Supplementary written evidence submitted
by the Department for International Development
MARCH 2010
1. DFID PROGRAMME
OVERVIEW
Basic Services
Behaviour Change Communications £22 million
over 5 years
DFID's consistent support to HIV and AIDS prevention
programme over the last decade has helped contribute to the decline
in the numbers of people living with AIDS. However at 13.7%, the
HIV prevalence rate remains high. DFID is providing £22 million
to a five year behaviour change programme co-funded with USAID.
This funding enables Population Services International (PSI) to
develop communication campaigns to address issues such as HIV
related stigma and multiple partnerships, as well as increasing
HIV prevention services, availability of socially marketed male
and female condoms and a network of testing and counselling centres.
Expanded Support Programme for HIV and AIDS in Zimbabwe
(ESP) £35 million over 5 years
DFID is providing £35 million over five
years for HIV and AIDS prevention, care and treatment. This is
a multi-donor common funding mechanism that supports the National
Strategy for HIV and AIDS, relies on UN agencies for implementation,
and is managed by a working group made up of government, donors,
UN agencies and civil society. In 2009, the ESP provided ARVs
for 58,000 people. Other donors contributing to the ESP are Canada,
Sweden, Ireland and Norway.
Health Worker Retention Scheme £1.9 million
over 2 years in addition to $4.1 million through the ESP
This programme is delivered through Crown Agents
and supports basic retention payments for health workers. DFID
initiated this programme in December 2008 in the worst cholera
affected areas with a $1 million contribution that paid US$ allowances
to nurses and other essential health workers enabling them to
get back to their clinics. The scheme helped result in the number
of health workers increasing from under 10,000 in December 2008
to over 26,000 by February 2009. DFID provided an additional £1.335
million in August 2009 with the money channelled through the ESP
programme (above). Other donors (UNICEF, UNFPA, EC, and Australia
and Denmark) also contribute to the scheme that as of October
2009 was adopted by the Global Fund.
Maternal and Newborn Programme £25 million
over 5 years
This programme aims to protect the lives of
mothers and newborns, especially those affected by HIV and AIDS. It aims
to maintain access to family planning services, including contraceptives
and to support access to life saving antenatal, obstetric, and
newborn care services. DFID supports the Ministry of Health and
Child Welfare priorities by funding implementing partners to implement
activities to reduce maternal and infant morbidity and mortality.
The funding goes through partners such as Crown agents, and NGOs.
The programme is built on a strong evidence base. The programme
includes subgrants to EGPAF who support national efforts to prevent
of mother to child HIV transmission and to Zvitambo who are supporting
nutritional interventions for pregnant women and children under
2 years. In addition DFID spends more than £2 million
annually on the procurement of reproductive health contraceptives
through Crown Agents Zimbabwe who work with the Zimbabwe National
Family Council (ZNFPC) and JSI Deliver in the distribution of
these commodities to all public sector service delivery points
around the country.
Support to Orphans and Vulnerable Children £22
million over 5 years
Zimbabwe has the highest proportion of children
orphaned by AIDS in the world. Over 25% of all children have lost
one or both parents. DFID together with the European Commission,
Australia, Germany, Sweden, the Netherlands and New Zealand EC
will give $85 million in support that will be managed by UNICEF
to implement the National Plan of Action in Zimbabwe. DFID's £22
million contribution over 5 years (2006-2010) represents over
40% of the total multi-donor basket. This supports orphans and
vulnerable children across the country including support to keep
children in school and to provide protection from all forms of
abuse. Civil society organisations implement the programme. As
of July 2009, a total of 353,400 children have benefited from
the programme. The programme aims to reach 1.5 million children
next year with school fees support.
Emergency Vital Medicines Support Programme £16.5
million over 3 years
DFID has provided £16.5 million to UNICEF
for the procurement and distribution of essential drug supplies
in Zimbabwe. This programme will ensure that all health facilities
across all districts in Zimbabwe will be stocked with the most
essential medicines and supplies. The programme will help meet
national health policy goals with particular focus on the needs
of children under five years, women, and the prevention and treatment
of transmissible diseases. ECHO (EC), Canada, Ireland, Australia
and the Netherlands are also contributing to this programme.
Emergency Malaria Spraying Campaign £0.75
million over 2 years
Malaria is endemic in eight rural provinces
Zimbabwe and occurs in 45 districts out of 62. It is the third
leading cause of morbidity and mortality in Zimbabwe after HIV
and AIDS and tuberculosis with over two million people suffering
from this preventable disease annually. The most vulnerable are
under-fives, pregnant women, the elderly and people living with
HIV and AIDS. DFID is providing £0.5 million for the procurement
of indoor residual sprays in 2009-10, building on last year's
contribution of £0.25 million. This is a short-term intervention,
implemented by Crown Agents.
Education £1 million over 1 year
By early 2009, the education sector in Zimbabwe
was in a crisis. The sector suffered particularly from high staff
attrition and teachers' salaries were insufficient. The number
of teachers dropped from about 120,000 to less than 60,000. On
top of this, education was severely disrupted for much of 2008
because of political violence. In the summer of 2009, DFID Zimbabwe
along with other donors agreed a new level of involvement in the
education sector. We are spending £1 million in 2009-10 to
provide technical advice and seed funding to a pooled financing
mechanism called the Transitional Education Fund (TEF) managed
by UNICEF. The fund's objectives are to support procurement of
education commodities (textbooks, exercise books, classroom furniture,
etc) and technical assistance and to provide funding for a strong
education technical expert based within the EC to guide, influence
and inform policy developments. This support for textbooks and
other learning materials compliments DFID Zimbabwe's support through
the OVC programme of support that provides assistance for OVCs
to access education. DFID Zimbabwe is currently preparing a larger
multi-year education programme.
Livelihoods
Protracted Relief Programme Phase II £54.8
million over 5 years
The DFID funded Protracted Relief Programme
Phase II (PRPII) assists the poorest and most vulnerable households
suffering from the effects of erratic weather, economic decline
and the HIV and AIDS epidemic. Its main objectives are to improve
the food security of the poorest through production and income-generating
activities, to improve access to water and sanitation, and
to provide social protection and care to the most
vulnerable such as the chronically ill. The programme is
reaching over two million poor and vulnerable people.
DFID has engaged a management consultant (GRM) for the co-ordination
and management of the programme which is delivered through 27
technical and implementing partners. The PRP has now become a
multi-donor funded project, with several donors funding through
DFID or directly through GRM. These donors are Australia, Denmark,
Norway, Netherlands, the European Commission and World Bank who
together will contribute at least £24 million over the lifetime
of the programme in addition to DFID's contribution. This positive
development has expanded the capacity of the PRP partners to reach
and support vulnerable communities and increase the number of
beneficiaries.
Humanitarian
Emergency Food Aid £4 million for 1 year
Food availability in 2009-10 has greatly improved
from last year following a good harvest, an end to the Grain Marketing
Board monopoly on importing cereals, dollarisation of the economy
and availability of donor-funded agricultural inputs (such as
through the PRPII). Nonetheless, hundreds of thousands remain
food insecure. In November 2009, DFID Zimbabwe contributed £4
million to help the World Food Programme (WFP) feed the most vulnerable
through the leanest time of year. Our funds will help 1.6 million
people through a combination of household distributions (1.2 million)
and targeted feeding of acutely vulnerable groups including IDPs
(0.4 million). Our support is also helping WFP pilot innovative
programming in places of household distribution where the ability
to purchase from the market is the obstacle, not the availability
of food.
International Organisation for Migration £6.5
million over 4 years
More than 1.5 million people have been displaced
by the policies of the GoZ since 2000 (including the Fast Track
Land Reform from 2000 to date and Operation "Murambatsvina"—drive
out trash—in 2005) and post-election violence (2008). Despite
the Inclusive Government, farm invasions continue today and the
risk of displacement for remaining farm-worker families remains
a concern. DFID Zimbabwe has had a programme with IOM Zimbabwe
to provide emergency assistance (food, non food items, and temporary
shelter) to IDPs along with humanitarian assistance at border
crossings. IOM continues to be at the forefront of responding
to new displacements and emergencies. The IOM are now working
in 29 out of 57 districts in 10 provinces and they are currently
assisting 251,000 individuals. Beitbridge Reception Centre on
Zimbabwe's border with South Africa was established in May 2006
and by the end of May 2009, it had assisted 320,000 returned migrants.
The programme will run until March 2010 and its total value is
£6.5 million (with £1.5 million provided in 2009-10).
Water and Sanitation £4.7 million over 1
year
Zimbabwe's cholera outbreak from August 2008
to July 2009 was a sharp indicator of the state of the water and
sanitation infrastructure across the country and the consequences
of its neglect over the last twenty years. In total, there were
nearly 100,000 cholera cases reported with an overall case fatality
rate of 4.3%. In 2009, there was a big push by the international
humanitarian community to carry out preventive rehabilitation
work on the water systems and to get supplies in place early to
minimise the worst effects of another cholera outbreak. The UK
gave £4.7 million to UNICEF in early October 2009 to help
to supply safe water and access to sanitation services for the
most vulnerable population groups through: (1) distribution of
emergency Non-Food Items (oral rehydration kits, soap, jerry cans
for water, purification tablets), (2) improvement of hygiene and
sanitation access and practices, (3) rehabilitation of water and
sanitation systems throughout the country in both rural and urban
areas. Cholera in the 2009-10 rainy season is a fraction of what
is was during the 2008-09 season. By mid-December 2009, the total
cumulative caseload stood at 146 cases compared to 17,908 cases
the year before. DFID Zimbabwe is currently working to develop
a multi-year water and sanitation programme.
Emergency Health Infrastructure Support £1
million over 1 year
In the spring of 2009, the Deputy Prime Minister's
office appealed to DFID for funding for a specific programme of
work to improve referral hospital infrastructure in six key hospitals
including the larger cities of Bulawayo, Masvingo, Harare and
Mutare. Health services in these hospitals were compromised due
to lack of equipment and damage to infrastructure in theatres,
laundries, boiler rooms, kitchens and mortuaries. Our short-term
investment should quickly yield visible improvements. Crown Agents
is managing the project and it is schedule to be completed in
the spring of 2010.
Gender Support Programme £0.95 million
over 3 years
In May 2009, DFID approved a three-year gender
support programme in collaboration with the EC and UNIFEM. This
is a follow-up programme to a one-year gender scoping study that
developed a gender strategy and tools and mechanisms for a multi-donor
funded programme. The main objective of the programme is to promote
gender equality and women's empowerment in Zimbabwe. The EC is
also contributing £0.98 million to the programme and UNIFEM
is the fund manager.
2. BACKGROUND
INFORMATION FOR
COMMITTEE SITE
VISITS IN
ZIMBABWE
The International Development Committee visited
Zimbabwe from 1 to 4 February 2010. The following briefing was
provided by DFID as background information to several site visits
that the Committee undertook whilst in-country.
BULAWAYO SITE VISITS
Addressing vulnerability and social protection
One of the serious effects of ten years of political
upheaval and economic decline has been the increased vulnerability
of young people, children, families with small children, the elderly
and the chronically ill. Household assets have been depleted over
time to manage illness, keep children in school and compensate
for poor harvests. The exposure to repeated external shocks in
a context where social networks are fragmenting and formal social
assistance is greatly diminished has rendered many households
unable to achieve even a reasonable level of subsistance let alone
to thrive.
DFID and its partners have been building programmes
that aim to help households manage these shocks, re-establish
a measure of control over their fortunes and to begin to thrive
again. The principle of these programmes is to give a leg up to
struggling households that will enable them to get back into the
economy and become independent again. This may involve a combination
of programmes that:
— get key members of the household onto
anti-retroviral medicines to help the ill become healthy;
— provide school fees or other support
where there are orphans or particularly vulnerable children in
the household;
— provide cash transfers to help re-establish
livelihoods and help adults young people to earn their own living;
— assist farmers to get more from their
land and strengthen their food security.
This field trip will make a series of stops
that, taken together, illustrate the inter-relationship of these
types of support and demonstrate how DFID and its partners are
addressing the complexity of vulnerability.
HOUSEHOLDS BENEFITING
FROM A
PACKAGE OF
INTERVENTIONS
Background
The programme is delivered by Catholic Relief
Services (CRS) as a component of the Joint Initiative in Bulawayo
and works through Sibambene and Oxfam, two other NGOs. Sibambene
implements Internal Savings and Loans, Income Generating Activities
and Home Based Care that have Youth Friendly Centres. Oxfam working
through a local NGO called Lead Trust implements the food voucher
programmes together with cash transfers and Low Input Gardens.
Outcomes
— 1127 households are receiving Home Based
Care after 258 Care givers trained
— 50 households have started to benefit
from cash transfers
— 657 Internal Savings and Loans trained
in Business Management Skills had accumulated savings of US$ 15,279
over a 6 months period.
— 600 Income Generating Activities trained
in Business Management Skills
— 520 Low Input Garden groups were trained
and realized profits of US$17,660. Of this total, 76% was from
individuals and the balance from groups.
— Food voucher distribution and cash transfer
reported 100% redemption on a monthly basis.
IOM BULAWAYO SAFE
ZONE SITE
VISIT
Background
For many young people in Zimbabwe, the future
seems hopeless and the prospect of gaining skills or employment
is poor. They face few alternatives. One option many young people
elect to try is to jump the border to Botswana or South Africa
to work on farms or in cities. They are exposed to exploitation,
prostitution, and other risks. The Safe Zone concept was developed
to reach young Zimbabweans between the ages of 15 and 24 to inform
them on the risks and realities of irregular migration and encourage
safe health practices, as part of the Safe Journey Information
Campaign.
The opening of this centre was made possible
through a partnership between IOM and Bulawayo City Council, which
provides the infrastructure for Safe Zone activities. The Bulawayo
Safe Zone is the second such centre in Zimbabwe after Chiredzi,
which opened in February 2007. Young people are assisted to make
the right choices for a safer future, by imparting knowledge,
building self-esteem, teaching life and livelihood skills and
empowering them to adopt safer migratory and sexual behaviour.
The Bulawayo Safe Zone is a hub of activities
for both in-school and out-of-school youths. Structured lessons
ensure that the target group is well-guided and occupied. The
centre helps make a difference in the lives of young people by
raising their risk perception through formal and informal lessons
on safe migration, gender-based violence, human trafficking, and
HIV and AIDS.
Outcomes
The Safe Zones in Bulawayo and Chiredzi are
currently operating on a budget of US$86,523 for the period September
2009 to June 2010 and has achieved the following:
— In Bulawayo and Chiredzi, benefited approximately
204,218 youths and other community members through its activities
in the centres and in the communities
— Engaged a vocational training institution
for pilot livelihood initiatives in Bulawayo.
— Peer educators have received intensive
training on gender-based violence, human trafficking and HIV and
AIDS to enhance their peer to peer messaging.
— Produced an edutainment video on the
Safe Zone concept. This video includes a documentary on the Safe
Zones, About IOM, music, drama and discussion clips from peer
educators at the two youth centres.
VISIT TO BULAWAYO—HEALTH SERVICE DELIVERY—HIV
PREVENTION AND MATERNAL HEALTH
In the context of political upheaval and economic
decline, the HIV epidemic has been adding an additional burden
to the lives of many people in Zimbabwe especially women and children.
Zimbabwe has an innovative HIV programme and the results are impressive:
a decline in prevalence and an increase in treatment.
The key to the successful and steady decline
in prevalence and incidence rates has been the provision of coherent,
high quality and accessible services across the country consistently
over a long period of time. While community level engagement in
understanding factors that drive the epidemic is important, people
need to be able to act on their determination to change their
own behaviour: to get a test, to receive high quality counselling,
to take measures to prevent themselves and their loved ones becoming
infected.
This field trip will enable the team to see
a range of services delivered close to community level all of
which give individuals, couples and families better control over
their own risk and their own behaviour. The services to be visited
will illustrate the range on offer from straight forward testing
and counselling, post test management of a positive HIV result,
male circumcision as a prevention strategy and maternal and newborn
management to prevent transmission from mother to baby (including
from father to mother to baby during pregnancy and breastfeeding).
Mpilo Hospital—Maternal Health and HIV services
including prevention of Mother-to-Child Transmission (PMTCT).
Elizabeth Glazier Paediatric AIDS Foundation (EGPAF) & their
partners
Background
The national PMTCT programme is well established
in Zimbabwe. However, the majority of sites are still delivering
only the single dose Nevirapine (sdNVP) drug regimen which is
not the most recent guidance. Through a programme of intensive
training and supervision, the more efficacious drug regime (MER)
has been rolled out slowly to new sites. Bulawayo has successfully
introduced these new regimens with support from the EGPAF Family
AIDS Initiative programme through Kapnek Trust.
Kapnek Trust supports Mpilo Hospital through
in-service training of health workers on PMTCT, including HIV
rapid testing, infant and young child feeding with family planning
integrated within the core PMTCT modules. Kapnek also carries
out site support visits providing supervision, data reviews and
mentorship. District review meetings are held to promote peer
support, monitor progress and plan for future activities.
Results:
National figures: (2008 Ministry of Health and Child
Welfare annual report)
— Estimated number of HIV+ pregnant women:
50,702 (15.6% prevalence)
— 224,637 pregnant women booked for a first
ANC visit
— 226,713 pregnant women were counselled
for HIV and 78% were tested.
— 24,896 HIV-positive pregnant women received
prophylaxis (91% of total nos. of HIV positive pregnant women
identified).
— 17,570 HIV-exposed infants received sdNVP
(63% of mothers identified).
Results from the Mpilo Hospital site 2009 include:
— 2,085 women seen in the Antenatal Clinic;
— 397 tested positive for HIV;
— 614 women given antiretroviral drugs
for prevention of mother to child transmission of HIV; and
— a total of 121 babies from the identified
HIV positive mothers put on antiretroviral drugs for prevention
of mother to child transmission.
OVERALL OUTCOMES
OF THE
EGPAF-FAMILY AIDS INITIATIVE
PROGRAM
The EGPAF Family AIDS Initiative programme is
supported by USAID (US$5 million) and DFID (US$1m). The programme
operates in 32 districts and cities (out of 62 possible districts)
with 620 PMTCT sites now supported. The programme has:
— Reached 146,412 pregnant women in ANC;
— Counselled and tested 132,506 pregnant
women; and
— 18,117 (93%) pregnant women with HIV
and 14,318 (71%) HIV-exposed infants received ARV prophylaxis
BAMBANANI "NEW
START" VOLUNTARY
COUNSELLING AND
TESTING CENTRE;
"NEW LIFE"
POST-TEST
SUPPORT CENTRE
WITH POPULATION
SERVICES INTERNATIONA;
BACKGROUND
New Start testing and counselling (T&C)
services aim to promote sexual behaviour change and also serve
as an entry point to care, treatment, and other post-test support
services to those who test HIV positive. Strong referral systems
are in place to ensure that all HIV positive clients receive access
to post-test support services.
In addition to the New Start centre network,
PSI also manages a network of New Life post-test support
services centres (currently 12 sites). New Life centres
are offering individual psycho-social counselling sessions; information
on HIV and AIDS, positive living, and nutrition for people living
with HIV and AIDS; and ART adherence counselling. The centres
are providing services at the site and through mobile services
which are offered at workplaces, to PLWH support groups, and to
patients accessing health care at public sector hospitals.
DFID supports PSI under their five-year, £20m
Behaviour Change Communications Programme which includes an average
of £2 million per year in support of the New Start/New
Life network in Zimbabwe. Key results to date include:
— Nationwide network of 18 static and 23
outreach teams
— Implementation through 14 partners, NGOs,
city health clinics, private sector partners
— 1.6 Million people reached since inception,
currently 35,000 per month
— High national coverage, 55% of monthly
client flow are reached through mobile units
— 18% of clients visiting the centres as
a couple
— 10% of clients are vulnerable population
groups (displaced, mobile population, people at remote workplaces)
— Integration of TB screening, about to
start laboratory services, 5 sites
— Integration of CD4 cell count laboratory
services, 6 devices for 4 sites
— Strong referral and referral tracking
system—PSI T&C and post-test counselling centres referred
128,150 clients for tuberculosis treatment, opportunistic infections,
anti-retroviral treatment, psychosocial support, family planning,
social welfare, and other non-governmental organizations for livelihood
support of various kinds in 2009.
Organisation
The Bambanani ("collaboration" or
"unity" in Ndebele) centre in Bulawayo opened in August
of 2001. The site has attended to 210,000 clients since it opened
its doors. About 4,000 clients are seen each month, with over
half of the clients accessing the services through mobile units
covering several districts around Bulawayo.
BULAWAYO MALE
CIRCUMCISION CLINIC
Background
There is now solid evidence that male circumcision
can prevent transmission of HIV infection. It is a cost effective
and efficient intervention. For example, in Zimbabwe, it is estimated
that, given the adult HIV prevalence of 13.7%, Zimbabwe could
avert almost 750,000 adult HIV infections between 2009 and 2025
if 80% of adult men and newborn boys were circumcised. The resulting
savings are estimated to amount to as much as US$3.8 billion between
2009 and 2025 in treatment and broader economic costs.
Despite the high level of interest and support
for male circumcision (MC) by all stakeholders and the development
of a roadmap to rapidly scale up MC services, only limited funds
have been available for expanding services in Zimbabwe and PSI
is using their own discretionary funds as well as receiving support
through USG and DFID. This is certainly a growth area in HIV prevention
though and services are expected to expand in the coming years.
Zimbabwe's national MC training programme was
established in April 2009 and a central level MC training centre
has also been established in Harare.
Outcomes
DFID is supporting this initiative under their
Behaviour Change Communications Programme. They support
research and staffing components of the National Training Programme.
Key results to date include:
— Supported the Ministry of Health to set
up MC pilot phase with one training site and four implementation
sites
— Recruitment of MC clients through New
Start centres
— Services include safer sex counselling,
MC procedure, follow up services and review
— 3000 men have been circumcised since
start in May 2009, rapid expansion is expected in 2010
— Provided technical assistance in policy
and strategy development
ORGANISATION
The Bulawayo male circumcision site is housed
in the Bulawayo Eye Clinic and has been operational since September
2009. Approximately 300 procedures are performed every month at
this site. More than 92% of the clients are referred from the
New Start testing and counselling (T&C) centres. The
site also provides T&C services for walk-in clients.
SITE VISIT TO TSHOLOTSHO
So far, the community and service delivery visits
have taken place in urban and peri-urban locations. This field
trip will focus on the challenges to different kinds of households
of overcoming vulnerability in order to build and maintain a successful
livelihood in a rural area of Zimbabwe where crops don't grow
well. The trip will take place in deep rural part of Matabeleland
Province (North) moving to three different rural communities.
The two Matabeleland Provinces (North and South) are the poorest
in Zimbabwe and were the sight of the Gakurahundi massacres in
the 1980s, a continuing source of conflict and mistrust between
different peoples in Zimbabwe. The farming is poor in this part
of the country and nutrition gardens and conservation farming
techniques are important to getting as much as possible from available
arable land. Water is also scarce and often situated very far
from households or cattle/livestock corrals. Improving access
to potable water is a critical element of strengthening livelihoods
and future household prospects for people in Matabeleland, especially
women.
This day trip aims to demonstrate, through a
combination of visits, how DFID is supporting the strengthening
of livelihoods and income generation, the reduction of women's
labour on water collection and household exposure to disease through
water and sanitation assistance and the mitigation of HIV and
other high impact chronic diseases through the delivery of home
based care.
The programmes to be visited include support
to micro finance schemes and income generation schemes.
FIELD VISIT
TO A
SAND ABSTRACTION
POINT (WATER
AND SANITATION
AND HYGIENE
(WASH), INTERNAL SAVINGS
& LOANS, NUTRITIONAL
GARDENS)
Background
Catholic Relief Services is installing sand
abstraction systems in Tsholotsho, a technology which draws water
from sandy river beds. The water is used for drinking, watering
livestock and gardening. The support from DFID will see the installation
of 14 sand abstraction and micro-irrigation systems for communal
gardens by June 2011. The self-help groups are trained on the
internal savings and lending methodology which is meant to economically
strengthen the community groups around the sand abstraction point,
including the water point and garden committees and some of the
most vulnerable individual households.
Outcomes
Water is a scarce commodity in this dry and
livestock-breeding district. Both people and livestock walk for
considerable distances (up to 5km) to access water, taking up
much of their productive time. The technology has not only reduced
walking distances to water points, but has also made an improvement
in household nutrition resulting from the tendency to use more
water together with the introduction of nutrition gardens. The
self-help groups have made it possible for the communities to
manage their own water points and gardens, making the projects
more sustainable.
The following activities have been carried out
to date:
— 10 sand abstraction & micro-irrigation
systems installed.
— 3489 households benefiting from self-help
groups.
— 10 communal garden latrines and 94 household
latrines constructed
— 300 Elephant pumps installed
FIELD VISIT
TO A
JUNIOR FARMER
FIELD SCHOOL
(JFFS)
BACKGROUND
JFFS have acted as vehicles for knowledge transmission
as they involve a practical approach to agreed study topics. A
JFFS can engage support from AREX officers in matters in which
they could have limited knowledge. JFFS have been used to integrate
the orphaned children into normal life after discovering that
they tend to isolate themselves when they lose either of their
parents.
OUTCOMES
CRS has provided training and agricultural inputs
through DFID to the JFFS. The trainings have reached out to 3,636
FFS members. The total cost for the training is valued at £27,000.
FIELD VISIT
TO SMALL
LIVESTOCK BENEFICIARY
Background
Catholic Relief Services (CRS) has been implementing
the small livestock project since 2008-09 when funding for PRP
II started. The program provides the poor and vulnerable households
with small livestock of their choice which include poultry and
goats. The farmers are also trained in Livestock management, feed
production, livestock disease management and construction of affordable
housing.
Outcomes
CRS has provided small livestock to poor and
vulnerable households. The small livestock have been multiplied
and sold to meet school fees expenses, food expenses and have
been converted to bigger stock such as donkeys, cattle and pigs.
The program is funded to the tune of £121,200
over three years. To date the following activities have been implemented
— 6,270 households have been trained in
small livestock management.
SITE VISIT TO MATABO
The trip will take place in deep rural part
of Matabeleland Province (South) beginning with a district town
and moving to three different rural communities.
The first stop though will be to the Kezi Maphisa
Hospital to see the impact of a flexible and innovative HIV and
AIDS treatment programme that has reached thousands of people
outside urban areas since it started in 2006. The Expanded Support
Programme has been an important driver of expanding access to
ARVs outside urban areas even in the context of collapsing systems.
VISIT TO
EXPANDED SUPPORT
PROGRAMME FOR
HIV AND AIDS (ESP) TO
OBSERVE HIV AND
AIDS CARE AND
TREATMENT SERVICES
AT KEZI
MAPHISA DISTRICT
HOSPITAL
Background
The ESP programme started in 2006 and provides
HIV and AIDS treatment and care support to 16 districts and some
national programmes. The ESP enabled the national ARV roll out
programme to make significant progress despite the economic downturn.
Maphisa district hospital—as with other
health facilities in Zimbabwe—has faced numerous challenges
in recent years. The hospital is serving an under privileged community
of 99,723 people. This site visit will focus more on the HIV care
and treatment aspects of the response. It will emphasise the important
links between HIV services and the broader health system.
ESP programme results:
1. Channelled $50m into HIV treatment and
care including laboratory support and safe blood services over
the last three years.
2. The number of people on treatment in
the 16 districts has increased from 5,266 in April 2007 to 27,140
in September 2009, a more than 5-fold increase in less than 3
years.
3. ESP supported procurement of ARVs for
treatment of 58,000 patients in 2009 (28,000 in ESP districts
and 30,000 through the national ART programme), approximately
30% of total national coverage.
4. More than 1,200 health workers have been
trained in HIV counselling and testing (rapid testing and provider-initiated
counselling and testing) and 900 in ART/OI management in ESP districts
since April 2007.
5. ESP support has helped to strengthen
coordination and Monitoring and evaluation. Training for Provincial
and District AIDS Coordinators has been completed. District HIV
and AIDS action plans have been developed in all ESP districts.
6. Kezi Matobo district has 2 ART initiating
sites. This district had no patients on ART at start of 2007,
compared to 2,206 on ART by end 2009.
MEETING AN
HOME BASED
CARE (HBC) GROUP
AND GOAT
BENEFICIARY IN
SONTALA WITH
WORLD VISION
INTERNATIONAL
BACKGROUND
The small livestock programme is targeting 150
households for the chronically ill, disabled; child-headed household,
elderly and generally vulnerable asset poor households. The beneficiaries
were trained on goat husbandry with the focus on health, shelter,
feeding and breeding. Each household was given 2 female goats
and 1 in every 10 households got an additional buck. By standard,
one HBC caregiver is supposed to work with five patients. About
1000 patients are reached through the HBC programme in Matobo.
Outcome
The goat programme was started in 2008-09 funding
year. 85% of the distributed goats have kidded. Households are
currently benefiting from goat milk and manure. The small livestock
programme is being funded by £10,000 from DFID. As a result
of the training, farmers are now better equipped to manage the
goats. The HBC programme is being funded to the tune of £94,000.
This has lessened pressure on hospitals and clinics as patients
are no longer travelling long distances for medication.
FOCUS ON
WATER AND
SANITATION AND
HYGIENE (WASH)
VISIT TO
HOUSEHOLD BENEFITING
FROM LATRINE
CONSTRUCTION
Background
This is a 3-year programme running from 2008-2011
targeting 150 households. The program includes capacity building
on latrine builders for Households and school latrines, health
and hygiene education to school health masters and communities,
community based management training to Water Point User Committees
and Village Pump Mechanics.
Outcomes
80% behaviour change on hygiene practices for
example hand washing method of run to waste is adopted. Time taken
for an individual household to collect water from a water source
was reduced by above 50% from 30 minutes to 15 minutes. Improvement
on general cleanliness of the water points and minor maintenance
spearheaded by the Water Point User Committees.
MEETING A
CONSERVATION FARMING
BENEFICIARY
Background
Conservation farming is in its second year running
for the current beneficiaries. 500 vulnerable households benefited
from the programme. These households will be taken through 3 years
of intensive training on conservation farming. Farmers are given
seed and fertilizer packs which cover about 0.6-0.7ha. Farmers
are trained on the conservation farming principles. The training
involves theory and practical training at demonstration sites.
This culminates into field day which is a platform to share lessons
learnt for others that are not targeted by the program.
Outcomes
The programme is in its second year running,
was started in 2008-09 farming season. The 2008-09 season saw
farmers producing good harvest from the conservation farming plots.
The activity is being funded to the tune of £130,000. Farmers'
knowledge on conservation farming has also improved greatly.
HARARE PROGRAMME VISIT TO HARARE HOSPITAL
The backbone of basic health service provision
is sound hospital-based services that can train staff, develop
new interventions, act as referral centres and ensure quality
and comprehensive support to peripheral primary services. Some
services are only appropriately delivered in a centralised way
(specialised child rape management) or are so specialised as to
require concentration of skills and equipment. Yet, they are also
vital to well being just as basic treatment is. This visit will
look at how DFID support to both the referrral level of health
services and to the main pillars of health services delivery (vital
medicines, human resources, information systems) has supported
the broader health system during a period of economic collapse
and crisis and has enabled some specialist services to continue
at least to some extent.
MALE CIRCUMCISION
TRAINING CENTRE
AND CLINIC
Background
PSI/Z provided technical and financial support
to set up a national MC training site in Harare as well as four
MC pilot sites. PSI provided technical support in the establishment
of the national MC training program, which started in April 09
with the training of 14 national trainers. The program, which
was adapted from the WHO MC training guidelines, consists of three
days theoretical and 4 days practical training using the forceps
guided method as the standard surgical procedure. 104 health workers
have been trained since the initiation of the training program.
A phased approach comprising of a learning phase with pilot sites,
each representing one model of service delivery, has been used
to initiate MC in Zimbabwe. An evaluation of the pilot phase,
conducted through technical support by PSI, is currently underway
to inform the MC strategic plan for the next five years, which
will be developed in February.
Outcomes
DFID is supporting this training site initiative
under their Behaviour Change Communications Programme. They
support research and staffing components of the National Training
Programme. Key results to date include:
— 3,000 male circumcisions have been conducted
since May 2009.
— 104 practitioners trained to perform
forceps guided method MC
— Most MC clients are recruited through
PSI's New Start Counselling and Testing centres. Services include
safer sex counseling, MC procedure, follow up services and review
VITAL MEDICINES
AND MATERNAL
HEALTH (DRUGS
AND COMMODITIES)
DELIVERY TRUCK
TOPPING UP
(DTTU) SYSTEM AND
EMERGENCY HOSPITAL
INFRASTRUCTURE REPAIR
AND REFURBISHMENT
WORK SUPPORTED
BY DFID.
Background
DTTU
Zimbabwe has one of the highest contraceptive
prevalence rates for modern contraceptive methods in Africa. Contraceptive
use increased from 38% in 1984 to over 60% now. DFID Zimbabwe
has supported the provision of contraceptive since the mid-1990s.
Under the current five-year programme, DFID Zimbabwe has provided
over £2.5 million for the procurement and distribution of
reproductive health commodities annually. Distribution of commodities,
vital medicines and HIV test kids is done through the DTTU which
is jointly funded by DFID and USAID and implemented by Zimbabwe
National Family Planning Council, National Pharmaceutical Company,
Crown Agents Zimbabwe and JSI Deliver.
Vital Medicines
DFID has provided £16.5 million for vital
medicines through UNICEF over the past two years. Other donors
including ECHO, Canada, Ireland, Netherlands and Australian Aid
have also contributed to this programme. This programme has been
instrumental in ensuring a basic supply of drugs and sundries
are available at all 1531 health facilities in Zimbabwe and especially
at rural health centres and district hospitals. Procurement of
drugs is done through UNICEF. The drugs are packaged into primary
health care packages which are distributed through DTTU system.
UNICEF, Crown Agents have received funding from DFID to conduct
a Vital Medicines Availability and Health Services Survey in order
to obtain a "snapshot" view of the state of the health
delivery services across Zimbabwe. This survey is carried out
on a 3-monthly basis in order to identify and trends. Data collection
takes place during routine essential drug supply visits to over
1300 health facilities throughout the country. Data is collected
by DTTU staff during their drugs delivery rounds and the data
analysed and a report drafted by UNICEF.
Health Restructuring Project
DFID has committed £1.1 million for the
refurbishment of three main hospitals and three provincial hospitals
in Zimbabwe. The aim is to ensure that these important health
facilities are able function and provide basic services. Support
has included replacing equipment such as reticulation systems,
boilers, incinerators, laundry and kitchen. Crown Agents is implementing
this project.
Key results to date
DTTU and ZNFPC
1. Delivery Coverage—there are over 1300
health facilities in Zimbabwe and DTTU makes deliveries to approximately
95% on each delivery run once every three months. The missed facilities
are mainly due to finding clinics closed as staff would have gone
for funerals, pay etc.
2. Stock outs are less than 5%. At the inception
of the programme the stock out rate was higher than 40%.
3 The majority of women get their contraceptives
from the public sector. According to recent reports 98% of women
know about at least one method of contraception
4 e number of children per woman is also decreasing
from 5.4 in 1988 to 3.8 in 2006.
5 HIV Prevalence rate has declined. This can
be attributed at least in part to increased condom usage. Condoms
are distributed via the DTTU system.
Vital Medicines
Results from the recent national Vital Medicines
and Health Service survey (VMAHS) which collects data from all
health facilities every two months.
1. The number of health facilities with at least
50% of the selected essential drugs in stock increased from 44%
in Round One to 65% in Round Two and to 72% in Round Three of
the vital medicines quarterly survey. Stock-outs of all the selected
antibiotics declined from 20% in Round One, to 7% in Round Two,
and to 2% in Round Three.
2. The range of fees charged for maternity consultations
decreased from a maximum of US$250 to US$100 in the second survey.
3. The number of health facilities offering free
consultation services to children younger than five years increased
from 66% to 70% in the second survey.
ANTENATAL CLINIC
FOR MATERNAL
HEALTH
Background
Background information on the national PMTCT programme
was provided earlier in the Bulawayo section of the brief.
National figures: (From 2008 MOHCW annual report)
— estimated number of pregnant women with
HIV: 50,702
— 224,637 pregnant women booked for a first
ANC visit
— 226,713 pregnant women were counselled
for HIV and 78% were tested.
— ANC HIV prevalence was 15.6%
— 24,896 HIV-positive pregnant women received
prophylaxis (91% of total nos. of HIV positive pregnant women
identified).
— 17,570 HIV-exposed infants received sdNVP
(63% of mothers identified).
Site level statistics:
— Nos. of pregnant women booking at ANC:
296
— Nos. of pregnant women tested, and received
results: 387
— Nos. of pregnant women with an HIV positive
test: 67
— Nos. of HIV-positive pregnant women receiving
ARV prophylaxis or ART: 84
— Nos. of deliveries: 3,224
Overall Outcomes of the EGPAF-FAI programme
The EGPAF-FAI programme is supported by USAID
(approx US$5 million) and DFID (US$1 million) annually. Between
Oct 2008 and Sept 2009, the EGPAF-FAI programme expanded into
32 Districts and cities (out of 62) with 620 PMTCT sites now supported.
The programme has:
— Reached 146,412 pregnant women in ANC;
— Counselled and tested 132,506 number
of pregnant women; and
— 18,117 (93%) pregnant women with HIV
and 14,318 (71%) HIV-exposed infants received ARV prophylaxis
FAMILY SUPPORT
TRUST AND
VICTIM FRIENDLY
CLINIC (CHILD
SEXUAL ABUSE
SUPPORT AND
TREATMENT CENTRE)
Background
Family Support Trust (FST) is a locally registered
Private Voluntary Organisation (PVO) with the primary aim of providing
holistic, child friendly, comprehensive, medical and psychosocial
support services to sexually abused children and their families
and to fighting all forms of child sexual abuse (CSA) in Zimbabwe.
FST recognizes the profound and long-term damaging effects to
children and communities of CSA.
FST has been running the Victim Friendly Clinic
for more than a decade in Zimbabwe, supporting child victims of
sexual abuse. The project has been supported by the Programme
of Support (PoS) since 2007 for a total of US$1,118,806 over three
years to scale up both the response and prevention aspects to
child sexual abuse. Other funding partners include Children First,
Save the Children Norway, and Firelight Foundation as at December
2009.
DFID Zimbabwe is the biggest contributor to
the multi-donor PoS, which is managed and coordinated by UNICEF.
PoS supports the implementation of the National Action Plan (NAP)
for OVC through strengthening community-level organizations providing
care and protection for vulnerable children and to put in place
a mechanism to ensure increased, more predictable funding for
OVC.
FST has a good working relationship with the
Ministry of Health and Child Welfare who have offered the NGO,
office and clinic space in four government hospitals for the victim
friendly clinics. The clinics are in the following cities and
districts: Beitbridge, Chitungwiza, Harare (head office) and Mutare.
Plans are underway to establish such a clinic in Bulawayo's Mpilo
Hospital.
FST is part of the "referral chain"
meaning that it is a critical part of ensuring child victims of
exploitation, abuse and violence receive specialized health and
welfare support. Support is also provided by FST pre-and post-
trial should the case be taken forward in the legal system. FST
also offers capacity development workshops to medical personnel
(nurses, doctors) and the police for better child friendly techniques
in gathering information that can then be used in court cases
from child victims.
Outcomes.
— FST clinics: 353 boys and 5010 girls
children received medical and psychosocial support from the four
operational clinics from January 2007 to November 2009 as indicated
in the table below.
— FST worked with Government and NGO partners
in various outreach activities to promote the messages of zero
tolerance, outreach and awareness for child sexual abuse in communities
beyond the FST clinics.
— Awareness has been raised on prevention
and response to child sexual abuse for both adults and children.
HARARE PROGRAMME VISIT ON ORPHANS AND VULNERABLE
CHILDREN (OVC) PROGRAMME
MAVAMBO LEARNING
CENTRE
Mavambo Learning Centre caters for 48 illiterate
children/year on an accelerated education project and who are
also provided with nutritional support and psychosocial support
services. Tafara 1 Primary School has a total enrolment of 1,600
children. The school contains children supported through the PoS,
some from families displaced as a result of Operation Murambatsvina,
living in temporary accommodation on Caledonia Farm nearby.
BACKGROUND
DFID Zimbabwe is the biggest contributor to
the multi-donor PoS, which is managed and coordinated by UNICEF.
PoS supports the implementation of the National Action Plan (NAP)
for OVC through strengthening community-level organizations providing
care and protection for vulnerable children and to put in place
a mechanism to ensure increased and more predictable funding for
OVC.
Until June 2009 DFID's support for education was
primarily through the "Programme of Support" (PoS) for
Orphans and Vulnerable Children (OVC) which by mid-2009 had
provided school fees and materials for 200,000 children. Since June
2009, PoS has been used to scale-up education provision through
the revitalisation and roll out of the BEAM—the Basic
Education Assistance Module in an attempt to rapidly increase
the number of OVCs reached. This system pays school fees and levies
for orphans and vulnerable children in primary schools and special
schools for children with disabilities. It improves access to
education for poor children and helps schools deliver good quality
education as the programme enhances their financial capacities.
This year BEAM will support about 610,000 OVCs with the payment
of fees and levies.
In June 2009, DFID also initiated and developed
a new Education Transition Fund. To date DFID has committed £1
million to this fund primarily for the provision of text
books and other learning materials for schools as well as
some Technical assistance for the education sector. The fund is
managed by UNICEF and is supported by other donors including USA,
EU, Austalia, Denmark, Sweden, and Norway.
Mavambo Trust was established in 2001 to target
illiterate OVCs with an Accelerated Literacy and Numeracy Education
which is a fasttrack educational program to prepare them for entry
into the formal school system. Mavambo provides a holistic approach
to education. Other services provided include HIV and AIDS Life-skills,
psychosocial support, nutrition, facilitation of Birth Certificate
acquisition, Child Rights Training and vocational skills training
(staff and community). Mavambo works with the community volunteers
(Shamwari Dzedu) for identification of the beneficiaries, home
visits and data collection. Furthermore, Mavambo provides educational
support to OVC in formal schools, such as Tafara 1.
Outcomes
By November 2009 PoS had:
— 247,987 children assisted with school
related assistance
— 188,157 children were provided with basic
social services, including nutrition, water, sanitation, medical
support and ART
— 49,967 children were reached with livelihoods
including lifeskills and vocational skills
— 10,970 children were provided with child
protection interventions including legal assistance and re-unification
within family environment
— 9,030 children assisted to obtain birth
certificates
— 1,857 children trained in child participation
Since 2007 Mavambo has:
— Fast-tracked 150 illiterate children
into the formal school system
— Assisted 9,000 children to attend school
— Assisted 97 children to get birth certificates
since 2007.
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