[{"bbox": [174, 152, 393, 181], "category": "Section-header", "text": "## 2.2 Problem Analysis"}, {"bbox": [96, 194, 1134, 301], "category": "Text", "text": "Despite improvements in the health sector, over the past decade, systematic challenges persist, especially in relation to quality of care. **Current levels of government allocations are significantly lower than the needs of the health sector.** Therefore, Zimbabwe remains heavily dependent on external donor support to provide services to the poorest people in Zimbabwe, especially in the context of the economic crisis and Covid-19 pressures."}, {"bbox": [96, 325, 1134, 510], "category": "Text", "text": "The role of Development Partners (DPs) is key to sustain quality service delivery in the country and strengthen the health system. **If donor funding for the HDF is terminated there is a risk that the gains made over the past decade, such as reduction in maternal and child mortality, will be reversed.** The MoHCC has also recognised, in the government's draft Programme Document for a Multi-Donor Pooled Fund for Health in Zimbabwe 2022-2025 **that continued external support remains necessary, to sustain results achieved over the past decade**, and to propel the health system towards a 'programmatic tipping point' beyond which local resources could be used to sustain results."}, {"bbox": [96, 538, 1134, 669], "category": "Text", "text": "Although other financing instruments (including EU supported Global Fund to Fight HIV, TB, Malaria (GFATM) and the Global Financing Facility (GFF), and bilateral funds from other donors such as USAID), provide investment in specific disease areas, a pooled donor fund, such as the HRF, is still needed to strengthen the wider aspects of the health system, build sustainability, and get the best results from these financing facilities and bilateral funds."}, {"bbox": [96, 697, 1134, 884], "category": "Text", "text": "An evaluation of the HDF **recommended an improved design to address gender-based issues that affect women of reproductive age and adolescent girls at community level** including human resources for health (HRH) and Nutrition. In response to this, the MoHCC developed priorities for health in the coming period, including institutionalising community-based primary health care (PHC) systems through the development of a costed community health strategy. Donor support is needed to implement this strategy.\nAs donor funds cannot cover all health needs, the future programme (HRF) must prioritise investment and strike a balance between health systems strengthening and provision of essential services to the most vulnerable."}, {"bbox": [96, 909, 1134, 1097], "category": "Text", "text": "Given that Zimbabwe has high maternal and child mortality rates, maintaining quality packages of care, during and after pregnancy, in rural areas, is a high priority especially since there is pressure on the MOHCC to concentrate services in the bigger urban centres. Evidence shows that maternal and neonatal deaths arise from the risks attributable to pregnancy and childbirth, low coverage, and poor-quality health services. **Scaling up high impact interventions and essential health services packages at the primary level has the greatest impact on the burden of disease⁷.** If these routine essential services are not maintained, Zimbabwe will not meet the Sustainable Development Goals (SDG) for mothers and children by 2030."}, {"bbox": [96, 1120, 1134, 1176], "category": "Text", "text": "**The new HRF will also contribute to the TEI on \"Gender Equality and Women's Empowerment\" to which**\nSweden, Netherlands and Ireland are contributing."}, {"bbox": [96, 1201, 1134, 1385], "category": "Text", "text": "Women and girls will be targeted through provision of services (maternal health services, family planning, Sexual Reproductive Health and Rights (SRHR), Gender Based Violence (GBV), and nutrition service) to improve outcomes for women and girls. These activities build upon and complement Pillar 2 (Institutional Strengthening) of the Spotlight Initiative⁸. This Initiative aims to eliminate sexual and gender-based violence (SGBV) and harmful practices. Integrated health/ GBV/SRHR services will be delivered at community level, especially through mobile health teams in rural areas, enhancing the protection of women thus contributing to the goals of the Spotlight Initiative."}, {"bbox": [96, 1412, 1134, 1467], "category": "Text", "text": "Gender inequality will also be tackled in the planning and delivery of health services to ensure that female healthcare staff are recruited in every healthcare facility. Measures will be taken to ensure that women and girls"}, {"bbox": [85, 1516, 1142, 1566], "category": "Footnote", "text": "⁷ A cost-effectiveness analysis of maternal and neonatal health interventions in Ethiopia, Solomon et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661540. Health Policy and Planning 34(3) May 18 2019"}, {"bbox": [85, 1565, 1142, 1615], "category": "Footnote", "text": "⁸ Technical Guidance Note on the Six Pillars of Spotlight Theory of Change, Spotlight Initiative, Guidance Note (undated), https://endvawnow.org/uploads/browser/files/spotlight_initiative_pillar_guidance note.pdf"}, {"bbox": [608, 1638, 623, 1660], "category": "Page-footer", "text": "7"}]