Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1696591185851.pdf (Zimbabwe)
RESULTS-BASED FINANCING IN HEALTH PROGRAMME Strengthening the health delivery system in Zimbabwe JUNE 2020 The Mark of Great Men RBF - OUR UNIQUE APPROACH AND IMPACT / WHY WE CANNOT SUCCEED WITHOUT THE INVOLVEMENT OF MEN SINCE 2012, MATERNITY WAITING HOMES HAVE HELPED CUT DOWN MATERNAL DEATHS BY AT LEAST 50%.
THE RBF PROGRAMME IS BEING IMPLEMENTED BY CROWN AGENTS IN... 42 rural districts covering a total of 849 rural health facilities 67 hospitals across the country It serves an estimated million 6,6 people 463 984 Number of women accessing ANC4+ in 2019 5 507 704 Number OF Growth Monitoring VISITS FOR UNDER 5 CHILDREN in 2019 OVER 2000 HEALTH WORKERS WERE TRAINED IN OPERATIONAL TRAINING IN 18 RURAL DISTRICTS RBF IS BEING IMPLEMENTED BY MoHCC PCU 2% The AVERAGE data error rate ON RBF INDICATORS declined from 56% before RBF ?
!

For the programme to succeed, the involvement of men is of great importance.

In many communities, men still have the authority and financial power in the family, which means that women need male approval for clinic visits and funds for transport.

That being so, it matters that men understand how and why women benefit from pre-and post-natal care and act accordingly.
This is why this issue is dedicated to all the male role models who support this work already in one way or the other, with the aim to inspire many other men to play a vital part in the next generation’s future.
ii MATERNAL AND CHILD HEALTH IN ZIMBABWE - THE ROAD SO FAR / Through the Multiple Indicator Cluster Survey, an international household survey initiative, UNICEF collaborates with governments in collecting and analysing data in order to fill data gaps for monitoring the situation of children and women.

MICS findings are used as a basis for policy decisions and programme interventions, amongst others.

Below is a selection of key findings of the Zimbabwe Multiple Indicators Survey of 2019.
The data clearly shows that there have been outstanding improvements in the healthcare sector in Zimbabwe- an achievement that all stakeholders working in the sector should be immensely proud of!
*Per 1,000 live births ** Per 100,000 live births 1 111 2 www.crownagents.com WHAT’S IN THIS ISSUE / • • • • • • • • • • • • • • FROM THE EDITOR A JOURNEY THROUGH THE DISTRICTS FROM THE PERMANENT SECRETARY FOR HEALTH THE CHANCE FOR A SECOND LIFE A MALE NURSE SAVING A NEWBORN WITH RBF FUNDS A MAN WITH A CARING HEART FOR WOMEN A MAN FROM MASVINGO DISTRICT LEADING BY EXAMPLE RBF INSPIRES GOAT PROJECT FOR IMPROVED FAMILY DIETS IN MUDZI A MAN IN ST PIUS MOTIVATES OTHER MALES TO COMMIT TO ZERO MALNUTRITION CASES IN THE COMMUNITY BUILDING A FOUNDATION FOR THE NEXT GENERATION A CHIEF FROM MATOBO PROMOTING IMMUNISATION MEN STEPPING UP IN HURUNGWE DISTRICT LOCAL LEADERS AND CLINIC HEALTH WORKERS IN THE CHIRUNDU COMMUNITY COME TOGETHER TO BUILD A MATERNAL WAITING HOME SOARING ABOVE THE STATUS QUO FOR A HEALTHIER POPULATION AT DOMBODEMBA RHC CASE STUDY MEN IN THIS COMMUNITY ARE AT THE FOREFRONT TO BUILDING A WAITING SHADE AND IMPROVE ACCESS TO HEALTH CARE MEN UNITED - STOTY OF MPOSI CLINIC MEN PROVIDING FREE LABOUR TO BUILD A WAITING MOTHERS HOME TO ENSURE INSTITUTIONAL DELIVERIES AND PREVENT NEONATAL DEATHS DEDICATION, CORE TO SUCCESS CHIPFUWAMITI STORY THE DETERMINATION OF MEN IN CHIPFUWAMITI COMMUNITY LED TO BETTER ACCESSIBILITY TO HEALTH CARE.
MOTIVATION IS THE FIRE WITHIN A COMMUNITY MEN TAKING CENTRE STAGE TO RENOVATE A CLINIC THAT WAS HIT HARD BY A HAILSTORM AN UNEXPECTED CHAMPION OF MATERNAL AND CHILD HEALTH AN INTERVIEW WITH DUDZAI ZANI TOP TIPS FOR MEN TO ENSURE SAFE PREGNANCIES AND CHILDBIRTH AN INTERVIEW WITH DR BHASERA, GLOBAL FUNDS COORDINATOR 5 6 8 10 13 15 17 19 21 23 25 27 29 30 3 3 COVID-19 AWARENESS / Hotline: 0714734539 whatsapp Hi Hotline:0774112531 Hotline(tolfree): 2019 4 FROM THE EDITOR / As we have celebrated one of the less publicised, yet important international days - Father’s day - we will not let it pass by quietly!
To honour Fathers appropriately, this issue is dedicated to celebrating the breaking of male stereotypes.

Throughout the publication we will tell the story of how traditional male roles in our society can diverge rom business as usual and become an act of caring for family health.
There is a well-established understanding in the public health community that men have fundamental influence on women and child health because of their decision-making and earning powers, which impacts health service seeking behaviour for all family members.

This is why men are instrumental in improving family health outcomes and why it is so crucial for the wellbeing of our societies to create more awareness about how men can play a constructive role in the country’s maternal and child health agenda.
In order for Zimbabwe to reach it’s goals for maternal and child health, it is important to shed light on what men can do to assist in the process.

When men are knowledgeable about maternal health issues and the way they can influence them, they are more likely to be supportive during pregnancy and may encourage better health care decisions for their families such as: early ante natal care visits, institutional delivery, and family planning.
Moreover, they will be able to support their pregnant wives ensuring they are in a conducive environment and receive emergency obstetric services as needed, rather than delaying recourse to such care.

It is generally assumed that men are not interested in nor supportive of family health issues.

We feel that it is our duty to show that this assumption is, in fact, wrong, and that it is possible for men to step up and be engaged.
Around the world as well as in Zimbabwe, there are dignified and honourable men who champion family health.

In this edition, we would like to pay tribute to those men and share with you their stories; introduce to you fathers, husbands, male health officials, community health committee members and health workers who go the extra mile to ensure that quality health care is available to women and children.

It is our hope that their commitment will inspire more men to be supportive of family health.
Happy Father’s Day!

On behalf of Crown Agents and the editorial team, I hope you all stay healthy and safe in these challenging times.
Marie-Jeanne Offosse HDF/RBF Team Leader at Crown Agents Zimbabwe 5 5 A JOURNEY THROUGH THE DISTRICTS / HURUNGWE DISTRICT MAKONDE DISTRICT BULILIMA DISTRICT MATOBO DISTRICT 6 6 www.crownagents.com RUSHINGA DISTRICT UMP DISTRICT MUDZI DISTRICT CHIKOMBA DISTRICT MASVINGO DISTRICT MBERENGWA DISTRICT 77 FROM THE PERMANENT SECRETARY FOR HEALTH / The Government of Zimbabwe remains committed to the continuous improvement of Maternal and Neonatal and Child Health (MNCH).
To that end, Zimbabwe has been actively engaging with the international community, adopting international agreements such as the 20-year Programme of Action which emanated from the International Conference on Population and Development, (ICPD), in Cairo, Egypt in 1994, calling upon all countries to strive and reduce maternal and neonatal mortality and other conventions and protocols that promote women’s rights to affordable and quality health care services.
Amongst others, the conference recognised that men have shared responsibility in responsible parenthood, sexual and reproductive behaviour and should be actively involved in all aspects of MNCH.

Indeed, men have a role to play in MNCH.

Specifically, in MNCH care, once they have the knowledge and understanding of MNCH issues, they are in a position to understand the health choices for women and children.
The Ministry of Health and Child Care always encourages husbands at all levels to actively participate in antenatal care consultations alongside their wives to ensure family education and proper understanding of maternity as a social function and the recognition of the common responsibility of men and women in the upbringing and development of their children.
The Results Based Financing (RBF) Programme has promoted male involvement in MNCH in various ways, from leading awareness activities among village members to construction of maternity waiting homes.
The involvement of men in MNCH coupled with other factors has contributed to an upward trend of institutional deliveries from 80% (Multiple Indicators Cluster Survey-MICS 2014) to 86% (MICS 2019), as well as a reduction in the mortality rate of children under five from 75 (MICS 2014) to 65 (MICS 2019) per thousand live births.

Full child immunization coverage is now at 84%.


We therefore appreciate the pivotal role men are playing in MNCH and encourage more men to be actively involved in ensuring equal access to health services for their women and children.
Dr Gibson Mhlanga Acting Permanent Secretary for Health and Child Care 8 8 www.crownagents.com UMP DISTRICT TOTAL CONTRACTED UNDER RBF 21 PUBLIC HEALTH FACILITIES 20 CLINICS 1 HOSPITALS Uzumba Maramba Pfungwe, commonly known as UMP is a unique district in the north-east of Zimbabwe.

The district formerly used to fall under Mrewa District until in 1986 when it was separated to stand on its own.
The “Mbende Jerusarema” dance of the Zezuru Shona people of UMP is considered by UNESCO as an important part of the intangible culture of Zimbabwe.
The moving story of a male nurse saving a new-born life Dr Mazani UMP DMO 35% DECREASE IN EARLY NEONATAL DEATHS FROM 2014 - 2019 82% AVERAGE CLIENT SATISFACTION SCORE Q2 2014 - Q3 2019 RURAL HEALTH FACILITIES TOTAL EARNINGS $500,000 AVERAGE EARNINGS HOSPITAL $40,000 RHC SINCE Q1 2019 $4,400 9 9 THE CHANCE FOR A SECOND LIFE / The moving story of a male nurse saving a new-born life It is a wide-spread belief that women have more empathy than men when it comes to others’ wellbeing, especially in relation to children.
But is this always true?

Baby Enet’s story shows otherwise- if it was not for the care, commitment and compassion of a man to her life and wellbeing, the baby would not be alive today.

The man in question is Mr Nyamondera, the Nurse In Charge at the Karimbika Clinic in the Uzumba Maramba Pfungwe District.
Mr Nyamondera (NIC) Enet was born with a rare congenital condition called omphalocele, a birth defect of the abdominal (belly) wall characterised by the infant’s intestines, liver and other organs sticking outside of the belly through the belly button.

To receive life-saving treatment before it was too late, the child needed an emergency referral to the Parirenyatwa Hospital, 100 km from his birth place.

With the parents having no money to cover the referral cost, the child was set to die.
Mother and baby Enet Enet’s life got a fresh chance when the Nurse In Charge, Mr Nyamondera, decided to try everything in his power to avoid the baby’s death, which he knew could be prevented.

Committed to not give up, he engaged the Health Centre Committee Chairperson to approve the use of RBF funds to hire ambulance services.

These services enabled the child to be transported to the hospital and receive the care it needed.
With Enet being healthy and well, it is evident how this has also influenced the life of Enet’s mother, Precious Hodzi, who is full of praise for all stakeholders involved who ensured her baby’s life was saved.

1010 10 www.crownagents.com MASVINGO DISTRICT TOTAL CONTRACTED UNDER RBF 43 PUBLIC HEALTH FACILITIES 27 CLINICS 2 HOSPITALS Masvingo district is in Masvingo Province, Zimbabwe.

The district boasts of the Great Zimbabwe which is recognized as a World Heritage site by UNESCO.
Among the edifice’s most prominent features are its walls, some of which are over five metres high.
Dr Muskwe Masvingo DMO 52% DECREASE IN EARLY NEONATAL DEATHS FROM 2014 - 2019 90% AVERAGE CLIENT SATISFACTION SCORE Q2 2014 - Q3 2019 RURAL HEALTH FACILITIES TOTAL EARNINGS $1,000,000 AVERAGE EARNINGS $64,000 EARNED BY TWO HOSPITALS SINCE Q1 2019 1111 11 12 12 12 Mr Bachi and family www.crownagents.com A MAN WITH A CARING HEART FOR WOMEN / Determined to ensure the safety of pregnant women, Mr. Bhachi, a male community leader 49 years of age, is now leading by example to champion maternal health in a way that has baffled men in Mashava, Masvingo District.
When his wife had a close call with death during her 2nd pregnancy, it caused a paradigm shift in Mr Bhachi in the way he views pregnancy and women.

As a result, he now shares the responsibility of ensuring quality health care for his family alongside his wife.

Mr Bhachi comes from a background where men had never occupied their minds with maternal health as they would relegate this to women’s issues which did not warrant their attention.
In Mr Bhachi’s community, the majority of women walk long distances by themselves to the clinic in order to access ante- and postnatal care services.

One day, Mr Bhachi decided, out of curiosity, to accompany his wife to an antenatal care visit.
Witnessing the difficulties that his wife endured during pregnancy, coupled with the hardship of walking long distances, was a wake-up call for Mr Bhachi and awakened the urge in him to raise awareness and support his wife and other women during and after their pregnancies.

He remembers: “I really wanted to do something to alleviate the plight of the women.
I therefore decided to apply for the position of Community based Organisation (CBO) member to be an enumerator for the RBF client satisfaction survey of my area.

This position gave me the opportunity to be a male champion for women’s issues, especially in relation to the long distances they walk to deliver.

During one of my feedback sessions with the Health Committee Chairperson, a resolution was found: It was decided that a waiting mothers’ shelter was to be constructed.
However, the health facility made it clear that their RBF subsidy earnings were not enough to cover the construction costs, hence additional resources were required.

As a result, I mobilized community resources to ensure the construction of this important facility.” However, Mr Bhachi’s engagement did not stop with the above: The CBO went a step further by encouraging men to accompany their wives to their ante- and postnatal care visits.
As a result of Mr Bhachi’s passion for and commitment to women, the attitude of the Mashava men towards maternal health has significantly improved, which has not only resulted in improved maternal health outcomes, but also in the prevention of mother to child transmission of HIV.

13 MUDZI DISTRICT TOTAL CONTRACTED UNDER RBF 27 PUBLIC HEALTH FACILITIES 26 CLINICS 1 HOSPITAL Mudzi district is one of the nine districts in Mashonaland East province.
The name, ‘Mudzi’ was derived from the main river that divides the district into Mudzi North and Mudzi South.

It is the only district in the province with a port of entry that borders with a country in this case Mozambique.

The major sources of livelihood in the district are subsistence agriculture and informal gold panning.
Dr Mutapure Mudzi DMO 40% DECREASE IN MALARIA CASES DURING 2014 - 2019 87% AVERAGE CLIENT SATISFACTION SCORE Q2 2014 - Q3 2019 RURAL HEALTH FACILITIES TOTAL EARNINGS $460,000 AVERAGE EARNINGS HOSPITAL $42,000 RHC SINCE Q1 2019 $4,800 14 14 www.crownagents.com RBF INSPIRES LIVESTOCK PROJECT FOR IMPROVED FAMILY DIETS IN ST PIUS / A man in Mudzi District motivates other males to commit to zero malnutrition cases in the community by setting up a goat project.
Stunting among children was a growing concern in the St Pius community.

Growth monitoring visits diagnosed a lack of protein, which prompted Primary Care Nurse Masango to sensitize the community on the impact of poor nutrition on children.

To challenge the status quo, men in St Pius, under the leadership of Health Centre Committee Chairperson Mr Parei Namutsotsa, set up a goat project.
Mr Namutsotsa remembers: “Motivated by RBF concepts such as community participation and teamwork to achieve a common goal, fellow men from four families teamed up and started the project.

They pooled together money to buy four nannies and one buck and intended for the livestock to grow and procreate.

Every year, families participating in the project share half of the goats amongst themselves, whilst others are sold within the community or slaughtered, the meat being shared.
To date, the project boasts of over 100 goats.

It is obvious how important the project is to promote the growth of under-five-year olds as it helps to provide protein, thus positively reducing malnutrition.

In addition, the project is generating funds for family upkeeps.” “I am pleased to say that men in this community really concern themselves with maternal and child health.

We used to have a number of undernourished children but since the community started this project, children are very healthy.
Furthermore, mothers used to miss immunisation visits for their children due to financial challenges; now they have money for transport from the income generated by the project”, testifies Mrs Masango, who is also Sister in Charge at the St Pius Clinic.

The livestock production started in 2014, and in addition to improving health outcomes, the project’s funds are also helping families to pay for school fees and basic food necessities such as cooking oil and rice.
Goat project at St Pius, Mudzi district 15 15 MATOBO DISTRICT TOTAL CONTRACTED UNDER RBF 17 PUBLIC HEALTH FACILITIES 14 CLINICS 2 HOSPITALS Matobo District is in Matabeleland South Province, Zimbabwe.

An area of cultural, historical significance called “Matobo Hills” is located in the district.

This is the place where the name of the district Matobo came from.

Matobo Hills are one of the oldest nature parks in Zimbabwe established in 1926.
The Park has earned the UNESCO World Heritage site due to its diversity.
Dr Mthunzi Matobo DMO 0 MATERNAL DEATHS RECORDED IN 2019 SAME PERIOD MALARIA CASES DECREASED BY 61% 16 16 85% AVERAGE CLIENT SATISFACTION SCORE Q2 2014 - Q3 2019 RURAL HEALTH FACILITIES TOTAL EARNINGS $300,000 AVERAGE EARNINGS HOSPITAL $34,000 RHC SINCE Q1 2019 $4,000 www.crownagents.com BUILDING A FOUNDATION FOR THE NEXT GENERATION / Chief Bidi champions innovative ways to promote immunisation for children in Matobo Faced with the challenges of avoidable diseases that were causing deaths to infants, St Joseph led by Sister in Charge Ngwenya prioritized the plans to bring immunization centers close to the community.
Chief Bidi, a young chief with an exceptional progressive mindset when it comes to family health, supported the idea of bringing immunization centres closer to the community.

Through word of mouth, Village Health Workers (VHWs) had sent information about the possibility of vaccinations to chiefs and village heads as part of the RBF programme’s outreach strategy.
This prompted Chief Bidi to disseminate information amongst his people on dates and places for vaccination appointments, which, in turn, lead to more children attending immunization appointments, resulting in a substantial reduction in mortality deaths in Matobo.

Chief Bidi Having access to local immunization opportunities is of particular importance for Matobo.
Most children in the village have been left behind by their parents who migrated to neighboring countries such as Botswana and South Africa in search of work.

As a result, these children are living with grandparents who cannot walk long distances to far away health facilities.

As a result, they are vulnerable to some of the dangerous diseases such as polio, tetanus and measles, just to mention a few.
Nomsa Sibanda, a community health worker, notes that “since the existence of these outreach activities, the outbreak of killer diseases among children in the community has lessened notably.

Children are now well protected through immunization and the burden of grandparents worrying about travelling long distances has been resolved.
After witnessing less cases of polio, tetanus and measles among children who were immunized, even some people who formerly opposed vaccinations are now actively seeking immunization for their children.” Immunization of children in Matobo district But the programme does not stop here: Health workers have now gone beyond child immunisation and have seized the opportunity to track and sensitize mothers who are not bringing children to the immunization centre to ensure a more targeted outreach approach.
17 17 HURUNGWE DISTRICT TOTAL CONTRACTED UNDER RBF 32 PUBLIC HEALTH FACILITIES 30 CLINICS 2 HOSPITALS Hurungwe district is the largest district in Mashonaland West, Zimbabwe both geographically and in terms of population.

Hurungwe has a mixture of rich farming soils, artisanal gold miners, safaris and the border post where most of the population earns their living.

Tobacco followed by cotton are the main cash crops and are widely grown in the area.
Dr Masiye Hurungwe DMO 27% DECREASE IN NEONATAL DEATHS RECORDED FROM 2014 - 2019 SAME PERIOD MALARIA CASES DECREASED BY 67% 18 18 86.3% AVERAGE CLIENT SATISFACTION SCORE Q2 2014 – Q3 2019 RURAL HEALTH FACILITIES TOTAL EARNINGS $1,000,000 AVERAGE EARNINGS HOSPITAL $58,000 RHC SINCE Q1 2019 $6,800 www.crownagents.com MEN STEPPING UP IN HURUNGWE DISTRICT / Local leaders and clinic health workers in the Chirundu Community come together to build a maternal waiting home and promote institutional deliveries The introduction of RBF trainings of Health Centre Committees have made a profound impact on the community.
It touches, amongst others, on the purchasing and procurement needs of health centres, one of the main programmatic goals of the RBF programme.

As a result of the knowledge obtained from the training, local councillors, village heads and chiefs are now ensuring that community health needs are addressed and resources are mobilised for clinics.
This has not only lead to increased social and financial resource mobilisation for health facilities, but also increased the responsibility and accountability of local community leadership.

One important tool to look into the health needs of the community are Client Satisfaction Surveys; Machiridza Chirundu, a male HCC Member, explains: “By holding conversations with staff as well as with patients, we were able to address the feedback received and understand the challenges faced on both sides.
Since adopting this approach, Chirundu has achieved strong quality of care results, which are now at 80% from a previous measurement of 65%.

In terms of concrete actions as a result of the information we obtained from the surveys, we, the Members of the HCC, decided that some of the areas for improvement, such as infrastructure and levels of cleanliness of the facility, could be addressed through our direct intervention.
With the help of the local council, we started gathering contributions from the community to support the development of the clinic’s infrastructure.

As part of this effort, we mobilised resources to build a maternity waiting home to resolve the challenges of pregnant mothers not being able to walk long distances to remote clinics for delivery- in some cases the closest clinics were located in our neighbouring country Zambia!
In addition, many of these facilities would require patient documentation, which not all mothers have, or access to foreign currency to pay for user fees.
Thanks to RBF, the Chirundu Clinic is offering the same services for free and is therefore able to provide assistance to the community where it is needed most.” Man at work 19 19 BULILIMA DISTRICT TOTAL CONTRACTED UNDER RBF 16 PUBLIC HEALTH FACILITIES The name Bulilima is derived from isililima, Kalanga language meaning (whosoever shall find them, as he goes on, shall go there).

Bulilima was originally a San community (Abathwa).


The San community, in Makhulela area are known for their sacred and entertainment dance called Amasili.

The livelihoods of the communities in Bulilima district depend entirely on cross border trading and livestock rearing.
Dr Hapanyengwi Bulilima DMO 85% AVERAGE CLIENT SATISFACTION SCORE Q2 2014 – Q3 2019 RURAL HEALTH FACILITIES TOTAL EARNINGS $370,000 AVERAGE EARNINGS RHC SINCE Q1 2019 $4,400 20 20 www.crownagents.com SOARING ABOVE THE STATUS QUO FOR A HEALTHIER POPULATION AT DOMBODEMBA RHC CASE STUDY / Men in this community are at the forefront to building a waiting shade and improve access to health care The lack of a waiting shade can discourage patients from coming to the health facility, especially during the rainy season and hot weather.
We noticed a decrease of patients coming to the facility around November to January, as patients avoided to be stranded in the rain.

Even mothers coming for growth monitoring and immunisation sessions would deliberately miss their visits.

This also meant that children under 5 were in danger of killer diseases and stunted growth altogether highlighted Mr Sitjaba Nleya, Nurse in Charge at Dombodema RHC.
Determined to improve access to health care, the HCC mobilised men and young people in the community who are now constructing a waiting shade to cater for all clients under unfavourable weather conditions.

The success of getting community members working together on a project made them realise that more development can be achieved through combined efforts.

Since then, quarterly community meetings are held to address broader health issues.
There is an increased attendance of fathers who are keen to get a better knowledge on maternal and child health.

Men working on the waiting shade at Dombodema RHC in Bulilima district 21 21 MBERENGWA DISTRICT TOTAL CONTRACTED UNDER RBF 35 PUBLIC HEALTH FACILITIES 29 CLINICS 4 HOSPITALS The plausible theory about the meaning of Mberengwa is 'verengwa' which is an act of census believed to have been conducted by the Lemba people stationed at Mount Mberengwa after a terrible plague.
Mount Mberengwa is one of the highest mountains in Zimbabwe found in the district, but not as high as the mountains in the Eastern Highlands.
2 MATERNAL DEATHS RECODED IN 2019 AVERAGE EARNINGS HOSPITAL $30,000 RHC SINCE Q1 2019 $4,500 91% AVERAGE CLIENT SATISFACTION SCORE Q2 2014 – Q3 2019 RURAL HEALTH FACILITIES TOTAL EARNINGS $800,000 Dr Ndagurwa Mberengwa DMO 23% DECREASE IN NEONATAL DEATHS RECORDED FROM 2014 - 2019 SAME PERIOD MALARIA CASES DECREASED BY 55% 22 22 www.crownagents.com MEN UNITED - STOTY OF MPOSI CLINIC/ Men providing free labour to build a waiting mothers home to ensure institutional deliveries and prevent neonatal deaths It was a nightmare for mothers who fell pregnant in the community served under Mposi clinic, as the facility had no Waiting mothers home.
The facility could only accommodate 8 mothers on the beds, if the number exceeded some mothers had to sleep on the floor.

Resultantly, the community begun to shun utilising their facility, and resorting to home deliveries, or to travel to Jeka Rural hospital which is 50km away from Mposi.

This resulted in Mposi clinic recording fewer deliveries.
Determined to reduce risky home deliveries, men in Mposi community led by Health Centre Committe (HCC) Chair Mr Pardon Tangawamira have imployed local resource mobilisation skills acquired during RBF operational Planning training.

Mr Tangawamira noted that “Every household had to send a male representative that is a young man or the father to supply pit sand, river sand, fetching water and moulded cement bricks for the project.
By so doing, we wanted to cater for our wives and make sure that no woman must die when giving birth.

I am very happy with the response of every men in our community and in building a waiting mothers home.

Women giving birth while on their way to Jeka rural hospital is now a story of the past.

Credit must be given to all men as well as to the RBF programme for the transformational development at our clinic.” The programme has facilitated community ownership and cooperation.
Deliveries at the clinic have improved significantly as pregnant women from Mposi community, Maziofa and Imbahuru are hosted in the newly constructed Waiting Mothers Home that can accommodate up to 20 pregnant women ” Mr Edson Shoko, Nurse in Charge (NIC) Mposi Rural Health Center.
Mposi waiting mothers home, Mberengwa district 23 23 MAKONDE DISTRICT TOTAL CONTRACTED UNDER RBF 39 PUBLIC HEALTH FACILITIES 29 CLINICS 3 HOSPITALS Makonde District (previously called Lomagundi) is situated in the northern part of Zimbabwe in Mashonaland West Province.

Makonde is home of the “Chirorodziva” Caves which means the “Pool of the Fallen”, popularly known as the Chinhoyi Caves believed to be discovered by a famous European hunter Fredrick Seolous.
The most prevailing economic activities in this district are farming and mining at Mhangura and Miriam Cooper Mines.
Dr Mudzengereri Makonde DMO 35% DECREASE IN MALARIA CASES DURING 2014 - 2019 88% AVERAGE CLIENT SATISFACTION SCORE Q2 2014 – Q3 2019 RURAL HEALTH FACILITIES TOTAL EARNINGS $800,000 AVERAGE EARNINGS HOSPITALS $58,000 RHC SINCE Q1 2019 $4,700 24 24 www.crownagents.com DEDICATION, CORE TO SUCCESS CHIPFUWAMITI STORY / The determination of men in Chipfuwamiti community led to better accessibility to health care.

Mr Taruvinga please tell us what motivated men in your community to construct a clinic?
We realised the burden of our women and children walking 12-17km to seek medical attention away from our community.

An incident once happened of a woman who was in labour and then gave birth on her way to the facility which was a great concern for us as this was very dangerous as she could have encountered complications.

As fathers in the community we thought we needed to do something to prevent such situations.
Can you describe the process of getting the staff house and the role men played In July 2016 we requested for a staff house from a nearby school and converted it to a temporary clinic with determined men.

We later teamed up to form a vibrant and dedicated HCC to upgrade the clinic.
Further to this in January 2017 we engaged the local authority for a clinic and stand and dedicated men in the community spontaneously contributed bricks, pit-sand, river-sand and free labour towards the construction of Chipfuwamiti clinic.

Our children and wives will no longer walk long distances when sick or when they are in labour.

What’s your general comment to combined efforts of men in your community to improve health outcomes of women and children?
I can say Chipfuwamiti clinic is the brainchild of the community.

I am forever grateful to my fellow men and I hope this action shall forever be remembered as the reflection of dedicated father’s efforts.

Chipfuwamiti clinic construction, Makonde district 25 25 CHIKOMBA DISTRICT Chikomba district is located in Mashonaland East Province and has many small- scale farmers who concentrate on maize and tobacco.

The district boasts of the Gandachibvuwa pool which is said to have a whirlwind that never stops.
Early neonatal deaths decreased by 54% from 2014 to 2019.

The trend of Malaria cases decreased by 60% during the same period.

Mr Mangezi Chikomba DNO 54% DECREASE IN EARLY NEONATAL DEATHS FROM 2014 - 2019 SAME PERIOD MALARIA CASES DECREASED BY 60% 26 26 26 www.crownagents.com MOTIVATION IS THE FIRE WITHIN A COMMUNITY / Men taking centre stage to renovate a clinic that was hit hard by a hailstorm.
Men in this community are still taking turns to provide firewood needed for the autoclave and incinerator Mr Masenda as we have just celebrated Father’s Day, could you share with us how men In your community are breaking stereo types and supporting maternal health?

In our community, I am happy to say men have always been on the forefront in providing labour and assistance for any repairs that have been needed at the clinic.
Frequent firewood stock shortages were an obstacle for mothers in the waiting maternity home due to electricity challenges.

Realising the problem this had to our autoclave and incinerator, we as the HCC and the community responded by conducting a firewood programme whereby community men and young men will take turns to supply firewood at the clinic for our mothers to use.

What more do you think men/ fathers can do to improve health quality services in your community?
Men are already doing critical work in supporting maternal and child health in our community.

They HCC are engaging the community man as their priority plans are to build more maternity rooms as there are only 3 rooms which are not enough.

Man providing firewood to mothers in waiting, Chikomba district 27 27 RUSHINGA DISTRICT TOTAL CONTRACTED UNDER RBF 13 PUBLIC HEALTH FACILITIES 10 CLINICS 2 HOSPITALS Rushinga District is one of the eight districts in Mashonaland Central province.
The district got its name from the vast forests which mainly had Shinga wild fruit trees.

The community survives on subsistence farming while artisanal mining has now become rife especially during the rainy season.

In the 1980s they mostly grew cotton as their cash crop.
Dr Mabika DMO Rushinga 33% DECREASE IN EARLY NEONATAL DEATHS FROM 2014 - 2019 2828 28 85% AVERAGE CLIENT SATISFACTION SCORE Q2 2014 – Q3 2019 RURAL HEALTH FACILITIES TOTAL EARNINGS $420,000 AVERAGE EARNINGS HOSPITAL $31,000 RHC SINCE Q1 2019 $6,600 www.crownagents.com AN UNEXPECTED CHAMPION OF MATERNAL AND CHILD HEALTH - AN INTERVIEW WITH DUDZAI ZANI / Mr Zani, please tell us a little bit about yourself and your previous involvement in maternal and child health before you got involved with the RBF Programme.
I am a father of two.

I did not believe men should be involved in women’s health issues and was of the opinion that women should be able to manage pregnancy by themselves.

I used to think that women would just go to the clinic all the time, even when it was not necessary.

Although I did not know much about maternal health, I would grant my wife permission to visit the clinic only if I felt it was needed.

What prompted you to play a different role as a husband and father when attending the RBF Training?
I became a changed husband when I joined the RBF programme as a Community based Organiser (CBO).

The training was an eye opener for me as it made me realise the benefit of antenatal visits as well as the dangers of risky home deliveries in comparison to much safer institutional deliveries.

My wife had experienced quite a few complications when delivering our first child, hence I could relate.

How did you support your wife as a result of the training?
During her last pregnancy, I took my wife for her first antenatal care visit and for HIV testing.

I also accompanied her to the clinic for the delivery of our baby, and the nurse made it possible that I witnessed my wife in labour, which made me realise how strenuous it is to give birth and empathise with her on a much deeper level.

Now I help carrying our baby and remind my wife to take her family planning tablets in case she forgets.
Mr Zani mother and baby 2929 29 TOP TIPS FOR MEN TO ENSURE SAFE PREGNANCIES AND CHILDBIRTHS / An Interview with Global Fund Grants Coordinator Dr Bhasera As we celebrate Father’s Day, honoring fatherhood, we recognize our fathers for their outstanding contributions towards maternal and child health across the country.

It is a fact that pregnant wives who are supported by their husbands/partners have higher chances of a healthy pregnancy and a safe birth altogether.
This raises the question of how men can best support their wives during pregnancy and childbirth.

Dr Basera, National RBF Programme Coordinator, highlights some ways in which men can support their wives to remain healthy and support the birth of healthy, strong children.

Discuss antenatal visits before the pregnancy Firstly, Dr Basera recommends for fathers to not wait for a woman to fall pregnant before discussing issues to do with maternal and child health.
“We are currently living in patriarchialsocial systems in which men tend to hold primary power.

As a result some women may need permission from their husbands to visit health facilities or send their sick children to a clinic.

It is therefore important for the couple to discuss the importance of family health care before a woman gets pregnant or before the child gets sick.

This will avoid any delay in seeking health care.


It is a “quick win” if this culture spreads in the community.” Dr Bhasera Once pregnant, women often need urgent access to prenatal clinic visits.

In some of our communities it is usual for women to seek permission from their husbands to attend clinic visits, which can often cause delays or missed appointments.

To avoid such predicaments, it is important that families raise these issues before a pregnancy occurs.
Assess funding options for essential travel For women to reach the relevant clinics, they will often need money for transportation.

The husband can help by setting aside funds for his wife so she has the funds to travel to the clinic as and when it is needed.

Consider accompanying your wife to clinic visits Lastly, Dr Basera encourages fathers to show love and feel for their wives as much as possible by accompanying them during pre and postnatal care visits.
Men are also encouraged to take their wives and their infants to growth monitoring and immunization appointments.

Attending appointments on a regular basis will not only increase a higher probability of safe delivery, but also ensure that every child has an equal opportunity to grow up healthy and strong.In addition, attending visits together will inevitably strengthen the bond between wife and husband and also give the husband an insight into his wife’s journey of carrying and giving birth to their child.
Retired Brigadier General, Dr Celestino Basera is a medical doctor with a renowned experience in project management in Zimbabwe.

He is the current Coordinator of Global Fund grants for HIV, Tuberculosis and Malaria; and also in charge of the National Results-Based Financing programme in Zimbabwe.
30 www.crownagents.com Outreach programme in Matobo district 31313131 Crown Agents staff 3232 32 32 www.crownagents.com 3333 33 33 This document was produced by Crown Agents on behalf of the Ministry of Health and Child Care.

The HDF and supporting donors do not necessarily share the views expressed in this document.

Responsibility for its contents rests entirely with the author.
Visit our website at www.mohcc.gov.zw Join us on: Facebook: Ministry of health and child care Twitter: @ MoHCCZim Physical address: Corner Central Ave/S.
V Muzenda or 4th Street Postal address: Ministry of Health and Child Care | P O Box CY1122 Causeway | Harare T: +263-242-798537/60 or 2901210 E: pr@mohcc.gov.zw C: +263 712 867 337 Visit our website at www.crownagents.com Join us on: Twitter: @crownagents Facebook: Crown Agents LinkedIn: Crown Agents Reg Office: Standards Association Building | Northend Close | Northridge Park Borrowdale | PO Box 4200 | Harare | Zimbabwe T: (+263 242) 850265 or (+263 91) 235064 | F: (+263 242) 884255 E: cazim@zw.crownagents.com Crown Agents Zimbabwe (Pvt) Ltd Registered in Zimbabwe No.
7634/97 VAT Reg No.

10002535 Whistleblowing: https://www.crownagents.com/who-we-are/business-integrity/