Zimbabwe National HIV/AIDS Policy - A Study

INTRODUCTION

The study sought to ascertain levels of awareness about the 1999 Zimbabwe National Policy on HIV/AIDS document and National AIDS Council Funds by Civil Society (including Non Governmental Organisations), progress in the implementation of these initiatives and make recommendations for their improvement. The study was undertaken between August and October 2001, on behalf of the National Association of Non Governmental Organisations (NANGO) and the Zimbabwe AIDS Network (ZAN).

The Government of Zimbabwe introduced a National HIV/AIDS Policy in December 1999; to guide programmes aimed a combating HIV/AIDS. The current belief among NGOs is that policy documents are little more than rhetoric, which as the pandemic continues to escalate is tragic. In 1999, the Government introduced the AIDS Levy which cumulated in the establishment of the National AIDS Trust Fund, managed by a National AIDS Council Board, responsible and reporting directly to the Minister of Health and Child Welfare. However, the much centralized control of the AIDS levy, and lack of awareness among the people of Zimbabwe makes access to these " public funds" impossible. The study was undertaken in recognition of the limited and available information pertaining to the level of awareness and implementation of the Republic of Zimbabwe National Policy on HIV/AIDS and accessibility of the NATF.

The term civil society and NGOs has been used interchangeably through the study and denotes "those organisations that are separate from the State, from political parties, and from quasi- governmental agencies", but constitute the larger membership of NANGO.

STUDY OBJECTIVES

1.1.1 Investigate Zimbabwe Government 's policy implementation in direct relation with the National HIV/AIDS Policy 1997 (revised in 1999).

1.1.2 Assess the level of awareness and of implementation by NGOs of the National HIV/AIDS policy

1.1.3 Assess the level of accessibility of the AIDS Fund amongst NGOs

1.1.4 Highlight the key areas of inadequacy in policy implementation and present strategies and recommendations for improved implementation

Study was conducted amongst purposive samples of Civil Society members, NANGO/ZAN membership and select key governmental informants at the national, provincial and district levels, in Gweru, Bulawayo, Masvingo, Bulawayo and Harare. Sample targeted programmers and implementers of development activities. Focus group discussions were conducted amongst student teachers as key implementers in the Education sector of the policy.

MATERIALS and METHODS

The cross sectional descriptive study comprised a combination of document review and primary data collection. Local and international literature was reviewed and reports/publications of the NACP/NAC/Ministry of Health and other relevant sources including local NGOs, ASOs, research institutions, UNAIDS and WHO were studied. Data was collected from participants attending a pre- study workshop conducted with participants from NANGO and ZAN membership, local authorities, public and private sector and representatives of People Living with HIV/AIDS and local authorities; through the use of a self administered questionnaire, trigger presentations and group discussions. Focus Group discussions (FGDs) were conducted in Masvingo amongst student teachers from three Colleges attending a Masvingo Regional Higher Education Workshop for the Training of Community Based Counselors (Teachers Colleges). A case study was compiled by a student teacher assessing the level of implementation in the Education sector of the Policy. Data was collected from a purposive a NGO sample, using a structured interview schedule and questionnaire during field visits conducted in Gweru, Masvingo, Bulawayo and Mutare.

A number of problems were encountered in carrying out the study. Sampling was problematic, as during field visits some NGO representatives' choice to complete the questionnaire in their own time, which resulted in limited returns, from those targeted. In addition a number of developmental NGOs appearing in the NANGO Directory of 2000, were not available or had cited wrong addresses. Others problems arose to do with the availability or inadequate information and limited respondent knowledge relating to the subjects (Policy and NATF) under discussion.

MAJOR FINDINGS

Government of Zimbabwe efforts to implement the national policy are spearheaded by the National AIDS Council and the disbursement of funds managed by the National AIDS Council Board. The Council has made great strides and progress to put structures at the national, provincial and district levels in place, for the creation of a conducive operational environment for the HIV/AIDS multi-sectoral approach. Though study findings are suggestive that these efforts though commendable, have lacked in their comprehensiveness to engage and include all civil society actors. Government leadership must be clearer in their intent and more aggressive in the promotion of viable prevention, care, control and mitigation interventions.

Policy awareness and availability is generally limited, patchy and varied amongst NGOs. There exits weak policy advocacy, dissemination and distribution strategies in place. NGOs continue to implement HIV/AIDS prevention, care, control and mitigation activities albeit the presence of the national guidelines - due to limited awareness of their existence, poor document advocacy. Though the Policy was generally perceived as an important document and milestone in the Government of Zimbabwe act or show of commitment to HIV/AIDS, little has been done by Government to popularize and enhance its use. Equally there has been limited advocacy and social mobilization activities by NGOs to do the same.

There exists poor capacities amongst civil society to engage in HIV/AIDS programming, thus only the traditional players (health related NGOs), are implementing the policy, albeit in a fragmented and uncoordinated manner. Limited individual and institutional capacities and resources exist amongst non-traditional HIV/AIDS civil society development programme implementers. Suggestive of the need for increased mainstreaming and incorporation of HIV/AIDS in existing development programmes. Findings were also suggestive of a "top - down" approach to policy formulation and strategic planning for policy implementation, with limited consultation, participation and involvement of key civil society stakeholders, in the ongoing national policy implementation, monitoring and evaluation. Civil society ownership of the policy is low; with unclear NGOs specified roles and responsibilities in the implementation process. Findings also reflected the low participation by NGOs of newly constituted District AIDS Action Committees, due to limited NGO knowledge and thus poor participation in the ongoing District policy implementation planning processes were indicative.

Policy gaps were also identified in the omission of key groups in the study. Notably enforcement of the implementation of policy in the absence of legal measures will continue to be problematic. A reason cited for low implementation.

Accessibility to the National AIDS Trust fund by NGOs is limited and reportedly low for several reasons including lack of available information pertaining to the fund operations. Other reasons cited are NGOs continue to be largely donor dependent and thus perceive no urgent need of the fund. NGOs do not constitute membership of the newly constituted District AIDS Action Committee and have limited participation in the District Planning forum, avenues generally seen as necessary for the accessing of funds. The overall administration and management of the fund were issues of concern cited by study respondents. The fund disbursements were reportedly lacking in clarity, rationale and justification and issues of financial management by benafarcies were alluded to. The findings were suggestive of the need for increased transparency and information pertaining to the fund operations and training for NGOs in financial management and HIV/AIDS programme design and management.

RECOMMENDATIONS

Study recommendations are addressed to NANGO, ZAN, NAC and the Government represented by the Ministry of Health and Child Welfare. From the discussion here - in and arguments thereto, it is the researcher observations and conclusions that:

OBSERVATIONS 1

There is limited Civil Society education and information pertaining to:

1) National HIV/AIDS Policy - Republic of Zimbabwe

2) National HIV/AIDS Strategic Framework- Republic of Zimbabwe

3) National AIDS Trust Fund and National AIDS Council operations.

4) National AIDS Council HIV/AIDS Programming guidelines/documents

RECOMMENDATION 1

NANGO in collaboration with other civil society networking bodies to hold a national conference to address these issues and inform its membership.

OBSERVATIONS 2

There is limited cooperation and collaboration between civil society, Government and the National AIDS Council, which militates against a successful comprehensive national multi- sectoral response to HIV/AIDS.

RECOMMENDATION 2

To overcome obstacles and facilitate productive collaboration between NGOs and Government the following actions are recommended:

• A comprehensive survey of civil society (inclusive of NGOs) and their scope of HIV/AIDS related action to give government a better picture of available resources;
• greater coordination of NGO activities so as to present a unified front when dealing with government agencies and departments;
• exchange programmes between NGOs and Government Departments to permit each sector to better understand the constraints and advantages of the others;
• the involvement of NGOs in all aspects of HIV/AIDS mitigation activities, including policy development, material development, training, programme design, implementation and evaluation;
• Ministry recognition of the importance of collaboration with NGOs, and the creation of procedures to facilitate this partnership on both fiscal and practical levels.
• It is necessary for NANGO and NAC to convene a Policy Stakeholders Meeting. This meeting will serve to discussion and clarify the following:
  
  - NGO/NAC - Roles and responsibility with reference to enhanced policy implementation
  
  - Collaboration , networking and information sharing organizational responsibilities
  
  - Planning for the way forward in terms of increased
  

OBSERVATIONS 3

Weak integration and mainstreaming of HIV/AIDS in the civil society development activities weak.

RECOMMENDATION 3

NANGO to actively advocate for the mainstreaming of HIV/AIDS issues into every level of Civil Society an (NGO) operations as HIV/AIDS is an issue that permeates through all development programming and the entire social fabric of the country. The life skills approach as defined by the World Health Organization as " abilities for adaptive and positive behavior that enables individuals to deal effectively with the demands and challenges of everyday life" (WHO, 1993), should be incorporated into NGO HIV/AIDS education programmes. There is a need for forging linkages of HIV/AIDS strategies to the broad development work being undertaken by varied actors within civil society.

As greater emphasis within the country is being placed on a multi - sectoral approach to the management of the HIV/AIDS epidemic, organizations within Civil Society are increasingly being called upon to join the Governmental AIDS partnership. Non Governmental organisations particularly those working outside of the HIV/AIDS field are a significant group within this sector. The National AIDS Council should establish greater communication with this group. "What is unquestionable is that the tentacles of HIV are growing longer and stronger, broader and wider".

OBSERVATIONS 4

Weak civil society leadership in HIV/AIDS

RECOMMENDATION 4

NANGO is urged to play an important leadership role by sensitizing its membership about the magnitude and urgency of HIV/AIDS epidemic in Zimbabwe. It is within its powers to play a catalytic role in the fight against HIV/AIDS by promoting research and disseminating research results, translating research into action, mobilize for civil society sector integration of HIV/AIDS into all development programmes and mobilize NGOs as leaders and agents of change and collaboration locally, regionally and globally.

OBSERVATIONS 5

Poor and limited civil society HIV/AIDS resource mobilization and allocation coupled with an unclear NATF position in this respect.

RECOMMENDATION 5

NANGO should seek to actively lobby the Government of Zimbabwe to revise the current NATF allocation of resources for HIV/AIDS health, education and social service provision, for the benefit of its membership. Resource allocation in the era of HIV/AIDS entails the need for re - thinking current methods of allocation and utilization of funds. NANGO should not only mobilize extra funds for its membership from Government, donors and the private sectors but capacity build its membership to closely monitor and evaluate funds so as to promote increased efficiency.

The National HIV/AIDS Policy implementation is an enormous undertaking and must be managed efficiently and effectively. NAC needs to develop and decentralize and delegate to other sectoral actors NGO included programme coordination mechanisms to maximize the full Zimbabwean participation.

As such there is need for NAC to allocate funds for the strengthening of NGO Provincial Chapters to enable effective coordination, monitoring and reporting to NAC, on the NGO HIV/AIDS activities at the provincial and district levels.

OBSERVATIONS 5

Unclear and perceived lack of transparency in the NAFT Disbursements.

RECOMMENDATION 5

Local level promotions /advocacy campaigns are necessary through community based workers, local traditional/political leaders, Community based organizations (CBOs), Non governmental organisations (NGOs). NANGO as the official networking body has a key role to play in creation of awareness and education of its membership on all issues pertaining to NAFT financial management and accounting procedures.

Through its membership who possess the requisite expertise, NANGO should provide capacity building and skills development programmes for its membership to facilitate their access to the funds. Training should be provided for those in leadership/ managerial and financial and accounting positions in CBOs and Non Governmental Organisations. NANGO should facilitate the provision of the NAFT Requesting and Accounting Documents to its membership.

NAC should facilitate the speedy adoption and facilitate public mass media announcements of the nominal allocations of the NAFT funds to:

1. The Districts fund: largest share

2. NGO fund focused on advocacy and mobilization

3. Public sector institutions/ Line Ministry fund and

4. Funds set aside for capacity building for NAC and supporting structures.

Decentralization of AIDS funds to the 59 Districts based on reviving multi-sectoral District Committees where these have lapsed to be adopted. Active inclusion and education of NGO to actively participate in the DAACs recommended to combat resistance and apathy and increase stakeholders' participation.

Facilitate the disbursement of the National NGO fund focusing on advocacy and mobilization activities to NANGO.

OBSERVATIONS 6

There exists varied organisational capacities amongst civil society for multi-sectoral implementation of the National AIDS Policy.

RECOMMENDATION 6

NANGO should facilitate participatory training for NGO/ASOs/CBOs and their clients/target groups in the following areas:

• National HIV/AIDS Policy and programming implications
• HIV/AIDS Education - Life skills approach
• Bottom up, cross-sectoral, gender - sensitive strategic planning and management skills.
• Development of Management Information systems on HIV/AIDS
• Advocacy and social mobilization
• Operational Systems training (financial planning, monitoring and evaluation, management, communication, decision making, personnel, administration, fundraising).
• Programme design, planning, implementation, monitoring and evaluation.

OBSERVATIONS 7

It would appear that although some civil society actors are implementing the National HIV/AIDS Policy, in varied manners, an integrated multi- sectoral coordinated national response is questionable.

RECOMMENDATION 7

NANGO should also facilitate a round table and provide technical assistance for Civil Society and NGOs discussions and organisational reviews, in a bid to enhance existing NGOs capacities for an effective coordinated multisectoral HIV/AIDS response.

• Review existing membership HIV/AIDS programme performance: Are they making a difference to people infected/ affected by HIV/AIDS? Are they in step with the national directions? Are their activities at a tangent with the Government of Zimbabwe? Are they adhering to the national guidelines and policies?
• Review of NGO administrative and financial arrangements in place.
• Review current programming interventions: relevance, effectiveness, efficiency, impact and sustainability and levels of community ownership. Individual organisational SWOT require to be conducted in light of HIV/AIDS.
• NGOs need to increase the participatory nature of its current HIV/AIDS and development programme strategies, its actual outreach to communities, its ability to influence public policy and effect changes on the lives of the individuals and communities.
• Current levels of accountability by NGOs to programme beneficiaries - communities, people affected/infected by HIV/AIDS
• Exploration of modalities to strengthen NGO networks such as NANGO and ZAN in HIV/AIDS capacity building, information management and exchange integrated communication management, marketing, public relations, advocacy and social mobilization.
• Review and revision of NGOs: leadership, resources, culture, structures, operational systems, legitimacy and identity in light of the HIV/AIDS epidemic.
• Exploration of modalities for the improvement and strengthening collaboration efforts with NAC, MOHCW and other relevant ministries. To strengthen external linkages NGOs will need to work closely and join existing structures at the national, provincial, district and grassroots levels. The development of strategic alliances between civil society, Government and private sector is necessary. NANGO needs to facilitate increased collaboration, networking, and information sharing amongst NGOs and other members of the civil society.

CONCLUSION

The study sought to ascertain the levels of National HIV/AIDS Policy awareness and implementation and accessibility by NGOs of the National AIDS Trust Fund. It concluded that awareness and implementation is low and NATF accessibility by NGOs is limited. The researcher hopes that NANGO and its collaborating partners will seek to address this situation, with the utmost urgency.

ACKNOWLEDGMENTS

The author wishes to thank Mrs. Makoni and UNICEF Harare staff, for their comments and particularly NANGO membership, Zimbabwe National AIDS Council and NANGO office staff for their cooperation.

by FELICITY LYDIA SEKAI HATENDI
P.O. Box 268 WGT, Harare, Zimbabwe
fhatendi@ecoweb.co.zw or felicity_hatendi@yahoo.com