Enhancing Access to Decentralised Maternal Health Care Services in Council-Run Clinics in Zimbabwe: Lessons from Kenya

Abstract

In 2020, during the COVID-19 pandemic, two aggrieved women and the Combined Harare Residents Association took the City of Harare to court for an order compelling the local authority to open its closed clinics. The clinics had been closed due to a lack of funding to acquire personal protective equipment (PPE) and refurbish the dilapidated health infrastructure that could no longer cater for patients needing assistance. This dissertation argues that access to all forms of health services, including sexual reproductive rights encompassing access to maternal healthcare, is essential to any population's survival and continued existence. Health services, including maternal healthcare, must be easily accessible to a country's population up to the lowest local government level. This is achievable through devolution of functions, powers and authorities to the lowest level of the central government. This dissertation analyses the causes of pregnant women's failure to access maternal healthcare at council-run clinics in Zimbabwe. It also measures these circumstances against the introduction of devolution in the 2013 Constitution of Zimbabwe, whose objectives include the equitable distribution of resources to all levels of government. Despite the provisions in Chapter 14 of the Constitution, the dissertation concludes that the existing legislative and institutional framework needs to be revised to implement devolution to improve service delivery that benefits local communities, including access to maternal healthcare. There are legislative gaps due to existing acts of parliament needing to be updated and requiring alignment with the Constitution, yet there needs to be more political will. Without devolving specific functions to lower tiers of government, they have no fiscal or political autonomy to improve service delivery to their communities independently. It considers Zimbabwe's regional and international obligations on sexual reproductive health rights and observes the dissonance between the current existing legislative framework and practice with regional and international standards. It also draws lessons from Kenya, which has a similar system of devolution and whose Constitution was adopted under a shared-power arrangement, just like Zimbabwe. Finally, the dissertation proffers recommendations, including legislative reforms that introduce institutions to effectively implement devolved functions to improve access to maternal healthcare at the constituency level.