Zimbabwe

Home » Countries » Zimbabwe

Some of our results

4,1million people reached with basic health services
>2,000maternal deaths averted
100,000children immunized annually
800health staff trained annually

Global Peace Index

131/ 163

GPI Rank

Political Instability

Safety & Security

Ongoing Conflict

Source: Global Peace Index (2020)

Cordaid in Zimbabwe

From 2011 to June 2018 implemented a World Bank and Zimbabwean Government financed results-based financing (RBF) health care program. It focused on reducing maternal, neonatal and child mortality and in 18 rural districts and helped to revitalise the national health system in Zimbabwe. During this period Cordaid, acting as national purchasing agency and fund holder, contracted 366 health centers and 34 hospitals to provide a defined set of primary and secondary level health care services.

In 2014 Cordaid started implementing a results-based financing Voucher program to strengthen quality maternal health care services for the most disadvantaged population in 2 urban districts in Harare and Bulawayo.

In 2018 Cordaid gradually handed over this program to the Program Coordination Unit (PCU) stationed at the Zimbabwean Ministry of Health.

In 2019 Cordaid Zimbabwe continues to provide technical assistance to the PCU to assure the quality and continuity of a health program that provides health care to over 4 million people.

Where does Cordaid work?

As a Technical Assistance unit to the PCU of the Ministry of Health, Cordaid Zimbabwe mainly focuses its work at the national level. However, it also provides technical assistance to the provincial levels of the Ministry of Health that play a role in the RBF program. This concerns the following provinces: Midlands, Matabeleland South- and North, Masvingo, Mashonaland West, -East and Central, Manicaland.

Furthermore, next to functioning as a Technical Assistance unit, Cordaid, with support from the World Bank, will continue to implement a demand- and supply-side results based financing intervention up to the end of 2019. We do this in two low-income urban health districts of Bulawayo and Harare. This urban program includes pregnancy-related health care services and strengthening the use of electronic health records for patient management. In 2019 we investigate how this urban program can be handed over to the city councils of Harare and Bulawayo.

14,9 Million

Population

Rural population

Urban population

0.7% annual

GDP growth

22.9 per 1,000

Mortality rate, neonatal

Source: worldbank.org

Current situation

Zimbabwe has good coverage of basic health services, like immunization and skilled birth attendance. But it has high infant and maternal mortality rates, which means that health care quality is still a critical issue. Zimbabwe is performing well in terms of coverage of basic maternal, reproductive and child health services compared to the Sub-Saharan Africa average. Four out of five women deliver in a health facility, and almost all women receive at least one prenatal care visit. However, the bottleneck analysis conducted for the 2016-2020 National Health Strategy highlighted that, despite high service coverage for most basic health services, quality of care at all levels remains poor or sub-optimal. The analysis also noted weak program integration, resulting in missed opportunities to achieve greater impact with the available resources, as well as the lack of continuum of care along the life cycle (newborns, adolescents) and across service delivery levels (community level, tertiary level).

Maternal Mortality Rate (MMR) declined from 960 per 100,000 live births in 2010-2011 to 651 per 100,000 live births in 2015. Similarly, the under-five mortality rate dropped from 84 deaths per 1,000 live births in 2010/11 to 69 deaths per 1,000 live births in 2015. The infant mortality rate decreased from 57 deaths per 1,000 live births in 2010/11 to 50 deaths per 1,000 live births in 2015 (Zimstat 2016). This progress did not, however, enable Zimbabwe to meet its health-related MDGs.

Cordaid in Zimbabwe

Our health program will continue until the end of 2019. The urban component, including the urban maternal health voucher scheme (demand-side), will be continued in Bulawayo and Harare. The same applies to the quality Improvement Innovation in 5 districts.

The Technical Assistance that Cordaid will provide to the RBF Project Coordination Unit at the Ministry of Health focuses:

advice on possible adaptations and improvements to the Project Implementation Manual;
guidance in relation to quality improvement of the health care services provide by the Health facilities under RBF;
support on data gathering and analysis of the data generated, this to, over time, improve and adapt the RBF program where needed;
advice in relation to the possible adaptations on the ICT and Data systems used for the RBF program;
advice that focuses on the verifications and the quarterly RBF invoice generation and payments.

Epartogram: Eletronic partogram
Sub-Saharan Africa has a high maternal death rate: 546 deaths per 100,000 live births. In Zimbabwe the partogram is one of the tools used to lower this rate. It is a paper graphical, real-time decision support tool that allows midwives to monitor cervical dilation over time, plot those measurements on the graph, and determine if labour is progressing normally. Where implemented, the partogram has shown to reduce maternal mortality by half.

However, the paper partogram has limitations: it is plotted by hand, it is time consuming and due to high nurse-patient ratio in Zimbabwe, midwives are overburdened and may not complete the task. Therefore, Cordaid is supporting the development of an electronic partogram (epartogram) by the Zimbabwean Ministry of Health and Child Care. The aim is to strengthen (real-time) monitoring of labour and improve quality of observations during the labour intrapartum period. Currently the epartogram is developed, tested and ready to be used anywhere in Zimbabwe where the prerequisite infrastructure is available. Also 34 nurses are trained as trainers to train others and 66 nurses and 3 doctors are trained by them in the use of the epartogram. The current plan is to train 54 trainers in the Seke and Marondera districts, so that they can train all 256 nurses and 7 doctors in these two districts.

Partners and donors

The main donor of Cordaid’s health care program in Zimbabwe is the World Bank. The World Bank Group has 189 member countries, staff from more than 170 countries, and offices in over 130 locations. It is a unique global partnership: five institutions working for sustainable solutions that reduce poverty and build shared prosperity in developing countries.

Our local partners are, amongst others: The Zimbabwean Ministry of Health, The Ministry of Finance of Zimbabwe and the city councils of Harare and Bulawayo.