THE country has made significant strides in its HIV/AIDS response with government working hand in glove with civil society organisations working within and with communities.
The tagline for the 2020 HIV response worldwide is ‘Communities Make The Difference’ as nations aim to reach the 90-90-90 targets of having 90 percent tested, 90 percent of those tested getting on treatment and the 90 percent on treatment having a suppressed viral load.
Derailing efforts made in reducing the HIV/AIDS burden in Zimbabwe are psychological issues such as stigma, denial and defaulting as well as viral load testing alongside corporate ill-governance within CSOS.
HealthTimes Reporter Kudakwashe Pembere (KP) caught up with Zimbabwe Aids Network National Coordinator Taurayi Nyandoro (TN) to reflect on the year 2019 while informing the nation and the world of their strategy for the year 2020. ZAN coordinates the activities, programs and interventions by over 200 civil society organisations working towards eliminating HIV by 2030. He speaks on challenges, positives and corporate governance issues among other issues in the excerpts below.
KP: As the umbrella body for Health, HIV and SRHR programming CSOs in Zimbabwe, how would you rate their performance in the year 2019?
TN: The first thing is to acknowledge that we might not have a scoring framework to demonstrate collective impact but this does not negate our contributions in 2019, to the contrary, as ZAN, we believe CSOs outplayed expectations especially considering our operating environment . In 2019, we demonstrated again that CSOs remains the mainstay of the HIV response in Zimbabwe if we are to consider the impressive result reported by stakeholders. We demonstrated capabilities to reach out to diverse target groups and geographic areas. We have accelerated the evolution of CSOs from a narrow focus on HIV to broader health issues. In doing this, we account for more than 60% in direct service deliveries, community linkages in support of the HIV continuum. Our advocacy work has relatively improved, with particular focus on increased domestic financing, removal of structural barriers to access to quality health services for all including key populations. I am also tempted to point you in the direction of the massive pieces of work around social accountability. Let’s look at the various researches done by civil society generating evidence to inform our HIV response in Zimbabwe. Let’s basically look at the resources we mobilize as civil society to bring into the country to address or compliment government efforts in delivery of quality health services in Zimbabwe. So if we are to aggregate all those issues, it gives you a sterling picture of what we have done in 2019. If I’m to rate our performance, despite operating at around 50% percent of our capabilities, l would say we are punching above our weight and you can imagine what we can achieve with substantial investments.
KP: You interact with communities as CSOs, how was the year 2019 for people living with HIV?
TN: When you look at it, you also need to understand the civil society generally in the context of the socio-economic situation in Zimbabwe. We have a fragile economy and a collapsed health delivery system and l would hesitate to say as People living with HIV we are feeling the brunt of these challenges. Let’s look at drug stockouts, precisely. the shortage of second and third line treatments which resulted in supplies which meant some of us had to regularly visit facilities and this means an extra financial and social costs. Let’s look at diminished access to nutrition. Let’s look at mental health issues again. We haven’t done enough to address mental health issues for people living with HIV. We haven’t done enough on HIV and ageing. We haven’t done enough addressing HIV and adolescents or young people. We hear of increased cases of of loss to follow up among the various groups of people living with HIV. So we need to address these issues. Let’s look at viral load test coverage. It remains at around depressed and is the least performing along the treatment cascade. What we need to appreciate about viral load testing is that its central to our prevention efforts as opposed to viewing it an issue for an ART client.
Indications are that mental health issues are retarding the HIV response and l fear mental health poses a significant threat to the response. We have stigma and discrimination which remains a social scourge affecting the response from various angles. I’m told about 35 percent of people living with HIV frequent psychiatric institutions which is a large proportion. You see, we need to go back to the basics. A comprehensive psychosocial support approach which is all encompassing is important to close the gaps, especially mental health gap and nutrition for people living with HIV. I can tell you now that the urgency with which we need to integrate mental health if we are to sustain progress we have made in treatment and care for all populations and sub-groups.
KP: What were the positives recorded by health civil societies?
TN: I think it was one of the busiest for organisations programming around health, HIV and SRHR. Let’s look at the work with UNDP. We have delivered on the three key outputs of our three year strategic action plan. That is the engagement and accountability framework for civil society, the CSO charter and the CSO database and website. With the support of UNDP, over 150 CSOs received high level training in various areas, which again is central to strengthening the capacity of CSOs as providers of services for local communities. Let’s look at how we impacted the discourse focusing on the review of the national strategic plans for health. We are satisfied with how organized we have been, but obviously there are opportunities to improve. Overall, we are happy with how we have deepened our engagements and input.
KP: How about the challenges?
TN: I think we have been operating in a volatile and unstable economic environment characterized by policy inconsistencies. Remember the statutory instruments promulgated by the RBZ. These negatively impact on our work, our ability to plan, execute the plans, meet our commitments and respond to emerging expectations. Let’s look at the depressed funding levels for civil society. I also recognize the slow pace to improve coherence among the different players. Despite these challenges again, we were able to reach out to hard to reach geographic areas and key populations.
KP: You mentioned poor viral load testing coverage across the country, what can be done to improve it?
What we need to do is to appreciate Viral Load testing as part of treatment. Let’s not look at viral load in isolation. If we are to achieve our treatment, prevention and retention targets, we also need to ensure our viral load testing coverage is at optimum levels. So lets not look further than intensifying treatment literacy, and last year we developed a new Treatment literacy manual, in collaboration between ZAN, Ministry of Health, NAC and UNAIDS. We are simplifying to be be accessible to our communities including for people with visual impairments. Secondly l propose accelerated decentralization of Viral load testing, reduce the turn around time between sample collection and availability of results. Tied to this, is the work we can do as CSOs to drive demand generation.
KP: What do you think Government should do to improve provision of medication and diagnostics?
TN: Health is enshrined in our constitution as a right. The government must ensure that health is a right and accessible to all groups within the country. By doing this we need to look beyond policies but implementing them. We have some of the beautiful policies around. Right now we are in the process of developing a new national health strategy. We are coming up with a new Zimbabwe National HIV, AIDS Strategic Plan. But moving forward we should not just develop documents but implement them. What do we mean by this? We need to resource them. We need to resource these policies. Let’s put funds. We need to increase the levels of domestic funding for health if we are to address the gaps that we experiencing around essential medicines and diagnostics. Let’s invest domestically. It’s not only meeting the Abuja declaration, we need to surpass the Abuja. We also need to surpass the SADC 11, 3 percent threshold. Let’s surpass those targets and see health become a priority. So if we are to recognize health as a priority in the country, let’s also match that with increased domestic funding and resource our facilities with requisite equipment and medications.
KP: What’s your strategy as CSOs for 2020?
TN: So for us it’s an issue of consolidating the work that we have been doing being supported by UNDP and UNAIDS. I’m happy to say that we have other partners that are also coming on board to support this work. So it revolves around capacity strengthening for civil society. Remember what we are saying is for us to end AIDS, we need to ensure communities are playing a critical and pivotal role. For this to happen, we need to invest in communities. We need to invest in civil society. Let’s also invest and increase funding levels for civil society. We know for instance the Global Fund coming up. We have the core processes coming up. We need to see that happening. We need to see those funding streams, those mechanisms, to what extend they are allocating resources for communities and civil society to do this work. For us that becomes an important part of our work. But equally important is to deepen our discussions on transitioning and sustainability. We can’t depend on donor funding for health. What is it that we are doing domestically as a country? Remember donor funding is not infinite. These are finite resources. They will come to an end. At some point donors are actually saying can you transition some of these things so that country takes ownership of these things. It’s not ownership in terms of name but ownership in terms of even funding because transitioning goes hand in hand with sustainability. The issue is as a country, what measures we are putting in place to ensure we can resource our response, we can finance health domestically. Part of our strategy is to place civil society at the centre of the response as the conduit and vehicle of delivering services. We won’t relent on that one as we want to see an active, functional civil society that is able to engage with communities, development partners, the development discourse in the country be it around SDGs or local development strategies. We want a civil society with at its fingertips engage with these things.
KP: How is ZAN responding to corporate governance issues?
TN: Even as we talk about capacity strengthening, it remains one of the issues again around governance. How do we improve our governance within civil society? I’m happy to say as ZAN we are providing leadership on that front. If you look at the profile of our governance board, we have an array of skills and we hope to develop a model for CSOs. So it is important our institutions continue to invest in supporting governance structures. I’m sure you are aware, last year we started discussions with UNDP around corruption. I’m happy to say these discussions remain on going. We had that engagement in Kadoma. We were talking about corruption and risk reduction in the health sector. So for us, we have basically bought in to the UNDP developed framework on corruption and risk reduction in the health sector. We are domesticating it. We are internalizing the framework and we want to use the framework to inform issues around corruption and risk reduction in the health sector. So for us, it is going to be a core area for us moving forward as ZAN and even as civil society in 2020. I think by the end of first quarter 2020, we should have civil society signing up to that protocol on corruption and risk reduction in the health sector. We should by the end of first quarter 2020. That is our projection because it is a core area for us so that we begin to address those issues.
KP: Any last words?
TN: I think for us moving forward is to acknowledge investment by UNDP as we talk about trying to build a coherent and cohesive civil society pulling in one direction and focused to contribute towards better health outcomes for our citizens. For us issues around coordination becomes important. We want to see a civil society that is pushing in the same direction. We are going to emphasize coordination and organisation in the civil society even as we move forward. We also want to appreciate support we are continuing to receive from our various partners in country and outside the country especially our UN partners such as UNDP, UNAIDS, they have been at the forefront.