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Roselyne Sachiti Features Editor
THE United Nations Millennium Development Goals deadline is fast approaching. The clock has been ticking for over 13 years now and only two are left before the 2015 deadline for the eight MDGs. Of the eight MDGs, Zimbabwe has been concentrating on 1, 3 and 6.
With the health sector suffering a huge blow because of the economic meltdown that dogged the country for almost a decade, some areas that include maternal and child health were crippled.

This resulted in increases in child and maternal mortality worrying Government and the donor community alike and giving them the zest to put aside funds and programmes that would help lessen and even eradicate this thorn.

One of the interventions, the Health Transition Fund (HTF) was launched in 2012 as a five-year plan to revitalise Zimbabwe’s ailing health system and reduce the country’s high maternal and child mortality rates.

The HTF targets MDGs 4 and 5 which are reducing child mortality and improving maternal health respectively.
In Zimbabwe, the maternal mortality ratio has doubled over the last decade from 283 per 100 000 live births in 1994 to 555 per                  100 000 live births in 2005/6.

According to the Zimbabwe Maternal and Perinatal Mortality Study (ZMPMS 2007), the maternal mortality ratio is currently estimated at 725 per 100 000 live births, translating to eight maternal deaths per day.

This is a far cry from the MDG target of 70 per 100 000 live births.
To assist in lessening these depressing statistics, HTF also additionally supports improvements in the quality of maternal and child health and nutrition services.

Additionally, HFT funds medicines, equipment and personnel also assisting in the development of health policy and planning.
HTF, a multi-donor pooled fund for the health sector in Zimbabwe, is managed by the United Nations Children’s Fund.

It aims at reducing maternal and child mortality through abolishing user fees and supporting high impact interventions and strengthening the health system.

International donors include the Canadian International Development Agency, European Union, Irish Aid, Norwegian Embassy, Swiss Agency for Development and Co-operation, Embassy of Sweden, UKAid and the United Nations.

Its four thematic areas include;

•  Maternal, newborn and child health and nutrition by enhancing obstetric and newborn care capacity of the health system

• Medicines and commodities

•  Human Resources for Health

•  Health Policy, Planning and Financing

It has brought with it success stories as there have been an improvement in health deliveries in most institutions.
For example, Harava – a small clinic in Zaka – services 10 307 people from wards 22, 17 and part of 16 and has been doing wonders using HTF funds it received.

Nurse-in-charge Mavis Mudzamba said they had many challenges before they started receiving HTF funds.
The list of challenges included drugs, gloves and detergents shortages. They also did not have a maternity ward.

But all this changed when they received US$6 000 under the HTF.
“We bought drugs, benches, bought a fence and planning to build waiting mothers shelters. We have sent our application to the District Administrator who indicated that the original plan for the clinic is in Masvingo. We will know where to build once we get it,” she revealed.

She said a total of 34 women register for maternity services each month and they have an average of 16 deliveries within the same period.

The clinic does not have an ambulance and they depend on the one from the four at Ndanga Hospital.

If one of the ambulances is not available and they have an emergency, the clinic seeks the services of private transporters.
“They charge us US$40 and we use the HTF funds to pay if it’s a maternity emergency,” she added.

Village head Mr Alex Chivasa is among a handful of other people who regularly attends community development meetings at the clinic.

He said before the HTF, pregnant women would go to deliver at the nearest clinic, Musiso, about 79 kilometres away.
“Some would give birth before getting to the clinic and this really worried us because we had a clinic close by, but not enough resources,” he said.

Mr Chivasa added that while Government and its partners that include Unicef among many others have been working hard to also ensure the prevention of mother to child transmission of HIV, the community has also been playing its part.

He boasted that all the men in his area are actively involved in maternal health issues and escorting their wives for pre-natal care and also getting tested alongside them is just one of the many great things they do.

He explained how the traditional leadership keeps an eagle eye on all those who do not comply and how they are punished.

“They do not get away with it.

“Those who do not go for HIV testing with their pregnant wives are brought before me or any other village head in this area and are fined chickens. If taken to the chief, they will be fined a goat. We want zero new infections on all new born children, we want a healthy nation and support what our government and its partners are doing,” he said.

He also said they encourage those from the apostolic sects to have their children immunised.

According to Unicef, no major cases of measles have been reported in Zimbabwe, since the inception of HTF another success story worth noting.

For instance, immunisation coverage in Zimbabwe has reached a high 90 percent with no major measles outbreak reported in the last four years.

Unicef Chief of Health and Nutrition Dr Assaye Kassie said this was a positive result of HTF.

The increase, he said could to some extent also mean that some Apostolic Faith sects — well known for refusing to have their children immunised because of religious beliefs — could have had a change in attitude and brought their kids forward.

This change of mindsets, he said, could have been a result of campaigns carried out.

“We have single cases here and there. There is a difference between a measles case and measles outbreak,” he explained.

He said that they were experiencing low coverage and thought this had something to do with the apostolic sects.

“We had denomination campaigns and saw members of some apostolic faith sects bringing their children, but we need to further investigate the trends.

“What is important for now is the trend. We have seen a rise since 2009 and we are relatively feeling good,” he said.
Dr Kassie revealed that out of the US$114 mobilised under HTF, close to US$86 million has been utilised adding that this was a big achievement.

Dr Kassie added that 1 000 midwives had been so far trained across the country through HTF and 900 were currently undergoing training.

He also said 1 300 rural health facilities received midwifery and resuscitation kits, bags and masks for neonatal resuscitation.
Masvingo Province Maternal, Neonatal and Child Health Medical Officer, Dr Kudzai Masinire applauded HTF saying it is now a major source of health care funding.

He noted that it complements Government’s resources and the programme funds also assisted in reviving the provincial hospitals transport system.

They now have four land-cruisers per province and recently received blood coupons making their work easier.

Their province has also been receiving support in midwifery schools.

“Provinces have been training districts on management of the funds . . . managing their account, procurement and acquitting,” he explained.

He said they hope to enhance obstetric and newborn care capacity of the health system by improving antenatal care to 90 percent.

“We also aim to improve skilled birth attendance to 80 percent — more midwifery trainings to ensure a good midwife patient ratio, more midwifery schools. We also hope to conduct regular maternal and newborn care training,” he revealed.

He also said they hope to revitalise waiting mothers homes and complement essential equipment and supplies (blood banks, theatres, delivery facilities).

Through HTF they hope to train village health workers and retain them through provision of bicycles, bags and allowances.

They also hope to create demand and abolishing user fees.

They also aim at strengthening referral system-ambulances for all hospitals (63), phones for all facilities.

“We also hope to establish or revitalise health centre committees, engage religious groups, objectors apostolic sects and promote social mobilisation to improve awareness on health, right to health, campaigns on user fees policy,” he said.

While HTF has brought some infrastructural improvements, there are still some areas of concern, especially on human resources.

For instance, he said, allowances were infrequent with goal posts on their release ever-changing.

“Critical allowances for health workers are too far apart, you can’t remember the when the last payment was conducted. The fund is inadequate, but a good complementary source,” he pointed out.

He suggested that it could be ideal if the money was released monthly as this would be a motivator for staff.

“We had one release since November last year. Currently releases are dependent on timeous submission of the monthly generic report and this is not a good motivator for health workers as it’s not a consistent or regular allowance,” he complained.

He cited that the money has been equally too little as they have been receiving US$750 per facility.

According to Dr Masinire, they also had challenges of their own as some clinics delayed opening bank accounts while others held-up procurement stirring a sense of relative adequacy of the money at present.

He added that mission and private hospitals and districts with more or less equivalent/similar sources of funding e.g RBF funded districts like Chiredzi and Mwenezi in Masvingo Province which have the support of CordAid were excluded from receiving HTF funds.

With such Government and partner initiatives to boost Zimbabwe’s health system by 2015, the question that remains is, will we have achieved MDG 4 and 5 come deadline?

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