The Urban Voucher Programme: A Lifeline for Mothers and Children in Zimbabwe

Being pregnant in Zimbabwe’s capital doesn’t always come with access to proper medical care. Many young mothers in Harare live in poverty and cannot afford the costs of giving birth under medical supervision. Health insurance that could protect them from financial catastrophe doesn’t exist. To provide women access to essential maternal and child healthcare, Cordaid implemented the Urban Voucher Programme from 2014 to 2023, funded by the World Bank.

This innovative system worked much like an insurance scheme: with a single voucher, women from vulnerable households received free antenatal check-ups, care during childbirth, and postnatal support, as well as full coverage for costly hospital care in the event of complications, such as a Caesarean section or ambulance transport.

The programme helped tens of thousands of pregnant women, young mothers, and children. The number of timely care registrations and antenatal check-ups rose sharply. More than 57,000 women gave birth safely in a clinic or hospital using their voucher. And thanks to the voucher income, participating clinics improved the quality of care and staff motivation.

At the end of 2023, external funding ended. But because this support is too necessary to lose, Cordaid decided to continue the programme with its own resources in 2025.

In this article, young mothers and a midwife in Harare share what the Urban Voucher Programme meant to them, and why this work must go on.

‘This voucher takes away so much stress!’

Twenty-five-year-old Esther lives with her two sons at her parents’ home in Hopley. In this neighbourhood, tens of thousands of people live without property rights and often without access to running water, sewage, or electricity.

Esther’s first delivery marked her life forever. ‘I could only go for a check-up late in my pregnancy. When labour began, I had to rush to the hospital. Everything took too long. My son, Joan, was born with brain damage caused by a lack of oxygen.’

Caring for Joan places a heavy burden on Esther and her partner. When her husband leaves, she is left to cope alone. ‘Honestly, I’ve felt alone ever since I was eighteen.’

Back at her parents’ home, Esther leads an isolated life. ‘I was either at home or in the hospital with a disabled and malnourished baby. I didn’t like being around people. They looked at my son strangely, and at me too.’

A year later, Esther reconciles with her husband and becomes pregnant again. It is 2019, and while the voucher programme is running, not everyone can be reached. Esther falls outside its scope and has no money for a hospital birth.

One day, after working in the fields, labour begins. ‘I gave birth in the street. Passers-by came to help. They couldn’t cut the umbilical cord and carried me and the baby to the clinic still attached.’

She survives, and so does her son, Mickael Junior. But the risks were life-threatening: infection, heavy bleeding, breech position, and neonatal complications. It could easily have been fatal.

After that traumatic event, Esther moves back in with her parents for good. ‘It was impossible to go on. My husband was violent, and I often had to call the police. What hurt even more was his total indifference towards Joan.’

To make matters worse, Esther discovers she is pregnant again. Unintentionally. ‘There was something wrong with my implant. My first thought was: I can’t go through this again.’

But things turn out differently. Esther hears about Cordaid’s renewed voucher programme. ‘I applied straight away, was eligible, and received the voucher.’

Now Esther has access to all the maternal and child healthcare she needs, along with support for family planning and her future goals. ‘My only options before were unsafe ones: giving birth at home, in the street, with a traditional midwife, or in church. Now I know that my baby and I will receive proper care for six weeks after birth. That takes away so much stress!’

What gives her even more hope is that the programme also offers vocational training. ‘I want to start my own small business one day. More than ever, I want to stand on my own feet.’

‘I was afraid I’d die just like my mother’

Ethel Chitike, 20, also from Harare, once dreamed of becoming an engineer. But life took a different turn. Three years ago, her father left, she dropped out of school, and her mother died.

‘When my mother became pregnant with her fourth child at 38, my father disappeared without a word. We never saw him again. My mother worked as a cleaner, and I left school to look after my two younger sisters.’

When her mother went into labour, Ethel went with her to the hospital. ‘They immediately referred us to a larger hospital for a Caesarean section. The ambulance was too expensive, so we took the bus. Everything took far too long. My mother died during the operation, and her baby was stillborn. I wasn’t even allowed to say goodbye.’

In an instant, Ethel lost her mother and primary source of support, and, as a teenager, became head of the household. ‘After the funeral, all I could think was: how are we going to survive?’

She married her boyfriend, Alexander. ‘My mother always told me: “Don’t marry too young.” But I had no choice.’ A year later, she was pregnant. ‘I was scared. I didn’t feel ready, but the pressure from my in-laws to have a baby was overwhelming.’

A nurse told her about the voucher programme. Ethel registered and gained access to complete medical care. ‘My blood pressure, the baby’s growth, everything was monitored. But I was still terrified that I’d die in childbirth like my mother. The counselling I received helped me a lot. And my husband, who took good care of me and my sisters, was my rock.’

Ethel’s daughter, Tanatswa, was born healthy. ‘She’s doing great. I feel good, too. I just miss my mother every single day. If she’d had this kind of support, she would still be alive.’

Preventing Unwanted Pregnancies

In many low-income countries, women and girls often become mothers at a young age, not by choice, but because of poverty, lack of education, limited access to contraception, and social pressure.

To prevent unplanned or unwanted pregnancies and to empower girls to make their own decisions, the Urban Voucher Programme offers more than just medical care. It also provides young mothers with sexual education, access to contraception, and training in economic skills that help them earn an income.

Juliette Gura, A Midwife on a Mission

Juliette Gura (55) is the head nurse at Mbare Poly Clinic in Harare, one of 35 clinics that took part in the voucher programme. On busy days, her team sees up to 200 pregnant women.

‘Vouchers give pregnant women and their unborn children access to vital care. We saw the impact: fewer risky home births and more medical check-ups and deliveries in clinics,’ she explains.

‘The extra income, 25 US dollars per voucher, was used for medicines, equipment, renovations, and staff bonuses. It really made a difference, both for the hospital and the wider community.’

When the programme paused temporarily at the start of 2024, Juliette immediately noticed the effects: ‘The number of unsafe deliveries started to rise again. We now see girls as young as 11 who are pregnant and give birth without medical supervision. They know nothing about their bodies or the dangers they face. It’s heartbreaking. Every pregnant woman needs protection and guidance, and it’s our mission to provide it. That’s why Cordaid’s relaunch of the voucher programme is such wonderful news.’

Not Back to Square One

The strength of the Urban Voucher Programme lies in its simplicity and impact. The voucher acts as a temporary health insurance for women who would otherwise have no safety net at all. In cities like Harare, where poverty is highly concentrated, that can mean the difference between life and death.

That’s why Cordaid restarted the programme in July 2025, using its own resources. In six months, the aim is to support 9,600 pregnant women in Harare, together with social workers, clinics like Juliette’s, Zimbabwean health authorities, and our donors.

Because every voucher is a lifeline. For Esther. For Ethel. For mothers hoping for a safe delivery. And for children who deserve a healthy start in life.