Community participation bears fruit
“Hapana hapana, Hapana Hapana mai vanofanira kufa vakazvitakura Hapana Hapana mwana ari pasi pemakore mashanu anofanira kufa nezvirwere zvinodziviririka Hapana Tose ikodzero yedu kupindira pane zveutano Tose.”
(No woman should die while giving birth. No child under 5 years should die from preventable diseases. It is our collective responsibility to improve quality of health services.)
This has become the traditional greeting and parting slogan for many rural communities as they take heed of the call to take ownership and responsibility of improving the health delivery system.
As the national fiscus continues to dwindle and the call to shun donor dependency get louder - Health Centre Commitees (HCCs) - a structure created at clinic level to complement Government’s efforts in improving health service delivery seems to be the solution to a myriad challenges facing the sector today.
Although HCCs have always been in place even as far as the 1980s, no significant improvements were noted in the health sector then, owing to the social economic meltdown that made it difficult for Government not only to sustain their operations but also their existence.
This was so until recently when two non-governmental organisations, Save the Children and Community Working Group on Health (CWGH) partnered with Ministry of Health and Child Care to specifically improve maternal and child health in 166 clinics across 21 districts supported by the Result Based Financing (RBF).
The RBF is a pool of funding by development partners meant to mitigate maternal and child mortality.
“We wanted to encourage mothers to give birth under a health facility for free and to ensure that no woman dies while giving birth and that no child under five years also dies from preventable diseases.
“But in the same vein, we also noted that for these women to deliver in a healthy facility the services must be accessible and available,” said Save the Children communications advisor Ms Sophie Hamandishe.
She said against that background, the two organisations then embarked on national programme aimed at strengthening community participation in health through revitalising HCCs and educating them on their role in improving maternal and child health.
“Many women were giving birth from their homes without assistance from medically trained and experienced midwives resulting in complications and sometimes deaths of either the woman or the child. We however knew that the same communities had solutions to their problems and we wanted them to be actively involved in improving maternal and child health. But this could not be achieved without the communities enlightened on what they were supposed to do, how they were supposed to do it and prioritisation of what they needed to do,” said Ms Hamandishe.
She said with funding from the United Kingdom’s Department for International Development (DFID) and European Union, they identified clinics across selected districts and assisted them to elect a full complement of HCC members, after which they were trained on identifying and addressing challenges from a community perspective.
“Prior to the project, most of the HCCs had few members, mostly less than five instead of the required 12 to 14 members. A properly constituted HCC should have representation from the education sector, traditional healers, traditional and religious leaders and business community among others. Furthermore, some committees had not received training on their roles and responsibilities and were not effective in facilitating the establishment of sound relations between the communities and health care providers,” said Ms Hamandishe.
She said these members were then trained to work hand in glove with staff from their local clinics, plan how to raise own resources, organise and manage community contributions, and tap available resources for development of their health facility.
With the programme coming to an end this July, Ms Hamandishe said based on lessons learnt since revitalisation of HCCs, giving communities room to participate in finding solutions to local challenges was the way to go in all disciplines of the health sector to improve service delivery.
Going forward, Ms Hamandishe said, district hospital executives must ensure that all clinics have functional and informed HCCs.
HCC chairperson for Twintops clinic in Mhondoro Ngezi, Muzvezve Constituency Mr Esau Mutetiwa applauded the recognition and training given to his committee saying it has enabled the village to turn an old farm house into a decent clinic.
Mr Mutetiwa said since the clinic was in a resettlement area people walked as many as 30 kilometres to the health facility hence, they were also completing construction of a modern waiting mother’s shelter to accommodate pregnant women so that they are not discouraged by the distance to the health facility.
He said they were also looking forward to construct accommodation for staff at the clinic, who are currently staying in rooms in the refurbished clinic.
He said they also managed to buy a solar system for the clinic, draw electricity and water supply, procure benches, chairs and fence the clinic.
“All this was possible through combined efforts from villagers and financial resources from the RBF. Villagers moulded bricks, brought pit sand and river sand and sometimes provide labour. We use our financial allocations only when we cannot source the required resource amongst ourselves and this has gone a long way in improving quality of services rendered at our clinic,” said Mr Mutetiwa.
Headman Zivanai Chikava from Mapanzure in Masvingo district who is also chairman of Shumba clinic HCC testified how service delivery has improved at their clinic in the past two years.
Mr Chikava said the clinic transformed to the extent of patients outside their catchment area shunning their nearest clinics for Shumba clinic.
“Shumba clinic has transformed to be an excellent primary health care service provider and we are actually now seeking district level status because many other patients outside our catchment area are coming here for medical care. As a community, we take pride and ownership in our achievements and urge other communities to also take charge of their women and children’s health,” he said.
He said as Save the Children weans them off, they are looking forward to start income generating projects to sustain their operations and achievements.
Commenting on the national impact of HCCs on the health delivery system, Family Health director in the Ministry of Health and Child Care Dr Bernard Madzima said tangible progress and impact had been noted.
Dr Madzima said since HCCs were revitalised around 2011 with support from developmental partners such as RBF, cases of women giving birth at their homes were decreasing as institutional deliveries increased.
He said this scenario resulted in decreased numbers of women dying while giving birth as well as children dying before the age of five years.
“Home deliveries increased chances of pregnancy complications some of which resulted in deaths of either the mother or the child or even both.
“But with the revitalisation of HCCs, we are beginning to see a decline in home deliveries as communities themselves encourage each other to deliver in a health facility.
“Some communities have even imposed a penalty for women who deliver from their homes in form of goats just to discourage them from delivering at home,” said Dr Madzima.
He said previously, many women gave birth on their way to the clinic because distances from their homes were too far also resulting in pregnancy complications and sometimes deaths.
But most HCCs have worked on constructing habitable waiting mother’s shelters to ensure that women have shelter nearer to the health facility as they wait for their date of delivery.
He said as the number of institutional deliveries increased, clinics also started getting increased financial resources from developmental partners whose funding was based on performance.
Some clinics have testified that they used to get as low as $50 from developmental partners as they fail to deliver many women but now they get up to $3 000 a quarter owing to the increased numbers of women they were assisting to deliver.
Dr Madzima said all clinics in the country now have functional HCCs through support from either RBF or Health Development Fund (another pool of funding).
He said Government would continue seeking resources and partnerships to ensure sustainability of HCCs as a model for development.
“The HCC model is a typical example of effectiveness of the bottom-up approach and should be sustained to ensure quality and efficient health services,” said Dr Madzima.