TUMELO Nare* recalls the horror and trauma she went through when she gave birth in a donkey-drawn scotchcart halfway to Manama Hospital from Gungwe village 30km away.
Her grandmother had assisted her deliver successful by the roadside while her younger brother, who had accompanied them to hospital, was told to move to a secluded place.
Nare believes she was lucky to survive the ordeal as she had heard of stories of women dying while giving birth. She christened her baby boy Nhlanhla or “luck” in Ndebele.
According to a 2007 study, 60,6% of rural women in low-income households delivered babies at home.
However, this is now a thing of the past as Gungwe Clinic under Chief Mathe 100km south of Gwanda town has built and electrified a prenatal and post-natal care centre that caters for women from seven villages through funding from the World Bank.
The programme — Results-Based Funding (RBF) for health — provides subsidies to rural health clinics and hospitals at the request of the government based on their performance in delivering a package of free health services to pregnant women and children under five and has been rolled out countrywide.
“We have managed to eradicate home deliveries as expecting mothers now come here to deliver. Women come here six weeks before they deliver and we keep them for at least three days after they have given birth to assess their health and that of the child, and all this is done free of charge,” said Zanele Ncube, a primary care nurse at Gungwe Clinic.
“In the past two months since the facility opened, we have conducted 20 successful deliveries at the clinic.”
Ncube added that they were also using the money to buy drugs for epileptic and psychiatric patients that were not readily available at the district pharmacy.
The coverage of institutional deliveries increased in Zimbabwe from 50% to 75% from March to December 2012; and immunisations from 33% to 62% during the same period.
Jacqueline Sibanda, a communication strategist with the World Bank, said the RBF programme was remarkable in that it involved the community in decision-making with a health committee elected by villagers to work with nursing staff in overseeing the improvement of health delivery in rural health centres.
“The community is actively involved in that together with nursing staff, the committee identifies its problems at village level and prioritises solutions to problems of a particular health facility,” she said.
Gungwe Health Committee chairman Givus Jabuli said RBF had changed the face of maternal healthcare in the area as the shelter for expecting mothers was saving lives.
“Patients now receive safer births and deliver healthier babies without having to pay. Besides, the clinic has received a major facelift as it has been painted and we now have electricity and a generator on standby,” Jabuli said.
“Over the years mothers would deliver under candlelight, but all this is now a thing of the past.”
The Health and Child Care ministry deputy director of policy development and planning Stephen Banda said the RBF programme had changed the way health used to be delivered in remote areas as there was emphasis on routine performance assessment.
“Assessors visit discharged patients at their homes to find out how they would have been treated during their stay at the clinic as a way to gather feedback on the performance of the staff and the health facility in general,” Banda said.
The programme came as the government sought to reduce maternal and infant deaths, which had remained high in the aftermath of an economic collapse and rising poverty in 2008.
A World Bank team helped the government of Zimbabwe design the results-based financing programme for rural areas, focusing on elimination of user fees.
Cordaid, a Dutch development agency, serves as the implementation agency working closely with the Health ministry.
Last month, World Bank group president Jim Yong Kim announced that the institution would have spent at least $700 million on the project by 2015 to help developing countries reach the Millennium Development Goals.
The fund will enable national scale-ups of successful pilot reproductive, maternal and child health projects that were made possible by support from the World Bank’s Health Results Innovation Trust Fund.
*Not real name