Harare, Zimbabwe — A transformative public health initiative is making significant strides in reducing maternal and neonatal mortality rates across Zimbabwe’s underserved urban areas.
Since its inception, Zimbabwe’s Urban Voucher Program has enabled over 80,000 women to access essential antenatal care and facilitated more than 35,000 safe deliveries, drastically lowering the risk of maternal and newborn deaths.
The program, a component of the Health Sector Development Support Project (HSDSP) backed by the World Bank’s Global Financing Facility (GFF), is reshaping healthcare delivery in urban settlements often characterised by overcrowding, poor infrastructure, and limited public services.
For 27-year-old Shorai Sande from Dzivarasekwa, a high-density suburb of Harare, the program was life-changing. Six months pregnant and unemployed, Shorai had not yet registered at a clinic. “I was walking around the neighbourhood when a Community Health Worker approached me,” she recalled. “They told me about the Urban Voucher Program. I kept the voucher for two weeks before finally going to Rujeko Clinic—they assisted me until I safely delivered my child.”
Her story mirrors those of thousands of women in similar communities who, due to financial constraints or lack of information, may have otherwise risked unsafe home deliveries.
The HSDSP, launched in collaboration with the Ministry of Health and Child Care (MoHCC) in 2011, sought to increase the availability, accessibility, and quality of maternal, newborn, and child healthcare. A turning point came in 2022, when results showed that 57% of maternal deaths occurred in provincial and central hospitals due to deteriorating care standards.
To address this, the project introduced a quality-focused, results-based financing (RBF) model. The approach links funding to hospital performance, allowing facilities to reinvest earnings into locally prioritised needs, including equipment and training. A portion of these funds also serves as performance incentives for healthcare workers.
At Marondera Hospital, this model yielded tangible results. “In 2023, we saw maternal deaths drop from 11 to 7, and neonatal deaths from 51 to 32,” said Mrs. Choruma, the hospital’s Matron. “We used project funds to procure critical equipment and supplies, helping us better manage complications like postpartum haemorrhage and preterm births.”
Sally Mugabe Central Hospital, Harare’s busiest maternity unit, also benefitted. According to Dr. Munyaradzi Nyakanda, Head of Obstetrics, the facility invested in intensive care and theatre equipment. “We procured ultrasounds for our fetal medicine unit—our busiest department—which has significantly enhanced service delivery.”
While urban centres saw immediate gains, rural districts also embraced the RBF approach. Initially piloted in 18 districts, the model expanded to all 60 rural districts with support from the Health Transition Fund (now the Health Development Fund). Funds were channelled into refurbishing facilities, installing electricity and water systems, and improving service delivery.
Village Health Workers (VHWs) became essential in bridging the gap between communities and clinics. Trained under the program, they now lead health education, pregnancy registrations, and HIV testing campaigns.
“In our community, we advise pregnant women to register early and get tested for HIV,” said Irene Goba, a VHW from Dora District, Mutare. “That way, we can help prevent mother-to-child transmission and improve newborn outcomes.”
Notably, VHWs contributed to increased uptake of long-acting reversible contraceptives and harmonised service delivery through an integrated register system that streamlined administrative tasks.
To safeguard the program’s impact, the Government of Zimbabwe has institutionalised RBF as a core health financing strategy in all rural districts. The approach is now integral to strategic purchasing mechanisms designed to ensure sustainable, equitable healthcare access.
As development partners and local authorities continue to work together, Zimbabwe’s innovative blend of community empowerment, performance-based funding, and targeted health service delivery offers a blueprint for reducing maternal and neonatal mortality in resource-constrained settings.
