“I am so relieved that, through the program, I will avert a home delivery and will be able to access free maternal services throughout my pregnancy,” says Sarah Musaimura, a resident of Mabvuku, one of the oldest suburbs in Harare. With she and her husband being unemployed, they could not afford to register for pregnancy and birth services at a clinic. A home delivery seemed to be on the horizon, until the Urban Voucher (UV) Program assisted her.
The UV Program, supported by the Health Sector Development Support Project (HSDSP), started in 2014 in two pilot areas: Mbare and Hopley wards in the Southern District of Harare and five wards in Nkulumane District of Bulawayo. The program provides a voucher to poor, pregnant women for a token amount of ZWL 20. Women can then present this voucher for highly subsidized maternal, newborn, and child health services. The pilot areas, which initially covered 11 health facilities and two central referral hospitals, were chosen because of the large population of women in the bottom 20% of the poor.
“My role in the program is to identify and refer pregnant women in our community to social workers who then administer a community assessment tool to ensure eligibility,” says Mildred Garafa, a Mabvuku Community Health Worker. Eligibility for participation in the UV Program is by proxy means testing, where a poverty assessment tool is used to determine the poverty status of a prospective beneficiary. The poverty status score determines whether they are eligible or not.
Mabvuku has the only enhanced poly clinic (these offer cesarean sections (c-sections) along with regular maternal health services) for pregnant women in Harare. The clinic serves a population of 57,082 with two satellite clinics, offering antenatal and delivery services, including c-sections and post-natal services. Despite the large volumes of people being served at the facility, the quality of services offered is high. The assessed technical quality is 84.1% and client satisfaction is 84.6%.
A 2018 process monitoring and evaluation of the UV pilot revealed that it was feasible for other areas to adopt this method of using vouchers and assessing poverty status, and rolling it out to remaining facilities serving the poorest quintiles of the population in Harare and Bulawayo. Since 2021, 24 additional facilities have started the program, bringing the total number to 35 with an estimated reach of about 1.2 million people.
All the stakeholders, such as health care and social workers, in the new districts were trained to allow for a smooth start in implementation. Refresher training on urban voucher implementation for stakeholders in the existing sites was also conducted to strengthen program performance. In addition, the Ministry of Public Service Labour and Social Welfare conducted its first counter-verification on beneficiary identification and enrollment, to check if district social workers enrolled the right beneficiaries into the program.
The Health Sector Development Support Project has increased coverage and quality of an integrated package of Reproductive, Maternal, Neonatal, Child, and Adolescent Health and Nutrition (RMNCAH-N) services. From inception, 70,320 beneficiaries have been enrolled in the program, and over 45,000 women and children have received services, with 35,227 of the women delivering babies.
Apart from assisting in deliveries, the program also provides Vitamin A supplementation for 6-59 month-old children and provides post-exposure prophylaxis (PEP) for sexual, gender-based violence-affected beneficiaries.
The UV Program has been funded by the World Bank’s Global Financing Facility with co-financing by the Government of Zimbabwe. CORDAID, an international NGO, is the implementing partner, working closely with the Ministry of Health and Child Care and Local Authorities in Bulawayo and Harare.
