Zimbabwe CSO GFF Platform-building and Action-planning Meeting Report
Hosted by the CWGH in co-operation with the GFF Zimbabwe CSO Interim Steering Committee
With support from CSO GFF HUB 19-21 February, 2020 PVO 01/2014 Harare, Zimbabwe Contents
I. Background 1
II. Health Sector Investment Case & GFF Process in Zimbabwe 2
III. The HSIC We Want 5
IV. Coalition structure & leadership 7
V. Next steps 12
Appendix 1: Programme 13
Appendix 2: List of Participants 18 broad categories:understandingtheGFF action technical wider working The identied; Anticipated 4. 3. 2. 1. Specic interim process. to Zimbabwe). Group coalition A engagement members collectively platform the coordinated The experienceofGFFcountrieshasshownthatcivilsocietyismosteffectivewhenitstructuredand Government I. Zimbabwe
small orient Background strengthen T T T T GFF interim o o o o dene identify ensure bring stakeholders planning steering (W meeting team process. in Zimbabwean T for steering partners. of and A wo weeksbeforethemeeting the joined dene steering together G), outputs a engagement This in with of all the of opportunities those structure health (2) , Zimbabwe committee, a participants Zimbabwean and objectives and platform group government A committee: the coalition. priorities including coalition/group
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Health Sector Investment Case & GFF Process in Zimbabwe Zimbabwe CSO GFF Platform-building and Action-planning Meeting ant W e
III. The HSIC We Want W
During the workshop, civil society participants broke into groups by the six priority areas of the HSIC zero he HSIC draft to: (1) Share experiences to identify the most important problems/or issues based on their T knowledge and expertise; (2) Compare these problems/or issues with those identied in the HSIC situational analysis; and (3) Evaluate the HSIC prioritized interventions to identify gaps and include those problems that have not be addressed. This process resulted in dozens of gaps or potential priority actions which were discussed plenary and captured on ip charts (for full details, please see the meeting notes here). Following this plenary report-back, one participant per organization identied the most urgent six priorities using a simple voting system. The facilitators then reviewed the prioritized priorities, and came back to the group with the results. In plenary, the group discussed and identied the cross- cutting issues and distilled the many suggestions into ve most urgent actions to be included in the HSIC. These are outlined below (in no particular order).
On the nal day of the workshop, the HSIC coalition had an opportunity to share their priorities for the HSIC with the GFF Secretariat members present and will continue engaging MOHCC around these priority areas, and further prioritizing the priorities.
Priority 1: Improving resources for the health sector: Better spent, coordinated, and effective Participants observed that inadequate levels of government nancing and wastage underlies many of the challenges in the health sector (Health system inefciencies). The Government of Zimbabwe provides around 9% of its budget for health, well below the 15% Abuja Declaration target. This funding is also well below the target of US$86 per capita. Additionally, countries must invest 5% of their GDP if they have to progress towards UHC.
Participants noted the challenges mobilizing government funding in the current environment. The Health Levy and AIDS levy are two positive examples, although the Health Levy funds are sometimes directed elsewhere to other sectors that are not necessarily health related. When properly designed and implemented, results-based nancing can pay for and motivate health workers, as well as promote efciency gains and enhance equity.
Priority 2: National health insurance then abolishing user fees The practice of user fees also emerged as a key barrier to health services across RMNCAH, communicable diseases, and noncommunicable diseases. Catastrophic costs are common particularly for chronic conditions, and still the health system is ill-equipped to treat them or provide palliative care. A sustainable, domestic source of funding is needed to bolster the public health system and accelerate progress towards achievement of Universal Health Coverage. The establishment of a universal national health insurance scheme would provide that resource base. With the sustainable nancing of health facilities through insurance, user fees could be truly abolished. However, the Free User Fee Policy must be backed by adequate resources
Priority 3: Safe water, good sanitation and food in health facilities Health facilities lack of supply of safe water, toilets, bathing facilities, inconsistent supply of electricity emerged as a key concern in all health priority areas and a main reason that people do not go to facilities in pursuit of health care. It is noted in the HSIC, but the potential response should be strengthened. Participants noted the challenge that these types of environmental improvements in health facilities often fall outside the responsibility of the MOHCC, for example running water is the responsibility of the municipal government. A special response must take a multi-sectoral approach or revise the arrangements for health facility infrastructure responsibilities to ensure that health facilities meet basic standards.
5 Zimbabwe CSO GFF Platform-building and Action-planning Meeting ant W
Priority 4: Emergency services: Functioning ambulances, availability of medicines, sundries, e W medical technology The weaknesses in the health sector’s ability to respond and refer to higher levels of care are most acute he HSIC when it comes to emergency services. The acute challenges with ambulances for transport repeatedly T came up-broken down vehicles, ambulances sitting idle in secondary or tertiary hospitals due to inadequate resources to support maintenance, while people in districts need transport. The lack of basic medical supplies and medicines, adequate bedding, inadequate food rations as well as medical technology was also a priority area that cut across the health care system.
Priority 5: Better community engagement and response in health emergencies In the aftermath of cyclone Idai, civil society has a lot of reections regarding what should be done differently next time. Health emergencies and Health in emergencies are included in the HSIC, but should be bolstered to ensure adequate community engagement in disaster preparedness, warning systems, and response (an evacuation plan, etc.). The time is right for a post-emergency audit that includes all stakeholders, including communities and civil society organizations, and a plan to better engage communities and use community data systems to prepare and respond to emergencies.
Ranking and scoring session
6 Zimbabwe CSO GFF Platform-building and Action-planning Meeting
IV. Coalition structure & leadership e & leadership
Civil society's recommendations to strengthen the HSIC outline what needs to be achieved to contribute tur to Zimbabwe’s GFF process. Facilitators presented experience from civil society engagement in country- led GFF processes in Kenya, Uganda and Senegal, which suggests that a coalition who can coordinate civil society engagement around shared objectives is more effective than a fragmented approach. The
emphasis on coalition engagement was reafrmed by the MOHCC and GFF Secretariat representatives. oalition struc C
The coalition developed a structure (See gure 1). Any organization is welcome to join the coalition, although there was some sentiment that members should be drawn from a network of specic constituency. The coalition consists of a steering committee responsible for developing operational guidelines (eg a terms of reference); overseeing inputs into the HSIC and developing advocacy materials, pursuing funding opportunities, and developing a communication mechanism for members, eg a Google Group. Organizations on the Steering Committee must be membership-based. The steering committee will rely on the six thematic groups to help advance certain areas of work as necessary.
College of Members (1 representative per member organization)
Steering Committee 7 members
Demand Service Advocacy and Citizen Resource Adolescent creation delivery communications monitoring mobilization and youth SRH
Thematic Groups
Figure 1. Zimbabwe Health Sector Civil Society Coalition
Participants noted the important progress that had been made by the interim Steering Committee members--CWGH, ZAN, WAG, and CeSHHAR Zimbabwe--in making the initial meeting a reality. There was unanimous support that those four members should remain on the steering committee. Some steering committee members and participants expressed a desire to add more members to the Steering Committee to help share the responsibilities. Since a Steering Committee typically has 7-9 members, there was support to add another three seats to the Steering Committee.
Facilitators explained that for purposes of representation to the global CIvil Society Coordinating Group on the GFF, the coalition will be asked to nominate a representative from a youth-led organization. Participants expressed that this youth representative should be on the Steering Committee. Participants started nominating youth-led organizations, and using a blind vote elected Youth Ignite.
In order to fully populate the Steering Committee, participants also suggested seats on the Steering Committee for; labor/health care worker organizations and elected Jointed Hands; and people with disabilities which unanimously nominated Disability HIV & AIDS Trust (DHAT).
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Coalition structure & leadership Zimbabwe CSO GFF Platform-building and Action-planning Meeting
Identifying civil society inputs into the HSIC
The HSIC We Want
11 Zimbabwe CSO GFF Platform-building and Action-planning Meeting eps V. Next Steps t St Nex
Participants identied a number of next steps and agreed on the most urgent actions. Next steps are:
1. HSIC Advocacy: The Steering Committee will consolidate CSO inputs into HSIC, re-prioritize to further rene the suggestions, and communicate these to the technical working group. The advocacy and communications working group is standing by and ready to assist as called upon.
2. Report-back: Participants will go back to their networks and share the outcomes of the meeting and next steps, ways to engage with any civil society organization whose work is implicated by the HSIC and related processes but could attend the meeting. There was also a suggestion to conduct a mapping exercise of civil society working in the health sector.
3. Coalition Terms of Reference & Workplan: The Steering Committee will develop the governance document for the coalition (a terms of references, charter or constitution with roles, methods of communications, expectations of steering committee, etc.). This was requested by the end of March, with a follow-up meeting to review the governance document and orient new members of the coalition by the beginning of May. The external facilitation team will share a few examples from other countries that may be adapted for the Zimbabwean context. CWGH volunteered to create a google group with all participants, immediately after the workshop. Working groups/subcommittees in each area should start meeting and communicating, and a workplan for the rst year should be developed.
For ongoing advocacy and collaboration, it will be important for the coalition to be introduced, then engage and work with MoHCC/GoZ. There was a suggestion to have an interface with the Permanent Secretary & Minister of Health on a quarterly basis, and also a need to link with other structures including the CCM (and HDF+CCM when that arrangement is decided).
4. Fundraising: The steering committee, with support from the resource mobilization working group, will develop a proposal for funding the most urgent next steps coming out of this meeting. This proposal should be part of an overall fundraising strategy for the coalition.
5. Budget tracking and accountability: The $25 million GFF Trust Fund grant is anticipated to be operational in June 2020. It will be important to conduct budget tracking of these funds,including the $34 million DRM, to monitor the utilization and impact on access to affordable, equitable quality health services to the citizens of Zimbabwe.
12 4. 3. 2. 1. Meeting 10:45-12:00 10:30 9:45-10 9:15 09:00 8 :30 T T T T strengthen o o o o – dene identify ensure bring – CSO GFFPlatform-buildingandAction-planningMeeting – – 9:45 9:00 09:15 10:45 :30 objectives: together a all opportunities structures/platform those participants February 18-20,2020HolidayInnHotelHarare,Zimbabwe country-level Expected Joyce Session Coffee/T purpose, Expected Consultant Presenters: Session Zimbabwe Dr Facilitators: Meeting Participants Itai W Participants elcome Fortunate focus CSOs l l l l Rusike Zimbabwe Kyalo Questions Presentation Questions Presentation areas; ea objectives, 2. 1. financing, that and outcome: outcome: Remarks have (CeSHHAR) – Overview Overview break Suzanna Suzanna & Community Machingura GFF Introductions are develop registration Appendix 1:P Suzanna CSOGFFPlatform-buildingandAction-planningMeeting a for working DA common and and process civil governance participants participants T (20 (20 Y witter: #GFFInCountry expectations Dennis Dennis, plans of of discussion discussion 1 society Dennis mins): mins): – Working the the - on A understanding T and Centre uesday to GEND GFF GFF: GFF: & Senior engage to Overview Overview opportunities Joyce are and have engage 13 focus (55 (25 Group for Country Model rogramme , aware & important February Health mins) a mins) Sexual A Kyalo, overview in areas common the in on of of of & of the the GFF the the Health Financing Process Governance Health for for the Health GFF stakeholders. GFF 18 GFF GFF; dialogue, engagement. processes; of understanding anticipated processes. ; the (CWGH) Systems and process; Advisor workshop HIV/AIDS and and stages Strengthening even , P of AI the agenda those Research & of GFF the working ’ s to
Next Steps 12:00 16:00 15:30 14:00 09:15 9:00 17:15 13:00 – – – – – – – – 9:15 17:15 16:00 15:30 13:00 10:30 17:30 14:00 overarching Zimbabwe, Expected needed In Facilitator: Session Coffee/T Zimbabwe, Expected Presentation services Community GFF Mahomva Permanent Case Session Lunch engaging Expected Co-presenters: experience Session W Suzanna rap reforms Expected HSIC Group Facilitators: Session Recap depth l l l Liaison l l and up Zimbabwe Questions engaging 2 break Questions they plenary Moderators: ea work: and Presentations, 3. 5. 4. of Dennis 2-3 Health in outcomes: outcomes: outcome: GFF identified. GFF Suzanna and and Secretary 6. Civil Investigation Official day break V country-level groupings and outcome: officer will (20 closing oices: Thematic Identifying Suzanna Participants Joyce Focal process CSOGFFPlatform-buildingandAction-planningMeeting opportunities opportunities one discussion financing lessons help mins) society in and and DA Dr the participants testimonies Opening Dennis – participants participants Fortunate Person shape: of . Kyalo Civil discussion Overview of discussion Patron Y process, priorities Dennis 10 the in civil engagement February GFF learned civil of 2 and society minutes break Zimbabwe on Ministry and Churches – the Dr for for of society Mafaune process governance the society W Machingura . from are the and Itai identified CS CS Robert understand HSIC understand 14 (60 ednesday into of ’ (40 (Kenya, s HSIC familiar each: Rusike priorities of W engagement. engagement. ’ lessons daily people s mins) minutes) groups orkshop 19 Health inputs in on inputs Health Mudyiradima content two opportunities in the agenda reforms Zambia) with ’ & s Session how how learned. for based into countries. experience and Itai GFF into , Associate & civil and the the the Rusike the Group The Child the to on IC society process 4. GFF GFF investment date: Health and and the HSIC Care, also Zambia with process process type health ’ challenges s country-level with identifies experience health Dr Sector of case. Agnes Moderator: small financing input is is working working Investment of the to groups the in in as
Next Steps Zimbabwe CSO GFF Platform-building and Action-planning Meeting eps t St 10:30 – 10:45 Coffee/Tea break Nex
10:45 – 13:00 Session 7. The HSIC We Want Facilitators: Joyce Kyalo
Small groups pair up to present their recommendationto a peer group and refine based on their colleagues’ inputs (1 hour)
Plenary presentation of 3-4 refined recommendations(1 hour 15 minutes)
Expected outcome: Consensus on civil society priorities for the HSIC.
13:00 – 1400 Lunch break
14:00 – 15:30 Session 8. Civil Society Engagement: Mapping & Setting Objectives Facilitators: Suzanna Dennis
Participants map out the next steps in the HSIC process (30 mins): l HSIC Document l GFF Trust Fund Investment l Decision-makers l Important allies l Mechanisms for CS engagement
What are the most important next steps for civil society to engage? (1 hour) Develop 2 SMART objectives:
l [Decision-maker][takes specific action regarding civil society’s recommendationsfor the HSIC] [by what date] l Process for overall CS engagement (CS engagementframework) Expected outcome: Identified upcoming opportunities to advance CS priorities into HSIC; objectives to take advantageof these opportunities.
15:30 – 15 :45 Coffee/Tea break
15:45 – 16:30 Session 9. Civil Society Engagement: Activity Planning Facilitators: Joyce Kyalo
l What is the most effective and timely ways to achieve each objective set in session 7? l By when do these activities need to happen? l What kind of collateral materials will help make the case? l Roughly how much money will this cost? l Where will the resources come from? l Who is responsible?
Expected outcome: A rough workplan with activities and responsibilities.
16:30 – 17:00 Next steps and closing remarks Suzanna Dennis
15 10:45 10:30 12:00 09:15 9:00 – – – – – 9:15 13:00 12:00 10:45 10:30 Facilitators: Session structures; Expected Report Facilitators: Session Coffee/T coalition/working Expected Small Facilitators: Session Recap l l l l l l l l Zimbabwe group of Group Group Group o o o Group Presentation engage What Questions coalitions coalition, Presentation back ea DA 12. 1 10. day outcomes: outcomes: 1. o o o o o Propose learning, resource the List work the Based o o understanding TBD Dr break Suzanna or V Mapping W Y structure CSOGFFPlatform-buildingandAction-planningMeeting from one work report work work . ision areas in Looking these How How (highlight coordinating What What Kenya, Examples Benefits examples potential orking GFF plenary in Fortunate 3 well principles engaging group/mechanism. HSIC? on – – group (30 Exercise (50 can can an etc.) Overview & are are (10 (15 Thursday back harmonized mobilization, (Networking, for Mapping of General the Dennis Zambia, governance more or Zimbabwe at institutional discussion strong min) min): of a they GFF roles the min): 3-4 the min): self-assessment of of mechanism the Machingura a of working and work in of governance mechanisms, governance good existing each) strengths comparative (25 effectively be engagement? the CSOs effective consensus and Benefits of knowledge discussion 16 of Senegal, and harmonized mins): civil GFF structures? governance , daily accountability activities group (15 CSO Communication diagram February 20 framework who national discussion society is , and minutes) & collaboration, who and needed agenda Coalitions structures structures Suzanna through others are on on advantage when (45 and exercise weaknesses challenges of is to the the currently for coalitions CS min) framework doing a skills? illustrate compared GFF better for national attributes , coordination (35 monitoring a Dennis presented, of done RMNCAH+N coalition and what of examples be Where min.) other engaging alignment of and different the of integrated by coordination, CS working where? of the to national results coordinating the are coalition the the and mechanisms? what CS of group, in actors. the criterion? coalition of What in evaluation or into resources? might coalitions: gaps? a interested engaging and advocacy any are to of the and in ,
Next Steps Zimbabwe CSO GFF Platform-building and Action-planning Meeting eps t St
13:00 – 14 :00 Lunch break Nex
14:30 – 15:30 Session 13. (continued) Consolidating group work and agreeing on a governance structure Facilitators: TBD
Plenary l Choosing the right governance structure for Zimbabwe CSOs l Establishing thematic groups l Assigning roles and responsibilities
Expected outcome: Agreed mechanism for coordinatedCS engagementwith designated roles and responsibilities;and persons or institutions responsible.
15:30 – 15:45 Coffee/Teabreak
15:45 – 16:45 Session 14. Interactive discussion on coordination and communication, how the mechanism will function, next steps Facilitators: TBD
Expected outcome: Agreed communication and coordination functions for inclusion into the coalition’s terms of reference.
16:45 – 17:00 Wrapup and closing
17 Zimbabwe CSO GFF Platform-building and Action-planning Meeting
Appendix 2: List of participants
Name Sex Organisation & Contact Details
V. T. S. Chitimbire F Zimbabwe Association of Church related Hospitals Thomas Chikumbirike M Counseling Services Unit Tawanda Zvakada M Zimbabwe Hospital Doctors Association R Kuyawa M Gays and Lesbians Association of Zimbabwe Edinah Masiyiwa F Women’s Action Group Caiphas Chimhete M CWGH C Terera F National Association of NGOs
Tanyaradzwa F CWGH Munouya
N Banda M Zimbabwe Congress of Trade Unions L. Mafare M Zimbabwe Congress of Trade Unions Anna C Penduka F Women and AIDS Support Network Emmanuel Gasa M The Arts and AIDS Foundation N Mushonga F Institute of Food, Nutrition and Family Sciences Mtandazo Maphosa F Sexual Rights Centre Tariro Kutadza F Zimbabwe National Network of Positive Women
Chamu Ndlovhu M Zimbabwe Young People’s Development Coalition-Bulawayo A. T. Sibanda M Carelite - Hwange James Goneso M General Agriculture Plantation Workers Union of Zimbabwe
Ndumiso Magutshini M Consumer Council of Zimbabwe Isao Zvarevashe M Family AIDS Caring Trust- Chiredzi Samson Coffee M Kariba Urban Residents Association Entrance Takaidza F ZIMRIGHTS Gellie Bepete F Village Health Worker - Chiwundura Ezabela Mombe F Village Health Worker - Chikwaka Otilia Tasikani F Network of Zimbabwe Positive Women+ Alexious Zindoga M National Council of Disabled People in Zimbabwe Delphine Chirimuuta F Association of Mine Workers Union of Zimbabawe Tjedu Moyo F Ignite Youth Organisation
18 Zimbabwe CSO GFF Platform-building and Action-planning Meeting
Thabiso Sibanda F Dot youth Mongi Khumalo M Youth Boundless Zimbabwe Desmond Ntini M Zimbabwe Council Of Churches Stephen Musarapasi Zimbabwe Environmental Health Practitioners Association Juliet Vambe F Mutare Residence Ratepayers Association Kudakwashe Matayi M Zimbabwe Young People’s Development Coalition - Mutare Donald Dennis M Jointed Hands Tobaiwa
Itai Rusike M Community Working Group on Health Suzanna Dennis F PAI Chelsea Mertz F PAI Joyce Kyalo F Consultant Charles Siwela M Youth Engage Chenjerai Sisimayi M World Bank Abebe Shibru M Population Services Zimbabwe Fortunate Machingura F Center for Sexual Health and HIV/AIDS Research in Zimbabwe Talent Maposa F Zimbabwe AIDS Network Patron Mafaune F GFF Liaison Officer Ayodeji Oluwole M World Bank Odutolu Luis Pinto World Bank M Caroline Mubaira F Crown Agents Norest Hama M World Vision Gwati Gwati M MOHCC Philimon Simwaba M Disability HIV and AIDS Trust Hon. D. Molokele M Parliamentary Portfolio Committee on Health Tonderai Chiduku M Zimbabwe National Network of People Living with HIV Calvin Fambirai M Zimbabwe Association of Doctors for Human Rights Nyasha Masunda M World Health Organization Tafadzwanashe M CWGH Nkrumah
Edgar Mutasa M CWGH T. Moyo M Parliamentary Portfolio Committee on Finance and Economic Development
Vanessa Gonye F Newsday Nokuthaba Nkomo F Daily News Anesu Tonde F The Herald
19 Community Working Group on Health
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