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Realizing the right to health for mothers and children

A multi-donor Health Transition Fund helps to revitalize Zimbabwe’s health system

12 July 2013 - With the first pangs of labour pain, Mercy Muchero started out on the long walk from her village to the nearest hospital. But she miscalculated how long it would take her to get there on time. “Suddenly, I felt my waters break. I couldn’t walk further. The child was on its way,” the 26-year-old woman from Chivi district in Zimbabwe’s south-east recalls.

Halfway to the hospital, an aunt who accompanied her spread a thin blanket on the ground. A few minutes later, Muchero gave birth to a baby boy on the side of the road. Her aunt cut the umbilical cord with a razor blade and tied it with string, unaware that Muchero’s uterus had prolapsed during the delivery.

Barely able to walk, carrying the newborn wrapped in her arms, the young mother and her aunt continued slowly until they reached Chivi District Hospital where a doctor instantly took Muchero to the operating theatre. “Her infection risk was extremely high. She could have died if a physician had not been available,” the hospital’s district medical officer, Dr. Emmanuel Chagondah, who was on duty that day, explains.

Just over a year ago, Muchero wouldn’t have been so lucky. Back then, the district hospital did not have a single doctor on staff, and many nursing positions were vacant. Such dire conditions were no exception. Many other health facilities in the southern African nation faced similar shortages of skilled personnel.

According to Zimbabwe’s Ministry of Health and Child Welfare, 69% of doctor positions, 80% of midwife posts and 62% of nursing tutor positions were vacant in 2011. Zimbabwe’s health sector – in the 1980s one of the best in sub-Saharan Africa – had nearly collapsed when a major economic crisis caused hyperinflation of more than 230 million per cent in 2008. Over the next years, chronic under-investment in the health sector made a bad situation even worse. “There was lack of equipment. Drug supply had dried up completely, apart from donor-funded medication, even in the private sector.

Public hospitals had to close. Most health workers left the country for better opportunities in other countries,” remembers Zimbabwe’s health minister, Dr Henry Madzorera. Mothers and babies suffered the most under the crumbling health system. Maternal and child mortality rates shot up.

Every day, around eight women die of pregnancy related complications, according to the 2010–2011 Zimbabwe Demographic Health Survey. In addition, an estimated 80 children under the age of five die each day from mainly preventable causes such as common newborn disorders, paediatric HIV, diarrhoea, pneumonia and malnutrition. Newborn disorders – including babies being born pre-term, asphyxia and infections – are the main causes of under-five deaths.

Three quarters of newborn deaths occur in the first week after delivery due to lack of basic services and because fewer than 30 per cent of women and their babies receive immediate post-natal care. Eventually, the international donor community stepped in. Through a Health Transition Fund (HTF), led by the Ministry of Health and Child Welfare and managed by UNICEF, a group of donors committed to ploughing $435 million between 2011 and 2015 – or about $80 million a year – into Zimbabwe’s health system. The money goes towards maternal and child health and nutrition, provision of essential medicines, vaccines and basic equipment and human resources, as well as assistance in health policy and financial planning.

One of the most urgent goals of the HTF is the retention of the few skilled health workers who are left in the country. In collaboration with the Global Fund to fight AIDS, Tuberculosis and Malaria, the HTF tops up health workers’ low wages to keep them in the system and ensure that not only positions in urban but also in rural areas are filled. “Our goal is to have at least three doctors in each of Zimbabwe’s 62 districts and one midwife per 5,000 people,” explains Aboubacar Kampo, UNICEF Zimbabwe’s chief of young child survival and development.

Since the first rounds of funds were disbursed in 2011, progress has been steady but hampered by administrative hurdles. “We now have at least two doctors in every district. We have improved the training of midwives. But we are not yet there. We still need to see some improvement,” the health minister admits.

“Biggest challenges remain the conditions of service, [low] basic salaries and allowances and little access to continuing education.” In mid-2013, many health worker posts continue to be vacant, the workload of health workers is excruciatingly high, and it is difficult to convince doctors and nurses to take up positions in remote rural areas where quality of life is poor.

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