A presentation from the 2014 Annual Results and Impact Evaluation Workshop for RBF, held in Buenos Aires, Argentina.

1. ZIMBABWE RBF URBAN VOUCHER PROGRAM
RONALD MUTASA
WENCELAS NYAMAYARO
PATRON MAFAUNE
CHENJERAI SISIMAYI
EUBERT VUSHOMA
BERNARD MADZIMA
March 2014

2. Overview of Program
 WB supported (US$2 million) pilot from August 2013 to December 2015
 Targeting the poorest pregnant women (bottom 20% households) in two
urban districts (Harare and Bulawayo Metropolitan Provinces)
 A performance-based payment and contracting mechanism focusing on
high impact MNCH services
 seeks to strengthen the quality of services offered in the two low-income urban
health districts; and
 seeks to strengthen community involvement, in monitoring and supervision of
service provision as well as building health awareness and health seeking.
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3. 3/29/14
Key Actors:
• MOHCC
• MOLSS
• City Health
Departments
• Voucher Management
Agency (CORDAID)
• Health Facilities
• Community
• External Verifiers
Objectives of the Pilot
Focused on…
 strengthening supply of quality maternal and neonatal
services to the poor in low-income urban health districts
 increasing utilization of maternal and neonatal care
and family planning services during the post-partum
period among the urban poorest quintile
 Reducing out-of-pocket expenditure and catastrophic
expenditure on maternal and neonatal care among the
urban poorest quintile
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4. Why urban voucher pilot?
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 Urban context: Evidence of gaps in delivery of MNCH services, barriers to
access and low utilization of available services
 User fees in some facilities
 Inadequate focus on quality of care in service delivery
 Negative health seeking behaviours - home deliveries
 Two additional motivators for the expansion of HRBF:
 Success of the rural HRBF initiative on its intended objectives;
 The demanding scenario of urban settings on improving maternal and child
healthcare status for the poor.
 Project envisaged to address both Supply Side and Demand Side issues

5. Challenges in Implementation
 Enrolment process took longer than anticipated
 Capacity of stakeholders participating in the process
 Limited exposure to poverty targeting methodologies
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6. Positives
 Positive uptake of the program by stakeholders,
community and its leaders
 Strong ownership by City Authorities (participation in
design, enrolment activities)
 IE integrated with program design (baseline study
completed)
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