Rational Of Operations
ZAN shifted from a narrow focus on HIV and AIDS and TB to embrace emerging development issues such as the integration of HIV with Sexual and Reproductive Health and Maternal Neo-natal and Child Health. Through employing the human rights based approaches, the organization targets Key Populations who include People Living with HIV, people with different sexual orientations, prisoners, migrants, vulnerable children, sex workers and people with disabilities. In addition, the pronounced programmes are top priorities in the Zimbabwe National Strategic Plan which guides implementation of the country strategy on HIV and AIDS and Health towards achieving zero HIV and AIDS related deaths, zero stigma and discrimination and zero new HIV infections. To ensure effective implementation of the programmes, the organization through the diversity of its network noted with concern the need to strengthen capacity building and advocacy among the members. Community Systems Strengthening (CSS) as reported by World Health Organization and Root and Whiteside, 2013 remains the cog towards reducing the impact of HIV and AIDS and other health related programmes. . The organisation also seeks to ensure that Zimbabwe adheres to regional and international agreements on health and HIV/AIDS issues including the UNGASS Declaration, High Level Meeting Declaration of 2011 and African Union.
Country Context and Problem Situations
Zimbabwe is battling to restore integrity in the health delivery service. The effects of the economic meltdown experienced in 2008 still haunt the nation. The entire health system of the country was severely compromised. As a result the service delivery and health commodities were critically low. According to the Zimbabwe Health Demographic survey report (2010-2011), critical health personnel left for greener pastures and non availability of pharmaceutical companies offering competitive prices for essential drugs as compared to foreign companies further compounded the situation resulting in drug stock-outs. Related to this the health delivery institutions have limited essential equipment in the form of X-ray machines, reagents among others which further complicates the health delivery matrix. However there were efforts by the donor community to pull resources together and form the Health Transition Fund to improve the health sector. Not much has been documented on the fruits of the Health Transition Fund as the same issues which were supposed to be addressed by the Fund continue to increase. Civil society participation in the coordinating structures of the Health Transition Fund remains low. Accountability and reporting on the Fund’s activities and results is required.
In tandem with the foregoing, Zimbabwe is struggling to harness the benefits of Maternal, Neo-natal and Child Health. EGPAF (2012) reported that 10 women and 100 children die every day in pregnancy or child birth. The report further indicated that a lot needs to be done to reduce child mortality of the under 5s and reduce maternal mortality rate by 2015 in line with the Millennium Development Goals. This was attributed to prohibitive user fees being charged by health institutions as most of the people die in queues or deliver at home. Most health institutions have inadequate mother shelters for waiting mothers. The long distances travelled to reach the nearest health facility was also cited as another challenge for mothers not delivering at a health centre. In the same token, religious and cultural beliefs have resulted in mothers delivering at homes thereby putting at risk the mother and unborn baby. Inadequate male involvement in Prevention of Mother to Child Transmission resulted in lost opportunities.
Adolescent Sexual Reproductive Health (ASRH) remains a critical component of programming in Zimbabwe. It has been indicated by the Zimbabwe Health Demographic Survey Report (2011, 2102) that lack of access to information by the youths has been hampering the effective implementation of the programme. Where the information is available at times it will not be youth friendly. Zimbabwe has inadequate youth friendly centres, resource centres or corners and where the corners or centres are available in most cases they will be poorly equipped. Zimbabwe National Family Planning Council 2012 report indicated that there should be ward based well- resourced youth friendly centres manned by professional trained counsellors or nurses. There has been limited participation of girls in ASRH activities due to cultural barriers that limit girls’ participation in issues to do with Sexual and Reproductive Health as well as chores at home which include spending most of their time looking for firewood or travelling long distances to fetch water. Organisations working with young people need capacity building to ensure their programmes are responsive to socio-economic dynamics prevailing in the country as well as inclusion of concepts from regional and international best practices in youth programming.
There have been efforts to mainstream disability into HIV and AIDS and other health related activities with limited success. People Living with Disability (PLD) were marginalised in health related activities. Information and services on sexual and reproductive health is not made easily available to them as they are not considered “sexual beings” due to the common misconception that perceives them as incapable of being sexually active. They face challenges in accessing general health services and even more so HIV and AIDS services. PLDs face stigma and discrimination and are not involved in decisions that concern their lives. The health information available is not user friendly in most cases as some may require Braille. Leonard Cheshire report (2012) lamented lack of proper infrastructure to cater for the needs of PLDs. Organisations working on HIV/AIDS leave out PLDs due to lack of capacity to tailor make their programmes to their needs. Most implementing partners do not have disability mainstreaming strategies and they do not take into consideration PLDs in their programme or project planning and execution.
The Key Populations remain a marginalised group in Zimbabwe. Key populations include sex workers, truck drivers, miners, prisoners, lesbians and gays. Zimbabwe currently has statutory provisions that outlaw soliciting for prostitution as well as sexual contact between males (sodomy). Law enforcement agents have a heavy handed approach when dealing with sex workers. They have their rights constantly violated by the police during raids. Gays and lesbians also face the same levels of rights violations. These violations include denial of rights to association, privacy and their sexual rights as well. The crackdown on these populations result in them going underground and this limits their access to health services and information. They thus have lower health seeking behaviours due to fear of being persecuted. Prevention, treatment and care thus do not reach them and this creates the risk of having them left out of programmes.