An urban voucher program in Harare and Bulawayo gives pregnant women access to antenatal care and safe deliveries they would not otherwise be able to afford
The program followed the success of a rural voucher system providing care to pregnant women and children under five
The voucher program aims to increase the demand for municipal health services by increasing their quality and giving material subsidies to clinics based on their performance
HARARE, January 10, 2019 – Memory Mrape was shocked to discover that she was pregnant with her fourth child. With her meager income and already three children to care for, she knew she could not afford to pay for the antenatal care she needed.
Community members heard of her plight and told her about a voucher program that would allow her to receive free health services. Mrape visited a health clinic in Hopley, a low-income area of Harare, where she filled out a questionnaire to determine whether she qualified for the voucher program. Once her eligibility was confirmed, Mrape was allowed to use one of four clinics and get maternity care at the hospitals in the event of complications, all for free. She gave birth to a healthy baby girl in 2016.
“I am amazed my pregnancy cost me nothing,” said Mrape, whose daughter is now two-years-old.
Mrape is one of thousands of expectant mothers in Harare and Bulawayo who have benefited from the Urban Voucher Programme (UVP), which has been providing free health services since its launch in 2014. The program targets mothers in the bottom 40% of households, increasing their access to health services and assisted births.
Before the program, most pregnant women could not visit health clinics regularly because they could not afford the $25 registration fee. In 2017, the UVP assisted more than 2,600 women at one clinic in Hopley. At the clinic’s busiest time that year, nurses recalled assisting 18 births a night.
“Where would we be without the program?” said Sister Hararwa, a nurse at Hopley. “Just look around and see our repainted walls, our laptop, our secure pharmacy and shelter.”
The UVP is buoyed by the success of the Rural Based Financing (RBF) initiative in rural areas—which subsidized health care services to provide a package of free health care for pregnant women and children under five. Through the voucher program, the use of maternal and neonatal family planning services has increased, the supply of quality maternal and neonatal services to low-income urban health districts has been strengthened, and out-of-pocket payments for people living in the poorest urban quintile have been reduced.
The program is funded by the World Bank’s multi-donor Global Financing Facility (GFF), which provides subsidies to selected clinics based on their performance.
The non-governmental organization (NGO) Cordaid has been the implementing partner for the funding, with the government also stepping in to provide co-financing.
“The government sees this project as an important instrument to increase the demand and use of services by poor households, and …to rebuild basic services weakened in past years,” said Major-General Gwinji, a retired military officer and doctor who is Zimbabwe’s Permanent Secretary for Health and Child Care.
The multi-donor [Health Results Innovation Trust Fund]https://www.rbfhealth.org/mission) funded the program before the GFF took over, providing supply-side subsidies to selected clinics based on their performance as defined by the coverage of selected services and the quality of care provided. This approach from both the supply and demand sides, subsidizes antenatal care and strengthens the quality of services offered by municipal health services.
“The UVP approach bridges a financial gap in implementing facilities through payments for supply-side performance on quality and for claims on services provided to women under the program,” said Mukami Kariuki, World Bank Country Manager for Zimbabwe. “It builds on the rural component where we have witnessed commendable progress in coverage and quality of services.”
The UVP program is complemented by a health sector component of the Results based Budgeting Technical Assistance (TA) Program. As one of the outcomes of the TA, the country’s first Health Financing Policy and Strategy has been developed. As a step toward Universal Health Coverage, UVP provides practical learning through the implementation of a health management system tool that can improve performance and reduce inefficiencies.