4 3 9 2 3 6

Maternity Waiting Homes

Operational Guidelines

MINISTRY OF HEALTH AND CHILD WELFARE

ZIMBABWE

World Health
unicef Organization
 Ministry of Health and Child Welfare Zimbabwe

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PNp

Maternity Waiting Homes

Operational Guidelines

World Health
unicef Organization
a

Maternity Waiting Homes Operational Guidelines

o
Government of Zimbabwe
Ministry of Health and Child Welfare
Harare, March 2010

Maternity Waiting Homes Operational Guidelines

 Ministry of Health and Child Welfare Zimbabwe
I

Table of Contents

Preface 2
Acknowledgements 4
CHAPTER ONE: Introduction 5
1.3 Why Develop MWHs guidelines? 6
1.4 Location of Maternity Waiting Homes 6
1.5 Siting of Maternity Waiting Homes: 6
1.6 Ideal Infrastructure: 6
1.7 Transport and Communication 7
1.8 At District Hospital Level 8
1.9 Human Resources 8
CHAPTER TWO: Admission Criteria 9
2.1 Prophylaxis Medications 9
2.2 Orientation of pregnant women 10
2.3 Services Offered at MWH 10
2.4 Early Signs of Labour 11

2.5 Nutrition in Pregnancy 11

CHAPTER THREE: Family And Community Participation 12

3.1 Family Roles 12

3.2 Community Roles 12

CHAPTER FOUR: Monitoring, Evaluation And Record Keeping 13

Annex 1: Contributors towards the Development of the Standard MWH Guidelines 19

List of Tables

Table 1: A proposed standard Maternity Waiting Home 7

Table 2: Maternity Waiting Homes log-frame 13

Table 3: Proposed Standard MWH 18

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 Ministry of Health and Child Welfare Zimbabwe

Preface
Maternal Mortality Ratio (MMR) is one of the important indicators for a country's health status, quality
and access to health care service delivery. The loss of a mother due to pregnancy or childbirth is a tragedy
for the family and the community as a whole. The recently published 2007/2008 Zimbabwe Maternal and
Perinatal Mortality Study (ZMPMS), conducted by the Ministry of Health and Child Welfare has
estimated the maternal mortality ratio at 725 deaths per 100,000 live births in Zimbabwe. This MMR is
one of the highest in the region and is unacceptably high. The international community and Zimbabwe in
particular, continue to address maternal and neonatal health challenges as reflected by several
international agreements adopted by most countries aimed at reducing maternal and neonatal mortality to
which Zimbabwe is also a signatory.

The Ministry of Health Child Welfare (MOHCW) has responded to the challenges through
implementation of several interventions aimed at improving access to maternal and neonatal health such
as development of the reproductive health policy, reproductive health service delivery guidelines and the
maternal and neonatal health road map. All these documents provide a framework for addressing the
three delays. The first delay is in making a decision to seek care, the second delay is in reaching a health
facility and the third delay is in receiving care. In a bid to strengthen efforts directed towards addressing
the second delay, the Ministry recently developed Maternity Waiting Homes (MWHs) Guidelines,
through a participatory and consultative approach, to facilitate their revitalization and standardization.
The overall objective of the guidelines is to provide service providers at all levels of care with key
information on standard operational procedures for the maternity waiting homes. The guidelines are
based on the most up to date information and can be used as reference during service delivery at facility
level.

Brigadier General (Dr) G. Gwinji

Secretary for Health and Child Welfare
March 2010

Maternity Waiting Homes Operational Guidelines

 Ministry of Health and Child Welfare Zimbabwe

Abbreviations
ANC Antenatal Care
AZT Zidovudine
BP Blood Pressure
EmONC Emergency Obstetric and Neonatal Care
FBC Full Blood Count
FCH Family and Child Health
FeSO4 Ferrous Sulphate
HIV Human Immuno-deficiency Virus
IPT Intermittent Preventive Treatment
MOHC W Ministry of Health and Child welfare
MWH Maternity Waiting Home
NVP Nevirapine
PITC Provider Initiated Testing and Counseling
PMTCT Prevention of Mother to Child Transmission of HIV
RDCs Rural District councils
RPR Rapid Plasma Reagent
TPR Temperature, Pulse, Respirations
TT Tetanus Toxoid
UN United Nations
UNFPA United Nations Population Fund
UNICEF United Nations Children's Fund
WHO World Health Organization
WT Weight

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 Ministry of Health and Child Welfare Zimbabwe

Acknowledgements
The Maternity Waiting Homes Operational Guidelines have been developed through the efforts of the
Ministry of Health and Child Welfare, Reproductive Health Unit, in collaboration with the United Nations
Population Fund (UNFPA), World Health Organization (WHO) and the United Nations Children's Fund
(UNICEF). Financial support was provided by the Japanese Embassy. The content of the National
Maternity Waiting Homes' Guidelines was developed through a consultative process that involved
experts from the Ministry of Health and UN partners. The Ministry also acknowledges the dedicated
service and hard work of all health workers at all levels of service delivery.

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 Ministry of Health and Child Welfare Zimbabwe

CHAPTER ONE: Introduction

LI Introduction

A Maternity Waiting Home (MWH) is a facility, within easy reach of a hospital or health centre where a
pregnant woman can stay towards the end of pregnancy and await labour. Once labour starts, women are
transferred to the health facility so that labour and child birth are assisted by a skilled birth attendant. The
MWHs also provide an opportunity for a pregnant woman to receive health promotion on pregnancy,
information on danger signs of pregnancy, labour and childbirth including new born care.

The aim of the MWH is to improve access to health institutions, skilled and emergency care to reduce
morbidity and mortality for mother and neonate should complications arise. The MWHs should be made
an integral component of the maternity ward of the main health facility where clinical and supervisory
services are available on a 24 hour basis. Clear operational linkages should be outlined covering a range of
services offered at MWHs and transfer of patients to the labour ward.

1.2 Rationale for Maternity Waiting Home (MWH)

The maternity waiting home provides a setting where high risk women can be accommodated during the
final weeks of their pregnancy near a hospital with essential obstetric facilities. The maternity waiting
home facilitates reduction in maternal and neonatal mortality and improved maternal and neonatal
outcomes by fast tracking women to emergency care should complications arise.

Key points about MWH:

• The concept of maternity waiting home does not require high technology;
• It relies mostly on human resources already present.
• It can serve as a practical way to meet the needs of a pregnant woman
• MWH are not merely physical structures and cannot function in a vacuum:

- Rather they aie alinkin alarger chain of comprehensive maternity care, a\\the
components of which mustbe available and of sufficient quality to be effective and
linked with the home.
- A maternity waiting home is not a standalone intervention, but rather serves to link
Communities with the health system in a continuum of care.

Maternal and neonatal mortality can be reduced if timely and adequate obstetric care is
Available when complications occur.
•• The level of success in reducing maternal and neonatal mortality will depend on the following
Factors:

Definition of risk factors and selection of a pregnant woman for the MWHs.
- Availability of health workers skilled in obstetric and neonatal care services
- (Including capacity to handle obstetric and neonatal emergencies)
- Availability of a viable communication and transport system for referrals and women's
compliance With the referral.
Community and family support available.

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 Ministry of Health and Child Welfare Zimbabwe

1.3 Why Develop MWHs guidelines?

The overall objective of the MWHs guidelines is to provide service providers at all levels of care with key
information on standard operational procedures for the maternity waiting homes. The guidelines are
based on the most up to date information and can be used as reference during service delivery at facility
level. The service providers will be oriented in the use of the guidelines.

1.4 Location of Maternity Waiting Homes

The maternity waiting home should be located in health facilities which can provide basic and emergency
obstetric and neonatal care with functional transport and communication systems to link with the next
level of care. The health facility should be managed by skilled health personnel especially midwives who
are able to identify complications during pregnancy, labour and the immediate post partum period and
treat and or refer promptly. The health facility should also be equipped with essential commodities and
equipment for basic and emergency obstetric and neonatal care.

1.5 Siting of Maternity Waiting Homes:

The maternity waiting home should be situated at a site which is easily accessible to the labor ward 24
hours a day. Ideally it should be part of the hospital or within 100 metres from the labour ward where it is
possible to use either a wheel chair or a stretcher to transfer the woman when labour begins.

1.6 Ideal Infrastructure:

An ideal maternity waiting home should be a structure with basic requirements for the pregnant woman
and it should be linked to a hospital with basic obstetric and neonatal care. It should be conducive to attract
at risk woman to come and stay at the home in an effort to mitigate the second delay. A MWH offers a low
cost way to bring a pregnant woman closer to needed obstetric and neonatal care. It is a strategy to bridge
the geographical gap in obstetric and neonatal care for the rural woman with poor access to equipped
facilities. The basic requirements for the MWHs will include the following components as outlined
below:

• Sleep ing rooms:

The sleeping rooms should provide comfortable sleeping conditions, safety for the pregnant
woman and their belonging including good lighting. The ideal sleeping rooms should consist
of the following;
- 4 bedded rooms (e.g. 3m X 4m)
- Minimum of 24 beds (6 rooms) at district level
Minimum of 8 beds (2 rooms) at clinic level.

• Kitchen:

- Heavy duty stove at district level

- Dover stove for firewood
- Kitchen cupboards which are lockable (preferably steel)
- Pantry (Storeroom): Walk-in lockable pantry with shelves
- Kitchen sink.

Bathroom

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 Ministry of Health and Child Welfare Zimbabwe

Table 1: Proposed Requirements for a Standard Maternity Waiting Home

Area Items Numbers

Sinks 4
Laundry area Washing lines 4 x 4 strands x 5 meters
Ironing slabs 5
Electric iron 1
Charcoal iron 1
TV set 1
Recreational room Radio set 1
Easy chairs 24
Coffee table 3
Beds 4/room
Lockers 4 (Lockable) /room
Bedrooms Fitted wardrobes 4/room
Kitchen/ Tables 5
Dining Room Chairs 6 per table
Walk- in Pantry Shelved pantry
Bathrooms Hand washing basins

Sundries Gloves
Delivery Pack 1
Transport & Equipment Stretcher 1
Wheel chairs 1
Bell system for rooms 1
Blankets 3/bed
Counter pens 2/bed
Pillows covered with 2/bed
polythene plastic
Mattresses covered with 4/room
polythene plastic
Lockable gate
Security Security fence

L7 Transport and Communication

Transport and communication play a major role in reducing maternal and perinatal mortality (MDGs 4
and 5). It is important to have a viable transport and communication system in place at all facilities with
maternity waiting homes. Primary level health facilities with maternity waiting homes should have:

• A functional telephone, radio or cell phone to facilitate communication in emergencies

• A working motor-bike/bicycle for health worker to use to go to the nearest phone to
communicate with the referral centre.

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1.8 At District Hospital Level

There should be a functional telephone, radio and cell phone, for effective communication with referring
health centre and the next referral centre in case of obstetrical and neonata reducing Emergencies. This
will assist in reducing delay in reaching the next level of care thereby maternal and neonatal mortality.

• A telephone extension in MWH from labour ward or a drum or bell should be in place for easy
• communication with maternity ward in case of emergency.
• There should be functional ambulances equipped for resuscitation so as to minimize loss of
life during transfer should complications arise.

/. 9 Human Resources
Human resources are a critical component that determines the capacity of MWHs to provide services.
Presence of trained personnel at the MWH will greatly facilitate appropriate and timely transfer of a
woman in labour to labour ward or referral hospital. Trained staff in FCH has a responsibility over the
MWH on a 24 hour basis and all staff members to report to the Sister in Charge of the maternity ward. In
addition to trained staff, the following are the recommended additional staff required for efficient running
of the MWH:

• A cleaner is necessary for the maintenance of the maternity waiting home

• A nurse aide is required and her function will be to facilitate prompt transfer of a woman to the
maternity ward when labour begins.
• The security guard is needed to provide security for pregnant woman during her stay in the
Maternity waiting home.

•:.=.

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 Ministry of Health and Child Welfare Zimbabwe

CHAPTER TWO: Admission Criteria

The concept of MWHs has been based on the premise that it is possible to identify pregnancies likely to
develop complications and need skilled obstetric care. With experience, however, it has become clear
that the "risk approach" may not be able to deal adequately with the issue of identification. Many obstetric
complications are unpredictable and most complications which do occur are among women with no
apparent risk factors. The success of using the risk approach depends on two factors; the correct
identification of risk factors, and the ability of the health system to provide care to the women so
identified. Identifying and caring for women with relatively common risk factors will have a positive
impact on the health of the whole community, especially if the factor is strongly associated with mortality
and morbidity.

It is important to have admission criteria to guide staff in the maternity waiting homes as to how, when,
and why pregnant women should be admitted. Identifiable conditions predictive of complications include
poor obstetric history (for example previous stillbirths, operative deliveries), high parity, age (extremes of
youth or old age), short stature, malnutrition, anaemia, high blood pressure, malpresentation, multiple
pregnancy. Other factors might include distance and transportation to health facilities and other socio-
economic and cultural conditions such as religious beliefs. A crucial element for identification of a high
risk woman should involve accurate history taking (both medical and socioeconomic), together with
symptomatic assessment.

When to Admit: The pregnant woman is expected to be admitted to MWH at 36 weeks of gestation.

Admission Process: When admitting a pregnant woman in the maternity waiting home the following
procedure should be;

During the Day: The pregnant woman is admitted to MWH through Family Child Health
department. In the Family and Child Health (FCH) department the following is
Done:

Registration
Vital observations, i.e. BP; WT, TPR, abdominal palpation, fetal heart check, urinalysis
Check if blood investigations were done, i.e. RPR, FBC, grouping and rhesus factor,
HIV test, CD4 if HIV positive
If not done, arrange for the test.

2.1 Prophylaxis Medications

Check whether the woman has received the following

FeSO4 and folic acid
Tetanus Toxoid (TT)
Intermittent Preventive Treatment (IPT)
NVP and AZT if HIV positive (If not taking, commence on treatment)
Check if on any other medications. If'yes', counsel for adherence
Assess if in labour. If in labour refer to maternity ward.
Refer to MWH if not in labour

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During the Night: The pregnant woman is admitted through maternity ward and the same procedure
as for FCH is followed. The woman should be escorted to MWH by staff on duty.

2.2 Orientation of pregnant women

Once admitted in the MWH, orient the pregnant woman on the following:
- Bathroom facilities,
- Kitchen,
- Dining,
- Sleeping rooms,
Recreational facilities.

Health Promotion on Admission:

Discuss the following danger warning signs like reduced fetal movements, early rapture of membranes,
ante-partum hemorrhage and headache, signs of true labor or illness and importance of early reporting to a
health facility when labour starts.

Expectations from the pregnant woman:

For the convenience of the pregnant woman during her stay in the MWH and the comfort of the expected
baby the pregnant woman is expected to bring;

- Layette
- Food
- Toiletries
- Assist in keeping the MWHs clean
- Maintain good personal hygiene
- Attend health promotion talks as stipulated
- Attend ANC on stipulated dates
- Any other duties as prescribed by in-charge.
- Be responsible for all movable assets in the MWH.

2.3 Services Offered Whilst at MWH

The overall goal of MWH is to have a healthy mother and baby after delivery. Therefore the
Following services should be offered to pregnant women during their stay in the MWH.

Health Services

Although most clinical services are offered in the FCH department, the in-charge of the MWH should
ensure that pregnant women have access to the following services as per guidelines:

- Admitting and screening pregnant women

- Monitoring fetal heart on admission and daily
- Orienting/familiarizing pregnant women on the maternity waiting home and maternity
ward
Giving information to clients on the ground rules of the home Counseling Services
These are an ongoing exercise from the time the health service providers get in contact with the pregnant
woman so as to create a good rapport.

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 Ministry of Health and Child Welfare Zimbabwe

Health Promotion Services

Health promotion should take into account the different needs of the pregnant woman. The health
assessment performed on admission guides the specific needs for health information. Some of the health
promotion issues covered are summarized below:

Danger warning signs in pregnancy

Labour process
Importance of personal hygiene in pregnancy
Importance of breastfeeding
Importance of good nutrition in pregnancy
Baby care
Immunization
Family planning
- STIs, HIV and AIDS
Malaria in pregnancy and importance of prophylaxis
Importance of antenatal exercises in pregnancy

2.4 Early Signs of Labour

As the due date approaches, many women do worry about how they will recognize the early to
signs of labour. The pregnant women need to know when to report labour when it occurs. The
women are report to the labour ward if they experience any of the following symptoms:

The waters may break, which may be a slow steady trickle or a gush and should be clear
The woman may experience a show which is a mucus plug from the cervix that has
been helping protect against any infections entering the uterus
Contractions may start and these will increase in duration and intensity as labour
progresses.
Contractions may be accompanied by a radiating pain which may include pain in the
back.

2.5 Nutrition in Pregnancy

Adequate nutrition to a pregnant woman is essential for growth and development of both
mother and baby. Three balanced meals per day are ideal, hence the need for the health
institution to provide meals to pregnant women staying in the MWH. The advice on the
balanced diet should take into account locally available foods. In case the health facility fails
to provide meals, pregnant women can bring the following items from their homes:
I Carbohydrates - mealie-meal, sweet potatoes, madumbe, wheat, rice, samp, mangayi,
bread, sugar.
Protein - meat, nyemba, beans, fish, nuts, macimbi, ishwa, majuru, mice, eggs, peanut
butter (dovi), milk.
Vitamins - green leafy and dried vegetables, carrots, peas, all types of fruits, tomatoes,
Pumpkin.
Fats - avocado pears, vegetable cooking oil, margarine.
Salts - iodized salt

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CHAPTER THREE: Family And Community Participation

The family and community play a vital role in the outcome of pregnancy. It is the responsibility of the
family and the community to ensure that a pregnant woman accesses skilled attendance at delivery,
therefore they should support the pregnant women staying in the MWH. There is also need for advocacy
and communication on the importance of MWHs and the need for the community to support them.

3.1 Family Roles

Members of the family are not expected to come and stay in the WMHs. They should work with the
woman to develop a delivery plan. If pregnant women need to go to MWHs the family should provide:

• Adequate money for transport to the MWH

• Support the upkeep of the pregnant woman whilst in the maternity waiting home
• Provide money for any other expenses that may be required
• Visit regularly as prescribed by the MWH
• Take care of the other children at home if any.

3.2 Community Roles

The death of a mother and her baby is not only a loss to her family but to the entire community in general.
Therefore, there is need for the community to support the MWHs in their area. Communities need to
Encourage pregnant women to utilize the MWHs especially those staying far away from health facilities.
The existing community health committees should work with the community to:-

Encourage pregnant women to utilize MWHs

• Assist in the building and maintenance of the MWH infrastructure
• Support the functioning of the MWH - mobilize communities to bring firewood, water, slash
• grass
• Mobilize resources for the MWH, e.g. firewood, transport and food
• Hold regular meetings with the health facility staff and the community, for continuous
Improvement Mobilize funds for vehicle hire in case there are complications at RHC level
where pregnant women need transfer.
Village Health Workers to encourage pregnant women to utilize MWH.

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 Ministry of Health and Child Welfare Zimbabwe

CHAPTER FOUR: Monitoring, Evaluation And Record Keeping

4.1 Planning, Monitoring and Evaluation Framework for the Maternity Waiting
Homes

The Maternity Waiting Homes (MWH) aim to contribute to the reduction of maternal and newborn
morbidity and mortality by increasing access to clean and safe delivery among pregnant women at risk of
I complications. Such women including those staying far from health facilities are admitted into maternity
waiting homes to facilitate easy access to maternity services. This is ultimately expected to contribute to
better pregnancy outcomes-healthy mothers and babies.

In order to clearly and operationally link the above results with resource inputs for the MWH, a baseline
appraisal should be carried out to establish the status of key output and outcome indicators outlined in the
log frame. Once the baseline status is established, a mechanism should be put in place to systematically
collect data for monitoring and evaluation using an agreed set of indicators. Trends in access and
utilization of MWH services have to be analyzed and report on a regular basis to provide information for
decision making as well as for improving the maternity waiting homes.

Table 2: Monitoring & Evaluation Log-frame For Maternity Waiting Homes

Intervention logic Indicator Means of Risk and

verification assumption
Goal To improve maternal -Maternal mortality -Demographic
and neonatal health in rate health survey
Zimbabwe (DHS)
-Infant mortality rate
-Census
Outcome Access to skilled -% births by skilled -DHS Ongoing
attendance at delivery attendant initiatives
improved nationwide -Census addressing 1 st
-% institutional and z,2nd
diiu
deliveries -Routine health
information Delays
system continue
Output 1 .Improved knowledge -Knowledge level on -Assessment Health
/Result on MWHs in targeted MWHs reports executives
districts commit to
-Coverage of MWHs -Survey reports MWHs
2. Increased availability in terms of number of strategy
and utilization of pregnant women - Routine health
MWHs nationwide accessing services information
system

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 Ministry of Health and Child Welfare Zimbabwe

4.2 Check list for theMWHs

Province: District:

Health Facility: Name of supervisor:

Date of visit: . Staff present:

1. Staff establishment: On Duty at Time of Visit:

2. Annual expected deliveries of facility catchment:

3. Number of deliveries from the MWH in the past 3 months
4. Bed Capacity of the MWH:
5. How many pregnant women are currently admitted?

6. How much do they pay for services offered?

7. Is there any transfer policy?
8. What communication is available?

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 Ministry of Health and Child Welfare Zimbabwe

Table 3: Proposed Standard MWH

Key Result Area Items Available Comments

Yes No

- General cleanliness
Security fence
Infrastructure Availability of water supply

Sanitation & water

Lighting system
Waste disposal

Beds
Equipment Wheel chair
Stretchers
Cleaning material

Admission criteria Any admission policy available

ANC
Services on offer PMTCT
PITC
Health promotion on:

Baby care
Immunizations
Risk factors
Exercises
Place of delivery
Breast feeding and
nutrition
Family planning
Birth Preparedness

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Key Result Area Items Available Comments

Yes No
Fetal Kick Charts
Laundry services Irons
Refrigerator
Kitchen Stoves: Dover
Electric
Nutrition Nutrition garden
Last support visit Day Month Year
Support & By whom?
Supervision
DHE
PHE
RDC
Mission Authority
SIC

Family Role

Community Role

General Comments

Action Taken

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Recommendation

Signatures:

4.4 Supervision

The following supervisors should visit the MWH as follows:-

SIC - FCH Daily

SNO III Weekly
CHS Monthly
DNO Quarterly
PNO Annually/biannually (twice every year)
DHE Quarterly

The frequency of the visits can be increased if there is need.

4.5 Records and Record keeping

Records are legal documents which should be kept safely. Documentation should be legible, clear and
precise. It should be accessible to health workers authorized to use the data. Information collected
should be relevant and adequate. Data should be analyzed and utilized at all levels to ensure provision
of quality services to the pregnant women at the MWH.

4.6 Registers

MWH register

The MWH register can be used for roll call. (See attached form)

Inventory register

Each room should have a room loading inventory sheet that includes all movable assets in that room.
Inventory should be conducted weekly due to high turnover. Spot checks need to be carried out
periodically.

Support and Supervision Register

Every health worker who supports and supervises the MWH, is supposed to record findings and make
recommendations.

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•
Health Promotion Register

Record all health promotion activities held for women at the MWH.

Visitors (Log) Book

All officials who visit the MWH should comment and sign in the visitors' book.

Matron's Report Book

Number of waiting pregnant women transferred to maternity, new admissions to be recorded in the
matron's report book.
The above identified registers should be kept in MWH in a safe place (cupboard).

4.7 Maternity Waiting Home Register (Format/Outline)

Serial Number
ANC Number
Date of Admission
Name
Address - Village, Chief, School, Ward
Age
Religion
Parity
Gravida
LMP
EDD
Gestation
Planned mode of delivery
Date of transfer (from MWH)

Outcome:

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Annex 1: Contributors towards the Development of the Standard MWH

Guidelines
Ministry of Health and Child Welfare, Zimbabwe
Ms Margaret Nyandoro, Deputy Director, Reproductive Health
Mr. Aveneni Mangombe, Adolescent Sexual and Reproductive Health Officer
Mr. Kenneth Dodzo, Sexual and Reproductive Health Officer

United Nations Population Fund (UNFPA)

Dr. Hillary Chiguvare, National Program Officer - Reproductive Health
Mrs. Agnes Makoni, National Program Officer - Emergency Obstetric Care
Mr. Sydney Nhamo, National Program Officer - Monitoring and Evaluation
Mrs. Tamisayi Chinhengo, National Program Officer -Adolescent Sexual and Reproductive Health

World Health Organization (WHO)

Dr. Trevor Kanyowa, National Program Officer - Child and Adolescent health

United Nations Children's Fund (UNICEF)

Mrs. Shelly Chitsungo, Health Specialist, Maternal and Neonatal Health

Other People Consulted:

Name Province District/Institution Designation

E. S. Tshuma MatabelelandNorth Malabeleland North Provincial Nursing Officer
B. Sibanda MatabelelandNorth Tsholotsho District District Nursing Officer
L. 0. Nqwababa MatabelelandNorth Tsholotsho Hospital Matron
B. Chikukwa Manicaland Manicaland Provincial Nursing Officer
C. Mundoringisa Manicaland Mutambara Mission Matron
S. Sifovo Manicaland Chimanimani District District Nursing Officer
F. Kahungwa MashonalandWest St Michaels Mission Matron
R .T. Banda MashonalandWest Kadoma District District Nursing Officer
C- Zvamashakwe Mashonaland Central Mashonaland Central Provincial Nursing Officer

R. Mushaninga Mashonaland Central St Alberts Mission A/ Matron

T. Madyauta Masvingo Zaka District Provincial Nursing Officer
C. Duro Masvingo Musiso Mission A/ Matron
C-K- Chigodo Masvingo Masvingo A/ Provincial Nursing Officer

E. Takura MashonalandEast Sadza District A/ District Nursing Officer

T. D- Guwa Mashonaland East Mashonaland East AJ Provincial Nursing Officer

T. Mutuva Mashonaland East Sadza District Hospital A/ Matron
A. Ndlovu Matabeleland South Filabusi Hospital District Nursing Officer
J. Sibanda Matabeleland South Matabeleland South Provincial Nursing Officer
C. Samson Matabeleland South Filabusi Hospital AJ Matron
J. Marembo Midlands Midlands Provincial Nursing Officer
D' T' Matiyenga Midlands Gokwe South District DistrictNursing Officer

..'"'

Maternity Waiting Homes Operational Guidelines