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Robin Muchetu, Senior Reporter
OVER 50 000 women have given birth for free at Mpilo Central, United Bulawayo Hospitals and Bulawayo City Council institutions in Bulawayo, through a facility that has been extended to vulnerable pregnant women by the Ministry of Health and Child Care and its partners under the urban voucher system.
BCC’s Director of Health Dr Edwin Sibanda-Mzingwane, whose clinics have recorded the largest beneficiaries totalling over 26 000 said the urban voucher system was part of the Results-Based Financing (RBF) programme focusing on maternal and child health and ensuring that women get quality service when pregnant.
“The urban voucher system enables women to register their pregnancies on time which is very important such that some diseases or conditions are detected and treated early for those that can be treated. The women are seen by health workers as many times as possible with a minimum of four times during pregnancy up to delivery. We have 26 380 that enrolled in the programme from 2014 up to the end of 2022 in Bulawayo at our clinics,” said Dr Sibanda-Mzingwane.
Mpilo Central Hospital recorded about 10 000 births through the same initiative, while United Bulawayo Hospitals that started the programme in January 2022 have so far recorded 12 000 births. Zimbabwe is in the process of getting validation by the World Health Organisation (WHO) that it has eliminated mother-to-child transmission of HIV and syphilis. Eliminating mother-to-child transmission of HIV and syphilis is key to the global effort to combat sexually transmitted infections and to end Aids by the year 2030.
“To meet this standard, Zimbabwe has to ensure that all pregnant women who book within the health systems are tested for these, those that are positive will get treatment. However, the unfortunate part is that there was a shortage of Benzidine Penicillin which is the treatment for syphilis, it was not available in the public sector, we then used RBF funds to procure it privately and managed to give all our women. In 2020 and 2021 we were the only province in the country where the treatment for syphilis was 100 percent because we used those funds to secure the medicines,” he said.
Dr Sibanda-Mzingwane said some expectant mothers had highlighted that they could not access maternal health services because of poverty as clinics needed payment for them to get the required services.
“Our charges then were US$30 for the whole antenatal services; women would struggle to raise that money and eventually arrive late at the clinics for delivery. What that meant was that even if the women did book with us, they did it late and some conditions would have actually gotten worse. Say a woman tests positive for syphilis, while she is pregnant. Syphilis, when transmitted in a baby, tends to result in a stillbirth at or around 33 weeks of pregnancy and even up to 36 weeks. Some stillbirths are a result of syphilis, so to prevent those a woman must get injections early, three of them given a week apart. If a woman books at 33 weeks they are already late for the jabs, we will no longer have the three weeks to administer the injections and for them to be effective,” said Dr Sibanda-Mzingwane.
The Director of Health said the urban voucher system was targeting vulnerable women.
“The leadership decided to do geographical targeting, which was basically looking at areas of the city where there are many poor women who may benefit from the programme. We visited Nkulumane district where we were targeting their six clinics. The programme entailed that a woman buys a voucher for US$1 after having been assessed by social workers and deemed to be eligible for the programme because social workers are the only ones who can diagnose poverty.
“If they meet the testing criteria then they qualify and use the voucher at a facility that will cover booking, all antenatal care visits, all tests required, and delivery of the baby. Say that a pregnant mother complicates and needs to be moved to Mpilo Central Hospital from Nkulumane Clinic, they get a free council ambulance for the transfer and be attended to. If they need a Caesarean section it will all be included in the US$1 voucher. After discharging they are sent back to their clinic of origin where they are seen up to six times for free again after delivery,” added the Director of Health.
After each delivery clinics then claim back their money from the RBF programme and do what they see fit at their institutions independent of the health service department. Health centre committees were then formed inclusive of the local councillor of the area, Sister-in-Charge of the clinic, and residents, who oversee this committee and decide what to do with funds reimbursed in an effort to improve the quality of care at the clinic.
Dr Sibanda-Mzingwane said quality was an important aspect of rendering care to pregnant women and a checklist was used to identify if the institutions were meeting the standard and computed into cash according to performance and also be used to improve services. Staffers also get a component of the funds as a way of motivation.
Fourteen clinics in Bulawayo have been initiated into the programme together with United Bulawayo Hospitals and Mpilo Central Hospital, and this has seen an increase in timeous bookings and a reduction in home deliveries. Medicines for pregnant women were also made available through this initiative.
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