GENDER AT THE CORE Women and the RBF Programme in

MARCH 2019 RBF

Approximately Foreword /

women die daily ‘due to complications800 of pregnancy and child birth. Our mission as the Ministry of by the Sustainable Development Goals stunting prevalence Health and Child Care (MoHCC), is to (SDGs) and the African Union’s Agenda at national level has ‘administer, coordinate, promote and 2063. Among other goals, the TSP seeks to dropped from 33% in advocate for the provision of equitable, address the following critical challenges in 2010 to 26% in 2018. appropriate, accessible, affordable and the heath sector: However, acceptable quality health services and females3.7 in the billion world today, yet women it remains above the care to Zimbabweans.’ Every citizen in • Sub-standard quality of maternal acceptable global remain underrepresented in the Zimbabwe should enjoy their inalienable health services, such as ante-natal threshold of Global Developmental Discourses 20%. right to health, as to deny it, is to deny the care, delivery, and post-natal care, right to life itself. Our mission is therefore including the prevention of mother-to- critical, but not easy; infrastructure must child transmission of HIV and sexually be developed, staff trained and deployed, transmitted infections medicines supplied and communities • Medicine shortages and the provision mobilised. To achieve this we need family planning products partners. This is why we are grateful for • Inadequacy of emergency transport 70%of constitute the world’s poor, make up Women 70% the support we receive through Crown and communication systems, which of the world’s working hours and earn only of 10% Agents under the Results-Based Financing have a bearing on mortality rates the world’s income, half of what men earn. Programme (RBF). • Strengthening the Health and Management Information System at Through RBF a number of health facilities facility level in several districts have already made good 2012 Muonwe Clinic and community has strides. We have seen buildings repaired, We continue to cherish and nurture the the first female chairperson, undergone significant improvement new maternity wings built and more invaluable partnerships which help us to Irene Silikombola, was since the appointment of its first medicines procured. In addition to this, the reach these goals. appointed. female Health Centre Committee (HCC) chairperson. support we receive though RBF which goes towards paying staff allowances has kept This publication presents real life stories 2012-2014 facilitated the drilling of a morale high and improved service levels. describing the impact of our partners’ borehole thus improving access interventions on real people and their to potable water. These developments are in line with the communities. The Ministry is proud to be government’s Transitional Stabilisation partnering with them in helping to create the second female chairperson Programme (TSP), which is informed these success stories. Maud Adam 2014-18 purchased $300.00 worth of bricks and half a ton of cement in her own capacity. Major General (Dr) G. Gwinji (Rtd) Secretary for Health and Child Care

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What’s in this Issue? List of Acronyms /

Foreword 3 ANC Ante-Natal Care List of Acronyms 5 CBO Community Based Organizer From the Editor 6 CEDAW Convention on the Elimination of all Forms of About The Publication 7 Discrimination Against Women News: New Minister of Health Appointed, Pledges Support for RBF 8 CSS Client Satisfaction Survey DHE District Health Executive Chapter One DSC District Steering Committee 1.1 Introduction: Women and the RBF Programme 10 EU European Union 1.2 Women’s empowerment goals in the strategies of RBF’s partner organisations 12 FP Family Planning 1.2.1 UNICEF: Saving Children through Empowering Women 12 GAP Gender Action Plan 1.2.2 Women’s health and the European Union 15 HCC Health Centre Committee 1.3 Women at the Core of Primary Health Care 16 HDF Health Development Fund 1.3.1 Women as primary healthcare service providers 16 HFO Health Field Officer 1.3.2 Community Based Organisation (CBOs): New roles for women in the provision HIV Human Immuno-Deficiency Virus of health services at community level 17 GEWE Gender Equality and Women’s Empowerment (A 1.3.3 HCCs: Opportunities for Effective Female Leadership at Grassroots Level 19 Programme of the EU) MoHCC Ministry of Health and Child Care Chapter Two MP Member of Parliament 2.1 Introduction: Gender Equality in Decision Making: Women in Health Policy Making 27 NCDs Non-Communicable Diseases 2.1.1 Dr. Labode: Using a Rich History of Leadership to Shape the Future of RBF 28 OPD Out Patient Department 2.2 What the doctor ordered: A female PMD tackles women’s health and defies PMD Provincial Medical Director gender norms 31 PMTCT Prevention of Mother to Child Transmission (for HIV) PNC Post-Natal Care Chapter Three PPH Post-Partum Haemorrhage 3.1 Introduction: RBF and Women: The Human Face Stories 37 RBF Results-Based Financing 3.2 There is Life in Darkness: Apostolic Faith Mothers Seek Maternity Services at Night 37 RHC Rural Health Clinic 3.3 No more lives lost unnecessarily 39 RMNCH Reproductive, Maternal, Newborn and Child Health SADC Southern Africa Development Community Chapter Four SDGs Sustainable Development Goals 4.1 Introduction: Crown Agents Eager to Deliver 40 TB Tuberculosis 4.2 Genesis: RBF and Women in Crown Agents Zimbabwe 41 TBA Traditional Birth Attendants 4.3 Women and the RBF Programme today and in the future 43 UNICEF United Nations International Children’s Emergency Fund WASH Water, Sanitation and Hygiene WHO World Health Organization

4 5 RBF RBF From the Editor /

This issue is a ‘shout out’ to women! As Crown Agents together with all of our stakeholders in the RBF programme we want to celebrate women and raise greater awareness of women’s issues, which are not getting the recognition they deserve.

Dedicated commemorative days such as Women’s Month, International Women’s Day, the number of days it will take you International Day of the Girl Child and the 16 to finish reading this booklet. By Days of Activism Against Gender are wonderful that time, globally, approximately women’s initiatives, but they are few and far between. This edition seeks to shine a light on 830 WOMEN would have died what women are doing every day in the health owing to pregnancy and sector all over Zimbabwe. We want to talk about childbirth related these women now and to keep talking. causes. /

This publication aims to highlight how women 1 have influenced and impacted, not only their personal spheres, but the health sector and Together with the Ministry of Health and Child human development discourses at large. We Care, UNICEF and the Health Development FROM LEFT: will present success stories and case studies Fund, the RBF programme is striving to achieve Caroline Mubaira, HDF-RBF Deputy team leader; Sister Matimba, Matron at Bikita Rural Hospital; and we hope to provoke serious reflection both measures; it is financing interventions Marie-Jeannne Offosse, HDF RBF Team leader and Muchaneta Mwonzora, Crown Agents Country Director. on the crucial role these women are playing to reduce maternal and neonatal deaths towards the betterment of our country. and making strides to empower women to participate in sustainable solutions for The situation for women today, not only in Zimbabwe. Zimbabwe but globally, is poor. The average reader will probably need a full day to read this It is not our intention for this issue to leave ABOUT THE PUBLICATION / edition cover-to-cover. As horrific as it sounds, you in despair, but rather to raise awareness of in that very same space of time an average the challenges women face, and to celebrate Millions in public funds are being conceived this publication – to simplify of 830 women would have died across the the champions and the heroines of women’s channeled towards development aid every development discourse by telling the real world from causes related to pregnancy and health. year. The need to demonstrate that these life stories behind our work. childbirth. Several more hundred would have resources are achieving their targets has lost their new born children, particularly those We hope that this edition will inspire you to see living in developing countries. women not as victims, but as heroes of their given rise to results frameworks which This is the third edition by Crown Agents. own and our collective struggles. can prove that they are being put to good The first edition was titled, Results-Based Yet the causes of this tolerated ‘femicide’ are use. Very often however, these frameworks Financing: The Story of Hope and Caring preventable. Only minimal investments are On behalf of Crown Agents and the editorial make our work too technical and scientific in Zimbabwe, followed by a second needed to make a difference as well as the team, I would like to wish you a very prosperous for an ordinary person to follow. Reports edition named Results-Based Financing: 2019! recruitment of more women in finding the based on log frames, for example, will fall Strengthening the Health Delivery System solutions to this inequity. Women are capable of taking on and delivering inordinate amounts Marie-Jeanne Offosse short of telling the full human story. The in Zimbabwe. In this edition we describe of work and responsibility, yet few women HDF/RBF Team Leader at Crown Agents tangible grass-roots impact of our work how the RBF programme impacts women’s in Zimbabwe play a role in decision-making Zimbabwe is sometimes lost as real people become health and we celebrate a diversity of and even fewer are acknowledged for their data and statistics. Somebody has to tell women who are driving the programme. contribution. the story differently and this is why we

6 7 6 News / RBF RBF

Under his charge the Central the availability of drugs, improving staff Hospital was also chosen as a venue to welfare and addressing the cost barrier for celebrate the United Nations 2013 Safe access to services with respect to women’s Motherhood Initiative. The hospital was health. recognised for its outstanding model in implementing systemic solutions If the zeal and commitment with which and building strategic partnerships to he has acted in previous assignments successfully deliver public health services is anything to go by, then Zimbabwe’s to disadvantaged communities. health sector, and by extension the RBF programme, has a very bright future. In alignment with the RBF programme Dr. Moyo’s priorities include; ensuring

FROM LEFT: Ian Malcomson, Crown Agents Chief Finance Officer; Dr Obadiah Moyo, Minister of Health and Child Care; Muchaneta Mwonzora, Crown Agents Zimbabwe Director and Marie-Jeanne Offosse, HDF/RBF Team Leader at Crown Agents Zimbabwe.

New Minister of Health Appointed, Pledges Support for RBF /

The President’s Cabinet has been he led the Chitungwiza Central Hospital described as an action team of technocrats with excellency throughout Zimbabwe’s with a record of delivery – a team carefully crisis years and the hospital has described curated to halt and begin to reverse the him as ‘a visionary and creative leader’ who decline in many sectors of the country’s adopts a ‘professional hands on approach development, particularly in healthcare. and is skilled in problem solving’. Towards this goal, President Emmerson Mnangagwa has recently appointed a new Dr. Moyo acted swiftly in the midst of minister, Dr. Obadiah Moyo, to turn around Zimbabwe’s cholera crisis and wasted little the fortunes of the health sector. time in containing the outbreak. He also raised awareness that the outbreak itself With a track record in delivering successful was just one symptom of a health sector in results we are delighted at Dr. Moyo’s need of urgent resuscitation. appointment. Among many achievements

8 9 RBF RBF CHAPTER ONE / WHAT IS THE RESULTS-BASED IN HEALTH FINANCING STRATEGY? This is just a small part of the picture in model for Zimbabwe’s health sector – the relation to a handful of development Results-Based Financing programme goals. The bigger picture is even more under the Health Development Fund (HDF). disturbing and makes for very sad reading. Introduction / The SDGs: Locating Women But while women are still living in cultures in the Contemporary and societies which disfavour them, About the HDF Results-Based Financing in Health is the Development Agenda more and more are rising to claim equal The HDF is a multi-donor fund to the transfer of resources to health providers opportunities. It is incumbent upon every Zimbabwean health sector, with a on the condition that measurable action Women represent around half of the global citizen and institution to support focus on Reproductive, Maternal, will/has been taken to achieve predefined world’s population, yet they remain them. Perhaps then the catastrophe Newborn, Child and Adolescent health system performance targets. RBF under represented in global development of ‘man-made’ poverty and under- Health (RMNCH-A). Women take an is increasingly being promoted by leading discourses, most of which affect them to a development might be overcome. active role in the steering committee global actors as a way to efficiently and far greater proportion. Women constitute of the HDF hence providing effectively increase performance in terms 70 per cent of the world’s poor, make up HDF AND RBF IN ZIMBABWE leadership in the RBF programme as of service quality, service utilisation, as 70 per cent of the world’s working hours well. well as improving staff motivation in a way and yet earn only 10 per cent of the world’s The foregoing analysis of the global that will ensure Universal Health Coverage income. development agenda instructs the funding (UHC). As a model, RBF in health rewards health facilities based in their performance The Global Poverty Project observes that; and achievements. ‘We live in a world in which women living in poverty face gross inequalities and WOMEN AND THE RBF PROGRAMME injustice from birth to death. From poor education to poor nutrition to vulnerable There are not enough resources in the and low pay employment, the sequence world to fund all the existing priorities for of discrimination that a woman may suffer human development. In 2015 a total of during her entire life is unacceptable but all 17 priorities were identified in the United too common.’ Nation’s Sustainable Development Goals (SDGs). But what if there was only one According to the World Health Organisation, priority which made the biggest impact on approximately 800 women die daily ‘due to all the rest? complications of pregnancy and child birth, including severe bleeding after childbirth, SDG number 5: to achieve gender equality infections, hypertensive disorders, and and empower all women and girls, is unsafe abortions. Out of these 99 per arguably the most important, given that cent are in developing countries and over nearly every other priority is significantly half occur in sub-Saharan Africa to which impacted by gender. Zimbabwe belongs.’

ABOVE: Smashing the glass ceiling: Women providing leadership in the HDF National Steering Committee. From Left: Redah Manga (MoHCC), Jane Mudyara (MoHCC), Martina Dhliwayo (DFID), Angelica Broman (SIDA), Amina Mohammed Unicef and Dr N. Zvongobani (ZNFP) 10 11 RBF RBF

The In Zimbabwe maternal mortality rates 1.2 Women’s empowerment afternoon to fulfil an appointment which I The role of UNICEF in the RBF remain at an unsustainable 443 mothers goals in the strategies of RBF’s have been trying to secure for weeks – an programme out of 100 000 live births. In response to partner organisations / interview with Dr Nejmudin Kedir Bilal, ‘UNICEF’s general goal is to make sure this, the RBF programme puts a premium UNICEF’s Chief of Health and Nutrition. that children survive, thrive and achieve on investments that seek to reverse this There are several key actors in the RBF the best in their lives,’ said Dr Bilal, before tide. programme, ranging from funding Dr Bilal is a busy person and so I hadn’t explaining that the organisation came to partners and coordinating agencies to thought twice about sparing my time to coordinate the RBF programme for women In Zimbabwe about 80 percent of all primary those involved in its implementation. accommodate the slot. In truth however, because ‘caring for children begins during health workers are women yet they remain Each of these organisations have their it wasn’t so much my time as my family’s. pregnancy.’ under-represented in decision-making. own goals, yet they all converge with My seven year-old daughter, whom I had They are entitled by both by demographic respect to women’s empowerment and just picked from school, and my father, He afforded a sobering example through and democratic imperatives to play a role gender equality. Through RBF they are who had just seen her perform in an end- the problem of stunting –a condition in finding solutions to contemporary world able to advance their own agenda towards of-term show, had been abruptly dumped affecting human development caused by challenges. As such RBF pursues gender women’s empowerment. In this section, we in the car park while I conducted our malnutrition which begins in pregnancy. equality in its processes, particularly with review the strategic goals of RBF partners interview. ‘Those affected don’t just bear the socio- respect to decision-making when it comes with respect to women. economic impacts of a shorter stature, to how resources are allocated and utilised. ‘You shouldn’t have left your daughter in but they are also affected by cognitive 1.2.1 UNICEF: Saving Children the car park, feel free to go fetch her and impairment and are at greater risk of bring her along –we are a child protection developing other illnesses, as well as through Empowering Women / Snapshot: Women in the RBF organisation and won’t allow children to premature death’ he said. be treated like that.’ Having been chastised Programme An interview with UNICEF’s Dr Nejmudin by Dr. Bilal, I found myself sheepishly Kedir Bilal In Zimbabwe today the prevalence of • Key targets of the RBF defending my fathering skills by explaining by Tayson Mudarikiri stunting has dropped from 33% in 2010 programme are aimed towards that the car was very warm and that she to 26% in 2018, but it remains above improving women’s health was accompanied by her grandfather, who the ‘acceptable’ global threshold of • Women are active at various could call me anytime if they needed me. 20%. levels in the implementation of the programme from the local I might have expected it really, given his If stunting and other conditions affecting community level to the national reputation for genuinely caring about children are to be addressed, then mothers policy making and coordination children. For Dr. Bilal working for UNICEF are a crucial entry point into the health functions is a vocation rather than just a profession, and survival of children. This, he explains, • 20 percent of Provincial Medical and both the UNICEF office and the person is why the RBF programme operates at Directors (PMDs) who coordinate behind the officer have a lot in common the nexus between women and children’s the implementation of the RBF when it comes to protecting children. health through interventions that seek to programme are women Another thing I learnt that day, is that reduce maternal deaths, as well as loss of • Evidence at community level protecting children starts with caring for newborns. is showing that women-led and supporting the mother - UNICEF’s Health Centre Committees entry point into the RBF programme. Whether supporting initiatives through are doing well in promoting the health sector, in agriculture, or women’s health under the RBF though water, sanitation and hygiene programme programmes, UNICEF acts to safeguard ABOVE: Dr Nejmudin Kedir Bilal, the UNICEF Chief of Health and Nutrition

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children by also helping to lighten their keeping with evidence-based prioritisation, The lessons learnt from this analysis have In 2010 the EU adopted two successive mothers’ burden of raising them. And in the organisation advises donors on how helped to instruct the RBF programme external action plans on GEWE: Gender describing the importance of delivering best to utilise the resources available and whereby equal premiums are placed on Action Plan I (GAP I) and Gender Action antenatal and postnatal care, he stressed also provides technical advisory services. both the quantity and the quality of services Plan II (Gap II). that these services ‘save both the lives of provided. Through the introduction of mothers as well as their children’. Dr Bilal also explained that UNICEF uses a client satisfaction surveys health facilities In 2016 the EU commissioned a gender broad evidence base to shape programmes are now increasingly inclined to listen to analysis which informed specific objectives Together with RBF, UNICEF recognises the such as the RBF owing to the fact that that their clients and measure the quality of from the following three thematic priorities gendered nature of Zimbabwe’s pressing indicators can be contradictory. To provide their services since the facilities are no for GAP II (2016-2020) in Zimbabwe. health priorities. an example, health indicators such as longer financed solely on the basis of the coverage might appear to be adequate, number of women they treat, but also on Evidence-based programming in yet child and maternal mortality rates their ability to meet their expectations. • Priority 1: Ensuring girls’ and women’s women’s healthcare remain high. To uncover this disparity ‘This has saved a lot of women’s lives’, physical and psychological integrity UNICEF manages the HDF through the organisation undertook a bottleneck remarks Dr.Bilal OBJECTIVES seven pillars, one of which is the RBF analysis, which revealed that many women 1. Girls and women are free from all forms programme. It’s role is to ensure that the would remain in delivering facilities for up 1.2.2 Women’s health and the of violence against them (VAWG) both in fund is prioritised for the sake of mothers to three days after giving birth in order European Union / the public and in the private sphere. and children of Zimbabwe and they do to receive specialised care, yet only 10 2. Promoted, protected and fulfilled right this through programme and finance percent of these women actually received Gender equality and the empowerment of of every individual to have full control monitoring to ensure accountability and this care. women and girls are fundamental human over, and decide freely and responsibly delivery of programme outcomes. In rights which are among the founding values on matters related to their sexuality of the Treaty on European Union (EU) and and sexual and reproductive health, the Charter of Fundamental Rights of the free from discrimination, coercion and EU. Equality between men and women is violence a principle objective for the EU as well as a prerequisite for long term democratic, • Priority 2: Promoting the economic and equitable and sustainable global social rights/empowerment of girls and development. As such, the European Union women works towards the removal of obstacles to OBJECTIVE gender equality, such as discriminatory 1. Equal access by women to financial legislation and policy, social norms, services, productive resources including cultural attitudes, gender stereotypes and land, trade and entrepreneurship. the distribution of power. • Priority 3: Strengthening girls’ and In 2007 the European Commission adopted women’s voice and participation the Communication on Gender Equality OBJECTIVES and Women’s Empowerment (GEWE) 1. Challenged and changed discriminatory in its Development Cooperation Policy. social norms and gender stereotypes Subsequently the EU Council called on 2. Equal rights enjoyed by women to the Commission services, the European participate in and influence decision- External Action Service and member states making processes on climate and to promote clear objectives and indicators environmental issues. ABOVE: on gender equality in all sectors. Nurse at Jari Clinic orienting community members on early booking 14 15 RBF RBF

These priorities are currently being are rewarded for their work and that their 1.3.2 Community Based implemented through programmes healthcare facilities are well-equipped. Organisation (CBOs): New roles including the Health Development Fund, of for women in the provision of which RBF is one initiative which helps the ANurses today are far more than just health services at community EU to achieve the above objectives. traditional healthcare staff who administer level / medicine. Their role within the health sector is evolving to meet the ever-changing 1.3 Women at the Core of For many people the words ‘women’ and that of the community based organiser, health needs of communities, particularly Primary Health Care / ‘healthcare’ suggests nursing. Nurses or CBO, who is responsible for giving in the field of sexual and reproductive are at the core of our work but the RBF feedback to facilities on their findings, as health and rights. With improvements in 1.3.1 Women as primary programme has also introduced other well as conducting feedback meetings with the provision of healthcare services to healthcare service providers / roles for women in the delivery of health the Health Centre include family planning, RBF subsidies are services. One emerging and crucial role is being used to dispatch specially trained Female nurses constitute around 80 per nurses to family planning centres. cent of healthcare personnel in rural areas, which puts them at the frontline of the This is one of many examples in which the RBF programme. Often working long hours RBF programme is empowering women as with limited resources and equipment, the primary health care service providers. RBF programme helps to ensure that they

ABOVE: Health workers at Mutorashanga Hospital, mostly women, pictured with family planning commodities

16 17 RBF RBF WE TALK TO NEW CBO 1.3.3 HCCs: Opportunities for MEMBERS / Effective Female Leadership at Grassroots Level / The majority (54%) of CBO members across Truly speaking, I feel humbled by the SH: One One of RBF’s key successes so far Health Care Act which stipulates that each all the districts in which Crown Agents and appointment. I am passionate about working has been to support the decentralisation clinic should have one. Although still few partners are rolling out the RBF programme for my community. My desire has always of decision-making to communities and HCCs are led by women, those that exist are women. As this edition celebrates the been to see positive developments within our to allow citizens to play an active role in perform extremely well. Muonwe clinic in role of women in the RBF programme, the communities, especially in our health facilities. running their own health facilities through Mashonaland District is one such facility Crown Agents HFO and regular contributor I feel confident that through this role I will be Health Centre Committees (HCCs). HCCs which has been successively led by women. to this publication, Shungurudza Mudereri contributing to improvements were established under the Primary Below is their story. (SM) caught up with newly appointed CBO members, Selina Hausi (SH) and CH: I am equally excited to be appointed a CBO Christine Huni (CH) at the side-lines of the representative. Despite this being a voluntary CBO members training and orientation to assignment I feel very encouraged to work hard discuss their role and aspirations for the towards improving our health facilities. RBF programme, particularly in improving the health of women. Below are excerpts of SM: How do you think your work as a CBO the conversations: member will help women and the nation at large? SM: How are you Selina? How are you Christine? Thank you for making it to the SH: From my understanding the RBF programme CBO members training and congratulations is more inclined towards mothers and children on your appointment. How do you feel under five. I believe that the satisfaction surveys about the appointment? we will undertake will improve issues to do with maternity homes, the availability of medicines and the quality of maternity healthcare. I see this as a result of the feedback that we will receive.

CH: I I think that there will be efforts to make use of the honest feedback to improve health care services. I have also heard that this feedback will be shared with district health executives, district steering committees and health field officers to help make decisions which improve access ABOVE: to services. Genia Jaka, Nyaure clinic HCC leader with community nurses, facility staff and Crown Agents. (Goromonzi ABOVE: Crown Agents staff with CBOs district in Mashonaland East Province)

18 19 RBF RBF

Muonwe Clinic / of schools and roads, neglecting the spearheaded by Ms Adam. To date she has SUCCESSFUL FEMALE LEADERSHIP IN HCCS community’s health needs. As chairperson purchased $300 worth of bricks and half a By Sarah Nyengerai she successfully lobbied for more funds to ton of cement. be allocated for the clinic. The building of the waiting-home began Ms Adam also works to ensure the day-to- in 2018 and her hope is that it will offer a day smooth running of the clinic and since complete package of care from pregnancy her involvement stocks of essential drugs to infant care, delivery wards and postnatal such as paracetamol has improved notably. wards. But keeping the clinic operational isn’t her only focus. Ms Adam’s is also striving to put For Ms Adam the sustainable delivery of in place long term transformations and health services to communities is only has advised local leaders on the necessity possible with the involvement of women. of doing more than just equipping a ‘Women need to be proactive in shaping 2014-18 community with immediate products. their destinies and in correcting the the second female chairperson, Maud Adam For her, there is a need to increase the patriarchal injustices that have for so long purchased worth of bricks and half $300.00 community’s capacity to take control of neglected maternal care,’ she says. a ton of cement in her own capacity. future developments. ‘Projects such as shelters for expectant Currently she is mobilising the community mothers can only really be understood to build a maternity waiting home by the women who have had to walk to a with seven rooms and the capacity to clinic while in labour.’ accommodate three women at a time. In most rural areas such as hers, pregnant It is this understanding that spurs Ms Adam women face numerous challenges when to commit to making sure that these women ABOVE: Ms Adam, The HCC Chairperson for Muonwe Clinic it comes to accessing health care services, are close to health facilities. She also wants often walking long distances on poor to disprove prevalent stereotyping which One of 13 rural health facilities in the to be productive in many other ways, roads to reach hospitals which don’t dictates that women cannot lead but notes Mashonaland Central province, the including giving them an opportunity to have ambulances.The construction of this that over the years these perceptions are Muonwe Clinic and its community has attend school. Access to clean water is also waiting-home will reduce maternal and changing as communities are bearing the significantly improved since the 2012 a prerequisite in preventing waterborne neonatal mortality often caused by poor fruits of female leadership. appointment of its first female HCC diseases such as cholera, typhoid, and health services and other risks associated chairperson, Irene Silikombola. dysentery. with born before arrivals. Expectant The story of Muonwe Clinic is by no means mothers that live in remote areas will an exception. In Gokwe North, Midlands On assuming her appointment her first Following her appointment in 2014 check-in approximately two weeks prior province, health facilities with HCCs led step was to action the drilling of a borehole the current chairperson, Maud Adam to their due date for access to skilled birth by women are also making improvements to improve access to portable water. In took over. She first served the HCC as a attendants and specialised emergency in maternal health. For example, facilities Zimbabwe the sourcing of water is largely committee member and was later elected care. The community will be responsible with the highest deliveries in the Zumba the responsibility of women and girls, as chairperson. The main source of funding for providing free labour and cheap Simuchembo and Chireya districts both who often have to walk long distances. for the committee is the government’s building materials such as river sand to have HCCs led by women who are using This one development had a major impact annual Constituency Development Fund. make bricks. For additional materials such their role in planning to prioritise maternal on reducing the workload of women and Prior to her appointment a large percentage as molds, cement and door frames, funds care. girls in the community by freeing them of this fund went to the development will be raised through various projects

20 21 RBF RBF Dete Clinic / ANOTHER FEMALE HCC CHAIR

Dete clinic is one of the facilities contracted under the RBF programme in Hurungwe district, Mashonaland West province. The clinic is about 90 km away from the district hospital in the remote mountainous Hurungwe communal lands.

The clinic’s HCC consists of seven members and a female chairperson, Tsitsi Kamutepa, appointed in 2014 when the RBF programme was introduced in Hurungwe district.

Under her leadership she has renovated ABOVE: the clinic as well as its maternity centre Mrs. Kamutepa, Dete Clinic HCC chairperson and staff homes, and has procured new linen and medical supplies. She has success to a very supportive community. also encouraged her team to prioritise Dete clinic is one of the best performing expectant women, newborns and children facilities with high antenatal care bookings under five. As one of the few women who as well as high institutional deliveries are occupying a position usually held compared to the national average. by men in Hurungwe, she attributes her

insert: Dete clinic before renovations. MAIN PIC: Jari Clinic

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Women Drivers / WOMEN DRIVERS CHALLENGING GENDER NORMS

ABOVE: Mavis Chapata, Ambulance driver

ABOVE: ‘I got my driver’s licence in 2000. When Asked what motivates them to claim their Laina Mageza, Ambulance Driver I joined the transport department there space in a ‘man’s world’ they say it is mostly Mashonland West Province was a lack of trust from some people who the thought of saving fellow women’s lives. Hurungwe District doubted if a woman would be able to ‘Most of the emergency calls we get are withstand the pressure associated with maternity cases. I always feel privileged Laina Mageza driving. It’s a profession seen by many as when I get a maternity referral and to be the domain of men,’ says Ms Chipata. able to bring the mother to the hospital As road traffic increases daily in Zimbabwe traffic and driving at speed and so in most in time for her delivery. Being a woman one of the most frustrating jobs in the people’s minds they are assumed to be Ms Mageza agreed; ‘In the workplace, men myself, I feel for these women,’ says Ms delivery of health services is that of an males. Not so in Hurungwe or Makonde feel challenged by my position and work Chipata. ambulance driver, for whom very few districts in Mashonaland Province, where as an ambulance driver. Usually they look drivers seem to want to give way. These the role is being handled by Ms Laina down upon women, though now things are drivers are taking responsibility for fragile Mageza and Ms Mavis Chipata. improving.’ lives, aggressively meandering through

24 25 RBF RBF CHAPTER TWO / Women Anchoring GENDER EQUALITY IN DECISION MAKING: WOMEN IN HEALTH POLICY MAKING

Community / 2.1.1 Dr. Labode: Using a Rich Participation in the RBF Programme History of Leadership to Shape the Future of RBF1 / In Zimbabwe the culture of working initiatives in building and maintaining together for the common good is a central health infrastructure so it’s a cost-effective Dr Ruth Labode stands at the intersection tenet of life, especially in rural areas. symbiosis. And although women are under- of the past and the future in healthcare. Zimbabweans are far more than just represented in influential positions in the In spite of having a rich background in passive recipients of aid, rather they come heath sector, under RBF they are becoming influencing Zimbabwe’s health policy, she together to build their own infrastructure more and more involved in community won’t rest on her laurels until more doors and to give whatever they can to see their initiatives to build and renovate health open for the meaningful participation communities develop. facilities. While unheralded, these women of women in the health sector and until are anchoring the RBF programme at women’s health improves. This culture of community participation community level through their manual is in-built into the architecture of the labour, which includes tasks like fetching Making History RBF programme. RBF provides financial water during construction projects. Having graduated as a medical doctor in resources to complement community 1984 Dr Labode made history when she became Zimbabwe’s first female provincial medical director (PMD).

Her working life began at Mpilo Central Hospital where she undertook her pre- qualification, after which she moved ABOVE: to Kadoma General Hospital before Dr. Ruth Labode successfully becoming the superintendent for the United Hospital. She 2.1 Introduction / held this position until taking on a role with Bulawayo’s City Council where she Under the RBF programme, new structures remained until 1992 when the government and roles such as HCCs and CBOs are appointed her as the first woman PMD. extending the role of women in primary healthcare beyond nursing. These From there, as they say, the rest is history. remarkable women have defied the odds She later served as the board chair for to become important influencers in the Mpilo Hospital before becoming a Member health sector and particularly within the of Parliament under the women’s quota, RBF programme. Below we hear from a befitting tribute to her unparalleled other female leaders on how they intend to contribution to her country. In recognition ABOVE: Community members, mainly women helped fetching water for the building of a maternity block at Mketi clinic, in use their influence to advance the cause of of her role in the health sector she has district funded by the HTF-RBF programme. Women are keen to participate because the intervention women, children and the nation at large. impacts them. Before the construction of the maternity wing the nearest delivery facility was about 20 km away. 1 This article was prepared during the 2013-2018 parliamentary tenure when Dr Labode was a Member of Parliament and Chair of the Portfolio Committee on Health 26 27 and Child Care. RBF RBF

also been serving in the Parliamentary chair of the health portfolio, I have also in important positions in the health sector. conducted to improve the representation Portfoliio Committee on Health and Child managed to get the Public Health Act Women remain underrepresented as PMDs of women. Those who have excelled in Care. reviewed, which was last reviewed in 1974. or as principal directors among other key public health should visit universities and This review process empowered health positions in the Ministry of Health and show other women that they can still lead Tenure as Policymaker and personnel, especially nurses and doctors, Child Care. Where are they?’ she asks. and be in positions of authority whilst also Portfolio Committee Chair to speak out with their issues. We also being a wife and mother,’ she advises. When Dr Labode stopped being a medical advocated for sexual reproductive health In spite of the inequity Dr Labode remains doctor she thought she was retiring to and rights, including comprehensive solution-oriented. ‘Mentorship can be rest. As fate would have it she was in fact sexuality education for adolescents.’ marking a new beginning as a policy maker who has remained steadfast in her Dr Labode’s role in championing women’s determination to finish what she started as health doesn’t end there. She has also a PMD. been an advocate for safe abortion and notes that many girls are forced into ‘I have grown to realise that my role as a unsafe abortions after being denied access policymaker is simply a continuation of to contraceptives and family planning what I started as a medical practitioner. services. She is also working towards When I was appointed PMD, my core the repeal of the law criminalising the business then was maternal mortality and transmission of HIV. ‘This law is unfairly children’s rights,’ recollects Dr Labode. affecting women because in most cases ‘While I played my role in that capacity, a women are the first in a relationship to lot remained to be done and my current know about being HIV positive and so end role allows me to finish what I started,’ she up being accused of bringing the virus into says. relationships.’

In a country where people still need to VIEWS ON WOMEN’S PARTICIPATION restore faith in their elected leaders, Dr IN DECISION-MAKING WITHIN Labode explains the role she and her HEALTHCARE colleagues play in driving the national For Dr Labode the involvement of women health agenda. ‘The mandate of MPs in the health sector is an imperative which is to develop laws which the portfolio is founded on fundamental human rights. committee follows up on. As an MP, you ‘It is women who get pregnant, women’s meet the community and play an advocacy hearts are softer, and as the Shona saying role at all levels through inputs of the goes, ‘musha mukadzi’ –a home is because constituencies you represent,’ she says. of a woman. Without women, children and families suffer. In our health services ‘I have been an advocate pushing for free women constitute almost 90 per cent of maternal health care. I have also advocated the personnel and they disproportionately for the reduction in the cost of blood used carry the burden of our daily life. Women ABOVE: Innovations are at the heart of delivering RBF in Zimbabwe. Women have for blood transfusions so that institutions are so crucial to the well being of our been leading in designing the innovations and training of people can afford to buy their own blood. As the society yet we do not have enough women

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2.2 What the doctor ordered: A female PMD tackles women’s health and defies gender norms /

Since Dr Labode became Zimbabwe’s first out of ten PMDs in the country are women, woman PMD (see 2.1.1) there has been no and while they wait for more women to join return for women working at high level in them, their performance in implementing Zimbabwe’s health sector. the RBF programme is proving their critics wrong. We talked to Dr Mafaune, the PMD Although still a long way towards achieving for the , about her gender parity in decision-making, the personal journey and her secret to success. world of PMDs has far improved since Dr through the RBF under her leadership. Labode broke the glass ceiling. Today, two

ABOVE: Smilling patient at Rutope Clinic, District, Mashonaland Central

On the RBF and Women shelters for expectant mothers in health In support of the RBF programme Dr facilities ensuring that they don’t need to Labode feels that ‘it in itself it is there travel long journeys at the onset of labour. to protect women’. Looking at evidence she says that programme’s results are a Several shelters have already been testimony that RBF is the best model for built, renovated or equipped since the financing the health sector, particularly in introduction of the RBF programme. In the rural clinics which are now well-stocked first edition of this publication we reported with essential medicines and whose a marked decrease in maternal and workers are well motivated. newborn deaths owing to these shelters.

PERSPECTIVES ON THE FUTURE OF This aside, Dr Labode would like to see THE RBF more local funding in the health sector with During her time as a PMD she remembers a focus on expanding access to services for “I feel WOMEN’S how the public health sector was served marginalised and remote communities. participation is IMPORTANT well by mobile clinics. ‘Nurses would go To achieve this, she feels that RBF will yet we do not have enough and stay in remote parts of the country, need to start supporting mobile clinics –a women in the important some for days, to conduct follow-up tradition that is proven to work. This will positions in the health maternal services. The biggest challenge be a stop-gap measure she says, as the sector” today is the distances that women have government and its partners continue to DR LABODE to travel leaving many unable to access support the construction of health facilities services.’ For pregnant women, part of in marginalised rural areas. RBF’s contribution has been to construct

30 31 RBF RBF AN Interview / with Dr Patron Mafaune, PMD Manicaland Province

provides oversight in the implementation A: The RBF programme focuses mainly on and their empathy for fellow women. of the RBF programme across various RMNCH, HIV, TB and some noncommunicable Women in leadership will add value to management functions including execution, diseases (NCDs). These mainly affect health systems as they bring with them their coordination, planning, organisation, women and children who are classified rich professional and personal experiences. monitoring and evaluation, as well as the as vulnerable populations. Through RBF, To achieve this though, there is a need to sharing of lessons learnt and best practices. financial access to such services has been nurture and mentor women and to prepare The PMD also undertakes advocacy at addressed and by focusing on quality of them for this role since many are raised to be provincial level, particularly with provincial care, client satisfaction has improved and submissive. Again, there is no better teacher heads and the provincial minister, among health facilities are now more responsive than experience. Considering that many other stakeholders. to their clients’ needs, especially with the women have experienced the different issue of prompt care. This is reducing the layers of the health system, I believe they Q: What are some of your success stories opportunity cost for mothers. Women can will make good leaders and decision makers of the RBF programme in Manicaland now go about their daily lives with the province? comfort of knowing they can seek help Q: What needs to change in the structure when necessary. Now they are giving birth and process of the RBF programme if it is A: As PMD I have worked with many in clinics and thereby avoiding unnecessary to fully address women’s health issues? stakeholders to ensure that we meet the deaths. As such, the health issues affecting targets of the RBF, especially in reproductive, our vulnerable populations are being A: Although the RBF programme is already maternal, newborn and child health addressed and the burden is being lifted. doing well, the programme still needs to (RMNCH). During my tenure and under the look at the demand side and reach out to RBF programme the province of Manicaland However, there are still challenges among remote pockets with services. I would also has witnessed a decrease in maternal and these successes. Cancer screening and recommend that the Minister of Health perinatal deaths with the exception of treatment is only at secondary level and not and Child Care shares this innovation with 2017, which was an outlier year. We have at the entry level for health care. In addition, other ministries in order to ensure that seen facilities such as the Hauna clinic it is important to ensure that when a rural social determinants of health are addressed refurbish their maternity waiting homes and health centre refers a client to secondary adequately. For improved population significantly reduce the referral of simple level facilities, there is a follow-up as some health, the health system can only do so deliveries to Hauna District Hospital. Such patients may be lost without systematic much, it will take a cross-sector approach initiatives have decongested the district care. Most importantly there is a great need to ensure that full potential is realised. ABOVE: hospital and improved efficiency in the for outreach programmes to cater for those Education for example is crucial. As the Patron Mafaune health delivery system. We have also seen in remote areas where facilities do not exist. saying goes, ‘if you educate a woman, you the Sakupwanya RHC build a maternity have educated the whole nation’. The nation Q: What role does a PMD play in the wing which accommodates a labour ward Q: Should Should we have more women will be healthier if women are empowered implementation of the RBF programme? and antenatal and prenatal care in positions of power in order to address through knowledge. women’s health concerns? A: The PMD is responsible for translating Q: In your view what are the pressing government policy into action. With the women’s issues with regards to health and A: It’s the way to go if we are to allow women government using the Results-Based how is the RBF helping to address them? to take action from their own experience Management (RBM) approach, the PMD

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Sakupwanya Rural care, family planning, HIV counselling and testing, PMTCT, disease surveillance and Community Sensitization Improves growth monitoring. There was no privacy Institutional Deliveries Health Centre / at the clinic and the 70’s building was in a a Story of RBF Success in Manicaland Province shambles – a leaking roof, hanging ceiling, Health Education including broken windows and cracked walls were sensitization was done with the some of features of this facility which is community, the HCC and the headman Sakupwanya Rural Health Centre: intended to promote wellness. What’s on the importance of institutional A Statistical Overview, 2017 more it was badly equipped and lacked deliveries and dangers of home Catchment population 0, 1% 5213 sufficient stocks of essential medicines. deliveries. The facility was able to Under 1 (3, 3%) 172 Today, though RBF subsidies and staff identify TBA and gave them health education on the complications which 1-4 years 11, 8% 615 Through RBF incentives, it’s a very different story. might rise due to home deliveries Under 5years 27, 2% 1 418 staff incentives Sakupwanya clinic has been Among many other improvements, like PPH, hypothermia, meconium 15years and over 57, 5% 2 997 renovated and managed to including repairs to the building’s aspiration leading to the loss of the 15-29years 26, 99% 568 procure essential medicines infrastructure, the facility has managed mother and the baby. Now institutional Women of Child Bearing 67% 234 to procure essential medicines, linen and deliveries have improved and in case Age 23 equipment. of complicated cases during delivery, Expected pregnant 8,8% 241 we have fuel coupons to refer these Sakupwanya RHC: RBF Successes mothers to the hospital. Expected births 33,4 / 174 Prior to receiving RBF’s support the 1000 Sakupwanya clinic only had one wing from Females 52,6% 2 742 which they provided general outpatient Males 47,4% 2 471 services as well as immunisation, antenatal

Through RBF, the facility managed to buy essential medicines and equipment

ABOVE: The facility managed to assemble own PPH Kit and the eclampsia kit. The kits are replenished regularly.

3434 35 RBF RBF If You Set Your Mind on It, YOU CAN ACHIEVE IT CHAPTER THREE / RBF AND WOMEN: THE HUMAN FACE STORIES Here’s what she had to say when she spoke to our editorial team: 3.1 Introduction / there are no evening pubs to gossip about What inspires your work? the day or live shows to dance the night So far in this periodical we have celebrated I love the work that I do. What inspired me was a away. a range of women at various levels in desire to change and improve the way hospitals the health system, each of whom play a operate. I wanted to give our hospital a ‘feel-at- Families will eat supper over stories of seminal role in the RBF programme, and home’ environment for our patients. I am also glad the day, huddled over a fire, while the each of whom are motivated by their desire to say that the funds we have been receiving from cloudless nights allow the heat of the day to help make the burden lighter for other RBF have been very motivating. For example, to escape, as if to spite the locals who women. In this chapter we speak to the I often end up using my own car to carry out the would have spent it complaining about the patients who have benefitted from their hospital’s immunization outreach programme burning sun. work – the women who have needed life- whenever hospital vehicles are down. saving services from our health system. But not all families are going to sleep after To motivate staff I give them an extra day off for the meal. Esther’s family is braving the the hard work that they do during outreaches. 3.2 There is Life in Darkness: darkness to venture out. She is a mother of It’s heartwarming to see the community happy Apostolic Faith Mothers Seek three and as soon as she puts the children when we are doing these outreaches. We even Maternity Services at Night / to bed, she and her husband set out to take advantage of them to provide other services visit the clinic for antenatal care. It’s not such as antenatal care, family planning, as well as The Seke rural community is a hive of a very long walk but a frightening one in male circumcision. activity during the day with people defying darkness. It’s a fear which, if unconquered, the scorching sun as they go about their could mean the difference between life and What has Bikita Rural Hospital achieved? daily chores. Yet when the sun goes down, death, as Esther well knows after two of her Before RBF we were operating under very difficult for many, the darkness can also invite fear. five previous pregnancies. Her apostolic conditions. We did not have enough working faith does not allow her to use health space and we had no outpatient department or Among the few exceptions punctuating facilities or to take medicines. On three ABOVE: treatment room or consultation room. This has this darkness are the small fires in the huts occasions she managed to successfully Sister Matimba: Matron at Bikita Rural Hospital all changed since receiving RBF funds. We have scattered across the plain with mothers give birth at home without any help, on the also decorated the postnatal ward and the labour busy making supper for their families other two she was unlucky, though lucky In spite of the many limitations to the pursuit of ward and have managed to erect an electronic before retiring to bed. The darkness is enough to still have her own life. female leadership roles, few are greater than lack hospital signpost. nature’s decree that the day has ended and of self-belief. Having been raised by societies that there can no more be activity outside the When local health staff sensitised them still diminish women, many struggle to find the Any parting words for women in the health house. Superstitious children will rarely to the risks of home births, she and her inspiration to aim high. For these women, Sister sector? loiter outside for fear they might disturb husband refused to relive the harrowing Matimba, the matron of Bikita rural hospital, has My word of encouragement to other women is the ghosts of their grandparents, though a experiences of losing their children. But the following message: ‘If you set your mind on it, that you can achieve all that you want if you set handful of habitual drinkers, emboldened although they are seeking to access health you can achieve it!’ your mind to it. I know this to be true based on my by their lost senses, might be heard singing services, they don’t want to leave their experience. as they stagger from their drinking holes church either –for them the apostolic after quenching their hot summer thirst tradition is more than just a faith, it is with home-brews. But this is not a city, a social foundation to which they are

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completely bound. For Esther and her At Kunaka Rural Hospital in Seke the 3.3 No more lives lost husband it is welcome relief that the clinic’s nurses have gone an extra mile to educate unnecessarily / nurses will allow them to access services the women of the Johanne Masowe at night, without the prying eyes of their and Johanne Marange churches. There For all the desire we have to remain alive successfully reaching health facilities, neighbours and fellow congregants. they opened a secret register offering sometimes our fate is not in our own hands. many still lose their lives if the facility is family planning, antenatal services and What if the conditions for life weren’t ill-equipped, as Pearson’s story tragically Apostolic churches are known for their immunisations. The women of these right? In spite of many expectant mothers illustrates. religious beliefs against seeking modern faiths know that they are welcome to healthcare, but health professionals are access these services after hours to avoid increasingly finding innovative ways discrimination by their communities, while to attract these populations towards the nurses treating them will often work improving maternal and new born longer hours to help save their lives and My sister may have been neglected, as indicators in line with the RBF goals. that of their children. I recall some of the nursing staff may have been harsh on her at a time when she needed care.

DID YOU KNOW? Sadly, the cause of my sister’s death is Apostolic religious doctrines and socio-cultural norms continue to influence the not something that should be killing behavior of apostolic women and female adolescents. Their doctrine inhibits women in labour or during child birth –if women and young girls from using modern services, including sexual reproductive hospitals are fully equipped and health health services. As such, apostolic believers would be a prime beneficiary of personnel are motivated and happy to targeted RMNCH communication strategies. do their job, many lives, including my sister’s, could be saved. Pearson’s Story: Bringing back smiles into the Although I am sad that my sister is no community. longer with us, I take heart in noticing that the same facility where she lost On 15th of May 2011 my sister gave birth her life has improved and that essential to a bouncing baby boy at one of the medical supplies are always in stock public hospitals. However, what should while nurses appear to be motivated have been a happy day for us turned and happier. into tragedy after she lost a lot of blood during labour and kept losing it for the next one and half days. She died from excessive bleeding. I would like to thank MoHCC and Partners for the RBF programme which has contributed to the healthcare system. Many families will not needlessly lose their loved ones. ABOVE: Some apostolic faith believers in Zimbabwe do not believe in accessing services offered by hospitals

38 3939 RBF RBF CHAPTER FOUR / CROWN AGENTS EAGER TO DELIVER understanding the challenges of accessing affordable health care. The programme Women, constitute 53% of all Crown Agents would fulfill government policy to provide staff, a major feat in a country where women’s free primary health care and this energised participation in key positions is still low as and motivated us all. Each of us can recall a decried in previous chapters of this edition. sad story about women and child birth, but here was an opportunity to write a happy ending.

At the beginning of the programme two incredible women stood out. They are Caroline Mubaira, Crown Agents Zimbabwe operation manager and the former scale- up manager, Bernadette Sobuthana, who both worked tirelessly to train health field and nursing staff on RBF. But within the development sector there were many other women who took up the baton in rolling out the programme. Among them were Cynthia Kamtengeni, UNICEF’s project IN HER OWN WORDS UNICEF’S manager and Jane Muita, UNICEF’s deputy PATRICIA DARIKWA SHARES HER country representative. Their efforts to VIEWS ON RBF keep the programme afloat and promote Since the start of the programme my more understanding of RBF in the sector main role has been in advocacy. I have were reinforced by Wendy Banda at DFID been there to listen to all sides, those and Joyce Mdlauzi at Irish Aid. 4.1 Introduction / for and as well as those hesitant about the programme, and to address their role women have played in advancing the A special mention also goes to HDF-RBF Over the years Crown Agents Zimbabwe concerns. On the technical side I tried RBF programme at Crown Agents. Programme Coordinator Patricia Darikwa has played a significant role in the to tailor the implementation of the at UNICEF, who played a huge role in management and implementation of the programme from the perspective of ensuring that reporting was done to RBF programme. The women in Crown mothers and children as this was the requirements and that the RBF progress Agents Zimbabwe have also played a 4.2 Genesis: RBF and Women in entry point for the RBF in Zimbabwe. reports for the HDF Steering Committee major role in its success owing to the Crown Agents Zimbabwe / I had to be an advocate and an were completed. female leadership team – the director Mrs articulator, contributing to decision- Muchaneta Mwonzora and the RBF team Mrs Mwonzora recalls the excitement she making within the RBF programme. leader, Marie-Jeanne Offosse. felt in April 2014 when asked to roll out After the Health and Development RBF across 42 districts in Zimbabwe. ‘This Fund introduced RBF at clinic level, I Women constitute 53 percent of all was an exciting proposition for us given continued to advocate for equity in Crown Agents Zimbabwe staff which is the objective of reducing maternal and access to health services so that in a major feat in a country where female infant mortality. This spoke strongly to the 2018 RBF was introduced at hospital participation in key positions is still far too grandmothers, mothers and young women level. low. Our contributor, Nakita De Barros, sat in the organisation, many of whom have down with Mrs Mwonzora to explore the roots in rural areas and have grown up

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4.3 Women and the RBF Programme today and in the future / government, having embarked on Results Based Management (RBM), was eager to roll By Muchaneta Mwonzora out RBF throughout the country as a way of institutionalising RBM. Like myself, at first Currently RBF has strong women at the donors were a little hesitant since they the helm with the team leader, Marie- were used to input-based financing. They Jeanne Offosse, a dedicated RBF health didn’t have a good understanding of the economist. She is also being assisted by RBF programme and were unsure of what deputy team leader, Caroline Mubaira, and results would be obtained for women in her staff of which 16 members are women. Zimbabwe. This significant representation of women also extends to many partner institutions I am happy to report that RBF has involved in RBF’s implementation. successfully complimented mechanisms Ensuring the smooth running of the that MoHCC and its partners have put programme and financial reporting in the in place to reduce maternal and infant MoHCC is Mrs H. Machamire, the finance mortality. Community participation and director. Her leadership and grasp of the ownership have been improved at all rural RBF mechanism has helped streamline health facilities in Zimbabwe through the the process of approving of RBF invoices, active participation of HCCs. thereby making the system more efficient in line with MoHCC and Crown Agents Going forward, several issues have emerged procedures. including the need to continuously reassess RBF indicators as some are very responsive The Future of the RBF in to RBF mechanisms while others aren’t. It Zimbabwe is important to sustain what works, while When we began RBF I had been involved in continuously seeking ways to ensure that the input-based financing model for health all other indicators work as well. financing. At first I wondered why we did not just give facilities the money they Finally, owing to the economic situation needed. It was only after six months that in Zimbabwe, there is an over reliance on my eyes were truly opened to the practical RBF funds because government grants benefits of RBF on the ground. I witnessed are minimal and inadequate to cover the huge strides in the improvement of data running costs of the facilities. Resultantly capture and reporting by health facilities RBF funds have become overstretched. and saw visible returns on investment of These funds are being used to procure RBF funds. The facilities could account medicines and other products which for funds which had been disbursed to means that any break in the RBF payment them and they had results to show over a cycle will adversely affect health facilities much shorter period than expected. The and therefore the health of women.

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Crown Agents CEO, Fergus Drake at Chirau Clinic, , Mashonaland West Province.

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