Strengthening maternal health systems: The role of MomCare in advancing universal healthcare
By Jonia Bwakea
Development is more than the expansion of infrastructure or the growth of economies. It is the transformation of human lives, ensuring that essential needs such as health, education, and dignity are within reach for all.
Among these, health stands out as a truly fundamental element. It is the foundation upon which every other aspect of human potential is built.
If sustainable development is to be realised, safeguarding health, especially maternal health, must be a central priority. A nation can only thrive when its people, particularly mothers and children, are healthy, protected, and able to reach their full potential.
The health of mothers reflects the health of the nation. Ensuring that every woman can experience pregnancy and childbirth safely is both a moral responsibility and a strategic investment in national development.
In Zanzibar, the push for stronger maternal healthcare reflects this understanding. Ensuring that every pregnant woman can access quality care, regardless of socioeconomic background, is not only a moral imperative but also a strategic investment in human capital.
A nation’s capacity to prosper depends heavily on the well-being of its people, and only healthy individuals can contribute meaningfully to national growth.
Notably, Zanzibar has made significant progress in maternal health, with 98.9% of pregnant women attending at least one antenatal care (ANC) visit and 79.4% completing four or more visits. Despite these gains, maternal and neonatal mortalities remain high, with neonatal mortality at 42 per 1,000 live births (TDHS 2022).
This highlights the fact that it is not only about ANC visits, but also the quality of each visit. Many women still fail to initiate care early in pregnancy, and financial barriers, gaps in service quality, and fragmented health services continue to pose significant challenges, particularly for economically disadvantaged populations. Persistent inequities disproportionately affect the most vulnerable. Notably, 26% of Zanzibar’s population is classified as destitute.
These realities highlight the urgent need for innovative, targeted approaches that improve access, accountability, and the overall quality of maternal health care.
To address these gaps, the Zanzibar Ministry of Health, in collaboration with PharmAccess and the Zanzibar Health Services Fund (ZHSF), launched the demonstration project, branded as the ZHSF Mothers.
This maternal project adopts the MomCare model leverages digital platforms, smart subsidies, and public-private collaboration to improve pregnancy outcomes for low-income and high-risk women. The project integrates with the government’s Health Equity Fund (HEF), ensuring co-financed maternal care insurance for the poorest women while promoting equitable access to quality maternal health services.
The ZHSF mothers Project implements a digital demand-side financing model, shifting the focus from (supply based) funding health facilities to directly empowering women. Eligible pregnant women receive maternal care insurance package that is digitally tracked, enabling them to access timely, high-quality maternal services while ensuring accountability and efficient use of resources.
By complementing Zanzibar’s traditional supply-side approach, this demand-side model incentivizes quality care, integrates real-time monitoring, and promotes greater equity in maternal health outcomes.
The initiative ensure seamless data flow within government-owned digital systems, including the Zanzibar Electronic Medical Records (ZanEMR), the ZHSF Claims Portal, and the Matibabu Information System, to ensure transparency, real-time tracking and monitoring, and efficient resource utilization.
By providing timely data on service use, the system supports prompt clinical interventions, making maternal care more proactive, responsive, and patient-centred.
The project directly aims to improve maternal and neonatal outcomes by promoting early and frequent ANC visits, skilled deliveries, and postnatal care. With the adequate financing, the project also ensures quality ANC visits as women receives all interventions as per the national maternal care guideline.
It is expected that, at the end of demonstration period, the number of early ANC bookings (within 12 weeks) will reach 40%, compared with the existing 16% and skilled delivery will reach 95% of all deliveries.
To date, over 2,300 pregnant women have benefited from the project, gaining access to comprehensive maternal and child health services across 25 healthcare facilities located at Kaskazini B and Micheweni districts in Unguja and Pemba respectively.
Enrolled women have the flexibility to choose where and when to access services, as ability to pay is no longer a barrier and their health information are available at all facilities.
The project also promotes a quality-driven approach to service delivery. Health facilities are incentivized to provide high-quality care, as patient choice and utilization directly influence facility revenue, which is subsequently reinvested to enhance services.
Although still in its early stages, MomCare demonstrates how digital health financing, targeted subsidies, and value-based care can be integrated within government systems without creating parallel infrastructure.
The model aligns with the WHO Digital Health Strategy (2020–2025), emphasizing user-centered design, data-driven decision-making, and sustainability. It also contributes to SDGs 3 and 5 by improving maternal health access for disadvantaged women in resource-limited settings.
The path forward is clear: with collective effort, sustained investment, and unwavering commitment, Zanzibar can build a maternal health system that leaves no mother behind. MomCare offers the blueprint—now it is up to all stakeholders to bring this blueprint to life and make it a lasting reality.
Jonia Bwakea is the Program Manager for Zanzibar Health Services Fund (ZHSF) Mothers’ Project
