People would come here to drink beer and watch Masquerades (Zvigure) dancing. All sorts of things would happen here. However, this is now a clinic and it is helping us a lot. I am here today to collect my Family Planning pills. I gave birth here two months ago,” said Mrs Spiwe Chihota (36), also known as Amai Gorosi, a resident of Mazowe West, Ward 15.

“I remember back in the day, we used to walk to the Hospital to collect Family Panning or control pills. At times we would end up neglecting and not collecting the control pills. This resulted in several unintended pregnancies in the community. Apart from just family planning services, even if I am to fall sick at night or my child is to fall ill, I just come here anytime, I no longer need to worry or wait for dawn to start walking to the hospital. Things have greatly changed for us.”

Dandamira Clinic has a catchment population of approximately 21,000. The facility was recently enrolled under the Results Based Financing (RBF) model though it is yet to get its first disbursement. The RBF is being financed under the Health Sector Development Support Project Additional Financing V, being implemented by the Ministry of Health and Child Care (MoHCC), Cordaid Zimbabwe and co-financed by the Government of Zimbabwe, and the World Bank (WB).

Mr Paradzai Chinyoka, the Councillor for Ward 15 said, the clinic was built following an outcry from the community regarding the long walking distance to the nearest health facility.

“Our Hospital in Concession is quite a distance to those who walk and it had become over congested. We tried to look for a vacant place to build a clinic to address those challenges but we failed to get one. That is when the community opted for this beer hall which was lying idle and we converted it into a clinic.

“We got the funds from the council beer levy and we also got the CDF funds. We also got the CDF from the Member of Parliament. We got the diagrams for the facility from the Ministry of Health. We started working in the outpatient department before moving to other divisions. I am happy to say that all stakeholders since inception have had an input into this facility,” said Councillor Chinyoka.

Supervision of the facility was handled by the Ministry of health including supplying the health personnel working at the facility. The Clinic also offers services to surrounding farms in Wards 12, 1, 31, 32 and 34. Only those with major ailments get services at the Concession District Hospital.

Dr Kudzai Chisenwa, the District Medical Officer for Mazowe said the Clinic at Dandamira has decongested the District Hospital.

“What this means is that the quality of services will improve even at the District Hospital. Where they would see maybe more than 200 patients every day, they are now concentrating on patients who require secondary health services. All those patients that require Primary health services are accessing them at Dandamira Clinic,” said Dr Chisenwa.

He added that the health facility is a product of a multi-sectoral approach where all stakeholders including the community, the Mazowe Rural District Council (MRDC), the Member of Parliament (MP), working together with the Ministry of Health, came together to transform the district’s healthcare.

“We also used our RBF funds to make sure that the clinic functions. The health facility has also helped us attain our RBF indicators which are the ANC, institutional and normal deliveries, post-natal care, growth monitoring and immunisation that has greatly improved. That to us, this is a success.”

Mzowe District started implementing the Results Based Financing (RBF) in 2012 and over the years, this has seen several improvements in terms of maternal healthcare services. The RBF improved access to healthcare services by removing user fees for patients as they are one of the barriers to access to healthcare services.

340 clinics in Mashonaland Central province have been enrolled under the RBF model. The province has 360 clinics and the other 20 are being assessed so that they be enrolled into the RBF. These are mainly newly established clinics and there are minimal requirements theta they should meet before being enrolled. This includes having Health Centre Committees (HCFs) to meet the criteria of RBF. Dandamira and Mariah Theresa Clinic are currently the new babies on RBF in the Mazowwe district.

The biggest motivation behind RBF is to improve Martnal and Child Health and the Damandamira Clinic initiative has bridged that access gap.

Meanwhile, Dr Cremence Chuma, the Mashonaland Central Provincial, Medical Officer (PMD), Dr Chuma said they encourage managers in the province and districts to think outside the box to come up with innovative means of improving healthcare.

“One of the challenges that RBF seeks to address is that of people walking long distances to get to health facilities. That’s one of the challenges we still have in some districts in our province. However. Mazowe District have managed to negotiate with their Rural District Council (RDC) and convert a beer hall into a clinic which we think is very good initiative and now people are able to access these services from their local clinic,” said Dr Chuma.

He added that because the Clinic at Dandamira is quite close to the Hospital, the hospital is now able to do its job and concentrate on offering Secondary Care services and more mothers are now accessing services because the clinic is right inside the location.

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