1

CHAPTER 1

PREVENTION

In pursuit of the overall prevention objective to reduce the number of new HIV infections, the country

scaled up in the coordination and implementation of various programmes including prevention of

mother to child transmission (PMTCT), HIV testing and counseling (HTC), control of sexually transmitted

infections (STI), condoms promotion and distribution, youth programmes, and behaviour change as well

as male circumcision.

1.1 Prevention of Mother to Child Transmission (PMTCT)

The PMTCT programme was scaled up through support from EGPAF and other partners like Family AIDS

Initiatives, Kapnek, OPHID and ZAPP they have supported 815 MoHCW sites throughout the country in

37 districts.

Coverage of services for PMTCT has increased steadily. By end of 2010, 1560 facilities were providing

ANC services, of which 60% were offering both on-site HIV testing and ARVs for prophylaxis while the

remaining 520 offered ARVs for PMTCT but did not yet offer on-site HIV testing. There is need to scale

up HIV testing in ANC. In 2010, 87% of pregnant women attending ANC services were tested for HIV,

compared with 85% in 2009. Various outcome and output indicators were monitored throughout the

year in line with the M & E plan:

Outcome indicators

Percentage of HIV infected pregnant women who receive anti-retroviral to reduce the risk of

Mother to Child Transmission – 67%

Percentage of HIV infected pregnant women who received ART for their own health – 45%

Output indicators

Percent of infants born to HIV infected women receiving any prophylaxis for PMTCT – 62%

2

Table 1: PMTCT Outputs

Activity 1st quarter

2nd quarter

3rd quarter

4th quaretr

Total

Pregnant women tested for HIV 77506 74992 80196 85794

312592

Pregnant women tested for HIV+ 10560 9687 10045 9803

39895

Positivitiy rate 13.6% 12.9% 12.5% 12.2% 12.7%

HIV positive pregnant women dispensed with ARVs prophylaxis

3372 5473 4611 5274

18730

HIV positive pregnant women dispensed with single dose nevirapine prophylaxis

5578 6163 6319 6608 24668

Infants dispensed with ARVs prophylaxis

3015 3620 4689 5317 16641

Infants dispensed with single dose nevirapine prophylaxis

3762 3916 3828 3584

15090

Male partners tested for HIV 5683 5805 6314 6978 24780

Although there are more women receiving the single dose prophylaxis the annual trends show that the

coverage ARVs prophylaxis improved tremendously in 2010 due to the roll out of the MER programme.

Male participation on PMTCT is still very as only 7.9% were tested against pregnant women tested.

Figure 1: PMTCT Outputs in the year

77506

74992

80196

79898

10560

9687

10045

9803

3372

5473

4611

5274

3015

3620

4689

5317

13.60%

12.90%

12.50%

12.27%

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

Quarter 1 Quarter 2 Quarter 3 Quarter 4

# o

f p

eo

ple

11.50%

12.00%

12.50%

13.00%

13.50%

14.00%

Po

sit

ivit

y r

ate

Pregnant Women Tested for HIV in ANC Pregnant Women Tested HIV positive in ANC

Pregnant HIV positive Women Dispensed with Neverapine Infants dispensed with PMTCT prophylaxis

Positivity rate

The number of pregnant women tested for HIV in ANC remains gradual throughout the quarters. The

positivity rate of PMTCT mothers a gradual downward trend. There is an increase in the number of

infants dispensed with PMTCT prophylaxis.

3

Testing male partners in the context of PMTCT remains a challenge. Involvement of men in

PMTCT is limited and very few participate in testing with their partners – 7%.

Policy issue

ANC user fees have also hampered efforts to increase access to and utilization of PMTCT

services as most pregnant women cannot afford the exorbitant fees. Most women end up giving

birth at home and hence failing to access PMTCT services. This policy issue needs to be

addressed if we are to achieve virtual elimination of mother to child transmission.

Ministry of Health and Childwelfare is at an advanced stage in Integrating Reproductive Health

and PMTCT. Guidelines are now being developed.

HIV Testing and Counseling (HTC)

High quality HIV counseling and Testing (HCT) is one of the most successful interventions in the national

response to HIV and AIDS in Zimbabwe to date. As a result of the expansion of Provider Initiated Testing

and Counselling (PITC), approximately 64% of health facilities were providing HTC at the end of June

2010.

Output indicators

The figure 2 below shows;

Number of people counseled and tested for HIV in the past 12 months (by age and gender)

Number of people testing HIV-positive (by age and gender)

Figure 2: HIV Testing and Counseling

22643

28482 52140

60697

115911

37805

26152 46931

84525

84959

149534

46726

5780

1845

4958

10689

39384

9671

5731

4525

14614

22886 5

0892

9973

0

20000

40000

60000

80000

100000

120000

140000

160000

<15 15-19 20-24 25-29 30-49 50+

Age group

# o

f p

eo

ple

# of people HIV tested Males # of people HIV tested Females

# of people tested positive Males # of people tested positive Females

The figure 2 above indicates that the majority of individuals tested and counseled are females with

limited participation by men. In 2009 a total of 625, 046 clients were tested as compared to 756, 505

which denotes an increase of 12%.

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There was a decrease in positivity rate from 30.6% in 2009 as compared to 23.9% in 2010. This can be

attributed to the impact of the various interventions like the behavior change programme. The following

table shows positivity rate by province.

Table 2 Positivity rate by Provinces

Provinces Positivity Rate %

Mat North 25,2

Midlands 29,9

Mash West 20,9

Harare 25,7

Bulawayo 24,7

Mash Central 20,8

Masvingo 22,1

Mat South 29,4

Manicaland 18,9

Mash East 27,7

Midlands has the highest positivity rate of 29.9% while Manicaland has the lowest, 18.9%.

Policy issues

PITC is not offered in all health facilities: 1 in 3 public health facilities do not have the capacity to

offer PITC

Although primary care counselors have been recruited to support HTC, they are only able to

offer pre and post-test counseling and are prohibited from undertaking rapid testing limiting,

the efficiency of the HTC process

1.3 Sexually Transmitted Infections (STIs)

Key approaches for STI prevention and management include condom distribution and promotion, as

well as encouraging early treatment of STIs. STI interventions are integrated into HTC, TB, PMTCT and

ART services. A total of 248 955 new STI cases were recorded in 2010 while 173 916 were recorded in

2009, an increase by 30%.

The table below shows the number of STI cases recorded per quarter

Table 3 STI cases recorded

Activity 1Q 2Q Q3 4Q Totals

Number of new STI cases

recorded

71005 62148 61147 54655 248955

Number of repeat visits 13610 12052 11600 10535 47797

Number of STI clients

tested for HIV

2346 2903 3390 5517

14156

5

Number of STI clients

tested HIV positive

846 1301 988 1541 4676

From the table above there was a steady decrease in the number of new STI cases during the year.

However the number of new cases remained high. The number of repeat visits are however a cause for

concern and needs further investigation. The incidence of STI clients testing positive increased from 846

in the first quarter to 1541 in the fourth quarter. This translates to 1,9% positivity rate.

Figure 3 New STI cases recorded

Masvingo recorded the highest number of STI cases during the year with 48 712, which is 19,6% of the

annual total number of STI cases, while Matebeleland North recorded the least number of STI cases, 10

650 (4,3%).

1.4 Condom promotion and distribution

In Zimbabwe, condom promotion and distribution is spearheaded by the MoHCW, the Zimbabwe

National Family Planning Council (ZNFPC) and Population Services International (PSI).

6

Figure 4 Male condom distributions by quarter

During 2010 the distribution of condoms in the public sector was constantly higher than the private

sector because the sales in the private sector were partly affected by the donation of Protector Plus

condoms by PSI to ZNFPC in 2009.

Figure 5 Female condom distributions by quarter

Female condom distribution had a marginal increase in the public sector compared to the private sector

and this was due to the capacity building for service providers done in the public sector.

7

The uptake of condoms was low in Midlands, Masvingo, Mat South and Mash Central during the year

and this necessitated the training of 136 Nurses, 273 CBDs, 32 Civil Society members, 48 Defence forces

members and 85 DACs.

A journalist, Mr. Paul Mundandi performing a role play on the use of a female condom during a media

capacity building workshop at Kadoma Hotel and Conference Centre, November 2010

1.5 Youth Programs

1.5.1 Youths in school programme

There are 2 493 260 pupils in primary school and 88 7695 in secondary schools giving a total of 3 380

955. While there is an increase in the number of youth in school receiving HIV and AIDS lessons, this is

still very low as compared to the number of youth in school.

Figure 6 Youth In-school

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The general performance of this programme continues to be very low as the highest exposure of pupils

to the life skills HIV and AIDS educations was 40,8% throughout the year. The low reporting of schools

also contributes to the low figures of exposure.

Table 4: Youth in School activities

Activity Male Female Total

Teaching of life skills based HIV and AIDS education

curriculum to youths in schools in all provinces.

87335 85364 172699

Number of Peer Educators active in school. 31546 31380 62926

Number of pupils in school AIDS Action Clubs 90917 103678 194595

HIV and AIDS prevention programmes for youth in schools is likely to improve in 2011 following training

of 157 District Education Officers in HIV and AIDS Life skills education in 2010. These officers are

expected to conduct outreach sessions with secondary school students with special focus on girls. With

support from VVOB, forty five student teachers from all teacher training colleges were trained in the use

of film in communicating HIV and AIDS messages, while SAYWHAT trained BC facilitators to conduct

sessions for students in tertiary institutions during their orientations periods. The training by SAYWHAT

was supported by the Global Fund.

1.5.2 Youths out of school programme

A total of 156 697 youths visited the YFCs while 7565 peer educators were active in the centres.

Table 5 Youth out of School

Activity Male Female Total

Number of youths visiting YFCs 89924 66773 156697

Number of youth peer educators who were active 3828 3737 7565

Number of out of school youths involved in IGPs 16623 13235 29858

NAC supported ZNFPC with USD 250 000 during the fourth quarter for youth peer educators’ training

and payment of allowances, renovations of youth centres and monitoring of activities at the various

youth centres in the country.

1.5.3 Young People’s Network on HIV and AIDS

With support from UNICEF, the YPNHA hosted a convention for 85 young people from all over the

country to hold youth focused commemoration of the World AIDS Day.

1.6 Male Circumcision (MC)

Roll out of MC has been slow since consultations are still in progress on the national model that the

country will adopt. Only five static sites complemented by mobile services offer clinical male

9

circumcision in the country. As a result 9958 males were clinically circumcised in 2010, with 481 of these

being circumcised in Mashonaland West as part of pre - World AIDS Campaign.

Table 6: Provincial distribution of MC services and outputs, 2010

Province No medically circumcised Sites offering MC

Harare 4279 2

Masvingo 1397 0

Mash Central 19 1

Manicaland 275 1

Mash West 538 0

Mash East 3 0

Mat South 15 0

Bulawayo 2976 1

Mat North 29 0

Midlands 427 0

The Mashonaland Central site at Karanda Hospital has circumcised fewer men compared to other pilot

sites owing to the absence of a doctor to perform the procedures. Through a partnership involving NAC,

MoHCW, UNFPA, PSI and the community of Chiredzi in Masvingo province, 1397 men were medically

circumcised.

Above part of the group of men that were circumcised at Chief Tsovani in Chiredzi.

1.7 Behaviour Change Communication Programme

The year 2010 marked the national roll out of the behavior change programme. Apart from the 26

districts that had been supported by the Expanded Support Programme (ESP) and EU, the programme

was rolled out to cover all districts including Harare and Bulawayo with the support of the Global Fund.

Implementation of behavior change in the GF districts mostly involved sensitization of the programme,

ward planning and training of community leaders. The recruitment of Behaviour Change Facilitators

(BCFs) started later in the year and as a result only 2278 BCFs were recruited trained. Following the

10

recommendations from Annual Independent Review 3 (AIR 3), the eleven week BC training sessions

were reduced to 6 week sessions as a means to address the high dropout rate.

Behaviour Change Youth Convention in Matebeleland South Province

1.7.1 BC interim survey

As a follow up to the baseline study on BC conducted in 2005 and the subsequent launch of the BC

strategy, a mid-term interim survey was conducted in 2009. The survey sought to determine the effect

of the BC programme on reported knowledge, attitudes, norms and behaviours in two of the provinces

in which the programme was implemented.

The major findings of the survey revealed that:

There has been an increase over time (2007 to 2009) in the level of HIV knowledge: 9%

compared to 16% of people have low knowledge, 55% vs. 62% have medium knowledge and

36% vs. 23% have high knowledge.

There has been a decrease in the number of young people starting sex early and the number of

lifetime sexual partners, partners in the last year, last 6 months and at present. Moreover, there

has been a significant increase in reported condom use.

Unmarried participants report higher condom use with the last partner (65%) compared to

divorced/separated/widowed (31%) and married people (15%).

There has been an increase in HIV testing and associated behaviours.. This is especially the case

for women; 55% of them are now tested for HIV compared to 41% of men. Moreover, 29% of

participants in the interim survey tested for HIV more than once compared to 17% of

participants in the baseline.

Youths reported having fewer sexual partners in the past 12 months in the focus districts when

compared to non-focus districts.

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1.8 Most at Risk Populations

While sex work is the not the main mode of transmission according to the 2009 Modes of Transmission

study by NAC, its impact is certainly not negligible considering onward transmission to male sex work

clients. A total of 3010 sex workers were attended to at Mbare while 745 were seen along the Highways

as part of a scale up of services for sex workers provided at identified major hot spots in Zimbabwe. As

part of the scale up, services such as peer education, treatment of sexually transmitted diseases, testing

and counseling for HIV, and birth registration were provided.

Table 7 Most at Risk populations reached

Activity Male Female Total

Number of sex workers reached with prevention programmes 499 3805 4304

Number of truck drivers reached with prevention programmes 1663 5 1668

Number of prisoners reached with prevention programmes 389 108 497

Number of fisherman reached with prevention programmes 144 30 174

Number of small-scale miners reached with prevention

programmes

807 192 999

Number of migrants reached with prevention programmes 2934 5193 8127

1.9 GENDER

The NAC commissioned MOT research included a review of gender programmes in national response. As

a result, a number of gaps were identified with the major recommendation calling for mainstreaming of

gender across all thematic areas of the national response.

NAC therefore facilitated the training of implementing partners to strengthen their capacity to

mainstream gender in all HIV and AIDS interventions resulting in 782 out of a target of 1785 people

being trained as trainers in mainstreaming.

Table 8: Output for the gender programme

Activity Q 1 Q2 Q3 Q4 Total

Number of women and girls reached with HIV

prevention programmes

34 673 52 261 37 028 72 061 196 023

Number of women and girls assisted in

economic strengthening programmes

5946 11 089 19 889 11 279 48 023

Number of women and girls reporting abuses

( sexual, physical, economic)

1204 1060 7495 1305 11 064

Number of women and girls assisted in legal

issues

2192 5337 3634 6704 17 867

12

There was a notable increase in number of women and girls reached with HIV prevention programmes

from 34673 in first quarter to 52261 in the second quarter, before declining in the third quarter and

peaking again in the fourth quarter. The highest number reached was among the 15-24 year age group

(94 085).

The highest number of reported cases of abuses (sexual, physical, and economic) was among those aged

below 15 years which could be attributed to increased awareness through such activities as the 16 Days

of Activism against gender based violence and improved media reporting.

1.10 WORKPLACE

Although interventions were scaled up in 2010, the workplace response still lagged behind for both the

public and private sectors. Reasons varied from lack of resources, lack of leadership commitment and

few implementers. Baseline data collected during the course of the year showed that companies and

organizations were at varying stages with respect to engagement on workplace HIV and AIDS issues.

1.10.1 Workplace Baseline Data

NAC carried out a baseline survey to establish district-level baseline data of both the private sector and

public sector entities in terms of size of labour force (gender disaggregated), stage of workplace HIV and

AIDS policy formulation and HIV and interventions under implementation. The following graph

illustrates the findings.

Figure 7: Organisations with policies and programmes

Data was received from 577 companies and institutions. Of the 577 companies and institutions, only

36% had policies in place and 23% were implementing at least one or more activities. As shown in the

graph, the majority of the companies and institutions are yet to consider HIV and AIDS as a serious

workplace issue. Those implementing comprehensive programmes are mostly the large enterprises

reflecting a serious gap on the Small and Medium Scale Enterprises.

13

Table 8: Number of employees reached with workplace HIV prevention programmes

Private Sector Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total

Small 4587 5519 2812 2702 15 620

Medium 1323 6941 11 349 3024 22 637

Large 29 871 15 551 19 278 80 814 145 415

Public Sector 3968 5337 5154 7324 21 783

Total 39 749 33 348 38 593 93 864 205 455

Although most companies have been experiencing economic challenges, there was a notable increase

in the number of employees reached with HIV prevention programmes from 106 036 in 2009 to 205

455 this year. The number of employees accessing ART through the workplace initiatives was 23 842

with more people being reached by large enterprises. A total of 37 510 were tested for HIV with a

positivity rate of 22%.

1.10.2 Capacity Building of DACs

NAC trained all its District AIDS Coordinators to strengthen their capacity to provide technical assistance

to workplaces so that action against HIV and AIDS in the workplace is accelerated. The training covered

issues around policy and programme development, situation analysis, monitoring and evaluation and

coordination of workplace programmes. A workplace guide was developed to provide direction to

effectively design, implement and coordinate the workplace response.

1.10.3 Global Fund Support

The following table presents the cumulative performance of various indicators implemented through

the EMCOZ/ZCTU consortium under Global Fund Round Eight Phase One grant.

Table 9: Activities contributing to the performance framework

Activity YR 1 Target Target Achievement

%age

Training of Trainers 250 250 100%

Peer educators 200 200 100%

Training of union leaders and business leaders 75 75 100%

Sensitization and advocacy workshop 195 195 100%

Training of labour inspectors 120 120 100%

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1.10.3 Mine Entra Business Conference on HIV And AIDS

NAC held a business conference alongside the Mine Entra motivate companies to come up with

workplace policies. Other issues discussed included funding for the national response and the utilisation

of the AIDS levy as well as related resource gaps. Seventy eighty (78) business representatives attended

the conference.

1.11 INFECTION CONTROL

Infection control programmes were implemented in most clinics and hospitals.

Table 10: Infection control programme outputs

Activity Male Female Total

Number of health facilities that had a stock-out of sterilization equipment 12

Number of staff reporting work-related injuries exposing them to HIV 66 143 209

Heath staff injured at work completing PEP 47 140 187

Number of sexually abused men and women provided with PEP 78 82 160

A total of 209 staff members reported work related injuries exposing them to HVI while 187 managed to

complete the Post Exposure Prophylaxis in 2010.

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CHAPTER 2

TREATMENT AND CARE

2.0 ART Programme

The goal of ART is to reduce mortality and morbidity due to HIV and AIDS and to improve the quality of

life of PLHIV. Although the number of people receiving ARVs rose by 66.5% from 215 000 by the end of

2009 to 358 000 by the end of 2010, the treatment gap further widened in the same period. This was

largely due to the adoption of the new WHO guidelines, which recommend the initiation of new ART

clients at a CD4 count level of 350 up from 200. In 2010, 86,075 new patients were initiated on

treatment compared to 65,123 in 2009 registering a 24% increase in ART initiations. (MOHCW report,

2010)

2.1 ART outreach

The national ART programme strongly benefited from the NAC support towards outreach programmes

by MoHCW teams. This has enabled all districts to conduct a minimum of four outreaches per month

and has assisted in increasing the number of clients commenced on ART.

The following figure shows how the number of initiating sites and follow up sites has been increasing

since 2004 to 2010. There are 128 initiating sites and 382 follow up clinic as at December 2010.

Figure 8 Comparison of the initiating sites and follow up clinics

2.1.2 Early Infant Diagnosis (EID)

In order to decrease infant mortality and to decrease hospital admissions MOHCW continues to roll out

the early infant diagnosis services. By the end of 2010, 371 sites were collecting and submitting Dry

Blood spot samples from children for DNA/PCR testing. By December 2010 16,352 samples were

collected and 14% (2373) of these were positive. To ensure that children are diagnosed early as well as

commenced on treatment early, by December nurse midwives from 20 sites had been trained to offer

ART in maternal, neonatal, child health (MNCH). The programme is facing some challenges that include:

Slow roll out of EID and early initiation of treatment

0 1232

64

175

263

382

748

68 86107 117 128

0

50

100

150

200

250

300

350

400

450

2004 2005 2006 2007 2008 2009 2010

Follow up clinics Initiating sites

16

Limited access to CD4 count machines for rHIV infected pregnant women

Stock out of reagents

Inadequate transport to take samples to the NMRl and transportation of results to sites.

Delayed data transmission to the national level

2.1.3 Laboratories

Of the total 62 public health laboratories in the country, 43 (69%) of these have the functional capacity

to perform all the clinical laboratory tests for ART. There are currently over 100 CD4 point of care

machines (POC) that are in the country that have been procured with support from the following

partners: UNICEF, EGPAF, KAPNEK. Training and deployment of the machines has started.

2.1.4 Viral load testing Validation of the machine and method has been done at NMRL. The machine ran over 1000 viral load tests in 2010. It has passed external CDC quality assurance PT test. 2.1.5 HIV DR NMRL ran 33 samples for HIV DR. For the lab to start running samples for the country it needs to be WHO accredited. Hence currently samples for HIV DR are being sent outside the country and lab is working towards WHO accreditation. 2.1.6 ART Support by Different Partners The following are some of the partners who have been assisting the MOHCW with ART commodities for clients. An outline of the support for adult ART and paediatric ART is given in the tables below Table 11: Support for Adult ART

Partner Number of clients supported

National AIDS Trust Fund/ Government of Zimbabwe NATF/GOZ

40,000

Global Fund (GF) 156,000

United States Government (USG) 59,000

Expanded Support Programme (ESP) 80,000

Clinton Foundation (CHAI) 2,300

Total Support 337,300

Table 12: Support for Paediatric ART

Partner Number of clients supported

United States Government (USG) 30,000

Global Fund GF) 4,000

Total support 34,000

The country has adopted the WHO guidelines which state that ART should be started in those in WHO

stage 3 and 4 and those with CD4 count less that 350 versus the 200 CD4 count that the country was

using. This is applicable to both adults and adolescents including pregnant women. The regimen also

states that MER should be started at 14 weeks. The country through the guidelines has to switch clients

17

from stavudine based regimen to tenofovir based regimen on agreed protocols for both first and second

line with different regimens for children and adults.

Implications for adopting the guidelines

Increase demand for services with numbers for those in need for ART almost doubling up from

the previous 340,000 to 593,000. The number of clients on the waiting list will also increase

Increase in treatment costs with Tenofovir based regimen costing double the stavudine based

regimen. Increase in ARVs for PMTCT also has an effect on cost.

Increased costs from supply chain management to reduce stock outs of drugs and commodities

Increased demand for HIV diagnostic and treatment monitoring (different laboratory equipment

including viral load testing for assessment of treatment failure)

New infrastructure may be required eg counselling rooms, drug storeroom etc

Need for increased linkage between ANC/ PMTCT and ART

It is anticipated in the medium term that morbidity and mortality will be decreased with a hope

for eventual elimination of peadiatric HIV

Policy Issues

The country has planned to start the phase out phase in of the new drug regimens in April 2011. The

plans are to phase out stavudine over three years. There is a plan on how to prioritize the

commencedment of tenofovir based regimen.

2.1.7 Clients on ART

There are 503 000 people (15+) needing ART in Zimbabwe, up from 350 000 in 2009. The rise in the

figure is as a result of the new WHO guidelines, which recommend the initiation clients on ART at CD4

count of 350 up from 200. As a result, this has affected Zimbabwe’s pursuit of universal access has been

Table 13: Clients in need of ART

Category Total in need of ART, At 350

CD4 (new WHO guidelines)

Number on treatment % coverage

Adults 503 678 310 360 61.6%

Children 89 490 31 904 35.7%

Total 593 168 342 264 57.7%

Universal access according to the ZNASP (2006-2010) is defined as any coverage that is above 75%,

suggesting that Zimbabwe is at 57.7% of those in need of ART.

The tables below show the number of adults and children on ART, from the first to the fourth quarter of

2010:

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Table 14: Adults on ART

Variable 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Annual target 260 000 260 000 260 000 270 000

Output 223 725 237 054 285 804 314 665

Variance -36 275 -22 946 +25 804 +44 665

% Achievement 86% 91% 109% 117%

Table 15: Children on ART

Variable 1st Quarter 2nd Quarter 3rd Quarter 4TH Quarter

Annual Target 25 000 25 000 25 000 30000

Output 25 694 29 443 34 021 32 430

Variance +694 +4 443 +9 021 +1975

% Achievement 102.8% 117.8% 136% 108%

The annual targets for both adults and children were surpassed because of the following reasons:

Improvement of reporting by the private sector in some provinces such as Harare

Establishment of new outreach sites

Training of Health workers under the Global Fund Round 8 and other partners

Provision of necessary equipment like 4 automated CD4 Count Machines procured for the

Central Hospitals

The following two tables give a provincial distribution of adults and children on ART:

Table 16: Provincial distribution of adults and children on ART

Province Children Clients on ART Adult clients on ART

Manicaland 3815 37972

Harare 7323 67412

Midlands 3750 34672

Mashonaland East 2706 20261

Mashonaland West 2308 27161

Matebeleland North 1826 20131

Matebeleland South 1854 18317

Bulawayo 3358 28166

Masvingo 2310 43188

Mashonaland Central 2735 29444

National 32 430 314 665

There is still a challenge in collection of ART from the private sector. As a result, the Ministry of Health

and Child Welfare estimates the figure at 10 000

The following graph shows the percent of HIV infected children and adults known to be on treatment 24

months after initiation of ARVs

19

Figure 9:

72%

62%

72%

64%

77%

67%70%

60%

69%

National average patient survival rate was 69%. Masvingo had the highest survival rate – 77%, and

Midlands had the lowest - 60%.

1.1.8 Early Warning Indicator Survey

NAC collaborated with the MoHCW and other partners in conducting the Early Warning Indicator survey

and the results will be disseminated in the first quarter of 2011.

1.1.9 Antiretroviral therapy (ART) Commodities

In support of the national ART programme, the National AIDS Council, utilizing the National AIDS Trust

Fund (AIDS Levy), ordered the following commodities, which will be delivered in 2011:

ARVs worth $5,903,711.60

16 CD4 Machines worth $818,995.00

16 Haematology Analyzers worth $1,043,086.78

HBC Kits worth $602,100.

1.1.10 CD4 Cell Count Machines

CD4 Count machines procured in the second quarter were distributed in the third quarter to

Parirenyatwa, Harare, Mpilo and United Bulawayo Hospitals. Conditioners for all the 4 sites were also

procured and distributed. Uninterrupted power supply unit was supplied to the Harare Hospital site. 16

CD4 machines have been ordered and the Uniformed Forces will benefit from these. In Mashonaland

West Chidamoyo Mission and Norton Hospital also procured their own machines.

20

1.1.10 Rapid HIV Test Kits

NAC through the NATF procured 1500 HIV Test Kits SD Bioline 1/23.B including diluents, lancents and

capillary tubes at a cost of $206,000 during the second quarter and distributed through the MOHCW

structures.

1.1.11 ART Consumables

The MOHCW has adopted the WHO ART guidelines which have recommended changing from Stavudine

based ARV regimen to Tenofovir regime. NAC has assisted with procuring of the new drug at a cost of

$USD6, 5m.

The following drugs which were procured in the second quarter using the NATF were distributed in the

quarter: Stavudine 30mg & Lamuvidine 150mg & Nevirapine 200mg B/60, Stavudine 30mg & Lamuvidine

150mg B/60, Lamuvidine 150mg/Zidovudine 300mg: 889; B/60, Lamuvidine 150mg/Zidovudine 300mg:

1,592; B/60, Lamuvidine 150mg/Zidovudine 300mg: 919; B/60

1.1.12 Blood Screening Kits

NAC in support of safe blood procured 2000 Blood Screening Kits which were handed over to the

National Blood Services. The ESP committed USD400 000 for safe blood commodities.

Further commodities below were also ordered by the Global Fund, of which some have already been

delivered while others are pending:

ARVs amounting to USD 16 million incorporating the new treatment regimen. (Delivery expected

in the first quarter of 2011).

HIV Test kits (32,440 SD Bioline test kits procured through Round 5 resources, already received)

Laboratory equipment and reagents (Delivery expected in the first quarter of 2011).

HBC kits (Delivery expected in the first quarter of 2011).

1.1.13 Traditional Medicine Capacity Building Support

NAC supported the Traditional Medicine Practitioners Council to conduct a capacity building workshop

for its 60 practitioners as well as commemoration of traditional practice at Masiye Camp in Matobo

district ,Matebeland South. The Capacity building topics included those for HIV and AIDS including issues

of ngozi as well as PMTCT.

1.2 Community and Home Based Care (CHBC)

Against a total of 400 000 clients, 112,244 were receiving home based care services by the end of the

2010. The CHBC programme has in general been losing donors with some of the well established

organizations such as MASO in Gweru and Zimbabwe Red Cross Society having lost funding. Advocacy

need to be done in terms of the new C&HBC focus which seeks to suort ART and no longer focuses on

nursing care and palliative care for bedridden/ critical clients.

21

The table below shows the number of clients on C& HBC and bedridden clients by quarter:

Table 17: Clients on CHBC by Quarter

Clients On CHBC

Secondary CHBC Givers

Care Giver to Client Ratio

Bedridden CHBC Clients

% Bedridden

1st Quarter

93795 22263 1:5 5492 5.8

2nd Quarter

80744 26621 1:4 9317 11.5

3rd Quarter

112244 33658 1:4 14278 12.7

4th Quarter

97419 20803 1:5 21905 22.4

Figure 10: Clients on C&HBC By functional status by quarter

There was an increase of bedridden clients throughout the year. This is inspite of the increase in the

number accessing ART throughout the year. This could be a as a result of distortion of reporting of

people who are bedridden. It might also be as a result of withdrawal of nutritional support to C&HBC

clients which might have implicated their health status to bedridden status.

HOSPAZ is working in 48 districts as an SSR for GFR8. There are working in 48 rural districts of the country. The organization continued to work with most partners who worked in GFR5 except for a few districts where new partners were engaged. The number of clients being looked after in the project is 18,094 against a target of 19,200. The overall goal of the project is:

Attaining reduced morbidity and mortality due to HIV and AIDS in Zimbabwe

22

Objectives of the programme are to:

Strengthen the involvement of communities in the provision of ART services

Ensure provision of “Care and support for the chronically ill” HOSPAZ has been contributing to the C&HBC programme in the 48 rural districts excluding those that are not being supported by ESP. Below is an outline of the status of clients by quarter in the programme districts. Table 18: Status of clients by quarter

Quarters No. of clients Bedridden Ambulatory working

Quarter 2 10,460 6% 31% 63%

Quarter 3 10,397 10% 26% 64%

Quarter 4 18,094 4% 22% 74%

The percentage of clients who are bed ridden has been changing from quarter to quarter but more leaned a reduction in these clients who require high levels of assistance. Two Training of Trainers workshops were conducted as outlined below. Table 19: Training of Trainers workshops

Training of Trainers Workshops Male female Total

CMEIACST 13 7 20

C&HBC 8 10 20

Following the training of trainers workshops the following cascade workshops were done outlined with the number of participants to the workshops, Table 20: Training of trainers workshops

Training of Trainers Workshops Male female Total

Food Security for caregivers 129 620 749

CMEIACST 93 120 213

C&HBC for caregivers 139 518 657

C&HBC for Health Workers 22 55 77

In addition the HOSPAZ has also conducted meetings with treatment buddies and distributed varied IEC materials to clients. 1.2.1 ESP/ZAN C&HBC programme The ESP is supporting 16 C&HBC Programmes in 16 districts of the country. The implementing partner for the programme is ZAN. The programmes looks after 400 clients per district with 60 caregivers working with clients . The programme conducted trainings in C&HBC for trainers and caregivers, food security for caregivers and CMEIAST for community leaders. In addition the programme developed M&E programme data collection tools that are currently being used in both ESP and Global Fun programmes.

23

1.2.2 Training of Care givers

A total of 5299 secondary care givers (1887 males and 3412 females) were trained in thyear 2010.

The trainings were funded by the ESP and the GF Round 8. Male involvement still remains a

challenge and there is need to scale up the male motivation campaigns.

Participants to a C&HBC cascade workshop in Lupane (HOSPAZ- GRF8)

1.2.3 Outcomes in the C&HBC Programme The positive programme outcomes from the programme include the following

1. Following training in CMEIACST community leaders and their community members of Shamva have built a toilet and a rocket stove for Madziwa hospital to benefit their community

The just completed rocket stove The completed Blair toilet

2. A community in Bubi built a house for an HIV and AIDS affected household being looked after by

a grandmother

24

Building a hut for a Grandmother with OVC. Bubi 3. A community in Nyahukwe (Makoni) repairing a clinic so that it can be upgraded to an ART

follow up site 4. Stigma and discrimination in the community has decreased and follow up of ART clients being

conducted by caregivers

1.2.4 HIV/ TB collaborative activities

Efforts were made throughout the year to scale up the HIV/TB collaboration , however a lot still needs

to be done. Because of the high HIV seropositivity rate amongst TB patients .The table below shows HIV

and TB collaborative activities.

Table 21: HIV and TB collaborative activities by province-2010

TB patients

tested for HIV

TB Patients Tested

HIV+

TB Patients

Started ART

ART Patients

Started TB

Treatment

Bulawayo 1814 1512 537 378

Harare 5374 3929 1574 837

Manicaland 2390 1632 786 545

Mash Central 1836 1197 340 419

Mash East 653 486 96 65

Mash West 2182 1635 300 823

Masvingo 2451 1896 547 428

Mat North 1038 792 120 154

Mat South 2549 2184 420 339

Midlands 1533 1344 703 896

Figure 11: HIV Positivity rate amongst TB patients tested for HIV by province

25

There is a high positivity rate amongst TB patients with a national average of 76.1%. There is need to

increase HIV/TB collaborative activities in all provinces. Provider initiated testing and counseling in

health institutions need to be scaled up and to intensify TB screening amongst HIV positive patients.

26

CHAPTER 3

MITIGATION

Mitigation programmes improve the lives of both the affected and the infected. Programmes are meant

to assist the communities to cope with their circumstances and improve their quality of life.

Achievements made are as a result of the contributions of various stakeholders which include

multinational, national and Community based Organisations.

3.1 Orphans and Vulnerable Children

The National coverage indicators outlined below show the mitigatory interventions for the OVC

programme and achievements of the year 2010 that range from 20 to 56 percent.

Table 22: Coverage of OVC assistance

Indicator Coverage

Percent of OVC (under 18 years of age) living in households that have

received basic external support in caring for the child (by age and

gender)

21% (MIMS 2009)

Percent of OVC provided with food/nutritional assistance 20%

Percent of OVC provided with psycho-social support 23%

Percent of OVC receiving school-related assistance 56%

Reasons of low performance could be attributed to limited funding and lack of proper database based

on need. The following graph shows provincial achievements in the same area:

Figure 12 OVC assisted by type of assistance and by Province

Most mitigation interventions for OVC which include provision of nutrition, school related assistance

and psychosocial support met their targets in 2010.

On School related assistance for OVC, the Midlands Province recorded the highest number of children

assisted as indicated by the graph above because of its population size and many donors who assisted in

that area. Psychosocial support generally recorded better performances throughout the provinces

because it requires limited funding to implement.

0

50000

100000

150000

200000

250000

School related PSS Nutrition

School related 115407 29163 149202 81630 141285 41531 42171 35421 180942 15947 PSS 28640 23397 19127 37373 7056 6207 6201 25220 22393 4346

Nutrition 18180 10557 9290 11999 19304 25038 11322 25540 27111 4231

Manicala nd

Mat South

Mash East

Mash Central

Mash West

Masving o

Mat North Harare Midlands

Bulaway o

27

3.1.2 Functional Child Protection Committees

By the end of 2010, 2246 Child Protection Committees (CPCs) were functional across the country at

various levels ranging from village, district and provincial levels. The roll out of the village registers

through support from Global Fund Round 8 contributed to the 2010 number.

The Midlands Province recorded the highest number of CPCs with the majority of them distributed in

rural districts, while Bulawayo had the least.

Below is a graph that shows the provincial distribution of CPCs.

Figure 13 Provincial distribution of CPCs

106 103 112

590

222181

36 52

824

30

0

100

200

300

400

500

600

700

800

900

Manica

land

Mat S

outh

Mash

East

Mash

Centra

l

Mash

West

Masv

ingo

Mat N

orth

Harare

Midla

nds

Bulawayo

3.1.3 People Living with HIV (PLHIV)

The graph below presents data on performance of national targets in the National M & E Plan.

Figure 14: National PLHIV support coverage

28

The lower coverage percentages in the above indicators does not necessarily indicate under

performance as not all PLHIV needed food assistance, PSS and medical assistance. Targeting too was

based on resources available to provide services although the measurement is based on denominators

that include all HIV positive people.

29

The table below gives a provincial summary of performance of some planned programme activities for

people living with HIV:

Table 23: PLHIV assisted by type of assistance and by Province

Province Nutritional support PSS Provided

Support groups

formation IGPs for PLHIV

Target Output Target Output Target Output Target Output

Masvingo 19121 21900 16025 16025 1020 792 813 848

Manicaland 20951 23422 33025 40632 469 1197 469 1328

Harare 23000 6255 33261 24600 751 916 287 234

Bulawayo 10340 8107 6330 10187 200 165 120 130

Mat North 25400 26148 22569 6121 130 167 113 55

Midlands 19139 22484 18700 38009 1568 1585 800 720

Mash East 15000 13537 25000 18563 700 660 955 1786

Mash West 5600 4332 31366 32865 144 12 500 474

Mat South 20432 19309 23832 24107 370 252 17 32

Mash Central 9612 9831 20052 9482 153 80 850 1075

National Totals 168595 155325 230160 220591 5505 5826 4924 6682

The table above indicates that most PLHIV were provided with PSS followed by nutritional support. It

can also be noted that there was significant increase in the number of IGPs and support group

formation. This could be attributed to the integration of PLHIV in BC, programme, CHBC and ART.

Although the provinces of Midlands, Masvingo, Manicaland, Matabeleland North and Mashonaland

Central had a 100% achievement in the provision of nutrition, the national average performance stood

at 92%.

Year on year, nutritional support and support group formation activities performed better in 2009 than

in 2010.

30

Figure 15: Support for PLHIV IN 2009 AND 2010

Under performance in 2010 could be attributed to the withdrawal of nutritional support by some

organisations as their funders felt that nutritional support to clients on ART was not sustainable, with

the attention shifting towards income generating projects.

3.2 Meaningful Involvement of People Living with HIV (MIPA)

Four National MIPA TWG Meetings were conducted during the year to discuss such issues as the

Implementation of Global Fund Round 8, application for Round 10, Training of Trainers Programme,

Constitutional Review Process, Stigma Index, Resource Mobilisation, the Integrated Planning Process,

ZNASP II and the 2010 AIDS Conference. PLHIV participated meaningfully in the development of ZNASP

11 where they were incorporated in all the thematic areas in line with the philosophy of MIPA. A total of

429 PLHIV were capacitated with planning, management and advocacy skills at national and provincial

levels. The MIPA programme also printed and distributed 2000 copies of the MIPA baseline survey

reports to all the provinces. The survey report is part of the core foundational documents guiding MIPA

programming.

The ZNNP+ constitution was reviewed resulting in the election of Provincial Executive Committees

(PECs) and a new gender balanced National Executive Committee (NEC). Thirty (30) officials from the

public sector were sensitised on issues of HIV, the concept of support group formation and MIPA. Six (6)

vehicles were purchased by Global Fund to support transport needs of PLHIV. A total of six (6) networks

and organisations of PLHIV received computers and faxes from Global Fund as SSSRs to ZNNP+. These

are Youth Engage, Batanai Masvingo and LESO which received computers and printers while ZHAAU,

Simbarashe and FACT Chiredzi received faxes. ZNNP+ with support from SAfAIDS conducted a series of

policy dialogues consultative meetings on the constitution in all the provinces with women and youths

which culminated in national dialogue session where Member of Parliament were engaged to push for

inclusion of the Right to Health in the national constitution.

31

CHAPTER 4

GLOBAL FUND

The following is a comprehensive list Global Fund activities implemented together with targets and

results for Round 8 phase 1 as well as details of grant management.

Table 24: UNFPA Progress Update: Behaviour Change

Activity Target Year 1 Result Year 1 Performance Rate

%

Number of people reached through interpersonal communication (person exposures) (GF Key Indicator)

2,730,000 4,434,290 162%

Number of people reached through interpersonal communication (course completions) (GF Key Indicator)

120,000 134,031 112%

Table 25: SSR- MoLSS Progress Update: Support for OVC

Activity Target

Year 1

Result

Year 1

Performance Rate

%

Number of ward level child protection committees making use of the village register in monitoring OVC interventions (GF Key Indicator)

440 554 125%

The SSR managed to achieve and surpass its cumulative target of 440 wards for the key performance

indicator. Roll out use of the Village/Area Register was in 330 wards

The registers had been distributed to all the districts where training had been conducted. The

involvement of community leaders and the feeling of ownership enhanced the utilization of the OVC

village register. The National AIDS Council managed to go out into the field to verify the actual utilization

of the register in three provinces namely Mash East, Mash Central and Mash West.

Table 26: SSR- CPCPZ Progress Update: PITC, PMTCT, ARV & Monitoring, TB/HIV, M&E and HSS

Activity Target

Year 1

Result

Year 1

Performance

Rate %

Training of health care workers to equip them with skills to undertake dry blood spots for HIV testing and early infant diagnosis counseling (To include nurses from PMTCT, EPI, doctors, laboratory technicians) in both private sector (GF Key Indicator)

25 44 176%

32

Conduct 5 day in-service OI/ART training workshops for ART providers in the private sector using IMAI materials & guidelines with 25 participants/workshop (GF Key Indicator)

25 44 176%

Comments

The target was achieved through 5 regional 3 day training workshops for health practitioners in the

private and public sector such as doctors, nurses, pharmacy technicians etc.

A team of facilitators comprising of two medical doctors from ZIMA, a laboratory scientist from

MOH&CW and a counselor consultant conducted the trainings.

The target was achieved through 5 regional 3 day training workshops for health practitioners in the

private and public sector such as doctors, nurses, pharmacy technicians etc.

A team of facilitators comprising of two medical doctors from ZIMA, a laboratory scientist from

MOH&CW and a counselor consultant conducted the trainings.

SSR- UZ Progress Update: Antiretroviral treatment (ARV) and monitoring and M&E

Clinical follow up visits were to 35 homes. Of these 35, 18 have transferred , 8 have defaulted visits

to clinic and 13 Have moved addresses & lost to follow upThe SSR does not implement any key

indicator activities but provides clinical attachments for doctors, nurses in centres of excellence and

also conducts training of these health workers.

Software development for pharmacy tracking is also delayed by entering demographic data and they

still have to enter clinical side of data.

Table 27: SSR- EMCOZ/ZCTU Progress Update: Work-Place based HIV prevention behaviour change

and work-place policy development

Activity Target

Year 1

Result

Year 1

Performan

ce Rate %

Identify and train leadership in unions, National Employment Councils (NEC) and at businesses by conducting 2day training workshops on HIV prevention and gender mainstreaming-Persons trained per day at provincial level (Part of the GF Key Indicator)

100 75 75%

Conduct sensitization and advocacy workshops for business leadership and management , union leadership to make them champions for scaling up workplace prevention, treatment care interventions and policy adoptions in the private sector (Part of the GF Key Indicator)

195 195 100%

Sensitize work force on HIV and AIDS issues, including importance of knowledge of HIV status and consistent and correct condom use (in

2 500 623 25%

33

250 companies)

Conduct a 5day training of trainers of peer educators at enterprise level in HIV behavior change (including issues of concurrency, gender, stigma, condoms etc.) and HIV services (including PITC, PMTCT and treatment - Persons trained per day at community level literacy), 250 companies, 1 per company (Part of the GF Key Indicator)

200 200 100%

Conduct a 5 day training of peer educators in HIV behavior change (including issues of concurrency, gender, stigma, condoms etc.) and HIV services (including PITC, PMTCT and treatment literacy)- Persons trained per day at community level (Part of the GF Key Indicator)

100 135 135%

Advocate with informal sector associations, labour unions and their affiliates, employer organizations and National Employment Councils (NECs) on policy and programme development including collective bargaining agreements- Persons attending meetings per day at national level (one day) (Part of the GF Key Indicator)

75 75 100%

SSR- ZNFPC Progress Update: Integration of family planning into HIV services (prevention of

unintended pregnancies among women living with HIV)

The SSR did not have any key indicator activities during the course of the year but managed to carry

out those that were in the implementation plan. These were the revision of training curriculum for

nurses and other service providers, development of IEC materials and M&E.

Global Fund Financial Management

Table 28: HIV Grant Annual Financial Management

Total Grant Amount Phase 1

Approved Budget

2010 (Year 1 Grant)

Total Disbursed

as of 31 Dec 2010

Interests in Account

Total Income

Expenditures in

2010

Commitments as at 31 Dec

2010

Total Amount

used Variance

(B) (C) (D) (E)

(F) = (D) + (E)

(G) (H) (I) = (G) +

(H) (J) = (F) -

(I)

84,641,215

53,162,194

46,304,485 125,195 46,429,681

46,525,956

0 46,525,956

-221,471

Of the total amount received, $11.9 m was disbursed to implementing partners as of 31 December

2010.

The overall disbursement rate as 31 Dec 2010 is 76%.

34

Table 29: Summary of Financial Expenditure

SSR/SR Cumulative Q1-Q4

Budget Actual Variance % Disb % Acquitted

(A) (B) (C) = (A) – (B) (D) = (B)/(A) (E)

NAC 563,187 769,833 -206,646 137% 69%

MOHCW 2,496,026 2,159,340 336,686 87% 72%

CPCPZ 167,336 109,198 58,138 65% 59%

EMCOZ/ZCTU 572,988 364,087 208,901 64% 49%

MOLSS 1,029,083 822,217 206,866 80% 59%

UNFPA 2,583,304 2,693,755 -110,451 104% 66%

UZ Dept of Med 263,455 187,950 75,505 71% 90%

ZNFPC 166,786 153,956 12,830 92% 65%

Challenges

Delays in the disbursement of funds due to challenges in meeting the 80% acquittal requirement

before getting another disbursement.

UZ and CPCPZ had not been allocated programme vehicles

Delays in the procurement of IT equipment for SSRs.

Low unit cost for accommodation and food during workshops.

Low unit costs for field activities including the M&M visits leading to low uptake of the activity;

Lack of transport due to the late delivery of project vehicles resulted in the delays in undertaking

M&M visits in some provinces.

Centralized payment systems proving to be a challenge for a big organization like the MoLSS. This is

compounded by the fact that accounting staff are not covered in GF support including in trainings

Recommendations

Approval of the supplementary M&E budget submitted by NAC to the PR. The budget sought to

bridge the gaps identified in the implementation plan. The approval was expected to go a long way

in improving the monitoring and evaluation of SSR activities.

Need for the SSRs to expedite the recruitment of project staff for the good of the programme.

Timely submission of DRs by SSRs to assist the PR in moving funds as and when they are expected to

move

Need for the SSRs to expedite the recruitment of project staff for the good of the programme.

35

The SSRs recommended that the PR should decentralize the procurement of computers to the SSR

so that the IT equipment can be purchased and distributed to the SSRs as a matter of urgency.

EMCOZ/ZCTU to recruit a Monitoring & Evaluation and a Finance Officer in order fill the gap that is

currently existing at the consortium.

The PR to finalize the reprogramming exercise and release the approved budget so as to enable the

SSRs to effectively implement the non reprogrammed activities.

Lessons learned

Timely disbursement of funds for the first quarter for 2011 will be critical. The rollout of the BC

program at national level should ideally include sensitization of key stakeholders of line ministries,

traditional leadership representatives of state security agents and armed forces including key

political figures.

The collaboration with NAP for OVC implementing partners has yielded positive outcomes in

widening coverage for ward level CPCs using the Village/Area registers;

Leveraging of resources can help address some challenges, e.g. transport

36

CHAPTER 5

MANAGEMENT, COORDINATION AND MONITORING AND EVALUATION

Major activities related to management and coordination of the national response in 2010 included the

National Partnership Forum meetings, the Technical Working Groups meetings, the ZNASP II

consultative as well as management meetings. At provincial and district levels, NATF resources were

utilized to hold PAAC, DAAC, stakeholders, taskforce, ZNASP consultative meetings and M&E activities.

5.1 ZNASP II NAC produced a draft Zimbabwe National AIDS Strategic Plan II for the period 2011-2015. The plan has

four pillars namely prevention; treatment, care and support; enabling environment; and management of

the response.

To promote public participation in development of policies, the ten provinces conducted one day

stakeholder consultative meetings to share the first draft of the ZNASP II and solicit their input in the

policy document. Over 200 participants drawn from sectors at district and provincial levels attended the

provincial meetings.

Externally, the draft document was also shared and reviewed by experts from the International HIV

Prevention Review Panel for Eastern and Southern Africa, the World Bank, UNAIDS and others. Overall,

the technical experts recommended the downward revision of outcomes to manageable levels.A two

year costed operational plan will be developed in first quarter 2011.

Some of the participants at the national ZNASP II stakeholders meeting in Harare.

37

5.1.2 NAC Management Meeting

NAC held four quarterly management meetings in 2010. The meetings aimed at improving NAC’s role as

the national coordinator of the national response. Areas of focus during the meetings included review of

progress towards targets in coordination, monitoring and evaluation, administration, prevention,

treatment and care and other among others.

Achievements and challenges in these areas as well ART roll out, M&E data collection and its quality

were also discussed. As a result the meetings took some important decisions such as the provision of

funds for ART outreaches and the strengthening of site based collection of ART data. The meetings were

also used to share and disseminate new developments in the national response as well as training of

staff in performance management was also done during some of the meetings.

5.1.3 National Partnership Forum

Two National Partnership Forum meetings were held during the year to give updates in respect of

various programmes including the Global Fund and Expanded Support Programme grants and

programmes in Zimbabwe, the UNGASS report, progress towards national targets in prevention,

treatment and care, new programmes like male circumcision, and the modes of transmission study. Due

to competing activities in the third and fourth quarters, it was difficult to hold the National Partnership

Forum meetings. The two meetings gave stakeholders, partners and implementing partners an

opportunity to share ideas and contribute towards improvement of the national response.

5.1.4 Integrated Planning Process

In line with the calendar of the integrated planning process, NAC structures completed this activity in

the fourth quarter. Stakeholders and partners representing various sectors participated in the process at

district and provincial levels. The provincial plans, which are a result of the district plans were

consolidated into the national annual plan for 2011.

5.1.5 National Technical Working Group (TWGs) meetings

Various Technical Working Groups held their regular quarterly meetings throughout the year. These

include the National Monitoring and Evaluation Group, the Research Advisory Committee, the Gender

TWG, the Communications TWG, the Care and Support TWG, the MIPA TWG and others. The meetings

38

discussed programmatic policy and implementation issues, standard operational guidelines, challenges,

and emerging issues.

Table 30: Coordination activities at district and provincial level

Generally, provincial and district coordination meetings were held throughout the year with NATF

funding. However, competing priorities and late disbursement in the 4th quarter were the main

challenges encountered.

Activity Target Output Comments

Hold PAAC Meetings 40 30

The ten meetings were not held because resources were channeled to IPP

Hold Provincial Stakeholders meetings

40 34

85% of the targeted meetings were held

Hold Provincial Staff Coordination Meeting

120

98

81% of the planned meetings were held with financial support from the NATF and other implementing partners

Hold Provincial M&E Taskforce meetings

40

31

Nine of the planned meetings were not held because of competing priorities that included IPP

Hold provincial C&HBC Taskforce meetings

40

17

The planned target was not achieved mainly due to commitments by MoH&CW staff that spearhead this activity

Hold provincial prevention Taskforce meetings

40

27

Planned target was not achieved due to late disbursement of funds during the 4th quarter

Hold Provincial Mitigation Taskforce meetings

40

29

Eleven of the planned meeting were not held due to late disbursement of funds during the 4th quarter

Hold District M&E Taskforce meetings

360

266

73.8% of the targeted meetings were held due to regular funding during the first three quarters.

Hold District Prevention Taskforce meetings

340

291

85.5% of the targeted meetings were held due to regular funding during the first three quarters.

Hold District C&HBC Taskforce meetings

337

275

81.6% of the targeted meetings were held due to regular funding during the first three quarters.

Hold PYPN on HIV and AIDS meetings

40

30

Ten of the planned meetings were not held due to unavailability of resources in the 4th quarter

39

5.2 MONITORING AND EVALUATION (M&E)

M&E activities conducted in 2010 included the compilation of the UNGASS and SADC epidemic reports,

the finalisation of national M&E plan, capacity building of NAC and partner structyures, as well the

continuous collection, entering, analysing of data and information dissemination to stakeholders.

5.2.1 UNGASS Report

NAC coordinated the compilation of the 2009 UNGASS report with support from the UNAIDS country

office. During data gathering for the report, it was noted that indicators related to most at risk

populations (MARPs) had no data available mainly because there are no significant programmes in the

country targeting the groups, suggesting a strong need for the country to take steps to address the gap.

5.2.2 SADC Epidemic Report

The SADC epidemic report 2009 was compiled and submitted to the SADC secretariat. Out of the 25

SADC HIV and AIDS Indicators the country managed to respond to 17 Indicators. Data for the other 8

indicators was not available from the source implementers. The report was presented at a SADC M&E

workshop conducted in September 2010 in South Africa

5.2.3 National HIV M&E Plan

The national M&E Plan covering the period 2010-11 was finalized during the first quarter of the year. An

indicator guide with definitions of all the core indicators, denominators and numerators and the

rationale for collecting the information, was successfully developed. The plan was submitted to the

Global Fund in order to satisfy one of the conditions necessary for the disbursement of Global Fund

grants.

5.2.4 Training

A five day M&E training workshop was conducted for all the District AIDS Coordinators, Database

Officers and M & E Officers. The training sought to appraise the various officers on the national M&E

system, the M&E plan, basic M&E concepts to improve their capacity for data management as well as

the Global Fund M&E System. The National Activity Form (NARF) was revised during the training

workshop and an Indicator Guide was developed detailing what each indicator mean and how they are

supposed to be collected. Additional training was also conducted focusing on the revised NARF and CRIS

version 2 database. NAC’s twelve M & E officers were also trained on the Early Warning Indicators (EWI)

data abstraction and were going to supervise and verify the exercise at clinical sites.

40

5.2.5 Ministry of Health and Child Welfare indicator review

Ministry of Health and Child Welfare is the source of data for the health indicators collected by NAC

using the NARF. However, data quality in this area has been hampered by gaps in the indicators and

absence of indicator guide. NAC supported MOH in the review of the indicators and indicator guide, and

the data collection tools which will be launched in the first quarter of 2010.

5.2.6 Global Fund and ESP M&E Activities

Under the Global Fund, the major activities undertaken during the period under review include the ART

cohort analysis, PR/SR joint data verification for the last quarter of Round 5 Phase 1 grant, revision of

the Round 8 Phase 1 and Round 5 Phase 2 Performance Frameworks, joint monitoring visits on

programmes, human resources and assets as well as capacity building of DACs and SSRs in Global Fund

and National M&E Systems.

A cohort analysis of the November 2007 ART patients was conducted to determine patient survival rate

after 24 months. The patient survival rate stood at 64% and this is far below the WHO stipulation that is

estimated at +-75%. The low survival rate was noted to be a result mainly of high numbers of patients

lost to follow up.

Under the ESP, a logical framework was developed and shared with relevant partners. The project

envisages adopting the Global Fund performance framework which is perceived to be user-friendly.

5.2.7 Global Fund Round Five data verification visits

This exercise revealed a lot of challenges in OI/ART data management in the health facilities. The

findings were discussed at the Global Fund Round Five Phase Two review meetings.

41

5.2.8 M&E Reporting

Table 31: National M&E System reporting performance analysis by province During the year under review a 72.0% achievement against a target of 90% reporting by implementers

was achieved. There is a need to scale up mentoring visits to implementers at district, provincial and

national levels. M&E taskforces for the 85 districts as well as 10 provinces are functional and meeting

routinely. Production and dissemination of quarterly reports were done during the stakeholder

meetings resulting in an achievement of 75% against a target of 96%.

Table 32: M&E activities at Provincial and District level

Harare Bulawayo Mat North

Mat South Midlands Masvingo

Mash East

Mash West

Mash Central

Manicaland

% of implementers regularly reporting to the national M&E system 75.2 77.8 48.5 87.5 59.3 71.1 85.6 74.8 85.7 63.0

No. of functional districts and provincial M&E taskforces 13 7 8 8 11 9 11 10 9 9

No. of M&E feedback reports disseminated at district, provincial and national 39 24 24 24 33 27 30 33 27 36

Activity Target Output Comments

Collection, consolidation and analysis of COIs

120

120

Target was achieved not withstanding late submission of NARFs by implementers

Updating of databases 96

96

Databases were updated quarterly at district, provincial and national level

Paying WAAC Focal Persons monthly allowance

1974 1974

WAAC Focal Persons were fully paid to 3rd paid

Production of district quarterly reports 340 340 Reports were produced and disseminated to stakeholders at respective levels.

Production of district annual reports 85 85

Production of provincial quarterly reports 40 40

Production of provincial annual reports 10 10

Production of national quarterly reports 4 4

Production of national annual report 1 1

42

Table 33: 2010 Implementer Reporting Status by province

Province Baseline Registered Reporting % reporting

Bulawayo 126 126 98 77.8

Harare 476 230 173 75.2

Mashonaland West 1152 1137 851 74.8

Mashonaland East 1092 1014 868 85.6

Matebeleland North 795 478 232 48.5

Matebeleland South 737 703 615 87.5

Midlands 1174 973 577 59.3

Masvingo 1133 754 536 71.1

Manicaland 1608 1374 865 63.0

Mashonaland Central 642 554 475 85.7

Total 8935 7343 5290 72.0

NAC places significance on the need for all implementers to report on a regular basis as stipulated in the

M&E system. IN 2010, a 72% reporting coverage was recorded. Achievement of a higher output was

negated by the late submission of data from primary source.

5.2.9 Modes of Transmission Study (MOT)

The National AIDS Council with support from UNAIDS and the World Bank, coordinated commissioned

the Modes of Transmission study to determine the key drivers of HIV and AIDS and the HIV incidence

rates among different at risk groups and distribution of new infections by mode of transmission. An

external consultant from the Technical Support Facility (TSF) worked with a team of local consultants to

implement the study. The study revealed that most infections are in the low risk hetero sexual group.

The results of the study were used in the development of the ZNASP II (2011 – 2015).

5.2.10 Research Priorities NAC convened a multi-sectoral meeting to update and finalise the National HIV and AIDS Research

Priorities 2010-2012, which was attended by more than 80 participants. To operationalise the National

HIV and AIDS Research Priorities, NAC called for expression of interest to conduct funded operational

research. In the response to the seven topic areas in the call, 38 proposals were received of which the

following four were recommended for funding:

Household coping mechanisms with economic costs of HIV AIDS

Condoms – availability, accessibility and usage in OI/ART clinics

Effectiveness of vaccines on children living with HIV

Barriers to accessing PMTCT in Zimbabwe

43

The four studies are funded by the Small Research Grants that NAC established to support the

implementation of the National HIV and AIDS Research Priorities.

On the regional front, NAC rendered support for the preparation of the implementation of the SADC

funded research studies, whose implementation will commence in 2011.

5.2.11 HIV in Prisons

The National AIDS Council is collaborating with regional HIV in Prisons Partnership Network to address

HIV in prisons. Towards this, two regional meetings were held in 2010 and consultations started to

implement assessment studies on the prevalence and behaviours which promote HIV in prisons,

wherein Zimbabwe will be included. The study will commence in the first quarter of 2011.

5.2.12 Other research studies in 2010

Various other studies were conducted in the wider multi-sectoral response to HIV and AIDS. They

include the UZ-UCSF study on discordant couples,

5.3 Internal Audit

5.3.1 Workplan Targets and Achievements

The table below shows planned audits for the year 2010 and the respective achievements for the year.

Audit Area Planned Audited Variences Routine Audits Review of Financial Statements 1 1 0 Head Office Department 2 0 -2 Provincial Offices 5 7 +2 DAACs 39 24 -15 Global Fund – (SR-NAC) 1 0 -1 Global Fund – (SSR) 2 0 -2 Global Fund – Districts 0 13 +13 Audit Follow-ups Global Fund – Follow-up 0 19 +19 Audit Investigations 0 1 +1 Other Activities GF: Capacity Assessments 0 6 +6 TOTALS 50 71 +21

44

5.3.1 Work covered during the year

The department covered the following during the year:-

a) Routine Audits of PAACs and DAACs.

b) Routine audits and follow-ups of Global Fund Districts.

c) Review of 2010 NAC’s Financial Statements.

d) Audit Investigation.

e) Capacity Assessments of Global Fund Round 8 SSRs.

5.3.2 Routine Provincial Offices Audits

The following Provinces were audited during the year;-

1. Bulawayo

2. Harare

3. Manicaland

4. Matabeleland North

5. Matabeleland South

6. Masvingo

7. Mashonaland West

Major Findings

Cashbooks Maintenance

Several cashbook entries took time to reconcile with the bank statement figures’ bulk

withdrawals.

One Province was maintaining cashbooks on excel copies which could be adjusted anytime.

Receipted change was not being banked intact as per the basic accounting requirement.

Motor Vehicles

Several motor vehicles had missing accessories.

PACs were not recording mileage traveled to and from work as part of their private mileage.

Some Provinces were not maintaining individual motor vehicle files while others maintained the

files but could not keep all the necessary documents therein.

Assets

Most Asset Registers were kept on excel spreadsheet soft copies only. The registers could be

adjusted anytime.

Assets sent to Head Office for repairs were not easily traceable by audit due to lack of proper

documentation.

Some assets were not coded.

45

Work plans and Budgets

Work plans and budgets were not being signed by PACs to indicate his/her approval.

Other Matters

In one Province, officers used computer generated T & S claims which resulted in all officers

using the same copy adjusting for the name only while in another Province multiple advances

were given to staff before they cleared the other advances.

Security Guards were working fifteen hours a day instead of the stipulated twelve hours.

Security Guards did not have protective clothing and other tools of trade.

5.3.3 Routine DAAC Audits

Twenty-four DAACs were audited during the year from a total planned thirty-nine (39). Audited DAACs

for the year were as follows:-

PROVINCE DAACS AUDITED

Mashonaland West Chegutu Urban

Nyaminyami

Kariba

Mashonaland Central Guruve

Mbire

Matebeleland North Nkayi

Tsholotsho

Mashonaland East Uzumba Maramba Pfungwe

Murehwa

Major Findings

Audit findings for the year were generally uniform throughout the DAACs indicating that more

training on NAC systems are required to reduce on audit observations.

Quarterly Reports and Coordination Meetings

Quarterly and annual reports were not being signed by DAAC Chairpersons to show that

the DAAC had made input. However, DACs pointed out that most information is

discussed in Taskforce and Stakeholder meetings and DAAC members will get an

opportunity to make their input.

Quarterly reports were characterized by cut and paste. Changes were made on some

pages while others remained word for word with previous reports.

46

Coordination minutes were not being signed by the Chairpersons. Some were not even

confirmed as correct record at the next sitting.

Money allocated to conduct meetings was being paid out in cash as allowances in some

DAACs instead of being used to pay for the venue, transport and refreshments.

No handover and takeovers were being conducted when a new DAC assumed duty.

Outgoing DACs left without handing over records and assets to the incoming DAC.

The visitors’ registers were not being signed by Provincial staff members whenever they

made support visits to DAACs.

ODFs and Implementer Registers

Most DAACs were not maintaining implementer registers.

Several ODFs were not being fully completed. The official section of the ODF was not

being completed by the DAC indicating the date of receipt and entry into the

implementer register.

Core Output Indicators (COI) and NARFs

COI data variances between quarterly and annual reports were observed in some

DAACs.

Most DAACs maintained COI data on soft copies without printing hard copies monthly.

Some NARFs submitted by implementers were incomplete.

DACs were filing such incomplete NARFs without corrections indicating lack of

seriousness in data collection.

Work plans and Budgets

Most plans produced from DAACs were not signed by the DAAC Chairperson.

Incidents of cutting and pasting on report writing were still occurring in some districts.

Asset Management

No evidence of regular physical checking of assets by senior officers such as PAAOs were

found in DAACs’ registers.

Mutasa DAAC had assets appearing in the register but could not be physically accounted

for.

Other assets did not have NAC asset code numbers as directed by HR and

Administration Department in 2006.

Non-functional or damaged assets were still appearing in asset registers years after they

became obsolete.

Several HBC bicycles issued out to DAACs in 2004/2005 were

not being checked their existence by Provinces and DAACs.

Some NAC assets were being used by Local Authorities staff without proper loaning

documentation.

47

I.T. equipment sent to Head Office for repairs was not returned to the DAACs. Most of

the equipment was still in the I.T. office pending repairs.

Several working and non working TV and VCR sets are lying idle in DAAC offices.

Motor Vehicles

Several ESP vehicles allocated to DAACs were stationed at Provincial Offices instead of

respective DAAC offices. The reason given by PACs is that the respective DACs were not

licensed to drive. However most PACs resorted to using the vehicles.

The ESP Motor vehicle for Nkayi DAAC travelled distances not consistence with the

recorded destinations in the logbook.

Security Items

Cash in the hands of the DAACs took long to be utilized.

Local Authorities receipt books used between 2002 - 2006 in some DAAC offices had

unissued copies not cancelled.

Gummed receipt books used by Mutasa DAAC office were still in the office as part of

security items.

Some security items registers were poorly maintained as some security items were

being issued before the other is completed. In some cases the security items register

was not even available.

Office Furniture and Equipment

Some DAACs did not have computers and furniture. Examples from audited DAACs were

Mbire, Nkayi and Insiza. Mbire and Nkayi did not have office furniture while Insiza did

not have a computer.

Office Accommodation

Several audited DACs were poorly accommodated. Some of the DAAC offices were also

used to store equipment such as the generator, while others have leaking roofs and are

poorly ventilated.

Several DAAC offices did not have sufficient space to store files and other equipment.

This resulted in a congested offices.

48

CHAPTER 6

ADVOCACY AND COMMUNICATION

As a consequence of sustained communication and advocacy activities in 2010, HIV and AIDS remained

on the public media agenda all year round with activities such as commemorations and campaigns,

exhibitions, and advocacy dialogues being successfully implemented.

6.1 World AIDS Day Campaign and Commemorations

Rimuka Stadium in Kadoma in Mashonaland West Province hosted the 2010 edition of the World AIDS

Day commemoration and campaign launch. Dr. H. Madzorera, the Hounorable Minister of Health and

Child Welfare was the Guest of Honour. The commemoration was held under the theme “ Universal

Access and Human Rights Together We Will Make It”.

The Honorable Minister of Health and Child Welfare Dr. H. Madzorera delivering his keynote address at the World AIDS Day. The commemoration the World AIDS Day and launch of the campaign were preceded by various pre

launch activities, which included HIV testing and counseling campaign in the Mashonaland West

Province, sporting activities for youths and people living with HIV (PLHIV), an advocacy dialogue access

to ART by children and development of various educative materials.

49

6.2 IEC materials

Hundreds of thousands of copies of various IEC materials such as pamphlets, banners, papers caps, T-

shirts, calendars, posters, ribbons among others were produced and distributed in Mashonaland West

and other provinces.

6.3 WAD local commemorations

In an effort to contribute to the dissemination of the World AIDS Day theme and localize it in various

communities, Bulawayo Province held their provincial commemorations. In addition, district

commemorations were also held in Chiredzi in Masvingo, Bubi and Lupane in Matebeleland North,

Gwanda in Matebeland South, Mutare Rural and Chipinge in Manicaland Province.

In a positive development, several companies also commemorate the World AIDS Day. These companies

were mainly from Harare and Bulawayo provinces. They included OK Zimbabwe, National Foods,

General Belting, Delta, Carousels, Triangle and Hippo Valley Estates, UZ –HAPs, LARFARGE, Mavambo

Trust, Mashambanzou, Care International, CAAZ, Imperial, ZESA, Windmill, Unilever, Legal Resource

Foundation, Child Protection Society, Zimbabwe Fertilizer Company and National Association of Housing

Cooperatives from Harare. The ZCTU also carried out this activity.

6.4 Resource mobilization

An additional $55,000.00 was mobilized towards WAD commemoration and campaign from Red Cross,

UNICEF and CBZ. Further support in form of bottled water, soft drinks, IEC materials and transport also

came from the corporate world, NGOs, UN partners, and other sectors.

50

2010 WAD Commemoration in Pictures

Part of the crowd at the WAD commemoration at Rimuka Stadium in Kadoma

Part of the traditional leaders at the commemoration Provincial and District Commemorations

As part of post launch activities National World AIDS Day Commemoration was to be followed by

Provincial commemorations. Only Bulawayo Province managed to commemorate the event during the

4th quarter 2010. Bulawayo WAD commemoration was held on 9 December 2010 at Large City Hall. The

commemoration was marked by exhibitions, solidarity speeches and edutainment. The main target for

51

the WAD campaign message were men and boys whose consumption of HIV and AIDS services remain

low as compared to their female counterparts.

Other provinces are to commemorate the WAD during the first and second quarter of 2011.

Several districts managed to commemorate the WAD after the National WAD commemoration. Five

districts from Bulawayo province managed to commemorate the day. Other district which managed to

commemorate the day are Chiredzi in Masvingo, Bubi and Lupane in Matabeleland North, Gwanda

District in Matabeleland South, Mutare Rural and Chipinge in Manicaland Province.

6.5 Exhibitions

Through exhibitions and displays, NAC participated in various shows and fairs across the country as a

means towards promoting its services and explaining its mandate to the public.

The exhibitions were characterized by dissemination of HIV and AIDS information through the

distribution of IEC material, interpersonal communication, showcasing of HIV and AIDS services and

strategies being implemented by various programme implementers. The shows and fairs include the

Zimbabwe International Trade Fair, the Harare Agricultural Show, Mine Entra, the various provincial

agricultural shows and the Protracted Relief Programme exhibition.

In Mashonaland Central, the National AIDS Council won a shield for the best exhibition stand in a

competition category for parastatals and a trophy for being second overall during the provincial

agricultural show.

52

NAC Mashonaland Central staff holding the trophy and shield won at the provincial agricultural show,

2010

6.6 Other commemorations All NAC provincial as well as some district structures participated in commemorations of the 16 Days of

Activism Against Gender Violence and candle light memorial.

6.7 Sensitization of leaders

A total 813 community leaders were sensitized on the role of NAC and the use of AIDS Levy with the

objective of increasing and strengthening their support for national response to HIV and AIDS and

ensuring that HIV and AIDS remains on the public agenda. In addition, NAC held advocacy dialogues with

chiefs and parliamentarians in the Parliamentarian Against HIV and AIDS.

The engagements sought to increase levels of knowledge on the role of NAC, the use of the AIDS Levy

and HIV and AIDS policies among policy makers, call for support and commitment in the national

response to HIV and AIDS, Issues raised during advocacy dialogue with parliamentarians focused on the

need for parliamentarians to be capacitated in order for them to effectively and efficiently support the

national response to HIV and AIDS.

From Left: Dr. G. Gwinji, the Permanent Secretary in the Ministry of Health and Child Welfare, Mr. A.

Manenji the NAC Finance Director, Dr. T. Magure the NAC CEO and Dr. W. Manungo the Permanent

53

Secretary in the Ministry of Finance, before the Senate Thematic Committee on HIV at Parliament

Building, giving oral evidence on the utilisation of the AIDS Levy.

6.8 The International AIDS Conference (IAC) Vienna- Austria (16-24 July 2010)

Zimbabwe participated at the IAC wherein a multi-sectoral team attended and mounted a country

exhibition. Members of the committee were drawn from NAC, UNFPA, ZAN, MOH&CW, WASN, PSI and

SAYWHAT. The success story of Zimbabwe’s declining HIV incidence and prevalence was one of the

major highlights of the conference.

The Deputy President of South Africa Honourable Mothlante listens as NAC’s BC Manager, Mr O.

Mundida explains the national response to the Deputy President.

The Zimbabwe stand was very popular with people who wanted more clarification on factors that have

contributed to the decline in the prevalence of HIV. A number of current and potential donors also

visited the stand. The presence of NAC Board Members DR Rev M Kuchera and Dr P Makurira also

helped in clarifying general policy issue pertaining to NAC.

54

NAC Board Chairman, Dr. Rev. M. Kuchera and Deputy, Dr. P. Makurira at the NAC stand at the IAC in

Vienna, 2010

Part of the Zimbabwe delegation attending the IAC in Vienna in 2010 (standing in the country stand)

6.9 Post Vienna Meeting

A post IAC feedback meeting was held in Harare in October 2090 to share with stakeholders the major

highlights of the conference and exhibitions of materials from Vienna. Several organizations that had

exhibited at the conference such as NAC, MOH&CW, PSI, UNFPA, ZAN, UZ-UCF and AIDS and TB gave

feedback at the meeting. The meeting recommended the need for better preparations and wider

sharing of information in future.

55

6.10 Policy Development

To improve NAC’s interaction with its publics and effectively disseminate HIV and AIDS communication,

NAC embarked on a process to develop internal and external communication strategies. Both strategies

are expected to be finalised in the first quarter of 2011.

6.10 Sensitization of community leaders

A total 813 community leaders were sensitized on the role of NAC and the use of AIDS Levy with the

objective of increasing and strengthening their support for national response to HIV and AIDS and

ensuring that HIV and AIDS remains on the public agenda. In addition, NAC held advocacy dialogues with

chiefs and parliamentarians in the Parliamentarian Against HIV and AIDS.

The engagements sought to increase levels of knowledge on the role of NAC, the use of the AIDS Levy

and HIV and AIDS policies among policy makers, call for support and commitment in the national

response to HIV and AIDS, Issues raised during advocacy dialogue with parliamentarians focused on the

need for parliamentarians to be capacitated in order for them to effectively and efficiently support the

national response to HIV and AIDS.

The chiefs stressed the need for NAC to resuscitate its support towards the Zunde Ramambo

programme as it stands to benefit the community in terms of access to food for orphans and vulnerable

children and people living with HIV.

6.11 Media relations

The media coverage of NAC activities improved in 2010, both in the output of and quality of the articles.

The increase in the coverage has been attributed to NAC’s deliberate proactive sharing of information

with the media. Capacity building workshops specifically organised ofr the media have also contributed

the improvement in coverage.

A cumulative total of 165 positive news articles on NAC activities and general HIV and AIDS issues were

published and broadcast in the mainstream print and electronic media during the year. The NAC funded

radio programmes Utano Hwedu and Uthini ngalokhu in Shona and Ndebele respectively, continued to

be on air throughout 2010 purveying information on current HIV and AIDS issues such as treatment

literacy, hospital user fees and others.

A lot more articles were published in community and online publications which could not be monitored.

56

6.12 Media capacity building workshops

To enhance coverage of HIV and AIDS issues by the media as well improve relations with the media, NAC

held three training workshops, two for editors and one for journalists.

A total of 36 editors from mainstream and community media houses as well as 20 journalists the three

capacity building workshops.

Editors, NAC staff and consultant (Pat Made – far right) pose for a picture at the Media workshop in

Kadoma, 2010

6.13 Media Tours

Twenty five journalists from different media houses participated in two NAC organised media tours to

Harare, Bulawayo and Chiredzi during the year. The tours are used as a window to expose the media to

HIV and AIDS interventions across the country.

Coverage from the Media tour was very positive.

6.14 NAC bulletin

A total of 1 500 copies of the NAC bulletin were produced during the year and distributed to NAC staff

and stakeholders a period of 3 years without publication due to funding challenges. However. Quarterly

publications will be resumed in the next year.

6.15 Resource Centre

Towards the operationalisation of its resource centre, NAC mobilized and received a printer, a desk top

computer, a scanner, as well broad band internet connectivity. Installation of the internet will be done

at Harare provincial offices in the 1st quarter of 2011.

57

CHAPTER 7

HUMAN RESOURCES AND ADMINISTRATION

7.1 Introduction

Human resources are a strategic component in the attainment of the organisational goals and

objectives. The nature of operations of NAC is driven by individual skill and experience and it is

imperative that these be retained for continuity and preservation of institutional memory. Staff

retention also brings in stability and “growth” of an organisation. The organisation continued to strive to

provide a conducive working environment by paying competitive allowances and salaries, improving

worker/management communication channels and other benefits.

Table 34: Staff Establishment as at 31 December 2010

POSITION ESTABL FILLED VACANT COMMENTS

CEO 1 1 0

Directors 6 6 0

National Coordinators 10 9 1 3 held against 7 vacant posts

Auditors 6 4 2

Accountant 1 1 0

Accounts Officers 4 3 1

Human Resource Officer 1 1 0

Administration Officer 1 1 0

Procurement Officer 1 1 0

Personal Assistant 7 7 0

Salaries Officer 1 1 0

Registry Assistant 1 1 0

Security Supervisor 1 1 0

Administration Assistant 1 1 0

Receptionist/Secretary 2 2 0

Driver 3 3 0

General Hand 3 3 0

DBO 1 1 0

Communications Officer 1 1 0

Security Guards 7 10 0

2 posts taken from Mash East, 1 taken from DAAO vacant posts

59 58 4

58

Table 35:Provincial Staff

POSITION ESTABL FILLED VACANT COMMENTS

PAC 10 10 0

PO - M& E 20 20 0

DBO 10 10 0

PAAO 10 10 0

PA 10 10 0

Driver/Messenger 20 19 1 Vacant Mash East

DAC 63 63 0

DAAO 71 40 31

General Hand 10 10 0

Security Guards 20 24 0

4 posts taken from DAAO vacant posts

TOTAL 234 206 28

Students 41 0 41

Table 36: Global Fund Positions within provinces

Prov HIV & AIDS Officer 10 10 0

DAC 22 22 0

Driver 24 23 Vacant mazowe

Total 56 55 1

Grand Total 349 319 30 7.2 Recruitment The following positions were filled in during the year under review; Table 37: Schedule of filled positions:

Q1 Q2 Q3 Q4 Total

BC Manager 1 1

Advocacy Coord 1 1

Accountant 1 1

M & E Coord 1 1

DAC 2 3 6 11

M & E Officer 1 6 7

DBO 1 1

DAAO 3 3

Driver/ Messenger 6 1 7

Security Guards 1 3 7 2 13

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General Hand 1 1

Caretaker 1 1

TOTAL 48

A resolution to fill in the M & E vacant posts that had been frozen in the previous year was made during

the course of the year due to improved funding. The general quality of candidates engaged improved

because NAC is paying generally competitive salaries. This translated into generally improved service

delivery by NAC at all levels. A resolution was also made to advertise on the NAC website as opposed to

the traditional way of recruiting which was through newspapers. This was done in order to cut on

recruitment costs.

7.3 Performance Management

Quarterly performance appraisals were carried out during the year and noted areas of weaknesses for

individuals were dealt with accordingly. Management made a resolution to adopt a new performance

management system and thus all staff members underwent training in the Balanced Scorecard approach

to performance Management. It is hoped that this new system shall be implemented in the coming year

and thus improve on individual performance management.

7.4 Staff Development

The organisation continues to recognise the importance of developing all staff members in a bid to

improve on performance. NAC facilitated the holding of the following courses for various staff members;

Table 38: Staff development Course

COURSE TARGET FACILITATION

Labour Relations for Managers

Directors, National Coordinators, PACs, HR Personnel

Stratways Consultancy Company

Disciplinary Handling Procedures

Directors, 2 National Coordinators, PACs, HR Personnel

Stratways Consultancy Company

Pension Fund Board of Trustees Training

Board of Trustees, HR Personnel

Fidelity Life Insurance

Payday Payroll Training HR Officer, Salaries Officer

Touchstone Computers

M&E Capacity Building

DACs UNAIDS, M&E Directors

Procurement Training 22 GF DACs, DAAOs, PAAOs, Finance Staff, HR & Admin Staff, Directors

State Procurement Board

Financial Management 22 GF DACs, DAAOs, PAAOs, Finance Staff, HR

NAC Finance Director

60

& Admin Staff, Directors

Performance Management Training

Directors and the rest of NAC staff

Industrial Psychology Consultancy

Financial Management/NSSA

DACs, DAAOs, PAAOs, Finance Staff.

NAC Finance Director

Thematic Area Training DACs, M & E Officers

UNDP, UNAIDS, NAC National Coordinators, MOHCW

End of Year Closedown for payrolls

Salaries Officer Touchstone Computers

Individuals also continued to undertake self sponsored studies and a total of 35 employees were granted

study leave at different points to pursue their studies.

7.5 Salaries, Allowances and Benefits

ESP Allowances – The payment of the retention allowance was extended to all NAC staff members who

were not on the scheme in the previous years. This was a positive move which really motivated most

staff members to stay with NAC throughout 2010.

Salaries – The board approved the review of salaries up to 100% of the approved NAC salary scales. A

commitment was also made to pay top up salaries to donor funded positions, on the NAC approved staff

establishment, whose salaries were below the approved salary scales.

Transport and Representation Allowance- These allowances were reintroduced in the second quarter

of the year.

Annual Bonus – all employees eligible to receive annual bonuses received a bonus equivalent to 10% of

their annual salary. This was paid out in the month of December.

NSSA – NSSA contributions were reviewed downwards to 3% from 4% up to a maximum insurable

earnings of US 200 with effect from May 2010.

Pension - A board of trustees for the NAC pension fund was elected into office and they received

training during the second quarter of the year. They also held one meeting after they had been trained.

The role of the trustees is to manage issues pertaining to the administration of the fund and it is hoped

that this will see an improvement in the way the fund is administered and also the benefits accrued

from the fund.

61

Labour Relations- 10 Disciplinary cases were handled during the course of the year. Four of the staff

members who went through the hearings had their contracts terminated, five received Final Written

Warnings while one was issued with a First Written Warning.

Three works council meetings were held during the year and various issues pertaining staff welfare and

NAC performance were discussed. There is generally a marked improvement in communication between

management and workers which creates a conducive environment for the attainment of the

organisation’s goals. Workers Committee Members had an opportunity to address all staff members

when they gathered for the performance management training in December.

Staff Welfare- The NAC board approved the request to provide lunch to all NAC employees and this was

implemented in the year under review. This was well received by staff at all levels.

7.6 Terminations

The following positions fell vacant during the year;

Table 39: Terminations

Position Q1 Q2 Q3 Q4 Total

OVC Coordinator 1 1

Accountant 1 1

M & E Officer 1 3 4

DAC 1 1

DAAO 1 1

Registry 1 1

Driver 5 5

Security Guard 1 1 2

TOTAL 5 7 4 0 16

Resignations - 12 Dismissals - 4 Deaths - 0 AWOL – 0 Retirement - 0 There has been a gradual decrease in the number of resignations from 2007 to date as highlighted

below;

Table 40: Termination by years

YEAR TERMINATIONS DACs

2007 32 14

2008 49 17

2009 25 7

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2010 16 1

The introduction of the USD salary scales and other retention packages by the organisation is beginning

to yield results and high staff turnover which was being experienced over the years is decreasing. Only

one DAC left NAC’s employ in 2010 and this was as a result of disciplinary action.

Retirement of one DAC at 60 years of age, application for continued service beyond NAC retirement age

being processed.

7.7 NAC Board Activities

The NAC Board undertook the following activities during the year under review;

18th International AIDS Conference in Vienna – this took place from 18 – 23 July 2010 and NAC

was represented by the Board Chairperson, Vice Chairperson and one Board Member. The

Board members expressed gratitude for attending the conference as it presented opportunities

to have a global perspective about the pandemic and will further enable them to formulate

appropriate and relevant policies.

Handover of CD4 Count Machines for Harare and Parirenyatwa hospitals in August 2010

Handover of CD4 Count Machines for Mpilo and UBH hospitals in September 2010

Male circumcision graduation in Chiredzi in September 2010

Traditional Medicines Day Commemoration in Matopo in September 2010

Ad Hoc Committee - An ad hoc committee was set up to make an evaluation on the

procurement of locally manufactured ART commodities. The committee held a series of

meetings with key stakeholders and came up with various findings and recommendations. It is

hoped that the recommendations will be useful in the procurement of the ART commodities.

Four board meetings were held during the year and various issues were discussed and various

resolutions were passed.

63

CHAPTER 8

FINANCIAL UPDATE

The quarter under review and the whole of 2010 was characterized by stable operating environment

and prices of goods and services increased marginally, however procurement of items that needed

formal tender remained a major challenge.

The Council’s sources of funds in 2010 were as shown by the cylinder graph given below.

$38,9m against a budget of $44.5m in income was realized by the Council during year. Inflows from the

AIDS levy exceeded budget by 18% while only 66% of the projected amount was received from the

donors. 50.5% ($19.7m) of the amount came from AIDS Levy, 44% (17.4m) and 3% ($1.6m) was from

Global Fund and other donors led by the Expanded Support Programme (ESP) respectively. Income from

investment was 1.6% (641 097)

Flow of funds from Global Fund was erratic during the year and only 66% of the budget was received.

Other donors met their obligation.

Total expenditure of $46.6m was 9% above budget ($42.8m). The expenditure of $3.8m above budget

was for the expenditure committed by Global Fund in 2009 and some under-budgeting in some budget

lines under administration particularity on payroll cost.

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Activities supported by NATF were 33.5% of this expenditure while Global Fund paid for 68.3% and the

balance was by other donors. $41.2m of the $45.2m was spent on interventions while logistics and

support took the difference.

The bar graph shown below shows the total expenditure for 2010 according to service delivery areas.

National AIDS Trust Fund (NATF) the major funding source of the Council surpassed targets by 18%.

Procurement of goods and services that needed to go through formal tender was a big challenge.

Income from AIDS levy of $6.7m in the fourth quarter surpassed projection and resulted in the total

income from the same source moving up to $19.7m against a budget of $16.6m. Expenditure for the

quarter was $14.8m against a budget of $9.4m and this pushed the total expenditure for the year to

$46.6m against projections of $42.8m.

8.1 Income in the quarter

Total income for the quarter amounted to $8.2m against a budget of $6.8million. AIDs levy contributed

81.9% of this amount while 7.9% and 7% respectively came from ESP and Global Fund respectively. The

balance of 3% came from investments.

8.2 Aids Levy

Income of $6.7m from AIDS Levy was 139% above budget of $4.8m. It exceeded income from the same

source by 217% during the same period last year (2009).

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8.3 Revenue Grants

ESP receipts were $527 740 against projections of $275 000. $252 740 above the budget was for

previous quarters whose remittances were had not been made. Out of a budget of $1.5m Global Fund

remitted $546 532.

8.4 Other Income

Income from investment amounted to $278 039 against a budget of US$125 000. $12 807 came from

assets that were disposed.

8.5 Year to date

$38,9m against projections of $44.5m was recorded as total income to the Council in 2010. 50.5%

($19.7m) of the amount came from AIDS Levy, 44% (17.4m) and 3% ($1.6m) was from Global Fund and

other donors respectively. Income from investment was 1.6% (641 097)

8.6 AIDS Levy

AIDS Levy accrued ($19.6m) for the year surpassed projection ($16.6m) by 18% and was 50.5% of the

total income recorded by the Council during the year. This was 344% above the income from the same

sources collected in 2009. By the end of the reporting date 31 December 2010 the Council had collected

$15.9m of the $19.6m and $3.7m was collected in January 2011. The 18% increase in AIDS levy

collection suggested some improvements in the revenue collection base.

8.7 Revenue Grant

Global Fund contributed $17.4m against a budget of $26.1m, the amount was 44% of revenue to the

Council. Other donors brought in 3% and $852 859 was from ESP against projection of $1.2m.

8.8 Other Income

Other income was made up of investment interest, disposal of fixed assets and sale of tender

documents and these contributed $648 097 against a budget of $466 000, $12 807, and $14 607

respectively.

8.9 Expenditure

Total expenditure for the third quarter was $14.8m against a budget of $7.4m, recording a negative

variance of 50%. This was mainly influenced by use of resources that were supposed to be used in the

previous quarters. 78% of this expenditure was on activities that were supported by NATF.

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$46.6m against a budget of $42.8m was spent during the year. Activities supported by NATF were 33.5%

of this expenditure while Global Fund paid for 68.3% and the balance was by other donors. $42.4m of

the $46.6m was spent on interventions while logistics and support took $4.1m.

This quarter

8.10 NATF- Supported Interventions.

NAFT funded interventions were $9.8m against a budget of $4.8m. The expenditure of $4m made above

budget was for resources that were expected to be used in the previous quarters. Treatment, Care and

Support used $8.3m, 84% of the total amount against a budget of $2.4m of the $9.8m spent in this area.

8.11 Grants Supported Interventions

$3.1m against projections of $1.6m was spent by Global Fund. The expenditure of $1.5m above

projections was for resources that were supposed to be spent in the previous quarters in the year.

$1.2m by other donors was spent on M&E and retention of critical staff.

8.12 Year to date

Total expenditure in 2010 was $46.6m against projections of $42.8m. $3.8m spent above budget were

for activities supported by Global fund whose resources were committed in 2009 and some under

budgeting in some line items.

8.13 NATF Supported Activities

NATF supported activities worth $18.4m against a budget of $16.9m of the $46.6m spent by the Council

in 2010. The $1.5m spent over and above projections was on line items that included treatment, salaries

and motor vehicle repairs.

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Of $18.4m, $14.6m was spent on HIV interventions. Treatment, care and support used 75%, $11m

against a budget of $8m.

8.14 Prevention

Intervention under prevention had a budget of $1.9m and only $839 543 was used. Absorption of funds

in this critical and important was below 30%. Detailed performance by programme area under this

section was as follows.

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8.15 Treatment, Care and support

Interventions under treatment, care and support which also includes Community and Home based care

(C&HBC) absorption more resources than budgeted amounts.

8.16 Mitigation

Mitigation covers OVC and MIPA. OVC used 9.7% of the resources ($40 601 out of budget of $420 600)

that were set aside for interventions under this area. The Council lost two officers who were responsible

for this area during the year and they were not replaced. Under MIPA $18 812.32 against a budget of

$185 800 was used during the year.

8.17 Advocacy, Communication and Research

Expenditure under this area was as show in the graphs given below.

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8.18 M&E and Coordination

Percentage resource utilization under M&E and coordination was at 80% ($1.2m out of a budget of

$1.5m) and 40% ($299 928 against projection of $745 500).

8.18 Programme logistic and support.

The delivery area covers general programme administration, Board expenses, payroll and capital items.

Resources were used as given below.

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The information given by the graph above shows that expenditure under general administration, Board

and capital items were within the budget. Payroll cost exceeded budget by 83%. The over expenditure

was caused by the level of salaries that were approved for staff that were above provision made in the

budget. However this was 13% and the percentage recommended by Government in this area is 30%.

$276 980. $4 410, $30 585 and $68 115 of the $380 090 was spent on buildings, office furniture, offices

equipment and computers respectively under capital items area.

Conclusion

The smooth flow and collection of amount above budget on AIDS levy ensured availability of adequate

resources for programme implementation in the Council throughout the year. Unfortunately the

capacity to absorb resources set aside was low in other areas. Delays by the State Procurement Board

(SPB) to grant authority to procure items/services that needed formal tender made the situation of low

resource up take worse.

Delays in the remittances of resources by Donors particularly Global Fund affected smooth

implementation of the interventions and my lead to the extension of the project implementation period.