In early 2012 Mabvuku Polyclinic sent a request for support to ZimHealth launching what would be our largest project to date lasting for over four years and with a total partner budget of USD 1.6 million. This report, authored by Gamuchirai Gwaza aims to evaluate the impact of the ZimHealth Mabvuku project. The research and findings presented herein are the result of extensive data collection and analysis conducted on-site in the first half of 2024.

Executive Summary

Introduction

This impact evaluation assessed the contribution of the Zimbabwe Network for Health’s (ZimHealth) investment in upgrading Mabvuku Clinic to provide Emergency Obstetric and Newborn Care (EmONC) in addition to the antenatal, delivery, postnatal, and childcare services already offered. The aim was to improve maternal health services delivery in Harare, Zimbabwe. The ex-post independent evaluation was conducted in April 2024 and examined the ZimHealth project implemented between January 2015 and December 2016.

Methodology

The evaluation had two primary objectives. First, it aimed to assess the impact of ZimHealth’s investment in maternal health services at Mabvuku Clinic. Second, it sought to provide lessons learned and recommendations for ZimHealth’s future projects. The findings from this evaluation are intended to assist in future resource mobilization, enhance accountability, and identify best practices for upcoming projects.

The evaluation employed a multifaceted approach to gather comprehensive data. It began with a document review, followed by quantitative data analysis utilizing statistics from the District Health Information System (DHIS) and data from Mabvuku Clinic and its laboratory. Key informant interviews were conducted with policymakers from Harare City Council, and a meeting was held with senior Ministry of Health and Child Welfare policymakers to share the findings and obtain additional feedback. Additionally, semi-structured exit interviews with women attending antenatal care provided valuable insights into their experiences accessing maternal health care.

Key Findings

Evaluation Criteria	Key Findings
Relevance	The intervention was highly relevant and strategic to the maternal health agenda of the Harare City Council and the Ministry of Health and Child Welfare.
Efficiency	The intervention was highly efficient in terms of project execution and delivery. It was completed in two years with an independent financial and project management team in place.
Effectiveness	• The intervention had a significant impact on the reduction in referrals to central hospitals, which was 40%, even though it did not meet the targeted 50% reduction.• There was an average of 26% increase in bookings for deliveries and 52% decrease in unbookings. • There was an average 30% increase in the number of women attending the second ANC visit and a 60% increase in the number of women attending all antenatal visits. • Women appreciated the comprehensive services that allowed for integrated same-day testing and return of results, including the dual HIV and syphilis test. • There was no significant impact of the Mabvuku upgrade at the impact level on maternal or neonatal mortality
Sustainability & Scalability	There were several factors identified to ensure the sustainability of the intervention and enable its scalability. However, despite these efforts, there is a risk that these benefits may not be sustained due to several challenges identified.

Recommendations & Policy Implications

Based on the lessons learned from this project, ZimHealth and the Harare City Council should consider the following recommendations for future interventions in primary care facilities across Zimbabwe:

1. Develop a clear and comprehensive implementation plan that includes adequate human resources, training programs, fit-for-purpose diagnostic tools, treatment pathways, supply chain
management improvements and functional referral and follow-up mechanisms.

2. Establish a formal partnership or agreement between the Harare City Council (HCC) and the Ministry of Health and Child Care (MoHCC) to ensure a common understanding, manage expectations, and enhance coordination. This agreement should ensure commitment and closer linkages between services provided by both entities.

3. Allocate dedicated staff to operate and maintain specialized facilities like theatres, ensuring they function at optimal levels.

4. Install strong substantive leadership with a clear vision to oversee project implementation and ensure continuity. Leadership gaps, such as the absence of a matron, can result in operational
challenges that affect service delivery and can lead to oversight of critical issues like maintenance of essential equipment such as BP machines.

5. Improve coordination and management of donor support to maximize impact and ensure sustainability. Establish partnerships with other local entities to leverage resources and enhance project sustainability beyond donor funding cycles.

6. Emphasize the generation and use of data to inform decision-making processes. Implement strategies based on empirical evidence and patient feedback to improve service delivery efficiencies and reduce waiting times.

Conclusion

The ZimHealth intervention successfully expanded access to maternal health services and reduced referrals to central hospitals. Still, critical gaps remain in emergency obstetric care and maintaining service quality at Mabvuku Clinic. These challenges underscore the urgent necessity for a comprehensive approach to health system strengthening. Addressing issues such as staffing shortages, leadership capacity, ensuring sustainable financing, and securing reliable medical supplies are essential for delivering integrated and high-quality healthcare services. Mabvuku Polyclinic serves as a poignant example highlighting that a resilient health system requires not only robust infrastructure but also a wellequipped workforce, consistent supply chain, and efficient service delivery to serve its community effectively. The ZimHealth intervention successfully expanded access to maternal health services and reduced referrals to central hospitals. Still, critical gaps remain in emergency obstetric care and maintaining service quality at Mabvuku Clinic. These challenges underscore the urgent necessity for a comprehensive approach to health system strengthening. Addressing issues such as staffing shortages, leadership capacity, ensuring sustainable financing, and securing reliable medical supplies are essential for delivering integrated and high-quality healthcare services. Mabvuku Polyclinic serves as a poignant example highlighting that a resilient health system requires not only robust infrastructure but also a well equipped workforce, consistent supply chain, and efficient service delivery to serve its community effectively.

To read the full report click here.

Prepared by: Gamuchirai Gwaza

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This document is an independent external evaluation. The opinions expressed do not represent the views of the City of Harare, ZimHealth, or the Ministry of Health and Child Welfare, Zimbabwe. The information compiled by Gamuchirai Gwaza may include material from other sources believed to be reliable but not verified or audited. Public information and statistical data are from sources considered reliable; however, the completeness or accuracy of this document cannot be guaranteed. No responsibility or liability is accepted for any inaccuracies, and such liability is expressly disclaimed. The opinions expressed are valid only for the stated purpose and date. There is no obligation to update this report to reflect subsequent changes, events, or conditions.