This component support deployment of vaccines that meet World Bank Vaccine Approval Criteria (WB VAC). Zimbabwe has been using five vaccines that meet WB VAC: Sinopharm, Sinovac, Sputnik V, Covaxin, and Johnson and Johnson.  The country also availed the World Health Organisation Emergency Use Listing (WHO EUL) vaccines from the African Union and COVAX Facility.

This sub-component contributes towards strengthening the public health system’s capacity to deploy vaccines through capacity building, eligible allowances, procurement of goods, and equipment. It also monitors whether deployment is proceeding according to the National Deployment and Vaccination Plan (NDVP) and strengthen vaccine related waste management transportation systems. Activities to be funded include:  

• Outreach and vaccine distribution including fuel, repair, and maintenance service of vehicles used for vaccine distribution.
• Supervision and monitoring of vaccine deployment including ensuring implementation of the NDVP. Special attention will be given to women, people with disabilities, and others among targeted groups who may face barriers to access information and services.  

TA to the MOHCC to revise, update, and implement the safety monitoring plan to enable swift detection of any AEFI. 

• Procurement of PPE for public COVID-19 vaccination centres and capacity building for rational use of PPE, including the development of guidance tools and training through physical and virtual methods.
• Supportive supervision and visits through strategic use of Information, Communication, and Technology (ICT).
• Procurement of electronic data capturing tools for health facilities
• Vaccine efficacy monitoring / checks. 
• Set up and implementation of Impilo COVID-19 Vaccination Authentication. This is an Electronic Health Record mobile application solution that enables a QR code to be assigned to every COVID-19 vaccination certificate. This application captures personal information including patient health status, contact address while also keeping information secure. 

Vaccine waste management training and logistics such as transportation of wastes related to vaccine deployment for off-site incineration, and M&E

This sub-component will also finance TA, eligible allowances, equipment and supplies to support risk communication and engagement at the community level to complement NDVP implementation:  

• Community feedback mechanisms at local level such as the use of registers or rumour logbooks and suggestion boxes, Grievance Redress Mechanisms (GRMs), seconding Health Promotion Officers (HPOs) to EOCs, as well as ensuring community feedback is transmitted to high level meetings. 
• Psychosocial support systems for both healthcare workers and the general population by building capacity of community health workers, and national psychosocial centre. 
• Community discussion forums with local and traditional leaders and school heads to share information about gender-based violence (GBV), sexual exploitation, abuse and harassment (SEA-H) and GRM. Priority will be given to the Tshwa and Doma districts which tend to be the most vulnerable and often forgotten areas.

Public-address vehicles

This component support complementary strategic activities to facilitate the implementation of the COVID-19 NDVP, focusing on climate friendly health system strengthening activities that support vaccine deployment.  It supports finance capacity building, goods, purchase and use of climate-friendly cold chain equipment including cold boxes and 250 solar direct drive refrigerators; installation of refrigerators on 8 trucks; and installation and maintenance of solar energy in 29 health facilities.

The implementation of activities under the parent project will continue as detailed in the Financing Agreement. Funding for the component is increased to support the new Component 4 activities and increase in overall costs of operation of PIE.

This is a new component that will support the continuity of EHS. The proposed activities to be financed under this component are:

This subcomponent will support the provision of a comprehensive package of essential health services including immunization, antenatal and postnatal care to communities without access to health facilities. Approaches that attract and engages adolescents and young people will also be prioritised and implemented for increased comfort, friendliness, and uptake of services. This sub-component will finance the procurement of: (i) solar-powered tricycles to be used by health facilities for outreach services, within a 20km radius. There are 1950 registered health facilities, and prioritization of distribution of the tricycles will be based on need. There is complementary support from other projects that are procuring 544 tricycles. To cover the remaining gap of 1218 tricycles, the project will work together with other development partners and the GoZ, to lobby for the necessary support. (ii) well equipped outreach vans to provide a range of services, including those requiring privacy to cover 8 rural provinces while targeting poorly performing and prioritized districts, beyond the hard-to-reach areas. The equipment for each of the outreach vans includes an Ultrasound Scan, Laboratory, Solar Powered Refrigerators for medicines and vaccines, exam couches, tents, and screens to be used during the outreach. (iii) Procurement of eight by 18-seater rough terrain minibuses that will be used to carry the integrated outreach teams. This subcomponent will also support (iv) operational costs for the integrated outreach teams and (v) costs related to the RMNCAH mentorship program which involves specialists from central and provincial hospitals mentoring district level doctors. 

This sub-component will finance: Village health workers (VHWs); (i) Upskilling/refresher trainings and support for 5,450 VHWs on the new/expanded community health package of services; including how to handle climate-related shocks and integrating gender responsive and adolescent friendly service delivery. Other funding streams will support upskilling of an additional 5000 VHWs, leaving a gap of approximately 11500. The project will support upskilling of VHWs, rather than train new cadres, as stipends for the additional VHWs are not assured and (ii) procurement of motorcycles for environmental health technicians to conduct community surveillance activities.

Maternal and Perinatal Death Surveillance and Response (MPDSR) reports show that most maternal and perinatal deaths in Zimbabwe are avoidable and are due to the 3rd delay i.e., delay in getting appropriate care at the health facility including inadequate biomedical equipment and commodities at health facilities. One of the focus areas of the Ministry of Health and Child Care is ensuring that health facilities are suitably equipped to provide safe deliveries in a bid to save the lives of women and babies. This subcomponent will fund (i) equipment for both basic and comprehensive emergency obstetric and new-born care to ensure that the supported facilities are able to offer both safe normal deliveries and Caesarean Section deliveries safely. Minor theatre renovation will be made to ensure adequate preservation and security of installed equipment and improved theatre outlook. Medical Oxygen reticulation will be included to suit some of the targeted facilities. Twenty-five (25) health facilities have been selected for this support to complement other MoHCC initiatives. The project will also support (ii) the procurement of family planning commodities to complement the major contribution from MoHCC in line with the Family Planning Investment Compact.

This sub-component will support the revitalization and improvement of quality of services provided in the MWHs to increase the utilization of the MHWs to promote institutional deliveries by bringing pregnant women closer to health facilities. An assessment conducted in Zimbabwe in 2017 showed high utilization of the MWHs, which was also linked to high institutional deliveries. The study, however, identified quality of care for mothers admitted as a major gap. In line with the proffered recommendations, the Ministry developed guidelines setting the standards of operations and care provided in MWHs.  Support from the project will therefore include (i) refurbishment and minor renovations of existing MWHs based on the guidelines including establishment of nutrition gardens. (ii) training of service providers at MWHs in emergency obstetric and neonatal care (EmONC), adolescent (and youth) friendly service delivery and sensitization on the MWHs guidelines. For a more comprehensive approach, this component will also support orientation of Health Care workers on the Maternity Waiting Homes guidelines which developed in 2020. 

This sub-component of the project aims to improve the efficiency and effectiveness of the health system in Zimbabwe through use of digital technologies and innovations. To complement the integrated outreach model, the AF will finance the following activities: 

• Support decentralization of the Electronic Health Record (EHR) System implementation: This activity will involve supporting the decentralization of the EHR implementation to the 25 supported district hospitals. Some complementary activities will include:
• Development of an e-learning platform on training on the use of EHR would be a strategic investment to scale up capacity building for EHR use in a sustainable way: This sub-activity will involve the development of an e-learning platform to train health care workers on the use of the EHR system. The platform will provide training on how to use the EHR system effectively and efficiently.
• Develop SOPs and guidelines on EHR: This sub-activity will involve the development of Standard Operating Procedures (SOPs) and guidelines on the use of the EHR system. The SOPs and guidelines will provide a framework for the use of the EHR system and ensure that health care workers are using the system in a standardized manner.
• Installation of EHR in the 25 supported district hospitals: This sub-activity will involve the installation of the EHR system in the 25 supported district hospitals. The installation will be done using the equipment that has already been procured by the Government of Zimbabwe with support from partners.
• Capacitating health care workers in the 25 supported district hospitals on EHR: This sub-activity will involve the training of health care workers in the 25 supported district hospitals on the use of the EHR system. The training will be provided to ensure that health care workers are able to use the system effectively and efficiently.
• Development of the Costing and Electronic Maternal and Perinatal Death Notification System (eMPDNS) modules in the EHR. This costing module will allow for billing of services while eMPDNS module will enable health care workers to report on timely notification of maternal and perinatal deaths.
• Capacity building on blockchain technology within MOHCC, particularly of the internal technical team that works on health informatics, data analytics and M&E, including the EHR Team. This phase’s outcome will then guide the MOHCC and WB on the way forward regarding piloting and implementation of blockchain technology in the health sector. 
• Development and piloting of a Digitized Community Transport Dispatch System for emergency services. This innovation that is proposed to work as an “Uber” type of model to link women and children needing emergency services in the community with the nearest transport provider to transport them to the nearest health facility. Activities will entail undertaking a feasibility analysis, developing the system, enrolment of providers, and piloting in select sites.

Strengthening the MOHCC monitoring and evaluation system including implementation of an Artificial Intelligence driven Early Warning System on Health System Disruptions. The project will support operationalization of the health situation room system as a priority for data visualization from MoHCC Top management utilizing already existing infrastructure in MoHCC Top Management Offices and cover the gap where necessary. Leveraging an existing Early Warning System prototype developed in a previous collaboration between the Ministry and the World Bank, this activity will focus on implementation through use cases such as the Weekly Routine Monitoring System. Activities will include sensitization of health managers and training of a core technical team within MOHCC and at sub-national level, conducting integrated monitoring and supportive visit to supported districts and reviewing, printing and distribution of M&E tools including VHW registers and referral slips. The project will also support development of private sector reporting framework.