Zanzibar’s efforts to reduce maternal deaths are increasingly shifting from the question of how much money is available to how health financing is structured, targeted and tracked.
Health experts have called for a sustainable financing pathway for poor and high-risk pregnant women, arguing that predictable funding, combined with digitally integrated care, could help close gaps that often emerge between pregnancy, delivery and postnatal services.
The issue was raised during a panel discussion on “No Mother Left Behind: Financing and Digitally Integrated Care for Poor and High-Risk Pregnant Women” at the 13th Tanzania Health Summit in Dar es Salaam.
The discussion drew on early evidence from the Zanzibar Health Services Fund (ZHSF) Mothers Care demonstration model, which is testing how targeted financing and digital tracking can improve access to maternal healthcare.
The central challenge, however, is whether such interventions can move from demonstration projects into a financing system that remains functional after individual projects or external support end.
World Health Organisation (WHO) Health Financing Expert Regina Ndakidemi said the government needed to establish a clear route for incorporating vulnerable groups into its health financing architecture.
Without such a pathway, she said, successful projects risk operating separately from the wider health system, making their long-term financing and expansion more difficult.
“If we have a clear path, projects like this one can be well embedded in our path because the government will come and say these are my priorities and within this path I will reduce maternal deaths,” Ms Ndakidemi said.
The financing issue matters because poor and high-risk mothers generally require more intensive care. Conditions such as pre-eclampsia, anaemia and previous Caesarean sections can increase the need for monitoring and timely intervention.
PharmAccess Zanzibar Interim Programme Director Jonia Bwakea said the response should therefore move beyond general healthcare financing towards a package specifically designed around the needs of mothers throughout the care cycle.
“Having a customised maternal care package covering the maternal care journey will help in meeting pregnant women’s needs well,” Ms Swakea said.
Her argument also highlights a weakness that can arise when maternal services are fragmented. A woman may receive antenatal care but still face difficulties accessing delivery or postnatal services, particularly when the system lacks mechanisms to track whether she has completed the next stage of care.
Digital systems could help close that gap by allowing health authorities and providers to identify mothers who miss appointments, monitor high-risk pregnancies and detect weaknesses in service delivery earlier.
That would make digital technology more than an administrative tool. Properly integrated, it could become part of the system used to decide where resources are needed and which mothers require immediate attention.
Sanofi Health Unit Medical Doctor-Global Lead Joseph Muga, however, warned against assuming that additional money alone would solve maternal healthcare challenges.
“Finances are not the only problem. We need to get our minds away from thinking that we do not have money, therefore we cannot do anything,” Dr Muga said.
His argument shifts attention towards efficiency. Reducing wastage, preventing medicine stock-outs, improving planning and making better use of health data could release capacity within the existing system even before new funding is secured.
This is particularly relevant as governments face competing demands for limited public resources. A financing model that increases spending without improving targeting, monitoring and accountability may not necessarily produce better outcomes.
Ministry of Health Zanzibar IRCH Programme Manager Kamilya Ali Omar said the Mothers Care initiative was designed to address these gaps through innovative financing, digital tracking, partnerships and health-system strengthening.
Jointly financed by PharmAccess and the Ministry of Health Zanzibar, the project began in May 2024 and targets 5,000 pregnant women from poor households over two years.
The programme also covers women considered at high risk because of conditions including pre-eclampsia, previous Caesarean sections, anaemia and other obstetric complications.
The significance of the model lies in whether it can demonstrate that targeted financing and digital monitoring produce better continuity of care for women who face the greatest risks.
If incorporated into the wider health financing architecture, such an approach could also provide a framework for identifying vulnerable patients before their conditions become emergencies.
The discussions come as the government strengthens monitoring of healthcare delivery, with greater emphasis on identifying service gaps early and improving frontline supervision.
The three-day Tanzania Health Summit, which ended yesterday, was held under the theme “Building Health Sovereignty and Strengthening Health Systems in a Changing Global Order.” It brought together more than 2,000 participants from over 350 institutions.
For Zanzibar, the broader policy question is no longer simply whether vulnerable mothers should receive additional support. It is whether the health system can finance, identify and follow those women consistently enough to ensure that support reaches them when it matters most.