HARARE, Zimbabwe, November 18, 2013 – Zimbabwe’s effort to restore and improve lifesaving health services for mothers and children in rural areas is achieving promising results. Thanks to Government leadership and the encouraging outcomes, new funding of USD $20 million from the Health Results Innovation Trust Fund (HRITF) – the World Bank’s vehicle for Results-Based Financing (RBF) – has been approved which will help the ongoing Health Sector Development Support (HSDP) Project extend its implementation period as well as expand its coverage to poor families living in urban areas in Harare and Bulawayo. RBF helps to accelerate progress on Millennium Development Goals (MDGs) 4 and 5 related to maternal and child health.
Since its approval in March 2011 and an initial grant of USD $15 million, the HSDP has been operating in 18 rural districts, covering a population of approximately 3.5 million. With its strong focus on tangible results, the project pays health centers and district hospitals according to their levels of performance in delivering a well-defined package of maternal and child health services. Such performances in both quantity and quality are independently verified before payments are made. User fees are waived for 16 maternal and child health services at primary care (rural health center) level and for 5 referral services at the secondary care (hospital) level. According to the Ministry of Health and Child Care records, between 2011 and 2013, the number of new outpatient visits to health centers in districts covered by the project went up by more than 90 percent, from 151,000 to over 292,000, compared to only 16 percent increase from 133,000 to 187,000 in comparison districts where HSDP is not implemented.
The number of normal deliveries supported by the project increased by 40 percent, from 2,300 in March 2012 to nearly 3,200 in June 2013. During the same period, number of women receiving at least four ante-natal checkups increased more than threefold, from 3,100 to 9,670. Number of women receiving at least two post-natal checkups also increased from 1,240 to 5,300. These significant improvements contribute to the Government’s objective of promoting reproductive health and prevent untimely and avoidable losses of life, income, and productivity in the country’s poorest households.
“The immediate objective of this grant is to help reduce Zimbabwe’s tragically high rates of maternal and child mortality and to bring good quality service-oriented healthcare within the reach of poor families,” said Nginya Mungai Lenneiye, World Bank Country Manager for Zimbabwe. “In the long run, the health and survival of mothers and children are critical factors to the social and economic progress of any country.”
With the new funding, the project now aims to provide 93,000 more pregnant women with four or more ante-natal care visits, nearly doubling its targeted coverage, and to fully immunize 33,500 more children.
"This is a very important program for the community, more so for mothers and children who can now access health care from the rural health center to the provincial hospital at no extra cost,” said Clever Gohori, Chiparawe, Health Center Committee (HCC) Chairperson. “We wish that the program will continue and expand its services to respond to the health needs of a larger community."
Community participation and local level planning are core components of Zimbabwe’s HSDP, with the HCC working closely with health facilities to ensure that the community’s voice is heard in the decision-making process and health service delivery.
As part of its expansion into urban areas HSDP will use vouchers to help poor families access essential mother-and-child services. It will also adopt the same performance-based approach that is delivering results in the rural areas.
“Access to maternal and child health has been a challenge in Zimbabwe, partly because poor families could not afford to pay the out-of-pocket costs for services,” said Olusoji Adeyi, World Bank Sector Manager for Health, Nutrition and Population for Eastern and Southern Africa. “ This program is reducing the high cost of health services, which is a barrier to access, expanding the use of essential health services and improving the quality of those services.”
The World Bank’s HRITF is supported by the United Kingdom and Norway. Under the technical and policy guidance of Zimbabwe’s Ministry of Health and Child Care and technical support from the World Bank, the implementing agency for the project is Cordaid—a non-governmental organization with global and regional experience in managing results-based activities in the health sector.
Across Sub-Saharan Africa, many countries—including Rwanda, Burundi, Nigeria and Kenya, to name just a few—are shifting their foci from inputs to health results by rewarding health facilities for performance and motivating health workers. This trend is showing encouraging results and making a real difference to people across the continent.