CWGH-Annual-Report Web.Pdf

1. Introduction to CWGH 2 2. CWGH Vision 3 3. Board Governance and Policy 4 ents 4. Organisational Structure 5 5. Staff and Interns 6 6. Foreword: Board of Trustees Chairperson 7 7. Executive Committee Chairperson’s Remarks 9 8. Executive Director’s Report 12 9. Advocacy and influencing the Health Agenda at National and Regional Level 16 10. Strengthening Community Feedback Mechanisms in Health 21 11. Strengthening Community Participation in Health for Improved MNCH in Zimbabwe 26 12. Core Support to Strengthening Public and Social Accountability Monitoring for HIV/AIDS Resources le of Cont in Zimbabwe 33 13. Strengthening Social Accountability Monitoring and Responsiveness to Sexual and Reproductive Health Rights (SRHR) in the Matabeleland and ab Midlands Region 39 14. HCC as a vehicle for Social Participation in Health T in East and southern Africa 45 15. Revitalizing and Strengthening Primary Health Care & Public responsibility for Health in Zimbabwe 49 16. Big Lottery Collaborate Project: Zimbabwe Community HIV Care Project 53 17. Accountability Loop Budget Advocacy (ALBA) 57 18. Adolescent Sexual Reproductive Health Programme 61 19. List of CWGH National Members 67 2016 in Pictures 68 20. 2016 in pictures 70 21. CWGH Districts 72 1. Introduction to CWGH 2 2. CWGH Vision 3 3. Board Governance and Policy 4 ents 4. Organisational Structure 5 5. Staff and Interns 6 6. Foreword: Board of Trustees Chairperson 7 7. Executive Committee Chairperson’s Remarks 9 8. Executive Director’s Report 12 9. Advocacy and influencing the Health Agenda at National and Regional Level 16 10. Strengthening Community Feedback Mechanisms in Health 21 11. Strengthening Community Participation in Health for Improved MNCH in Zimbabwe 26 12. Core Support to Strengthening Public and Social Accountability Monitoring for HIV/AIDS Resources le of Cont in Zimbabwe 33 13. Strengthening Social Accountability Monitoring and Responsiveness to Sexual and Reproductive Health Rights (SRHR) in the Matabeleland and ab Midlands Region 39 14. HCC as a vehicle for Social Participation in Health T in East and southern Africa 45 15. Revitalizing and Strengthening Primary Health Care & Public responsibility for Health in Zimbabwe 49 16. Big Lottery Collaborate Project: Zimbabwe Community HIV Care Project 53 17. Accountability Loop Budget Advocacy (ALBA) 57 18. Adolescent Sexual Reproductive Health Programme 61 19. List of CWGH National Members 67 2016 in Pictures 68 20. 2016 in pictures 70 21. CWGH Districts 72 CHAPTER CHAPTER t 2016 t 2016

epor 1.0 Introduction to CWGH 2.0 CWGH Vision epor Annual R Annual R To be a leader in organizing and HEALTH has long been one of the most important social concerns of Zimbabwean people. Major gains were championing communities' right to achieved in the 1980s through joint and complementary action between the health sector and communities. However, the combined impact of AIDS, structural adjustment programmes and real reductions in the health health and equitable health services budget and in household incomes, has reversed many of these gains. The quality of health care has in Zimbabwe. declined, and health workers and their clients have become demoralized. Communities have had to take on more and more responsibility for looking after the ill, by providing home-based care, paying for their health care and dealing with their health problems. But despite this critical involvement, they have been little more Mission Statement than passive observers of changes to the health system itself. To enhance community participation in

By the late 1990s a wave of strikes strategies for implementing these comprising a chair, vice chair, health through advocacy, networking amongst health workers signalled priorities. secretary and three committee and capacity development for the that health workers were also not members from among the local attainment of the Right to Health and happy with the situation. While a lot The participating civic groups civil society groups. These local Equitable Health Services in of attention was given to the strikes decided to form a network of CWGH fora co-ordinate local by doctors and nurses, those o r g a n i s a t i o n s c a l l e d t h e activities including education and Zimbabwe. working at clinic level and in Community Working Group on health action, and link civil society communities also lost wellbeing H e a l t h ( C W G H ) , w i t h a groups with all health providers and morale. As 2000 approached, responsibility to add weight to (public, private, traditional, NGO) Core Values “health for all” seemed like an their input in health policy and local authorities on health empty promise. negotiations and maximize the issues. They inform their members Accountability effect of their joint actions in the of national and local CWGH Being answerable to our beneficiaries, As a result of this situation several health sector. In March 1998 they activities, policies and issues; national civic organizations, came together and discussed the promote health actions within their donors, other stakeholders and our coordinated by the Zimbabwe feedback they had received. The organizations and area; and take structures Congress of Trade Unions (ZCTU) CWGH members invited the up health issues raised by were motivated to come together in a s s o c i a t i o n s o f h e a l t h communities with health providers. 1997 to review the current state of professionals and representatives Transparency affairs in the health sector and look of government, churches, the The CWGH also advocates for the Openness in the execution of our at ways in which communities could private sector, NGOs and establishment of health centre duties (doing things above board) achieve greater control of their own traditional health providers in committees and district health health. order to identify conflict or b o a rd s t h a t i n v o l v e l o c a l Professionalism consensus over community views councillors, civic groups and The first step was to carry out and strategies. The result was a health providers to enable Being diligent, disciplined and abiding research on communities' and civic final report, Community Views on participation and effective links by ethics organizations' perceptions of health S t r a t e g i e s f o r H e a l t h i n between members of the public and health services in Zimbabwe. Zimbabwe, which summarized This was done in 1997. The survey the perspectives and experiences and health providers. It advocates Integrity brought up concerns about the of CWGH and communities for hospital advisory boards to Being truthful, reliable, honest with inadequacy of public funds for o r g a n i s i n g f o r h e a l t h i n include civil society organizations, good social standing health, the declining quality of Zimbabwe. particularly those that represent public health services, the negative hospital users. This enables civil attitudes of providers and the After the establishment of the society participation in the Teamwork weakness of current mechanisms CWGH, it started working on a planning and implementation of Ability to work together towards the f o r e x p re s s i n g c o m m u n i t y number of programs including health activities in a more participation in health. After the establishing local CWGH fora at same goal regardless of personal substantive manner, including in finalization of the Survey Report in district level. These fora comprise differences (co-operation and respect of CWGH activities. The January 1998, a meeting of representatives of all civic groups collaboration) constituent organizations was held in the local authority area and in CWGH was initially registered as a to review the outcomes; examine the immediate surrounding peri- Trust in 2002 and later transformed the health, and health care, urban, rural and urban areas. as a Private Voluntary Organisation Non-partisan priorities they implied; and suggest They have an elected committee in early 2014. Not aligning ourselves to any political party

2 Community Working Group on Health Community Working Group on Health 3 CHAPTER CHAPTER t 2016 t 2016

epor 3.0 Board Governance and Policy 4.0 Organisational Structure epor Annual R Annual R

THE 40 national, civil society and community based organizations that make up the CWGH constitute the The Executive Members 'national membership' of the organisation. Each organization nominates a person to represent them in AGM National Membership CWGH through their governing bodies. They come together at the Annual General Meeting (AGM) where Mr John Ngirazi - Chairperson (Zimbabwe they elect an executive committee. The AGM brings members to discuss 'politics' of the CWGH and plan Policy Making Bodies Congress of Trade Unions) future work.

Mr Desmond Ntini - Vice Chairperson National Executive Board of Trustees (Zimbabwe Council of Churches) The CWGH also has a Board of CWGH programmes in all its groups. The committee is (Elected) (Nominated) Trustees nominated by the districts. The secretariat has full- responsible for coordinating local membership. The Executive is the time staff that provides training, activities, and coordinating with all Mr Shadreck Tondori - Treasurer (Zimbabwe management committee of the gives logistic support to local civic groups, local government Homeless People's Federation) CWGH and makes decisions on the activities, and manages the leaders and health providers on policies and programmes of the resources to suppor t the health issues in their area through Co-ordinating Unit Mr Didymus Chinyowa - Committee Member organization. The Board of Trustees programmes. The Secretariat joint meetings. The communities Secretariat (Implementation) (Marondera Residents and Ratepayers'

oversees the policy formulation to reports to the membership update the CWGH secretariat on Decision & policies make sure that what is done is in line through the Executive Committee. the steps taken for action on a Association) with the aims and objectives of the regular basis. Health centre organization. There are also district committees committees work with the CWGH Mr Ndumiso Mgutshini - Committee (volunteers) which are made up of and help people in the area identify Ideas Feedback Member (Consumer Council of Zimbabwe) The secretariat is responsible for a chair, vice chair, secretary and and act on their priority health District Health coordinating and implementing the four other committee members issues. Fora (volunteers) Mr Masimba Ruzvidzo - Committee Member chosen from among the local civic (Informal Traders' Association of Zimbabwe)

Community level (Participants/Beneficiaries) Mrs Margaret Mangena - Committee Member (Zhombe Aids Aid Organisation) Health Centre Committee (Volunteers)

BOARD OF TRUSTEES

Dr Dickson Dick Chifamba - Chairperson

Sr. Maria Magdalena Savanhu - Vice Chairperson

Mr Shepherd Shamu - Health Economist

Dr Portia Manangazira - Public Health Specialist

Mr Norbert Dube - Civil Society Activist

Mr Rogers Matsikidze - Legal Advisor

Mr Farai Edwin Chitsa Some Members of the CWGH Executive Committee and Board of Trustees - Human Resource Specialist CWGH Executive Committee member Mr. Didymus Chinyowa, the Executive Treasurer, Mr Shadreck Tondori, and Legal Advisor, Mr Rogers Matsikidze

4 Community Working Group on Health Community Working Group on Health 5 CHAPTER CHAPTER t 2016 t 2016

epor 3.0 Board Governance and Policy 4.0 Organisational Structure epor Annual R Annual R

Community level (Participants/Beneficiaries) Mrs Margaret Mangena - Committee Member (Zhombe Aids Aid Organisation) Health Centre Committee (Volunteers)

BOARD OF TRUSTEES

Dr Dickson Dick Chifamba - Chairperson

Sr. Maria Magdalena Savanhu - Vice Chairperson

Mr Shepherd Shamu - Health Economist

Dr Portia Manangazira - Public Health Specialist

Mr Norbert Dube - Civil Society Activist

Mr Rogers Matsikidze - Legal Advisor

4 Community Working Group on Health Community Working Group on Health 5 CHAPTER CHAPTER t 2016 t 2016

epor 5.0 Staff and interns 6.0 FOREWORD: Board of Trustees Chairperson epor Annual R Annual R into opportunities. We tailored our communities can play in the national advocacy to make sure change from MDGs to SDGs. that health needs of the The meeting emphasized need to communities are known, well implement primary health care represented and looked into. As approach as articulated in the Alma per tradition, the CWGH collected Ata declaration as it remains the and synthesized community views cornerstone of healthcare delivery into a position paper for the 2017 towards the attainment of UHC. It national health budget. Interviews Itai Josh Rusike also noted that incentivizing village Executive Director were also done with the national health workers through provision of Dr. Dickson Chifamba membership, board, executive Board of Trustees Chairperson uniforms, bicycles and timely and district chapters. The final disbursements of their monthly The brand CWGH paper was shared with the allowances was necessary to continues to gain local relevant stakeholders including improve their welfare and motivate and international traction MoHCC, Ministry of Finance and them in promoting PHC. with each year that Economic Development, the passes which is evidence Parliamentary Portfolio Committee The meeting urged the government of the important work the on Health (PPCH). to urgently adopt innovative Nonjabulo Ncube Takada Masiyiwa Esther Sharara Edgar Mutasa Faith Kowo organisation is doing in Team Leader Finance Officer M&E Officer Health Literacy Officer Provincial Engagement Coordinator domestic health financing learning To ensure maximum publicity, the the health sector. I can from best practices from other position paper was also widely proudly say that the year countries doing well to improve the disseminated during the CWGH 2016 was not an exception health care delivery system to national meeting held on despite the amounting achieve SDGs as well as minimize November 16, 2016 that ran under social and economic donor dependence. Emphasis was the theme, “Leaving no one challenges that prevailed. also placed on the need for Behind in National Health: What government to priorities health in Zimbabwe's Contribution should be”. Discussions at the the national budget to meet the Kundai Chebundo Caiphas Chimhete Tafadzwanashe Nkrumah Mandy Mathias Plaxedes Garamukanwa Health remains on the global Abuja target of 15%, speed-up the Provincial Engagement Coordinator Information & Communications Officer Regional Co-ordinator Programmes Officer Administration Officer (Harare Office) meeting centered on issues such development agenda as one of the as health financing for UHC, re-alignment of health policies to crucial priorities that governments serving the underserved on the constitution as well as investing must address. To that end the maternal, child and adolescent more resources towards the fight Sustainable Development Goals and sexual and reproductive against non-communicable (SDGs) adopted by UN member health rights as well as the role diseases (NCDs) and improve states in September 2015 aspire to palliative care. end poverty, protect the planet, and ensure prosperity for all. SDG 3, which focuses on health, aims to Priviledge Mchenga Sandra Machingauta Tanyaradzwa Munouya Mongi Khumalo Nyasha Penelope Mandeya Accounts Clerk Office Assistant Intern Intern Intern "Ensure healthy lives and promote well-being for all at all ages.”

And rightly so, it is CWGH mandate to ensure all citizens enjoy the right to health as enshrined in the country's Constitution Section 76 through enriched health promotion, awareness raising programmes and advocating for national policies Tafadzwa Rusike Raymond Muguneyi Wellington Mathias Volunteer (MSU Student) Security Officer Security Officer that promote the health cause.

However the CWGH, as the country leading advocacy civil society CWGH Board and Executive Committee members with the OSF group, we turned the challenges Delegation during a field visit to Zimbabwe.

6 Community Working Group on Health Community Working Group on Health 7 CHAPTER CHAPTER t 2016 t 2016

However the CWGH, as the country leading advocacy civil society CWGH Board and Executive Committee members with the OSF group, we turned the challenges Delegation during a field visit to Zimbabwe.

6 Community Working Group on Health Community Working Group on Health 7 CHAPTER t 2016 t 2016

epor 7.0 Executive Committee Chairperson's Report epor Annual R Annual R I would like to thank the secretariat It is pleasing to note that the clear introduction of the surrogate In the past year, I am pleased to for doing a good job in steering the currency (bond Notes) made very highlight that CWGH excelled in its CWGH to greater heights. There demarcation of the roles of our little impact on the cash crisis. thrust of promoting Health Centre has been in some organizations a Committees (HCCs) as a vehicle for 'mandate constipation' resulting in structures in law and practice has The current EL Niño-induced social participation in health not either a secretariat usurping the drought that affected most parts of only in Zimbabwe but regionally. It powers of the Executive and /or the assisted a lot in preventing such the country has severely affected was through CWGH's efforts that Board on one hand or the Board/ scourges the sick, especially those taking HCCs' influence on community Executive interfering in the activities ARVs, as they could not take level health interventions continues of secretariat on the other. It is medication without eating first. to grow as evidenced by their Mr John Ngirazi Equally affected were the u5s and pleasing to note that the clear Executive Committee Chairperson inclusion in various health projects demarcation of the roles of our pregnant mothers who require being run by other partners within structures in law and practice has It is that time of the year nutritious food for their unborn. out the country. HCCs are a assisted a lot in preventing such again when, on behalf of The food crisis at household level community structure that facilitates scourges. the CWGH Executive a l s o n e g a t i v e l y a f f e c t e d communities to identify their priority Committee, I am pleased community participation in health- health problems, actions and plan Last but not least, I would like to to share with you our related activities as people opted how to raise resources, organise welcome on board new CWGH achievements, challenges to do food-for-work programmes and manage contributions for executive committee members -- in the past year and our than voluntary work. community health activities. ITAZ and ZHAAO -- who were elaborate plans for 2017 In spite of the national challenges, elected at the last AGM in for the advancement of What is disturbing however is that, CWGH continued working towards November 2016. health in the country. despite the acknowledged crucial its vision of being the leader in role HCCs play in the country's Let's all work towards a healthy organizing and championing health sector, there is still no legal nation in 2017 and beyond. The year 2016 was one of the communities' rights to health and provision that governs their roles toughest years for most non- equitable health services in and functions. However, CWGH's Remember health is your right and governmental organizations Zimbabwe. I am proud to advocacy efforts in the past years responsibility. (NGOs) and even profit-making announce to you that the appears to be bearing fruits as the companies due to the prevailing organisation has not faltered in its Ministry of Health and Child Care I thank you. economic meltdown that has quest to achieve that vision (MoHCC) and the Parliamentary The CWGH Board Chair Dr Dickson Chifamba with the Chairperson of d e s p i t e w h a t l o o k s l i k e Dr Dickson Chifamba resulted in the closure of several Portfolio on Health (PPCH) Chairperson – CWGH Board of the Parliamentarian Budget Committee, Honourable MP David firms throwing thousands of people insurmountable challenges. It has promised to ensure that the Public Chapfika at the CWGH 23rd Annual National Conference Trustees into the street. Funding for NGOs in not been a walk in the park. Health Act Amendment Bill is tabled Zimbabwe like in most African for debate in parliament by 28 countries has dwindled in the past year as donors shifted focus to other more needy and problematic areas such as the refugee crisis in Europe.

The cash crisis currently bedevilling the country negatively affected the implementations and execution of activities to that extent that it became a huge challenge to achieve some of the set targets and outcomes. It became extremely difficult for programme officers to withdraw money to enable them to carry out different activities as the banks had no cash or gave out very Chief Ruzane of Wedza making a presentation at the CWGH insignificant amounts as the Annual National Conference

8 Community Working Group on Health Community Working Group on Health 9 CHAPTER t 2016 t 2016

8 Community Working Group on Health Community Working Group on Health 9 t 2016 t 2016 epor epor Annual R Annual R February 2017. If passed into law, PPCH for consideration during the Enhancing Transparency and saw the organisation exhibiting its suspended resulting in the lifting of this year's glamorous Africa NGO the bill will give formal recognition 2017 budget formulation process. Accountability in the Management work, programmes and also shared the suspensions. L e a d e r s h i p A w a r d f o r i t s not only to HCCs but village health In our input, we highlighted the of Health Related Issues in the its IEC materials for increased outstanding achievements in the workers (VHWs) who also play a need to progressively move Extractive Industries. The research visibility. The organisation continues to host health sector at the 6th Edition of the crucial in the provision of primary towards meeting the Abuja target project saw our officers travelling to two regional projects namely: the Africa Leadership Award held at Le health care. In 2017, the CWGH will of not only allocating 15% of the such countries as the Democratic The CWGH continues to occupy African Platform for Civil Society Meridian in Mauritius in December continue to play its advocacy role to national budget to the health Republic of Congo, Zambia, very important spaces and on UHC and the Health Centre 2016. ensure that the bill is tabled in sector but ensure actual spending Namibia and Mozambique for data developing new partnerships in the Committees as a vehicle for Social parliament and signed into law by of that percentage of all collection. health sector. During the course of Participation in Health in East and The award, received by CWGH the President. gover nment expenditures. the year, the MoHCC nominated Southern Africa. The regional Executive Director Mr Itai Rusike, is Reaching SDGs and achieving The research found out that mining CWGH to be a member of the project gives a regional impetus given to those who make a One of our major projects, the universal health coverage (UHC) and extractive industries plays an National Reproductive Neonatal on HCC work by increasing inter- difference to the lives of others. S t r e n g t h e n i n g C o m m u n i t y requires optimal funding, enabling important economic activity in all Child and Adolescent Health country collaboration, ensuring Winners are chosen for the quality Participation in Health (SCPH) p o l i c i e s , a c c o m m o d a t i n g , the countries but this also comes (RMNCH-A) committee and the legal recognition of HCCs and of their work, global reach and came to an end in June 2016 with responsive and a reliant health with serious environmental Maternal Deaths Surveillance and strengthening the existing training outlook and ability to contribute initial indications revealing that the system. This can only be achieved consequences such as air, land, Response Committee (MDSR), a tools of the committees. value of social change. project registered improved if Zimbabwe crafts innovative water pollution which affects the body mandated to spearhead maternal, newborn and child health domestic health financing health of the ordinary citizenry. activities aimed at reducing On the regional and global scene, It is prudent to mention that CWGH continues with its long-term plans to (MNCH) outcomes in areas where it mechanisms rather relying on maternal deaths in the country. The the CWGH was invited to On the domestic scene, the CWGH search and acquire its own was being implemented. The donors who can withdraw support appointments are clear indication participate at such high level has also done some research and property in Harare so that we end project was later extended for at any time. It should be known of the MoHCC's trust in CWGH's meetings and conferences such produced position papers that have challenges associated with paying seven months in Mashonaland and that presently 90% of the country's capabilities in monitoring health as the United Nations General rentals and moving offices Manicaland provinces. become so prominent in terms of resources and promoting quality, Assembly (UNGA) High Level drug requirements are funded by regularly. I would like to thank the advocating for more funding to the accessible, affordable health care Meeting on ending AIDS by 2030 external partners. CWGH secretariat for managing to It is pleasing to note that the CWGH health sector. One such paper is in the country. held in New York in June 2016, save money enough to buy a managed to secure funding to What is even more worrying is that MNCH policy brief that assessed International AIDS Conference in decent property. scale-up the SCPH project in three after such intense advocacy for government financing for RMNCH The CWGH also sits in national South Africa in July, International districts of Matabeleland province services in the country which was cancer body and the Health Conference on Global Health in increased allocation to health, the To CWGH Executive Committee namely Bubi, Umguza and done jointly with our partners. Matters Magazine, a publication of sector was only given a paltry Germany and the UHC2030 Members, Board of Trustees, the ministry, a clear indication of its Umzingwane for another three US$282 million, which represents conference on: Working together secretariat and partners, I say thank The organisation's visibility years. However, the project has 6.9% of the total national budget influence in the health sector. to Strengthen Health Systems held for making 2016 a success through n a t i o n a l l y, r e g i o n a l l y a n d been renamed Strengthening vote. This means the ministry will in Geneva, Switzerland. your dedication and hard work. internationally has increased in the It should also be noted that due of Community Feedback Mechanism unlikely be able to employ more past years. This is has been made its known impartiality, the CWGH in Health (SCFMH) and it nurses in the coming year, it will CWGH's good work in 2016 and I wish you a prosperous 2017. possible through the constant and successfully mediated in a dispute encourages the development and not be able to buy enough drugs previous years has not gone intensive use of CWGH website, between the Health Services Board use of mechanisms for holding key a n d m e d i c a l e q u i p m e n t unnoticed. I am proud to Mr John Ngirazi Facebook and twitter to publicise (HSB) and doctors that had been Executive Committee Chairperson State actors accountable to fullﬁl desperately needed in the announce to you that the the organisation's work and their health commitments. The country's health facilities. This organisation was conferred with projects. There are more hits from project advocates for increased also entails that preventable Europe and America on the resources for MNCH through diseases like typhoid, cholera and website. CWGH features almost innovative mechanisms and ensure malaria will continue to ravage the every week in local, regional and that these are consistent and country. responsive to community needs international media commenting on and plans. These efforts are all The CWGH will continue to current health trends. a i m e d a t c o n t r i b u t i n g t o strengthen its research desk to Sustainable Development Goals ensure that its advocacy The CWGH actively participated at (SDGs). messages are backed by factual the World Aids Day (WAD) information. I am proud to notify commemorations held in Kwekwe As is now the tradition, the CWGH you that our research work is not presented its budget input for the restricted to Zimbabwe but has in December 2016. The event which health sector to the Ministry of gone regional. In 2016, the CWGH was held under the theme; “Closing F i n a n c e a n d E c o n o m i c carried out some research on the tap of new HIV infections”, Development, MoHCC and the

10 Community Working Group on Health Community Working Group on Health 11 t 2016 t 2016 epor epor Annual R Annual R February 2017. If passed into law, PPCH for consideration during the Enhancing Transparency and saw the organisation exhibiting its suspended resulting in the lifting of this year's glamorous Africa NGO the bill will give formal recognition 2017 budget formulation process. Accountability in the Management work, programmes and also shared the suspensions. L e a d e r s h i p A w a r d f o r i t s not only to HCCs but village health In our input, we highlighted the of Health Related Issues in the its IEC materials for increased outstanding achievements in the workers (VHWs) who also play a need to progressively move Extractive Industries. The research visibility. The organisation continues to host health sector at the 6th Edition of the crucial in the provision of primary towards meeting the Abuja target project saw our officers travelling to two regional projects namely: the Africa Leadership Award held at Le health care. In 2017, the CWGH will of not only allocating 15% of the such countries as the Democratic The CWGH continues to occupy African Platform for Civil Society Meridian in Mauritius in December continue to play its advocacy role to national budget to the health Republic of Congo, Zambia, very important spaces and on UHC and the Health Centre 2016. ensure that the bill is tabled in sector but ensure actual spending Namibia and Mozambique for data developing new partnerships in the Committees as a vehicle for Social parliament and signed into law by of that percentage of all collection. health sector. During the course of Participation in Health in East and The award, received by CWGH the President. gover nment expenditures. the year, the MoHCC nominated Southern Africa. The regional Executive Director Mr Itai Rusike, is Reaching SDGs and achieving The research found out that mining CWGH to be a member of the project gives a regional impetus given to those who make a One of our major projects, the universal health coverage (UHC) and extractive industries plays an National Reproductive Neonatal on HCC work by increasing inter- difference to the lives of others. S t r e n g t h e n i n g C o m m u n i t y requires optimal funding, enabling important economic activity in all Child and Adolescent Health country collaboration, ensuring Winners are chosen for the quality Participation in Health (SCPH) p o l i c i e s , a c c o m m o d a t i n g , the countries but this also comes (RMNCH-A) committee and the legal recognition of HCCs and of their work, global reach and came to an end in June 2016 with responsive and a reliant health with serious environmental Maternal Deaths Surveillance and strengthening the existing training outlook and ability to contribute initial indications revealing that the system. This can only be achieved consequences such as air, land, Response Committee (MDSR), a tools of the committees. value of social change. project registered improved if Zimbabwe crafts innovative water pollution which affects the body mandated to spearhead maternal, newborn and child health domestic health financing health of the ordinary citizenry. activities aimed at reducing On the regional and global scene, It is prudent to mention that CWGH continues with its long-term plans to (MNCH) outcomes in areas where it mechanisms rather relying on maternal deaths in the country. The the CWGH was invited to On the domestic scene, the CWGH search and acquire its own was being implemented. The donors who can withdraw support appointments are clear indication participate at such high level has also done some research and property in Harare so that we end project was later extended for at any time. It should be known of the MoHCC's trust in CWGH's meetings and conferences such produced position papers that have challenges associated with paying seven months in Mashonaland and that presently 90% of the country's capabilities in monitoring health as the United Nations General rentals and moving offices Manicaland provinces. become so prominent in terms of resources and promoting quality, Assembly (UNGA) High Level drug requirements are funded by regularly. I would like to thank the advocating for more funding to the accessible, affordable health care Meeting on ending AIDS by 2030 external partners. CWGH secretariat for managing to It is pleasing to note that the CWGH health sector. One such paper is in the country. held in New York in June 2016, save money enough to buy a managed to secure funding to What is even more worrying is that MNCH policy brief that assessed International AIDS Conference in decent property. scale-up the SCPH project in three after such intense advocacy for government financing for RMNCH The CWGH also sits in national South Africa in July, International districts of Matabeleland province services in the country which was cancer body and the Health Conference on Global Health in increased allocation to health, the To CWGH Executive Committee namely Bubi, Umguza and done jointly with our partners. Matters Magazine, a publication of sector was only given a paltry Germany and the UHC2030 Members, Board of Trustees, the ministry, a clear indication of its Umzingwane for another three US$282 million, which represents conference on: Working together secretariat and partners, I say thank The organisation's visibility years. However, the project has 6.9% of the total national budget influence in the health sector. to Strengthen Health Systems held for making 2016 a success through n a t i o n a l l y, r e g i o n a l l y a n d been renamed Strengthening vote. This means the ministry will in Geneva, Switzerland. your dedication and hard work. internationally has increased in the It should also be noted that due of Community Feedback Mechanism unlikely be able to employ more past years. This is has been made its known impartiality, the CWGH in Health (SCFMH) and it nurses in the coming year, it will CWGH's good work in 2016 and I wish you a prosperous 2017. possible through the constant and successfully mediated in a dispute encourages the development and not be able to buy enough drugs previous years has not gone intensive use of CWGH website, between the Health Services Board use of mechanisms for holding key a n d m e d i c a l e q u i p m e n t unnoticed. I am proud to Mr John Ngirazi Facebook and twitter to publicise (HSB) and doctors that had been Executive Committee Chairperson State actors accountable to fullﬁl desperately needed in the announce to you that the the organisation's work and their health commitments. The country's health facilities. This organisation was conferred with projects. There are more hits from project advocates for increased also entails that preventable Europe and America on the resources for MNCH through diseases like typhoid, cholera and website. CWGH features almost innovative mechanisms and ensure malaria will continue to ravage the every week in local, regional and that these are consistent and country. responsive to community needs international media commenting on and plans. These efforts are all The CWGH will continue to current health trends. a i m e d a t c o n t r i b u t i n g t o strengthen its research desk to Sustainable Development Goals ensure that its advocacy The CWGH actively participated at (SDGs). messages are backed by factual the World Aids Day (WAD) information. I am proud to notify commemorations held in Kwekwe As is now the tradition, the CWGH you that our research work is not presented its budget input for the restricted to Zimbabwe but has in December 2016. The event which health sector to the Ministry of gone regional. In 2016, the CWGH was held under the theme; “Closing F i n a n c e a n d E c o n o m i c carried out some research on the tap of new HIV infections”, Development, MoHCC and the

10 Community Working Group on Health Community Working Group on Health 11 t 2016 t 2016 epor 8.0 Executive Director's Report epor Annual R Annual R principle, and we will strengthen system and the family. We should funding, management and community structures such as rather invest in preventing them. monitoring of their services. health centre committees and boards, committees at district and Despite this, the health budget for The country has 8 rural provinces, national level to organize public prevention has been going down, but 7 provincial hospitals, efforts to achieve this principle. and is now about 10% of the health (Matabeleland still without), 7 budget compared to the 14% it was central hospitals and 62 district Instead of health for all by 2000, at the beginning of the 1990s. hospitals, and a total of 1551 health we have had 2 decades of Preventive and field services such institutions. Specialists are declining health, worsening as environmental health have been available only at central hospitals Mr. Itai Josh Rusike health conditions and raising seriously underfunded. There is a and few provincial hospitals, with Executive Director death, especially due to HIV/AIDS need to call a halt to this, and none at the district level. In addition The Community Working and NCDs. For the CWGH, our realize that if we reinvest in there is a distinct rural – urban Group on Health (CWGH) district activities have made it very prevention most of the cases difference in quality and availability applauds Zimbabwe for clear that people need to reclaim flooding the hospitals can be CWGH Executive Director Mr Rusike and the EU Ambassador to of services, which is in direct making provisions for our role and rights in relation to avoided. Zimbabwe, Mr Philippe Van Damme contrast with both the principal of improved health and health, or our health will continue quality and equity in health that quality of life in the new to decline. It is absolutely critical It is very worrying that Zimbabwe defaulting on their medications health, but are getting poorer Ministry of Health and Child Care constitution by for us to deal with all those factors has over 4000 qualified general because of lack of food. We quality services. While the health strives to practice. Since time acknowledging that that are making us ill, to have nurses sitting at home – they are continue to witness rising Out-of- services cannot cope and are i m m e m o r i a l , h e a l t h c a r e health is a fundamental access to a certain basic jobless – but there are no enough Pocket expenditures for health, a calling for shared responsibility, professionals have shunned the human right, and that standard of health care, properly nurses in clinics. As CWGH, we situation that has led to general low there has been a growing gap rural and lower levels of health care believe it is high time the access to quality health equipped, with adequate staff level of utilisation of health services between health systems and the delivery, and this has translated government unfreezes health posts by people. Some patients do not care should be universal and drugs, to ensure that we are people. Communities are not into adverse health outcomes and treated early and effectively. The and revise the staff establishment even go to clinics anymore opting effectively involved in the way unfavourable indicators on to all citizens. We further amount of money, time and lost so that it speaks to the current for divine intervention from health services are planned and population health status from appreciate the income that ill health costs to disease burden and population Pentecostal churches due to governed, and communities have c o m p ro m i s e d a c c e s s a n d opportunity given to the people, especially the poor, increase. prohibitive costs. themselves had inadequate utilization of the health care CWGH, other members of makes this an urgent need. information to monitor their own services. the civic community, It is also worrying that the Greater priority must be given to the health services. individuals and Our healthy depends on our government's user fees policy prevention of ill health. The public The Zimbabwean health care institutions to have their housing, overcrowding, water continues to be applied in an ad sector should allocate a minimum This means putting people at the delivery system must therefore voices heard in the supplies, toilets, waste disposal, hoc manner and vary depending per capita allocation to preventive top of the health system, not at the quickly move to embrace the World constitution making and the extent of pollution, of long on the service provider remaining a health, across all ministries. Rural bottom. People should know their Health Organization's six building process, and we now grass for breeding sites for barrier to access health services. local authorities should set rights to health, and be treated with blocks of an effective system in demand to see the mosquitoes and other hazards. In Some health centres continue to standards for water and toilets for respect within the health system. order to reverse most of these provisions of this new the work in the districts it has charge user fees to buy essential all households, and public funds The CWGH has been promoting adverse health indicators. constitution implemented. become clear that some people drugs because the government is should be earmarked to match the patients charter and giving are living in substandard failing to avail enough resources. households' inputs to meet these people more information on their The Review Commission on Health conditions, and do not have even Infant, U5s and maternal rates goals. The CWGH calls for a health services. It is however not in 1999 recommended the creation In order to achieve the right to health a basic standard of safe water, remain a cause for concern. The national campaign to raise the simply a matter of health of a Health Service Commission for and health care with full community toilet and shelter. In some urban country is far from achieving its demand for and supply of toilets education. It would be better for all Health Workers in order to improve participation, CWGH envisage full a r e a s w a s t e i s p i l l i n g . target of 326 deaths per 100 000 and safe water, and to ensure that concerned to take ownership to their number, availability and implementation of the principles of Overcrowded housing, water and live births by 2020. At 651 deaths basic standards of refuse their health services, rather for working conditions. This became Primary Health Care (PHC) concept toilet systems have breakdowns per 100 000, maternal mortality rate collection, toilets and air pollution some to be treated as owners, and known in 2005 as the Health and strongly advocates for a and blockages. On some informal also remains unacceptably high. are met in urban areas. This is an others as passive and uninformed Service Board, (HSB). This Board comprehensive PHC system, if s e t t l e m e n t s p e o p l e h a v e issue that we are working on in all users. Community representation must convince Government of the there is hope for change in the extremely poor housing, unsafe The deteriorating health situation our districts. It is an issue that we needs to be strengthened across unique nature of health care health sector. The CWGH will water and inadequate toilets. As a has been worsened by the food would want tabled as a priority in all all structures, together with workers, and also ensure they are c o n s i s t e n t l y e n g a g e w i t h result of these, people suffer from crisis that affected over 70% of local authority agendas. elected leaders and health fully capacitated and closely stakeholders and government to d i a r r h e a a n d re s p i r a t o r y households in the country. It should professionals, so that the users of monitored to deliver the health make PHC a more central policy diseases. It is costly for the health be noted that some patients are People are putting in more health services have a say in the mandate to an ailing population. community time and resources for The HSB's impact is still to be

12 Community Working Group on Health Community Working Group on Health 13 t 2016 t 2016 epor 8.0 Executive Director's Report epor Annual R Annual R principle, and we will strengthen system and the family. We should funding, management and community structures such as rather invest in preventing them. monitoring of their services. health centre committees and boards, committees at district and Despite this, the health budget for The country has 8 rural provinces, national level to organize public prevention has been going down, but 7 provincial hospitals, efforts to achieve this principle. and is now about 10% of the health (Matabeleland still without), 7 budget compared to the 14% it was central hospitals and 62 district Instead of health for all by 2000, at the beginning of the 1990s. hospitals, and a total of 1551 health we have had 2 decades of Preventive and field services such institutions. Specialists are declining health, worsening as environmental health have been available only at central hospitals Mr. Itai Josh Rusike health conditions and raising seriously underfunded. There is a and few provincial hospitals, with Executive Director death, especially due to HIV/AIDS need to call a halt to this, and none at the district level. In addition The Community Working and NCDs. For the CWGH, our realize that if we reinvest in there is a distinct rural – urban Group on Health (CWGH) district activities have made it very prevention most of the cases difference in quality and availability applauds Zimbabwe for clear that people need to reclaim flooding the hospitals can be CWGH Executive Director Mr Rusike and the EU Ambassador to of services, which is in direct making provisions for our role and rights in relation to avoided. Zimbabwe, Mr Philippe Van Damme contrast with both the principal of improved health and health, or our health will continue quality and equity in health that quality of life in the new to decline. It is absolutely critical It is very worrying that Zimbabwe defaulting on their medications health, but are getting poorer Ministry of Health and Child Care constitution by for us to deal with all those factors has over 4000 qualified general because of lack of food. We quality services. While the health strives to practice. Since time acknowledging that that are making us ill, to have nurses sitting at home – they are continue to witness rising Out-of- services cannot cope and are i m m e m o r i a l , h e a l t h c a r e health is a fundamental access to a certain basic jobless – but there are no enough Pocket expenditures for health, a calling for shared responsibility, professionals have shunned the human right, and that standard of health care, properly nurses in clinics. As CWGH, we situation that has led to general low there has been a growing gap rural and lower levels of health care believe it is high time the access to quality health equipped, with adequate staff level of utilisation of health services between health systems and the delivery, and this has translated government unfreezes health posts by people. Some patients do not care should be universal and drugs, to ensure that we are people. Communities are not into adverse health outcomes and treated early and effectively. The and revise the staff establishment even go to clinics anymore opting effectively involved in the way unfavourable indicators on to all citizens. We further amount of money, time and lost so that it speaks to the current for divine intervention from health services are planned and population health status from appreciate the income that ill health costs to disease burden and population Pentecostal churches due to governed, and communities have c o m p ro m i s e d a c c e s s a n d opportunity given to the people, especially the poor, increase. prohibitive costs. themselves had inadequate utilization of the health care CWGH, other members of makes this an urgent need. information to monitor their own services. the civic community, It is also worrying that the Greater priority must be given to the health services. individuals and Our healthy depends on our government's user fees policy prevention of ill health. The public The Zimbabwean health care institutions to have their housing, overcrowding, water continues to be applied in an ad sector should allocate a minimum This means putting people at the delivery system must therefore voices heard in the supplies, toilets, waste disposal, hoc manner and vary depending per capita allocation to preventive top of the health system, not at the quickly move to embrace the World constitution making and the extent of pollution, of long on the service provider remaining a health, across all ministries. Rural bottom. People should know their Health Organization's six building process, and we now grass for breeding sites for barrier to access health services. local authorities should set rights to health, and be treated with blocks of an effective system in demand to see the mosquitoes and other hazards. In Some health centres continue to standards for water and toilets for respect within the health system. order to reverse most of these provisions of this new the work in the districts it has charge user fees to buy essential all households, and public funds The CWGH has been promoting adverse health indicators. constitution implemented. become clear that some people drugs because the government is should be earmarked to match the patients charter and giving are living in substandard failing to avail enough resources. households' inputs to meet these people more information on their The Review Commission on Health conditions, and do not have even Infant, U5s and maternal rates goals. The CWGH calls for a health services. It is however not in 1999 recommended the creation In order to achieve the right to health a basic standard of safe water, remain a cause for concern. The national campaign to raise the simply a matter of health of a Health Service Commission for and health care with full community toilet and shelter. In some urban country is far from achieving its demand for and supply of toilets education. It would be better for all Health Workers in order to improve participation, CWGH envisage full a r e a s w a s t e i s p i l l i n g . target of 326 deaths per 100 000 and safe water, and to ensure that concerned to take ownership to their number, availability and implementation of the principles of Overcrowded housing, water and live births by 2020. At 651 deaths basic standards of refuse their health services, rather for working conditions. This became Primary Health Care (PHC) concept toilet systems have breakdowns per 100 000, maternal mortality rate collection, toilets and air pollution some to be treated as owners, and known in 2005 as the Health and strongly advocates for a and blockages. On some informal also remains unacceptably high. are met in urban areas. This is an others as passive and uninformed Service Board, (HSB). This Board comprehensive PHC system, if s e t t l e m e n t s p e o p l e h a v e issue that we are working on in all users. Community representation must convince Government of the there is hope for change in the extremely poor housing, unsafe The deteriorating health situation our districts. It is an issue that we needs to be strengthened across unique nature of health care health sector. The CWGH will water and inadequate toilets. As a has been worsened by the food would want tabled as a priority in all all structures, together with workers, and also ensure they are c o n s i s t e n t l y e n g a g e w i t h result of these, people suffer from crisis that affected over 70% of local authority agendas. elected leaders and health fully capacitated and closely stakeholders and government to d i a r r h e a a n d re s p i r a t o r y households in the country. It should professionals, so that the users of monitored to deliver the health make PHC a more central policy diseases. It is costly for the health be noted that some patients are People are putting in more health services have a say in the mandate to an ailing population. community time and resources for The HSB's impact is still to be

12 Community Working Group on Health Community Working Group on Health 13 t 2016 t 2016 epor epor Annual R Annual R demonstrated in ensuring the Most of the 20 urban locales b y a n e q u a l l y h u g e n o n - Zimbabwe. The current situation their operations in the case of Home, was finally issued with a highly skilled Zimbabwean health including the capital city, Harare c o m m u n i c a b l e b u r d e n o f where external partners fund more societies that have invested in “Partial Handover Certificate” by care workers are availed to work in have since the unprecedented nutritional insufficiency, cancers, than 90% of the country's drug areas outside their core business. government. This means pregnant their own country, and contribute to cholera outbreak of 2008/9 hypertension, heart disease, requirements is unsustainable. mothers can now use the facility, a the reversal of the high morbidity continued to have poor sanitation, diabetes mellitus, injuries, among What is needed though is strong In order to strengthen primary development that will hopefully help and mortality currently prevailing. overcrowding (poor living other diseases and conditions. management and accountability of h e a l t h c a r e a n d r e d u c e reduced maternal and child The recent statistics show a conditions), erratic potable water Most of these are fuelled by the funds so that they are strictly unnecessary referrals to higher mortality rates in Goromonzi district. w o r s e n i n g r a t h e r t h a n supplies of questionable quality; determinants that are outside the used for the intended purpose. The levels: The primary care level The final handover certificate will be improvement of some key health and these conditions continue to health service Ministry and success of the fund will also see the needs to be funded fully in order to issued upon completion of the indicators that directly relate to f u e l t h e k n o w n k i l l e r therefore require concerted efforts strong advocacy for other options also address the non-referrals at phase 2 section by the community. population health and avoidance of communicable infections which by all sectors to address these for domestic funding of the MoHCC the secondary and tertiary levels. preventable deaths. used to be rare in the country. In causes of ill health. to be explored further. Other The CWGH also supports the idea The CWGH greatly appreciates all addition, unregulated urbanization options for increasing domestic of having district hospitals in our partners and donors namely The economic situation has has resulted in overloading of the The CWGH was born in 1998, to resources could include the Harare and Bulawayo in order to Save the Children, OSF, EC, DFID, c o n t i n u e d t o d e t e r i o r a t e , old poorly maintained public lead and give visibility to following, increasing further the alleviate the burden of patients at OSISA, OSIEA, OXFAM Canada, c h a r a c t e r i z e d b y d e - h e a l t h i n f r a s t r u c t u re a n d community processes in health. We duties / taxes on cigarettes, the central level. Health Grants to TDH-Schweiz and TDH-Germany. i n d u s t r i a l i z a t i o n , c o m p a n y overloaded underfunded systems; fully embrace the concept of equity alcohol; adding a new earmarked urban local authorities for We wholeheartedly continue to closures and reduced local r o a d s , r e f u s e c o l l e c t i o n , and universal health coverage, tax on products with high sugar supporting primary health care treasure your support in making manufacturing, (CZI 2014). sewerage. The National Shelter (UHC) in Zimbabwe in line with the content; genetically modified delivery need to be increased. Zimbabwe's health better. According to the 2010/11 Indicator Survey has indicated up primary health care philosophy. To foods; earmarking a certain This will enable the local May I also congratulate the CWGH Demographic and Health Survey, to 20% of households in Harare are this end the CWGH has worked percentage for third part insurance authorities to lower their user fee family for their hard work and more than 70% of the productive living in backyard, illegal sub- c l o s e l y w i t h t h e M O H C C , for funding hospital emergencies, charges to more affordable levels. dedication in making 2016 a better age groups are engaged in s t a n d a r d s t r u c t u r e s . T h e supporting the implementation of extending tax concessions for and successful year informal economic activities, with sewerage and water reticulation its National Health Strategy, 2009- private sector contributions to the After a couple years of hard work, I limited sustainability of earning due systems remain unimproved 2013: “Equity and Quality in health system to contributions to am delighted to announce that Aluta-Continua. The struggle for to the erratic nature of the informal despite high deaths and debility Health – a People's Right”. The primary care and public health Mwanza Rural Health Centre, health continues!!! sector in Zimbabwe, compounded from diarrhoea and related Strategy, now extended to 2015, programmes; ensuring that tax w h i c h C W G H h a s b e e n b y l a c k o f f i n a n c i n g a n d diseases. raises universality, equity and concessions to medical aid s u p p o r t i n g t h r o u g h t h e capacitation. This situation not only quality as central principles. As the societies (as non-profit) are only ITAI JOSH RUSIKE construction of a Waiting Mothers' results in deepening poverty The country has battled the Ministry embraces the UHC and applied to the non-profit share of CWGH Executive Director through job insecurity and losses, it H I V / A I D S p a n d e m i c a n d equity monitoring through its also results in dumping of registered successes of reduction national health information system, substandard foreign foodstuffs, in both incidence and prevalence. we are optimistic that the drugs and medical supplies, as However it is important to note that importance of multi-sectoral quality of these cannot be it has not yet stopped new influences on health should be guaranteed as could be done infections nor stopped AIDS acknowledged in order that there is through the local production chain. deaths. ART coverage is high, but a clear link between monitoring of This situation has also contracted not universal, and TB prevalence progress towards UHC with the number of medically insured mirrors that of HIV; meanwhile the monitoring the social and people, thus exposing an even supply of basic drugs and health environmental determinants of greater proportion of the population services remains erratic such that h e a l t h a n d s u s t a i n a b l e to out of pocket and catastrophic some patients still complicate development. expenditure on health. The socio- and/or die from preventable economic situation exposes the diseases. Neglected tropical T h e G o v e r n m e n t m u s t b e population to diseases and diseases, (bilharzias, intestinal applauded for introducing the 5% conditions associated with poor worms, elephantiasis, leprosy, tax on airtime and mobile data to incomes, overcrowding and poor sleeping sickness and blinding finance the purchase of drugs and service provision. These include trachoma), that have in the past not equipment. This is the only way that stress, under-nutrition, STIs, received much attention have g o v e r n m e n t c a n e n s u r e HIV/AIDS, diarrhoea, neglected become highly prevalent. The s u s t a i n a b i l i t y o f c u r r e n t tropical diseases, cancers, and above mentioned communicable programmes in the event that injuries. disease burden is compounded external partners pull out or reduce their funding commitments in

14 Community Working Group on Health Community Working Group on Health 15 t 2016 t 2016 epor epor Annual R Annual R demonstrated in ensuring the Most of the 20 urban locales b y a n e q u a l l y h u g e n o n - Zimbabwe. The current situation their operations in the case of Home, was finally issued with a highly skilled Zimbabwean health including the capital city, Harare c o m m u n i c a b l e b u r d e n o f where external partners fund more societies that have invested in “Partial Handover Certificate” by care workers are availed to work in have since the unprecedented nutritional insufficiency, cancers, than 90% of the country's drug areas outside their core business. government. This means pregnant their own country, and contribute to cholera outbreak of 2008/9 hypertension, heart disease, requirements is unsustainable. mothers can now use the facility, a the reversal of the high morbidity continued to have poor sanitation, diabetes mellitus, injuries, among What is needed though is strong In order to strengthen primary development that will hopefully help and mortality currently prevailing. overcrowding (poor living other diseases and conditions. management and accountability of h e a l t h c a r e a n d r e d u c e reduced maternal and child The recent statistics show a conditions), erratic potable water Most of these are fuelled by the funds so that they are strictly unnecessary referrals to higher mortality rates in Goromonzi district. w o r s e n i n g r a t h e r t h a n supplies of questionable quality; determinants that are outside the used for the intended purpose. The levels: The primary care level The final handover certificate will be improvement of some key health and these conditions continue to health service Ministry and success of the fund will also see the needs to be funded fully in order to issued upon completion of the indicators that directly relate to f u e l t h e k n o w n k i l l e r therefore require concerted efforts strong advocacy for other options also address the non-referrals at phase 2 section by the community. population health and avoidance of communicable infections which by all sectors to address these for domestic funding of the MoHCC the secondary and tertiary levels. preventable deaths. used to be rare in the country. In causes of ill health. to be explored further. Other The CWGH also supports the idea The CWGH greatly appreciates all addition, unregulated urbanization options for increasing domestic of having district hospitals in our partners and donors namely The economic situation has has resulted in overloading of the The CWGH was born in 1998, to resources could include the Harare and Bulawayo in order to Save the Children, OSF, EC, DFID, c o n t i n u e d t o d e t e r i o r a t e , old poorly maintained public lead and give visibility to following, increasing further the alleviate the burden of patients at OSISA, OSIEA, OXFAM Canada, c h a r a c t e r i z e d b y d e - h e a l t h i n f r a s t r u c t u re a n d community processes in health. We duties / taxes on cigarettes, the central level. Health Grants to TDH-Schweiz and TDH-Germany. i n d u s t r i a l i z a t i o n , c o m p a n y overloaded underfunded systems; fully embrace the concept of equity alcohol; adding a new earmarked urban local authorities for We wholeheartedly continue to closures and reduced local r o a d s , r e f u s e c o l l e c t i o n , and universal health coverage, tax on products with high sugar supporting primary health care treasure your support in making manufacturing, (CZI 2014). sewerage. The National Shelter (UHC) in Zimbabwe in line with the content; genetically modified delivery need to be increased. Zimbabwe's health better. According to the 2010/11 Indicator Survey has indicated up primary health care philosophy. To foods; earmarking a certain This will enable the local May I also congratulate the CWGH Demographic and Health Survey, to 20% of households in Harare are this end the CWGH has worked percentage for third part insurance authorities to lower their user fee family for their hard work and more than 70% of the productive living in backyard, illegal sub- c l o s e l y w i t h t h e M O H C C , for funding hospital emergencies, charges to more affordable levels. dedication in making 2016 a better age groups are engaged in s t a n d a r d s t r u c t u r e s . T h e supporting the implementation of extending tax concessions for and successful year informal economic activities, with sewerage and water reticulation its National Health Strategy, 2009- private sector contributions to the After a couple years of hard work, I limited sustainability of earning due systems remain unimproved 2013: “Equity and Quality in health system to contributions to am delighted to announce that Aluta-Continua. The struggle for to the erratic nature of the informal despite high deaths and debility Health – a People's Right”. The primary care and public health Mwanza Rural Health Centre, health continues!!! sector in Zimbabwe, compounded from diarrhoea and related Strategy, now extended to 2015, programmes; ensuring that tax w h i c h C W G H h a s b e e n b y l a c k o f f i n a n c i n g a n d diseases. raises universality, equity and concessions to medical aid s u p p o r t i n g t h r o u g h t h e capacitation. This situation not only quality as central principles. As the societies (as non-profit) are only ITAI JOSH RUSIKE construction of a Waiting Mothers' results in deepening poverty The country has battled the Ministry embraces the UHC and applied to the non-profit share of CWGH Executive Director through job insecurity and losses, it H I V / A I D S p a n d e m i c a n d equity monitoring through its also results in dumping of registered successes of reduction national health information system, substandard foreign foodstuffs, in both incidence and prevalence. we are optimistic that the drugs and medical supplies, as However it is important to note that importance of multi-sectoral quality of these cannot be it has not yet stopped new influences on health should be guaranteed as could be done infections nor stopped AIDS acknowledged in order that there is through the local production chain. deaths. ART coverage is high, but a clear link between monitoring of This situation has also contracted not universal, and TB prevalence progress towards UHC with the number of medically insured mirrors that of HIV; meanwhile the monitoring the social and people, thus exposing an even supply of basic drugs and health environmental determinants of greater proportion of the population services remains erratic such that h e a l t h a n d s u s t a i n a b l e to out of pocket and catastrophic some patients still complicate development. expenditure on health. The socio- and/or die from preventable economic situation exposes the diseases. Neglected tropical T h e G o v e r n m e n t m u s t b e population to diseases and diseases, (bilharzias, intestinal applauded for introducing the 5% conditions associated with poor worms, elephantiasis, leprosy, tax on airtime and mobile data to incomes, overcrowding and poor sleeping sickness and blinding finance the purchase of drugs and service provision. These include trachoma), that have in the past not equipment. This is the only way that stress, under-nutrition, STIs, received much attention have g o v e r n m e n t c a n e n s u r e HIV/AIDS, diarrhoea, neglected become highly prevalent. The s u s t a i n a b i l i t y o f c u r r e n t tropical diseases, cancers, and above mentioned communicable programmes in the event that injuries. disease burden is compounded external partners pull out or reduce their funding commitments in

14 Community Working Group on Health Community Working Group on Health 15 CHAPTER t 2016 t 2016

epor 9.0 Advocacy and Influencing the Health Agenda from Local epor to National Level Annual R Annual R

Programme officer: Caiphas Chimhete Activities in 2016 Other personnel: Tanyaradzwa Munouya Social Media Background The use of social media mostly facebook, twitter and Building on the successes of the past whatsapp groups has greatly improved as the years, the Infor mation and organisation communicates and interacts Communication Department with its publics on these platforms. The 9.0 continues to play a central in social media platforms have enabled improving both internal and the CWGH to quickly communicate external communication of the with its audience and also get organisation. The department feedback promptly. During the works closely with other course of the year, the department departments and programmes to managed to establish google group e- ensure that it fully understands the m a i l a c c o u n t s e n a b l i n g t h e organisation to send news and dynamics of the organisation and the Caiphas Chimhete information it needs to communicate. It information quickly to CWGH national plays a crucial role in the organisation's success members and other key stakeholders. Every staff as it builds the CWGH brand. member was taught how to tweet. It is refreshing to note that twitting took centre-stage during such big In the past year, the department continued to use the events as the CWGH National Conference and Annual newspapers, radio, television, the CWGH website, General Meeting (AGM) in November, the National facebook and twitter to communicate with its publics Advocacy Meeting in April and the WAD within and outside Zimbabwe. The communication commemorations in December 2016. The number of and interaction through the various platforms helped likes and traffic to the organisation's facebook and to inform, educate, entertain and even improve twitter accounts have increased significantly despite relationships with the organisation's constituency. the organisation being deeply rooted at community The feedback that has been coming through social level with limited access to internet services. platforms such as Facebook and Twitter has been fantastic and this has been used to improve how Website Management CWGH does interact with its stakeholders. It should Cornerstone Connect Pvt Limited, an information be noted that effective communication is a building technology company, continues to manage the block of a successful organisation. CWGH organisation's website which has become very relationship with members of the Health Journalists popular as evidenced by the increasing number of Association of Zimbabwe (Hejaz) has flourished visitors on a daily basis. On a regular basis, photos, and the number of incisive stories written about the speeches, announcements, press releases and organisation's projects has tremendously increased statements as well as stories from newspapers are and the quality has also improved. uploaded regularly to furnish visitors to the site with currents developments in the country's health sector. In the course of the year, an intern in the department, However, what is worrying is that the website has been Wendy Muperi left the organisation to pursue her Advocacy and Influencing the Health Agenda from Local to hacked twice in the course of the year, a development journalistic career elsewhere. She was replaced by which affects the CWGH stakeholders and publics National Level Tanyaradzwa Munouya, who has been with the since the website has become a treasure source of organisation as an intern but serving in a different information for university students, researchers and capacity. the academia in general.

16 Community Working Group on Health Community Working Group on Health 17 CHAPTER t 2016 t 2016

epor 9.0 Advocacy and Influencing the Health Agenda from Local epor to National Level Annual R Annual R

16 Community Working Group on Health Community Working Group on Health 17 t 2016 t 2016 epor epor Annual R Annual R Media Advocacy resources and services so that they report from an The media are important sources of information for a informed viewpoint. It was also a platform for CWGH to wide range of audiences and engaging them is a interact, network and build lasting working relationship priority for the success of programme advocacy. with journalists who report on health issues so that Various methods were used to engage the media to they assist in advocating for improved health delivery. achieve the organisation's advocacy and During course of 2016, the CWGH issued several communication objectives. It is against this press releases and statements on issues that were background that the CWGH and Save the Children affecting smooth delivery of health services in the invited journalists from several media houses to tour country. Some of the statements were reproduced or health centres under the SCPH project to hear, see written as stories in national newspapers. and record stories of change that have occurred since National Advocacy the project started in 2013. A lot positive changes have The CWGH through various national level fora either taken place as a direct result of the project but if such organised by project partners or external stakeholders positive developments were not highlighted in has used the platforms to advocate for a number of community and national newspapers, radio and policy issues including the Public Health Act television, very little would have been known about the Amendment Bill that caters for the recognition of HCC positive changes to the outside world. and village health workers, the development of a In 2016, journalists visited clinics in Mashonaland East standalone HCC statutory instrument; the Health and West, Midland as well as Matabeleland North and Financing Policy to ensure UHC. Though results of the South provinces. Several stories about the successes advocacy have been slow, it is encouraging that the and challenges faced while implementing the SCPH MoHCC and PPCH have promised to push its tabling The Information and Communications Officer flanked by the Provincial Health Officers project were highlighted in the process. The articles in parliament by February 28, 2017. looked at various issues including advocating for more The CWGH has, for several years been advocating for conference has become a resource platform that other countries to improve the health care delivery funds for the health sector to attain the 15% Abuja the government to allocate a minimum of 15% of the informs the MoHCC policy and programming. system to achieve SDGs. It urged government to target, innovative ways of health financing, awareness national budget to the health sector and strengthening minimize donor dependence on donor funding. The conference, which was attended by 130 and efforts against home deliveries and calls to human resources for health to ensure quality health delegates, agreed that there is need to implement address the shortages of drugs and health workers. It service delivery in the country. The conference also agreed that: was noted in some of the stories that the SCPH project primary health care approach as articulated in the l Government must unfreeze nurses posts had helped to reduce maternal and child deaths in the CWGH National Conference Alma Ata declaration as it remains the cornerstone of country, improved health literacy in communities and Each year, the CWGH holds an Annual National healthcare delivery towards the attainment of UHC. It l Speed up the re-alignment of health policies to sensitized people on the issue of user fees. Conference with the aim to bring to light health noted that incentivizing village health workers through the constitution. advocacy issues of concern from the communities to provision of proper uniforms, bicycles and timely CWGH also held a one-day media advocacy workshop l There is need to re-look at the cost of blood so disbursements of their monthly allowances was on December 5, 2016 in Bulawayo to sensitize relevant stakeholders such as MoHCC, oversight that those who need it access it. necessary to improve their welfare and motivate them journalists about the new project, “Strengthening bodies such as Parliamentary Portfolio Committee on in promoting PHC. l Need to properly package and simplify health Community Feedback Mechanisms for Improved Health (PPCH) and other ministries such as Ministry of messages to communities to ensure that no one Health Service Delivery” as well as capacitating them Finance. The 2016 CWGH national conference which The conference highlighted the need for government is left behind. with knowledge and skills on reporting effectively on was held on the 16th of November under the theme to priorities the health sector in budget allocations to maternal and child health (MNCH) issues. meet the Abuja target of 15% of the national budget l Raise awareness on patients' rights through the “Leaving no One Behind in National Health: What and to invest more resources towards the fight against dissemination of the Patients' Charter in local The workshop, which was attended by 25 journalists should Zimbabwe's contribution be?” brought languages NCDs and improve palliative care. With a small from Midlands and Matabeleland regions, also together various stakeholders such as WHO, UNICEF, national budget, it recommended that Zimbabwe l MoHCC should put in place an accountability highlighted to journalists the importance of community CSOs, academia, media and the community. The should urgently adopt innovative domestic health framework to deal with preventable maternal monitoring and public accountability for health financing taking lessons from best practices from and child deaths.

18 Community Working Group on Health Community Working Group on Health 19 t 2016 t 2016 epor epor Annual R Annual R Media Advocacy resources and services so that they report from an The media are important sources of information for a informed viewpoint. It was also a platform for CWGH to wide range of audiences and engaging them is a interact, network and build lasting working relationship priority for the success of programme advocacy. with journalists who report on health issues so that Various methods were used to engage the media to they assist in advocating for improved health delivery. achieve the organisation's advocacy and During course of 2016, the CWGH issued several communication objectives. It is against this press releases and statements on issues that were background that the CWGH and Save the Children affecting smooth delivery of health services in the invited journalists from several media houses to tour country. Some of the statements were reproduced or health centres under the SCPH project to hear, see written as stories in national newspapers. and record stories of change that have occurred since National Advocacy the project started in 2013. A lot positive changes have The CWGH through various national level fora either taken place as a direct result of the project but if such organised by project partners or external stakeholders positive developments were not highlighted in has used the platforms to advocate for a number of community and national newspapers, radio and policy issues including the Public Health Act television, very little would have been known about the Amendment Bill that caters for the recognition of HCC positive changes to the outside world. and village health workers, the development of a In 2016, journalists visited clinics in Mashonaland East standalone HCC statutory instrument; the Health and West, Midland as well as Matabeleland North and Financing Policy to ensure UHC. Though results of the South provinces. Several stories about the successes advocacy have been slow, it is encouraging that the and challenges faced while implementing the SCPH MoHCC and PPCH have promised to push its tabling The Information and Communications Officer flanked by the Provincial Health Officers project were highlighted in the process. The articles in parliament by February 28, 2017. looked at various issues including advocating for more The CWGH has, for several years been advocating for conference has become a resource platform that other countries to improve the health care delivery funds for the health sector to attain the 15% Abuja the government to allocate a minimum of 15% of the informs the MoHCC policy and programming. system to achieve SDGs. It urged government to target, innovative ways of health financing, awareness national budget to the health sector and strengthening minimize donor dependence on donor funding. The conference, which was attended by 130 and efforts against home deliveries and calls to human resources for health to ensure quality health delegates, agreed that there is need to implement address the shortages of drugs and health workers. It service delivery in the country. The conference also agreed that: was noted in some of the stories that the SCPH project primary health care approach as articulated in the l Government must unfreeze nurses posts had helped to reduce maternal and child deaths in the CWGH National Conference Alma Ata declaration as it remains the cornerstone of country, improved health literacy in communities and Each year, the CWGH holds an Annual National healthcare delivery towards the attainment of UHC. It l Speed up the re-alignment of health policies to sensitized people on the issue of user fees. Conference with the aim to bring to light health noted that incentivizing village health workers through the constitution. advocacy issues of concern from the communities to provision of proper uniforms, bicycles and timely CWGH also held a one-day media advocacy workshop l There is need to re-look at the cost of blood so disbursements of their monthly allowances was on December 5, 2016 in Bulawayo to sensitize relevant stakeholders such as MoHCC, oversight that those who need it access it. necessary to improve their welfare and motivate them journalists about the new project, “Strengthening bodies such as Parliamentary Portfolio Committee on in promoting PHC. l Need to properly package and simplify health Community Feedback Mechanisms for Improved Health (PPCH) and other ministries such as Ministry of messages to communities to ensure that no one Health Service Delivery” as well as capacitating them Finance. The 2016 CWGH national conference which The conference highlighted the need for government is left behind. with knowledge and skills on reporting effectively on was held on the 16th of November under the theme to priorities the health sector in budget allocations to maternal and child health (MNCH) issues. meet the Abuja target of 15% of the national budget l Raise awareness on patients' rights through the “Leaving no One Behind in National Health: What and to invest more resources towards the fight against dissemination of the Patients' Charter in local The workshop, which was attended by 25 journalists should Zimbabwe's contribution be?” brought languages NCDs and improve palliative care. With a small from Midlands and Matabeleland regions, also together various stakeholders such as WHO, UNICEF, national budget, it recommended that Zimbabwe l MoHCC should put in place an accountability highlighted to journalists the importance of community CSOs, academia, media and the community. The should urgently adopt innovative domestic health framework to deal with preventable maternal monitoring and public accountability for health financing taking lessons from best practices from and child deaths.

18 Community Working Group on Health Community Working Group on Health 19 t 2016 t 2016 epor epor Annual R Annual R National Advocacy Conference challenges of which they are cushioning themselves A national advocacy conference organized by CWGH by charging user fees. If passed, as expected, the and Save the Children was held in Harare in April 2016 health financing policy will address challenges to do under the theme “Progressing towards Universal with user fees. CWGH to continue lobbying for more Health Coverage”. The conference, attended by over funding to health to ensure there are no user fees. 100 delegates, also discussed measures aimed at finalising and adopting the health financing policy Public Discussion on Innovative which ensures UHC, development of a user fee policy, Domestic Health Financing speedy passage of PHA Amendment Bill and The CWGH and the Parliament of Zimbabwe jointly 10 strengthening the human resources in Zimbabwe. It hosted a public discussion meeting on 20 June 2016 in established that implementing the policies would solve Harare under the theme “Innovative Domestic most of the identified health challenges to attain UHC. Health Financing: Options for Zimbabwe”. It was attended by over 50 participants including members of The conference raised key advocacy issues affecting PPCH, MoHCC officials, CSO representatives, women and children's access to healthcare and the community representatives and media. problem of maternal health with the view to influence policy changes and implementation for improved The objectives of the discussion were to review the MNCH outcomes. MoHCC's 1st quarter performance reports, explore opportunities for increasing domestic health funding The conference noted the PHA Amendment Bill which for UHC as well as raise key advocacy issues on caters for the recognition of HCCs and VHWs is HIV/AIDS and health currently affecting communities. already with the Attorney General's Office where it is being put in legal language. At the meeting, the PPCH The meeting also looked at innovative ways of promised to push its tabling in parliament during the financing the country's health care system such as next sitting. taxes on airtime, alcohol and tobacco. The government was urged to address the plight of village It was revealed at the conference that the Health health workers as it is critical in the success of the Financing Policy which ensures UHC was being primary health care approach. worked on by MoHCC to incorporate comments from the technical working group. The MoHCC officials assured participants at the meeting that the draft will soon be handed over the Permanent Secretary in the MoHCC for review. CWGH and SC will continue Future Plans advocating for government to allocate at least 15% of Staff in the department will continue to upgrade their the national budget to the health sector. skills to ensure that the uploading of the CWGH website is not outsourced. The staff can now upload Delegates were reminded that the country was still some sections but there are other areas that still need using the1983 staff establishment although the further training. Just like in the past year, the use of population has more than doubled. Due to intense CWGH website, Facebook and twitter will be advocacy, the MoHCC in May 2016 pledged to recruit 8 intensified in 2017 to make sure that relevant 500 more nurses. However, more lobbying still needs information and messages reach the intended targets to be done to ensure the pledge is fulfilled. as quickly as possible. It was also highlighted that no user fees are being CWGH's relations with the media, membership and collect at all government clinics and that Results Strengthening Community Feedback Mechanisms in Health other key stakeholders will continue to strengthened Based Financing (RBF) had reduced charging of user and consolidated to accrue benefits associated with fees in RDC and mission clinics. However, the networking and increased numbers especially during government was failing to disburse grants to RDCs advocacy. and mission institutions which are also facing financial

20 Community Working Group on Health Community Working Group on Health 21 t 2016 t 2016 epor epor Annual R Annual R National Advocacy Conference challenges of which they are cushioning themselves A national advocacy conference organized by CWGH by charging user fees. If passed, as expected, the and Save the Children was held in Harare in April 2016 health financing policy will address challenges to do under the theme “Progressing towards Universal with user fees. CWGH to continue lobbying for more Health Coverage”. The conference, attended by over funding to health to ensure there are no user fees. 100 delegates, also discussed measures aimed at finalising and adopting the health financing policy Public Discussion on Innovative which ensures UHC, development of a user fee policy, Domestic Health Financing speedy passage of PHA Amendment Bill and The CWGH and the Parliament of Zimbabwe jointly 10 strengthening the human resources in Zimbabwe. It hosted a public discussion meeting on 20 June 2016 in established that implementing the policies would solve Harare under the theme “Innovative Domestic most of the identified health challenges to attain UHC. Health Financing: Options for Zimbabwe”. It was attended by over 50 participants including members of The conference raised key advocacy issues affecting PPCH, MoHCC officials, CSO representatives, women and children's access to healthcare and the community representatives and media. problem of maternal health with the view to influence policy changes and implementation for improved The objectives of the discussion were to review the MNCH outcomes. MoHCC's 1st quarter performance reports, explore opportunities for increasing domestic health funding The conference noted the PHA Amendment Bill which for UHC as well as raise key advocacy issues on caters for the recognition of HCCs and VHWs is HIV/AIDS and health currently affecting communities. already with the Attorney General's Office where it is being put in legal language. At the meeting, the PPCH The meeting also looked at innovative ways of promised to push its tabling in parliament during the financing the country's health care system such as next sitting. taxes on airtime, alcohol and tobacco. The government was urged to address the plight of village It was revealed at the conference that the Health health workers as it is critical in the success of the Financing Policy which ensures UHC was being primary health care approach. worked on by MoHCC to incorporate comments from the technical working group. The MoHCC officials assured participants at the meeting that the draft will soon be handed over the Permanent Secretary in the MoHCC for review. CWGH and SC will continue Future Plans advocating for government to allocate at least 15% of Staff in the department will continue to upgrade their the national budget to the health sector. skills to ensure that the uploading of the CWGH website is not outsourced. The staff can now upload Delegates were reminded that the country was still some sections but there are other areas that still need using the1983 staff establishment although the further training. Just like in the past year, the use of population has more than doubled. Due to intense CWGH website, Facebook and twitter will be advocacy, the MoHCC in May 2016 pledged to recruit 8 intensified in 2017 to make sure that relevant 500 more nurses. However, more lobbying still needs information and messages reach the intended targets to be done to ensure the pledge is fulfilled. as quickly as possible. It was also highlighted that no user fees are being CWGH's relations with the media, membership and collect at all government clinics and that Results Strengthening Community Feedback Mechanisms in Health other key stakeholders will continue to strengthened Based Financing (RBF) had reduced charging of user and consolidated to accrue benefits associated with fees in RDC and mission clinics. However, the networking and increased numbers especially during government was failing to disburse grants to RDCs advocacy. and mission institutions which are also facing financial

20 Community Working Group on Health Community Working Group on Health 21 CHAPTER t 2016 t 2016

epor 10 Strengthening Community Feedback Mechanisms in Health epor Annual R Annual R organisations and other institutions and sectors. It Programme Manager: Nonjabulo Mahlangu Internal assessment to identify clarifies their different roles and responsibilities in Programme officer: Kundai Chebundo, mechanisms for holding key State actors capacity need gaps of HCCs contributing to improved health of the communities. Mandy Mathias, Mongi Khumalo accountable to fullﬁl their commitments. The Prior to the capacity building trainings of HCCs, a mini HCC members were trained on MNCH issues so as to Other personnel: Esther Sharara and project advocates for increased resources for assessment on the capacity and needs gaps of HCCs create demand for services through prioritising MNCH Caiphas Chimhete MNCH through innovative mechanisms was conducted to identify the areas where the needs in their health action plans. They were also and ensure that these are consistent committees needed to be strengthened. A capacity empowered on accountability, community monitoring and responsive to community building plan was developed that informed the training mechanisms and strategies for the participation of Background needs and plans. These efforts programme for HCCs. Issues common to the HCC Maternal mortality is a global vulnerable groups. are all aimed at contributing to were the capacity gap on their roles and concern as the health of mothers the Millennium Development responsibilities as committees beyond Results Based and children is an important Health Literacy Facilitators (HLFs) Goals (MDGs) 4 and 5 targets Financing (RBF), composition and constitution, rights indicator of national health and and Sustainable Development and responsibilities of patients, gaps in trainings t h e s o c i o - e c o n o m i c Health education sessions by HLFs aim to increase Goals (SDGs). knowledge/capacity building as most had last development of a country. Despite the communities' awareness on their MNCH received a form of training in 2013. the progress over the past years, entitlements, rights and responsibilities for improved Zimbabwe's maternal and child Kundai Chebundo HCC trainings MNCH outcomes. HLF trainings were also done in the mortality still rank amongst the highest in In order to strengthen community engagement in 3 districts the project is being implemented. A total the world with 525 maternal deaths per 100 000 advocacy for improved MNCH outcomes, HCC number of 80 HLFs selected among VHWs in the live births and 86 deaths per 1000 live births Activities in 2016 trainings took place in the 3 districts of Bubi, Umguza respective communities were trained in various respectively. Factors that contribute to high mortality and Umzingwane. At least 100 members from 20 participatory methods to use for information rates include a deteriorating health delivery system HCCs with each clinic represented by 5 HCC dissemination. A number of activities were implemented during the characterised by poorly functioning health members were trained. machinery, dilapidated infrastructure, inadequate period under review. These include the development of CM Trainings At least 60 VHWs from the 3 districts were trained as health workers and shortages of essential information, education and communication (IEC) Thirty-five HCC members were trained in Bubi, Community Monitors (CMs) to enable them to collect medicines. According to a baseline study done for materials, stakeholder project sensitization, capacity another 35 in Umzingwane and 30 in Umguza. The feedback from the communities on access and Strengthening Community Participation in Health building trainings for community cadres, roll-out of trainings equipped HCC committees with knowledge utilization of services. The objectives of the trainings (SCPH) project in 2014, the main barriers to community feedback mechanisms and monitoring and skills to effectively execute their duties. These were to educate CMs on their roles and utilisation of Maternal, Neonatal and Child Health support visits, stories collection, a CWGH national focused on their roles and responsibilities in the health responsibilities, MNCH and use of the score card. CMs (MNCH) services include cultural and religious conference and Annual General Meeting (AGM) and system in Zimbabwe as well as on the role played by are responsible of collecting information on factors within certain segments of the Apostolic World Aids Day commemorations. HCCs during the community feedback mechanism community perceptions and views on the quality of Faith sects, distances to health facilities, staff processes in order to contribute to improved MNCH MNCH services using score cards. attitudes, shortages of health workers and poor Stakeholder sensitization meetings outcomes. An HCC training manual was used to equip physical infrastructure such as lack of a Waiting CWGH is currently implementing the project in three committees with information and knowledge on their Mothers' Homes, electricity, and water. Most districts of Bubi, Umguza and Umzingwane and roles and responsibilities. The manual is a social Roll out of the Community community members face financial barriers that limit already districts stakeholder sensitization meetings accountability tool produced to support capacity Feedback Mechanism (CFM) and their access to health services. have been done. The purpose of meetings was to building of HCCs in various initiatives. It uses Monitoring Support Visits participatory methods as its approach to raise sensitize the relevant stakeholders on the design of Following the introduction of the project and the It is against this background that CWGH in community voice and build skills and knowledge on the project and it was also an opportunity to build capacity building of key players, the districts started partnership with the Ministry of Health and Child the evidence and experience generated within partnerships and alliances for effective programming the whole project cycle of sharing information through Care (MoHCC) are implementing a three-year communities. and networking. The meetings also provided a HLFs, collection of feedback using the scorecard by project on Strengthening Community Feedback platform for project buy-in by the local and traditional CMs with HCCs installing suggestion boxes, a Mechanism in Health (SCFMH) in 3 districts in the The manual also serves as a lever to draw on the leadership. Discussions on the community feedback community feedback mechanism. Matabeleland provinces of Zimbabwe with support knowledge and experience of the people in districts mechanisms to be used which included suggestion working in health, the health workers, local fromthe European Commission. The project This was done through the monitoring and support boxes and community score cards were discussed at government personnel, community based encourages the development and use of visits by the CWGH programme officers to support and the meetings.

22 Community Working Group on Health Community Working Group on Health 23 CHAPTER t 2016 t 2016

22 Community Working Group on Health Community Working Group on Health 23 t 2016 t 2016 epor epor Annual R Annual R assist the project cadres in the initial stages of the data printing. These materials included the Patients' empowered to demand effective provision of quality feedback gathering on health service delivery and collection cycle. The support was given at clinic level to Charter, MNCH fliers and training manuals such as MNCH services by holding duty bearers accountable. engagements with different stakeholders at all levels in enable a more one on one with the cadres compared to the HCC, HLF and the CM manual. Other Information, Also the establishment of the community mechanisms addressing raised community concerns. Furthermore, collective training. Education and Communication (IEC) material such as in these communities saw a lot of challenges being more support will be given to the trained cadres and posters, banners, t-shirts, hats and bags were printed addressed and giving an opportunity for space to males as agents of change in order to create The project developed a mechanism that enables and were used to increase awareness and engage with duty bearers. The project will continue community ownership so as to ensure continuity and beneficiaries and community members to provide understanding of the project among communities. implementation in 20 health facilities in the 3 districts sustainability. feedback on access to MNCH services. Gathering of in 2017. It will continue with information sharing, Information was simplified to ensure it is clear, easy to feedback using different social accountability tools, understand and available in the preferred local data analysis and development of reports is being languages. Existing monitoring tools were also done on a quarterly basis. Data collected is used to reviewed and necessary adjustments were made to compile social accountability reports, identify ensure they are relevant for the proposed action. The recommendations and advocacy strategies for community score card is the basis for monitoring particular districts. Community Monitors will circulate MNCH care at community level. these reports as part of advocacy for dialogue meetings with communities, local authorities and other key stakeholders. The same report will be tabled at the CWGH National Annual Conference District Health Team forums, Rural District Council This event brought together various stakeholders such meetings and full council meetings to influence policy, as CBOs, civil society organisations, government decision making, budget processes, planning and officials, policy makers, UN Agencies and the media. action. The conference provided a platform for advocating for improved availability and access to quality health care Support National Health Events and ensures civic participation in health issues. Key and Campaigns stakeholders in the provinces and districts The CWGH takes part in national or international participated in the conference and had an opportunity awareness days set by international or by government to voice out issues of concern and contribute to the to commemorate a public health or ethical cause of advocacy agenda that will result in improved quality of importance. The project therefore rode on the life. commemoration of some of these days to raise The conference provides for an opportunity to network awareness on MNCH related issues. Such platforms and build alliances with other like-minded provide opportunities to raise awareness on topical organizations, share experiences and also document health issues and also to educate the community best practices for future programming. The about their rights and responsibilities using the conference, which was attended by 130 participants, Patients' Charter. Of note is CWGH's participation at was held in Harare on the 16th of November 2016 the WAD commemorations held in Kwekwe and the Umzingwane Community Monitors Training: Administration of scorecard group work under the theme, “Leaving no one behind in support the organisation gave to the Matabeleland National health: What should Zimbabwe's North province WAD celebrations. At both contribution be”. commemorations, CWGH shared its statement on the current HIV/AIDS situation in the country and possible Future Plans intervention measures. The project has been scaled up in the two districts of Bubi and Umzingwane to cover more clinics IEC developments compared to the numbers covered under the SCPH The project managed to review existing materials project which ended in June 2016. Community being used during training and implementation and participation in health in the two districts has made the necessary editing and changes before increased and the communities are also now

24 Community Working Group on Health Community Working Group on Health 25 t 2016 t 2016 epor epor Annual R Annual R assist the project cadres in the initial stages of the data printing. These materials included the Patients' empowered to demand effective provision of quality feedback gathering on health service delivery and collection cycle. The support was given at clinic level to Charter, MNCH fliers and training manuals such as MNCH services by holding duty bearers accountable. engagements with different stakeholders at all levels in enable a more one on one with the cadres compared to the HCC, HLF and the CM manual. Other Information, Also the establishment of the community mechanisms addressing raised community concerns. Furthermore, collective training. Education and Communication (IEC) material such as in these communities saw a lot of challenges being more support will be given to the trained cadres and posters, banners, t-shirts, hats and bags were printed addressed and giving an opportunity for space to males as agents of change in order to create The project developed a mechanism that enables and were used to increase awareness and engage with duty bearers. The project will continue community ownership so as to ensure continuity and beneficiaries and community members to provide understanding of the project among communities. implementation in 20 health facilities in the 3 districts sustainability. feedback on access to MNCH services. Gathering of in 2017. It will continue with information sharing, Information was simplified to ensure it is clear, easy to feedback using different social accountability tools, understand and available in the preferred local data analysis and development of reports is being languages. Existing monitoring tools were also done on a quarterly basis. Data collected is used to reviewed and necessary adjustments were made to compile social accountability reports, identify ensure they are relevant for the proposed action. The recommendations and advocacy strategies for community score card is the basis for monitoring particular districts. Community Monitors will circulate MNCH care at community level. these reports as part of advocacy for dialogue meetings with communities, local authorities and other key stakeholders. The same report will be tabled at the CWGH National Annual Conference District Health Team forums, Rural District Council This event brought together various stakeholders such meetings and full council meetings to influence policy, as CBOs, civil society organisations, government decision making, budget processes, planning and officials, policy makers, UN Agencies and the media. action. The conference provided a platform for advocating for improved availability and access to quality health care Support National Health Events and ensures civic participation in health issues. Key and Campaigns stakeholders in the provinces and districts The CWGH takes part in national or international participated in the conference and had an opportunity awareness days set by international or by government to voice out issues of concern and contribute to the to commemorate a public health or ethical cause of advocacy agenda that will result in improved quality of importance. The project therefore rode on the life. commemoration of some of these days to raise The conference provides for an opportunity to network awareness on MNCH related issues. Such platforms and build alliances with other like-minded provide opportunities to raise awareness on topical organizations, share experiences and also document health issues and also to educate the community best practices for future programming. The about their rights and responsibilities using the conference, which was attended by 130 participants, Patients' Charter. Of note is CWGH's participation at was held in Harare on the 16th of November 2016 the WAD commemorations held in Kwekwe and the Umzingwane Community Monitors Training: Administration of scorecard group work under the theme, “Leaving no one behind in support the organisation gave to the Matabeleland National health: What should Zimbabwe's North province WAD celebrations. At both contribution be”. commemorations, CWGH shared its statement on the current HIV/AIDS situation in the country and possible Future Plans intervention measures. The project has been scaled up in the two districts of Bubi and Umzingwane to cover more clinics IEC developments compared to the numbers covered under the SCPH The project managed to review existing materials project which ended in June 2016. Community being used during training and implementation and participation in health in the two districts has made the necessary editing and changes before increased and the communities are also now

24 Community Working Group on Health Community Working Group on Health 25 CHAPTER t 2016 t 2016

epor 11 Strengthening Community Participation in Health for epor Improved MNCH services in Zimbabwe Annual R Annual R

Programme Manager: Nonjabulo Mahlangu Programme officers: Faith Kowo, Kundai Chebundo, increasing the uptake and demand for quality Tafadzwanashe Nkrumah, MNCH ser vices. Community feedback Edgar Mutasa mechanisms were also set up to create a platform Other personnel: Esther Sharara, Mongi Khumalo, where issues affecting MNCH service provision Caiphas Chimhete are raised as a means of finding ways to address them. At national level, the 11 Background mass media was engaged while Zimbabwe, like most Sub- advocacy was intensified to Saharan African countries, still ensure that policymakers put an bears a heavy burden of high enabling environment for maternal and child mortality improved service delivery. rates, despite having made progress over the past 5 years. According to the Zimbabwe

Demographic Health Survey (ZDHS) Faith Kowo of 2015 the country's maternal mortality rate standsat 525 deaths per 100 000 live births Activities in 2016 while child mortality is at 86 deaths per 1000 live births which is unacceptably high. This has been A number of activities were implemented during the attributed to lower public sector investment in health year under review to achieve the aims and objectives and limited community involvement in health of the project. These included district stakeholder processes. There is still need for impact meetings, monitoring support visits, end of project interventions in order to reverse the trends and evaluation, a national advocacy meeting and the achieve the health-related Sustainable CWGH national conference. Development Goals (SDGs). It was against this background that the CWGH and Save the Children in partnership with the Ministry of Health and Child Community monitoring rounds Community monitors have continued to monitor the Care (MoHCC) have been implementing a three- quality of MNCH services in their respective year project on Strengthening Community communities. At least two rounds of monitoring were Participation in Health (SCPH) for improved done during the year in all the districts. The data Maternal, Newborn and Child Health (MNCH) collected from the community monitoring rounds was services in 21 districts across 8 provinces in used for advocacy at district level, which saw a number Zimbabwe. The project was being supported by the of issues beings resolved at that level such as European Commission (EC) and the Department for shortage of water at some clinics so as to improve International Development (DFID). The project, quality of MNCH services. which ended in June 2016 but extended in

Matabeleland provinces under a different name, Strengthening Community Participation in Health for Improved aims to address key barriers to uptake in MNCH Community advocacy quarterly services. Barriers such as service charges, long level meetings MNCH services in Zimbabwe distances to health facilities, staff shortages are Community level meetings were done in all the districts addressed through building the capacities of HCCs, on quarterly basis. These meetings were done at CMs and HLFs. The cadres are responsible for to district level whereby HCCs consolidated their quarterly data analysis reports and present them to the

26 Community Working Group on Health Community Working Group on Health 27 CHAPTER t 2016 t 2016

epor 11 Strengthening Community Participation in Health for epor Improved MNCH services in Zimbabwe Annual R Annual R

26 Community Working Group on Health Community Working Group on Health 27 t 2016 t 2016 epor epor Annual R Annual R Project evaluation the provincial health executive and the DHE. The evaluation of the end of project stared in March In Buhera district, the team visited Mudanda and 2016 with the overall purpose of assessing the extent Nerutanga clinic on the 18th of March while in Bubi to which the SCPH project had started bringing about district, they visited Siganda and Majiji rural health anticipated changes, to examine which factors have centres on 15 March 2016. At clinic level, the evaluation proved critical in helping or hindering change and team met project cadres such as HCCs, HLFs and the drawing lessons for future programming. The CMs. The annual review meetings established that the evaluation is being conducted by an independent project has had a huge positive impact to the consultant, Oxford Policy Management (OPM) communities as they are now are aware of their health Limited based in the UK. As part of the evaluation rights through the Patient's Charter and are now Annual Review meetings were done in Buhera and d e m a n d i n g q u a l i t y M N C H s e r v i c e s . A The Health Centre Committee at Madzorera Clinic, Zvimba Bubi districts. A team consisting of representatives recommendation to take the project to other clinics was from DFID, UNICEF, CWGH, SCI and other given as quality of services has improved in the clinics DHE and RDC. Information was drawn from l Shortage of medicines especially for non- organizations implementing MNCH projects being the project is being implemented. community score cards, suggestion boxes, HCC communicable diseases (NCDs) funded by DFID visited 2 clinics in each of the districts, recording forms and HLF community awareness l Shortage of transport for referral to the next level reports. It was however noted that much of the of care is a major challenge as most districts Advocacy and Communications Activities information was drawn from the score cards as most of have one ambulance or a broken down one the suggestion boxes did not have much feedback. which they cannot be used to ferry patients to the Community views and recommendations were all Media Tours, Newspaper articles Newspaper articles next level of care. written in local languages. During these meetings, a and Documentaries A lot positive changes have taken place as a direct number of advocacy issues were raised. These result of the project but if such positive developments l Use fee policy not applied in all districts The media plays a key role in achieving any advocacy included the need to push for the legal recognition of goals. It is against this background that the CWGH and are not highlighted in community and national HCCs so that their work would be respected by nurses, l Shortage of health personnel Save the Children invited journalists from several newspapers, radio and television, very little will be water problems in most clinics as boreholes had dried media houses to tour health centres under the SCPH known about the positive changes to the outside up, while some pipes needed replacement as well as l Absence of CD counting machines and cancer project to hear, see and record stories of change that world. poor efficiency in the supply of medicines resulting in screening services at rural health centres have occurred since the project started in 2013. shortages at some health facilities. During and after the tours, several newspaper stories Journalists from The Herald, H-Metro, Radio on the SCPH were published. The articles looked at a Monitoring &Evaluation (M&E) Zimbabwe, NewsDay, Daily News, ZBC and FlamZee, number of various issues including advocating for District Stakeholder Meetings a documentary production company, visited provinces Visits more funds for the health budget (15% Abuja The community feedback mechanism allows for HCCs of Mashonaland East and West; Midlands; During the period under review, community cadres Declaration), awareness and efforts against home to share feedback from the community monitoring Matabeleland South and North. deliveries, addressing the health worker shortages as rounds with the DHE, RDC and other district received extensive, regular support and supervision well as the scarcity medicines. Some of the stories stakeholders so as to provide solutions to the issues from the field-based programme officers, project M&E In Midlands province, the media visited Mlezu and also looked at how the SCPH project managed to raised concerning MNCH service delivery. The district Senkwasi clinics; in Bulilima district in Matabeleland specialists and management team through regular reduce maternal and child deaths in the country; the stakeholder meetings were done in all the districts. South province they visited Bezu and Sithathini clinics assessments of capacity gaps, and responding importance of health literacy for improved health while in Bubi district in Matabeleland North province coaching and mentoring. This was particularly with outcomes and the scrapping of user fees. The articles The following are the advocacy issues that emerged the journalists interviews HCCs and health staff at appeared in the Chronicle, Herald, NewsDay, Daily from the meetings: regards to participatory methodologies, feedback Lukala and Singada clinics. In Mashonaland West News, Financial Gazette, and the Standard among mechanisms, data analysis, and documentation and province they visited Sutton and Long Valley Clinics others. Some of the articles published were titled: Joy l Need to review the current staff establishment reporting of feedback. while in Mashonaland East they recorded interviews at and Relief for Pregnant Mother, Home Delivers policy Maramba and Chitsungo health centres. Decline in Bulilima and Coping with Pregnancy when Disabled.

28 Community Working Group on Health Community Working Group on Health 29 t 2016 t 2016 epor epor Annual R Annual R Project evaluation the provincial health executive and the DHE. The evaluation of the end of project stared in March In Buhera district, the team visited Mudanda and 2016 with the overall purpose of assessing the extent Nerutanga clinic on the 18th of March while in Bubi to which the SCPH project had started bringing about district, they visited Siganda and Majiji rural health anticipated changes, to examine which factors have centres on 15 March 2016. At clinic level, the evaluation proved critical in helping or hindering change and team met project cadres such as HCCs, HLFs and the drawing lessons for future programming. The CMs. The annual review meetings established that the evaluation is being conducted by an independent project has had a huge positive impact to the consultant, Oxford Policy Management (OPM) communities as they are now are aware of their health Limited based in the UK. As part of the evaluation rights through the Patient's Charter and are now Annual Review meetings were done in Buhera and d e m a n d i n g q u a l i t y M N C H s e r v i c e s . A The Health Centre Committee at Madzorera Clinic, Zvimba Bubi districts. A team consisting of representatives recommendation to take the project to other clinics was from DFID, UNICEF, CWGH, SCI and other given as quality of services has improved in the clinics DHE and RDC. Information was drawn from l Shortage of medicines especially for non- organizations implementing MNCH projects being the project is being implemented. community score cards, suggestion boxes, HCC communicable diseases (NCDs) funded by DFID visited 2 clinics in each of the districts, recording forms and HLF community awareness l Shortage of transport for referral to the next level reports. It was however noted that much of the of care is a major challenge as most districts Advocacy and Communications Activities information was drawn from the score cards as most of have one ambulance or a broken down one the suggestion boxes did not have much feedback. which they cannot be used to ferry patients to the Community views and recommendations were all Media Tours, Newspaper articles Newspaper articles next level of care. written in local languages. During these meetings, a and Documentaries A lot positive changes have taken place as a direct number of advocacy issues were raised. These result of the project but if such positive developments l Use fee policy not applied in all districts The media plays a key role in achieving any advocacy included the need to push for the legal recognition of goals. It is against this background that the CWGH and are not highlighted in community and national HCCs so that their work would be respected by nurses, l Shortage of health personnel Save the Children invited journalists from several newspapers, radio and television, very little will be water problems in most clinics as boreholes had dried media houses to tour health centres under the SCPH known about the positive changes to the outside up, while some pipes needed replacement as well as l Absence of CD counting machines and cancer project to hear, see and record stories of change that world. poor efficiency in the supply of medicines resulting in screening services at rural health centres have occurred since the project started in 2013. shortages at some health facilities. During and after the tours, several newspaper stories Journalists from The Herald, H-Metro, Radio on the SCPH were published. The articles looked at a Monitoring &Evaluation (M&E) Zimbabwe, NewsDay, Daily News, ZBC and FlamZee, number of various issues including advocating for District Stakeholder Meetings a documentary production company, visited provinces Visits more funds for the health budget (15% Abuja The community feedback mechanism allows for HCCs of Mashonaland East and West; Midlands; During the period under review, community cadres Declaration), awareness and efforts against home to share feedback from the community monitoring Matabeleland South and North. deliveries, addressing the health worker shortages as rounds with the DHE, RDC and other district received extensive, regular support and supervision well as the scarcity medicines. Some of the stories stakeholders so as to provide solutions to the issues from the field-based programme officers, project M&E In Midlands province, the media visited Mlezu and also looked at how the SCPH project managed to raised concerning MNCH service delivery. The district Senkwasi clinics; in Bulilima district in Matabeleland specialists and management team through regular reduce maternal and child deaths in the country; the stakeholder meetings were done in all the districts. South province they visited Bezu and Sithathini clinics assessments of capacity gaps, and responding importance of health literacy for improved health while in Bubi district in Matabeleland North province coaching and mentoring. This was particularly with outcomes and the scrapping of user fees. The articles The following are the advocacy issues that emerged the journalists interviews HCCs and health staff at appeared in the Chronicle, Herald, NewsDay, Daily from the meetings: regards to participatory methodologies, feedback Lukala and Singada clinics. In Mashonaland West News, Financial Gazette, and the Standard among mechanisms, data analysis, and documentation and province they visited Sutton and Long Valley Clinics others. Some of the articles published were titled: Joy l Need to review the current staff establishment reporting of feedback. while in Mashonaland East they recorded interviews at and Relief for Pregnant Mother, Home Delivers policy Maramba and Chitsungo health centres. Decline in Bulilima and Coping with Pregnancy when Disabled.

28 Community Working Group on Health Community Working Group on Health 29 t 2016 t 2016 epor epor Annual R Annual R It is important that the media was taken to the on health-related stories around the country. Apart addressed the poor relations that previously between It was also agreed that: communities because they are key in shaping public from providing community-based stories, the CWGH communities and clinic staff, raising awareness on the opinion. The media can be a key instrument in also sits on the Editorial Board of the magazine which need for pregnant women to deliver at a health facility - National Social Protection Framework including awareness raising, information dissemination and has a huge circulation. with the help of qualified health worker. The other health insurance needs to be finalized. advocating for change of policies in any country. documentary is a summarized version of the main Some of the articles looked at how community health production. - There is need to ensure the enforcement of Radio Slots workers were working towards reduction of maternal implementation of policies and Acts in support of UHC such as the user fee policy. In 2016, Radio Zimbabwe broadcasted four interviews mortality, advocating for government to allocate 15% National Advocacy meeting with community health workers such as HCCs, CMs, of the national budget to health meet the Abuja target The CWGH and Save the Children held a national - There is need for resource mobilization and HLFs and health staff from different clinics in Midlands as well as calling for universal health coverage. One advocacy conference on April 13, 2016 in Harare that resource coordination for UHC, liaising with all and Mashonaland West provinces. They noted that other article looked at how the concept of community was attended by over 100 delegates including donors and partners to avoid duplication of apart from reducing the distance pregnant women participation has become an important aspect of parliamentarians, MoHCC officials, civil society, resources and ensure equitable distribution. travel to clinics for delivery, waiting mothers’ homes Zimbabwe's public health system as communities take community cadres and journalists. Among key issues ensure the safety of both the mother and child as centre stage in addressing challenges affecting health that were discussed were how to fund health to - The importance of monitoring and evaluation, delivery is done by trained health personnel under delivery in their areas. achieve UHC and the user fee policy which is not being data collection for decision making and very clean environments. implemented in all districts. The conference advocated evidence-based policies and planning was The distribution of the magazine is done via the for the speedy passing of Public Health Act underscored as necessary components of The interviewees also applauded the SCPH MoHCC and partners with the bulk being collected for Amendment Bill, the Health Financing Policy covering UHC. programme attributing the slowing down of child and distribution by Provincial Medical Directors (PMDs) for all aspects of public and private health financing maternal deaths in their areas to the project. They further distribution to the provinces, districts and rural including medical aid societies and also agreed to highlighted that due to increased health literacy some health facilities. The magazine enables CWGH to urgently improve of the human resources for health. Future plans church sects especially apostolic members who used reach out to SCPH target districts and communities The country still uses the 1983 staff establishment The project has had a huge positive impact and this to shun modern medicines were beginning to seek with important information about the project and other although the population has more than doubled and has resulted in DFID considering a project extension. health issues. The magazine has a readership of 200 treatment and also delivering at the health facilities. disease burden increased. The importance of UHC The extension has started in December 2016 and will 000 and distributed countrywide. However, more still needs to be done to raise was unanimously endorsed and all participants end in June 2017. The same activities will be awareness among some religious objectors as some agreed on the need to push the agenda forward in line implemented. seek treatment during the night or secretly. The Documentaries with SDG 3. communities also noted that most people in areas After the media tours, two television documentaries on where the SCPH project is being implemented are the SCPH project were produced and shown on the aware of the importance of registering pregnancies country's national television, ZTV, for maximum early, ANC visits and delivering at a health centre by publicity to raise awareness among the people of trained staff. Zimbabwe. The documentaries, which broadcasted under ZTV's Communities In Action Programme, Radio, with its ability to reach a wide range of were produced by Flamzee, a private documentary audiences, even in the most remote parts of the production company. country is an important tool for reaching communities and policy-makers with the project's key advocacy The main documentary gave a background of the messages such as the need for a human resources SCPH project looking at the objectives, districts the policy which is critical in attaining primary health care. project is being implemented and how it has reduced Radio Zimbabwe is one of the most popular stations in home deliveries in the communities. It also touched on Zimbabwe and according to Zimbabwe All Media how communities are contributing to the building of Survey (ZAMPS) the station has 40% share of the health facilities within their localities including local market. construction of WMHs leading to significant reduction of maternal and child deaths. Health Matters Magazine It also came out clearly that HCCs and HLFs of Every quarter, the CWGH publishes informative different health centres in districts where the project mostly community-based stories in the Health Matters was or is being implemented had successfully Magazine, a publication of the MoHCC which focuses HCC Members at Esibomvu Clinic, Umzingwane District in Matabeleland South Province

30 Community Working Group on Health Community Working Group on Health 31 t 2016 t 2016 epor epor Annual R Annual R It is important that the media was taken to the on health-related stories around the country. Apart addressed the poor relations that previously between It was also agreed that: communities because they are key in shaping public from providing community-based stories, the CWGH communities and clinic staff, raising awareness on the opinion. The media can be a key instrument in also sits on the Editorial Board of the magazine which need for pregnant women to deliver at a health facility - National Social Protection Framework including awareness raising, information dissemination and has a huge circulation. with the help of qualified health worker. The other health insurance needs to be finalized. advocating for change of policies in any country. documentary is a summarized version of the main Some of the articles looked at how community health production. - There is need to ensure the enforcement of Radio Slots workers were working towards reduction of maternal implementation of policies and Acts in support of UHC such as the user fee policy. In 2016, Radio Zimbabwe broadcasted four interviews mortality, advocating for government to allocate 15% National Advocacy meeting with community health workers such as HCCs, CMs, of the national budget to health meet the Abuja target The CWGH and Save the Children held a national - There is need for resource mobilization and HLFs and health staff from different clinics in Midlands as well as calling for universal health coverage. One advocacy conference on April 13, 2016 in Harare that resource coordination for UHC, liaising with all and Mashonaland West provinces. They noted that other article looked at how the concept of community was attended by over 100 delegates including donors and partners to avoid duplication of apart from reducing the distance pregnant women participation has become an important aspect of parliamentarians, MoHCC officials, civil society, resources and ensure equitable distribution. travel to clinics for delivery, waiting mothers’ homes Zimbabwe's public health system as communities take community cadres and journalists. Among key issues ensure the safety of both the mother and child as centre stage in addressing challenges affecting health that were discussed were how to fund health to - The importance of monitoring and evaluation, delivery is done by trained health personnel under delivery in their areas. achieve UHC and the user fee policy which is not being data collection for decision making and very clean environments. implemented in all districts. The conference advocated evidence-based policies and planning was The distribution of the magazine is done via the for the speedy passing of Public Health Act underscored as necessary components of The interviewees also applauded the SCPH MoHCC and partners with the bulk being collected for Amendment Bill, the Health Financing Policy covering UHC. programme attributing the slowing down of child and distribution by Provincial Medical Directors (PMDs) for all aspects of public and private health financing maternal deaths in their areas to the project. They further distribution to the provinces, districts and rural including medical aid societies and also agreed to highlighted that due to increased health literacy some health facilities. The magazine enables CWGH to urgently improve of the human resources for health. Future plans church sects especially apostolic members who used reach out to SCPH target districts and communities The country still uses the 1983 staff establishment The project has had a huge positive impact and this to shun modern medicines were beginning to seek with important information about the project and other although the population has more than doubled and has resulted in DFID considering a project extension. health issues. The magazine has a readership of 200 treatment and also delivering at the health facilities. disease burden increased. The importance of UHC The extension has started in December 2016 and will 000 and distributed countrywide. However, more still needs to be done to raise was unanimously endorsed and all participants end in June 2017. The same activities will be awareness among some religious objectors as some agreed on the need to push the agenda forward in line implemented. seek treatment during the night or secretly. The Documentaries with SDG 3. communities also noted that most people in areas After the media tours, two television documentaries on where the SCPH project is being implemented are the SCPH project were produced and shown on the aware of the importance of registering pregnancies country's national television, ZTV, for maximum early, ANC visits and delivering at a health centre by publicity to raise awareness among the people of trained staff. Zimbabwe. The documentaries, which broadcasted under ZTV's Communities In Action Programme, Radio, with its ability to reach a wide range of were produced by Flamzee, a private documentary audiences, even in the most remote parts of the production company. country is an important tool for reaching communities and policy-makers with the project's key advocacy The main documentary gave a background of the messages such as the need for a human resources SCPH project looking at the objectives, districts the policy which is critical in attaining primary health care. project is being implemented and how it has reduced Radio Zimbabwe is one of the most popular stations in home deliveries in the communities. It also touched on Zimbabwe and according to Zimbabwe All Media how communities are contributing to the building of Survey (ZAMPS) the station has 40% share of the health facilities within their localities including local market. construction of WMHs leading to significant reduction of maternal and child deaths. Health Matters Magazine It also came out clearly that HCCs and HLFs of Every quarter, the CWGH publishes informative different health centres in districts where the project mostly community-based stories in the Health Matters was or is being implemented had successfully Magazine, a publication of the MoHCC which focuses HCC Members at Esibomvu Clinic, Umzingwane District in Matabeleland South Province

30 Community Working Group on Health Community Working Group on Health 31 t 2016 epor

Annual R Stories of Most Significant Change

Name of Clinic: Mdutsheni Rural Health Centre After Intervention: The numbers of people seeking District: Bubi health services has generally risen as the community is now free to approach the current health staff with Change: Nurse' attitude towards patients their problems. Members of the community now and WMH regularly and freely go for HIV testing and counseling at the clinic a thing that would not happen during the Situation Before: For a long time, a tense relationship days of poor relations. existed between nurses at Mdutsheni Rural Health centre and the community. Members of the community The HCC has also done sterling work by renovating an were reluctant to seek health services at the centre old building, re-painted and converted it into a Waiting because of the poor attitude exhibited by one of the Mothers' Home. The home, which has a capacity to health workers at the clinic. The nurse was accused of accommodate 10 mothers, is a structure that any shouting at patients, not greeting them and at times pregnant mother from the community would want to failing to keep secrets as required by the health deliver in. The clinic is now recording between 15 and profession. As a result, patients shunned seeking 20 institutional deliveries every month up from about 5 health services at the facility, which has a catchment deliveries per month before the project was population of 7 406, for fear the nurse. Pregnant introduced. The numbers of ANC visits have also go mothers would not come to register their pregnancies up. Food for pregnant is provided free at the clinic. or for ANC visits. Several letters were deposited into the suggestion box complaining against that particular Following health literacy campaigns by members of nurse. the HCC, some apostolic sect members have started Intervention: The HCC convened several meetings in seeking treatment at the clinic while other are now an effort to address the problem. However, the nurse members of the HCCs. The coming on board of some would not change her attitude and at times challenging members of the apostolic sect have helped reduced the committee. The committee had to approach the maternal and child mortality in the community. District Health Executive and Rural District Council However, a lot still needs to be done to convince other fearing that the impasse would continue to impact members of the apostolic sect to also seek treatment negatively on the community's health seeking at health centres. behavior. After realizing that the r e l a t i o n s h i p b e t w e e n t h e community and the nurse could not b e s a l v a g e d , t h e D H E recommended that the nurse be transferred to another clinic. The nurse was later transferred.

The project has also assisted much especially through the work of Health Literacy Facilitators in educating communities on MNCH issues. Communities have also been educated on their right and responsibilities through the use of the Patients' Charter. People now have a deeper understanding of their rights, thereby increasing their health seeking behaviours. A visibly happy nurse attends to patients at Mdutsheni clinic

32 Community Working Group on Health t 2016 epor Annual R 12

Core Support to Strengthening Public and Social Accountability Monitoring for HIV/AIDS Resources IN ZIMBABWE

Community Working Group on Health 33 CHAPTER t 2016 t 2016

epor 12 Core Support to Strengthening Public and Social Accountability epor Monitoring for HIV/AIDS Resources IN ZIMBABWE Annual R Annual R

l HCCs in Chiwundura were relatively new, as of HIV/AIDS services in communities and at primary Program Officer: Esther Sharara The objectives were to empower communities to most were elected into committees mid last year. care level by end of November 2016. Other Personnel: Nyasha Penelope Mandeya monitor national and local government responses Therefore, continuous support and supervision and Faith Kowo to HIV/AIDS at local level against national was required for them to function fully. Community Meetings commitments and results by end of June 2016.It Community information dissemination meetings l Respondents to scorecards were highly Background was also meant to create community driven (CIDMs) were done in Midlands Province in the 2 knowledgeable on HIV/AIDS issues affecting implementing districts with minimum support from the This project, which started in 2011, demand for improvements in quality of their community. This was because of the CWGH secretariat. CIDMs are platforms were HCCs was implemented in Kwekwe and HIV/AIDS services in communities awareness raising and health education provide communities with feedback from district Chiwundura districts in the and at primary care level as well provided by health workers at the facility, Village e n ga g e m e n t m e e t i n g s to c o m p l e te t h e as advocating for increased Midlands province targeting four Health Workers (VHWs) and other community communication loop. health financing for improved and six health facilities cadres in the communities. It was however service delivery by end of respectively. The decision to stressed that CMs need to strengthen their The new Health Rights Programme Manager for November 2016. implement in this province was documentation to ensure what is discussed is OSISA visited the country and met with various civil based on need because Midlands what is captured and used for engagement and society organizations and government officials to has some of the worst health advocacy. familiarize with the context and get a better understanding of health priorities in the country. A field outcomes in comparison with other Esther Sharara visit to Mwanza Health Centre in Goromonzi was provinces. The HIV Hotspot Analysis in l Medicines such as ARVs and those for TB are conducted where she met with CMs, HCC and the Zimbabwe ranks Midlands second in HIV after available but is feared that the poor rains Activities in 2016 local leadership. Matabeleland South in risk terms. The province has threatening food security could increase high HIV prevalence and neo-natal mortality rates of defaulter rates. Capacity building activities were conducted to satisfy A one day Public discussion meeting under the theme, 15% and 39 deaths per 1000 live births respectively, the objective of empowering communities to monitor “Innovative Domestic Health Financing: Options according to the Multiple Indicator Cluster Survey of national and local government responses to HIV/AIDS HCC Feedback Meetings for Zimbabwe” was held in Harare to review the 2014. HCCs were supported on data analysis and report at local level against national commitments and MoHCC 1st quarter performance reports, explore production for community and district level The work was implemented through Health Centre results. HCCs were equipped with core skills on opportunities for increasing domestic health funding engagement. Key issues highlighted include: Committees (HCCs) and Community Monitors communication, networking and advocacy. The CM's for Universal Health Coverage (UHC) and raise key training highlighted government's major health advocacy issues on HIV/AIDS and health in its entirety (CMs). HCCs are a joint community-health centre l MoHCC moving from CD4 count to viral load currently affecting communities. A number of structures for social participation in health programmes with a specific focus on those addressing testing. Gweru Provincial Hospital being the challenges that militate against achieving the 90-90- processes covering the catchment area of a health HIV/AIDS. It equipped CMs with knowledge on health sample referral centre for the entire Midland 90 targets were identified as resource constraints facility. CMs are community level cadres trained to rights, responsibilities, national HIV/AIDS and gender Province among others. Over 50 delegates attended the collect community perspectives on health service commitments and other guiding frameworks to inform meeting among them members of the Parliamentary delivery using the community scorecard. Therefore, their Social Accountability Monitoring (SAM), l Viral load testing commencing yet no syringes in Portfolio Committee on Health (PPCH), MoHCC, the work of CMs feeds into HCCs, as the latter carry advocacy and engagement. Three-day trainings for clinics in Kwekwe for blood sample collection. CSOs, NGO representatives, communit y the responsibilities of collecting community HCC members drawn from the executive for the 10 HWs feared they might miss the date for samples to Gweru. representatives and media. An explicit commitment grievances and developing action plans to address implementing facilities were successfully conducted. from duty bearers on addressing the plight of VHWs concerns. Two-day trainings for CMs were conducted in both l Test and start approach to commence soon and and options for increasing domestic health financing districts. These were followed up with monitoring visits The project goal was to contribute to ensuring that HWs are currently being trained. was registered. to community cadres to observe them applying the there is an increase in public accountability and knowledge gained during the trainings. Monitoring responsiveness of national HIV/AIDS institutions to Regional Networking and Solidarity data was collected using observation and checklists. District Level Meetings the needs of people living with HIV. This was District level engagement meetings were conducted in As part of regional networking and solidarity, two CMs were observed administering the scorecard, attained through the following strategic sub “ both Kwekwe and Chiwundura during the first and programme officers attended the People's Health whilst checks were done on HCCs' minute books. Key goals/objectives. second half of the year. The district level engagement Movement (PHM) South Africa's National Health issues identified during monitoring were: action falls under the specific objective of creating Assembly at the School of Public Health at the community driven demand for improvements in quality University of Cape Town.

34 Community Working Group on Health Community Working Group on Health 35 CHAPTER t 2016 t 2016

epor 12 Core Support to Strengthening Public and Social Accountability epor Monitoring for HIV/AIDS Resources IN ZIMBABWE Annual R Annual R

34 Community Working Group on Health Community Working Group on Health 35 t 2016 t 2016 epor epor Annual R Annual R The regional workshop, attended by seven African Budget input and CWGH National Future Plans demand improvements in quality of HIV/AIDS services countries, discussed country experiences in Conference in their communities and at primary care level. advocacy, campaigning, knowledge generation and The annual collection and synthesis of community dissemination, capacity development among others. Successes Members of support groups for PLWHIV, capacitated views for the 2017 National Health Budget into a CWGH which hosts PHM-Zimbabwe shared the Communities were empowered through trainings and by CWGH during the previous grant, revitalized their position paper was done including interviews with the platforms utilized to influence policy change such as continuous monitoring, support and supervision. This groups and recruited new members. The national membership, board, executive and district institutional relationships with Parliament, media and was also evident in community level reports of the implementation of income generating activities has chapters. Review of project reports was also done to the MoHCC among others. scorecard (HCC data analysis reports) where provided food and nutritional benefits to their families obtain key information as input into the budget. The final communities showed clarity in terms of their rights and and communities. paper was shared with the relevant stakeholders It was noted that community health workers (CHWs) entitlements for HIV/AIDs service delivery through the including MoHCC, Ministry of Finance and Economic work under very poor conditions and that health questions they posed to duty bearers and their plans of “We have a flourishing poultry project. Not only Development, the PPCH and other key stakeholders. committees barely function. Therefore, the need for a action to address their challenges. Kabanga clinic in do we get income to pay our children's school National Health Insurance that includes CHWs was Chiwundura did not have a nurse trained in pediatric fees, but we get food and nutrition from The position paper was also widely disseminated emphasised as well as the need to advocate for more ART up until this year. This posed huge challenges for consumption of the produce,” says Richard during the Annual CWGH national conference that ran money for health to address the identified challenges parents and caregivers of young ART patients as they Matimba of Zivapaumire Support Group in under the theme, “Leaving no one behind in national and to utilize the International AIDS Conference to had to travel long distances to the nearest facility Chiwundura health”. A Post-Budget Analysis meeting held soon after demonstrate the health system challenges faced in where the service was offered. As a result, more the announcement of the national budget and it was South Africa and other countries. children who needed ART were not registered for The groups conduct monthly meetings, organize and noted that the amount allocated to the health sector had treatment or defaulted. After the HCC approached the significantly gone down. discuss issues affecting them and ensure their A programme officer, Esther Sharara, attended the DHE, the clinic is now offering the service. integration into the wider HCC operational plans. Pan African Social Accountability Learning Lab C W G H p a r t i c i p a te d i n t h i s ye a r ' s WA D Through support groups, Community ART Refill Conference in Swaziland to discuss how context Mbizo 11 clinic serves a large catchment area commemorations held in Kwekwe and officiated by Groups (CARGS) are now fully operational. CARGS affects social accountability outcomes. Delegates including resettlement areas established through the Vice President Emmerson Mnangagwa. The are groups of people that take turns to go to the health were given spaces to share experiences and debate land reform programme. Overcrowding and patients commemorations held under the theme, “Closing the centre and collect medication for each other. They the notion of context in social accountability. being turned back were challenges and at times, tap to new HIV infections” saw Chiwundura and Voluntary Testing and Counselling (VTC) services were piloted by Medicines Sans Frontieres and Kwekwe districts showcasing their work through IEC The conference noted that South Africa outcomes were not offered. However, the HCC worked closely adopted by the MoHCC. In areas where support materials. A press statement highlighting the need to were founded on good social mobilization for citizens with their local councilor who managed to advocate for groups (SGs) were trained and are involved in IGAs, end HIV/AIDS was also released to the media on the to understand their roles and responsibilities and that a mobile clinic at Mbizo 16 to relieve staff and offer VTC CARGs were quickly set up and began functioning at a day of commemorations. citizens are responsible for services. better pace than in areas where there were no existing participating in terms of being part SGs. CARGS have improved ART adherence. of the accountability systems and More broadly, the project strengthened community structures especially looking at the level structures' engagements with duty bearers and Challenges, Setbacks and Learning “social contract” between citizens various stakeholders at district and provincial levels. and States. “As community monitors we are now able to The Political Climate It was also noted that media is a key articulate our challenges in the presence of Zimbabwe is in an election mode as it prepares for the partner as it keeps duty bearers on district officials and demand answers, something parliamentary and presidential elections in 2018. their toes through naming and we could not do before the project due to fear,” Campaigns have begun and public gatherings are shaming those who deny people says Ms. Mashiri, Monitor, Chiwundura treated with suspicion requiring rigorous protocols for access to public ser vices. Clinic. Wastages are also identified and clearance. CWGH worked closely with MoHCC and the expected quality of standard is Community structures are now able to engage with Ministry of Local Government to ensure transparency also publicized by the media. duty bearers with limited support from CWGH staff, a in the organization's operations and reduce suspicion. positive for sustainability. The interface between This included attending ad-hoc meetings with the local district officials, health centre and communities has authorities and providing regular project update Honourable MP for Chiwundura, Kizito Chivamba, Chief Gambiza improved. This creates platforms for communities to reports. (Chiwundura), Ntokozo Dlamini from OSISA and Emmanuel Kamonyo of OSIEA

36 Community Working Group on Health Community Working Group on Health 37 t 2016 t 2016 epor epor Annual R Annual R The regional workshop, attended by seven African Budget input and CWGH National Future Plans demand improvements in quality of HIV/AIDS services countries, discussed country experiences in Conference in their communities and at primary care level. advocacy, campaigning, knowledge generation and The annual collection and synthesis of community dissemination, capacity development among others. Successes Members of support groups for PLWHIV, capacitated views for the 2017 National Health Budget into a CWGH which hosts PHM-Zimbabwe shared the Communities were empowered through trainings and by CWGH during the previous grant, revitalized their position paper was done including interviews with the platforms utilized to influence policy change such as continuous monitoring, support and supervision. This groups and recruited new members. The national membership, board, executive and district institutional relationships with Parliament, media and was also evident in community level reports of the implementation of income generating activities has chapters. Review of project reports was also done to the MoHCC among others. scorecard (HCC data analysis reports) where provided food and nutritional benefits to their families obtain key information as input into the budget. The final communities showed clarity in terms of their rights and and communities. paper was shared with the relevant stakeholders It was noted that community health workers (CHWs) entitlements for HIV/AIDs service delivery through the including MoHCC, Ministry of Finance and Economic work under very poor conditions and that health questions they posed to duty bearers and their plans of “We have a flourishing poultry project. Not only Development, the PPCH and other key stakeholders. committees barely function. Therefore, the need for a action to address their challenges. Kabanga clinic in do we get income to pay our children's school National Health Insurance that includes CHWs was Chiwundura did not have a nurse trained in pediatric fees, but we get food and nutrition from The position paper was also widely disseminated emphasised as well as the need to advocate for more ART up until this year. This posed huge challenges for consumption of the produce,” says Richard during the Annual CWGH national conference that ran money for health to address the identified challenges parents and caregivers of young ART patients as they Matimba of Zivapaumire Support Group in under the theme, “Leaving no one behind in national and to utilize the International AIDS Conference to had to travel long distances to the nearest facility Chiwundura health”. A Post-Budget Analysis meeting held soon after demonstrate the health system challenges faced in where the service was offered. As a result, more the announcement of the national budget and it was South Africa and other countries. children who needed ART were not registered for The groups conduct monthly meetings, organize and noted that the amount allocated to the health sector had treatment or defaulted. After the HCC approached the significantly gone down. discuss issues affecting them and ensure their A programme officer, Esther Sharara, attended the DHE, the clinic is now offering the service. integration into the wider HCC operational plans. Pan African Social Accountability Learning Lab C W G H p a r t i c i p a te d i n t h i s ye a r ' s WA D Through support groups, Community ART Refill Conference in Swaziland to discuss how context Mbizo 11 clinic serves a large catchment area commemorations held in Kwekwe and officiated by Groups (CARGS) are now fully operational. CARGS affects social accountability outcomes. Delegates including resettlement areas established through the Vice President Emmerson Mnangagwa. The are groups of people that take turns to go to the health were given spaces to share experiences and debate land reform programme. Overcrowding and patients commemorations held under the theme, “Closing the centre and collect medication for each other. They the notion of context in social accountability. being turned back were challenges and at times, tap to new HIV infections” saw Chiwundura and Voluntary Testing and Counselling (VTC) services were piloted by Medicines Sans Frontieres and Kwekwe districts showcasing their work through IEC The conference noted that South Africa outcomes were not offered. However, the HCC worked closely adopted by the MoHCC. In areas where support materials. A press statement highlighting the need to were founded on good social mobilization for citizens with their local councilor who managed to advocate for groups (SGs) were trained and are involved in IGAs, end HIV/AIDS was also released to the media on the to understand their roles and responsibilities and that a mobile clinic at Mbizo 16 to relieve staff and offer VTC CARGs were quickly set up and began functioning at a day of commemorations. citizens are responsible for services. better pace than in areas where there were no existing participating in terms of being part SGs. CARGS have improved ART adherence. of the accountability systems and More broadly, the project strengthened community structures especially looking at the level structures' engagements with duty bearers and Challenges, Setbacks and Learning “social contract” between citizens various stakeholders at district and provincial levels. and States. “As community monitors we are now able to The Political Climate It was also noted that media is a key articulate our challenges in the presence of Zimbabwe is in an election mode as it prepares for the partner as it keeps duty bearers on district officials and demand answers, something parliamentary and presidential elections in 2018. their toes through naming and we could not do before the project due to fear,” Campaigns have begun and public gatherings are shaming those who deny people says Ms. Mashiri, Monitor, Chiwundura treated with suspicion requiring rigorous protocols for access to public ser vices. Clinic. Wastages are also identified and clearance. CWGH worked closely with MoHCC and the expected quality of standard is Community structures are now able to engage with Ministry of Local Government to ensure transparency also publicized by the media. duty bearers with limited support from CWGH staff, a in the organization's operations and reduce suspicion. positive for sustainability. The interface between This included attending ad-hoc meetings with the local district officials, health centre and communities has authorities and providing regular project update Honourable MP for Chiwundura, Kizito Chivamba, Chief Gambiza improved. This creates platforms for communities to reports. (Chiwundura), Ntokozo Dlamini from OSISA and Emmanuel Kamonyo of OSIEA

36 Community Working Group on Health Community Working Group on Health 37 t 2016 t 2016 epor epor Annual R Annual R Liquidity crisis Sustainability The continued cash shortages coupled with the Chiwundura is one of the 18 Cordaid districts introduction of bond notes, feared by many as the implementing Results-Based Financing (RBF). The return of the Zimbabwe dollar, affected programme pulling out of the World Bank leaves the communities in implementation as it became more difficult to withdraw limbo as they relied on RBF grants to implement their funds from the bank and pay suppliers for services community action plans. It is not clear who will take over rendered. To mitigate this, CWGH continuously after RBF. However, suggestions for Crown Agents to engaged the bank and submitted timely cash forecasts take over are welcome, although with dire implications in order to secure sufficient funds timely. Most goods on the resource envelope. 13 and services were settled using bank transfers. However, cash was required to meet participants' the MoHCC and the local authorities were key transport reimbursements and facilitation costs. stakeholders in the success of the project. The local leaders such as headmen, chiefs, councillors, village The payment of hefty allowances for other community heads were key in the project as gatekeepers and programmes mainly by international NGOs in the community mobilisers. They were also beneficiaries in same areas which could not be matched by CWGH improved quality of services. It was crucial to involve MPs as they were able to interrogate certain issues and undercut the success of the project, particularly in advocate on behalf of the communities in parliament. Kwekwe urban district. This undermined progress as For example, the MP for Chiwundura constituency took cadres selected to work with organizations which community issues and advocated for the speedy offered higher allowances. passing of the Public Health Act Amendment Bill and more money for health. Drought and Food insecurity The El Nino-induced drought that ravaged southern The CWGH noted the need to continuously strengthen Africa has created food insecurity in the country. This, structures in the community and mobilization of local coupled with the current economic meltdown resources for sustainability of community projects. characterized by cash crisis, has resulted in less and Further, capacity building initiatives, such as budget less people participation in voluntary community advocacy, should include community gatekeepers activities opting for food-for-work programmes. especially village heads to ensure success.

IMG_6710

Strengthening Social Accountability Monitoring and Responsiveness to Sexual and Reproductive Health Rights (SRHR) in the Matabeleland and Midlands region CWGH Chiwundura community monitors and key stakeholders at a partners meeting

38 Community Working Group on Health Community Working Group on Health 39 t 2016 t 2016 epor epor Annual R Annual R Liquidity crisis Sustainability The continued cash shortages coupled with the Chiwundura is one of the 18 Cordaid districts introduction of bond notes, feared by many as the implementing Results-Based Financing (RBF). The return of the Zimbabwe dollar, affected programme pulling out of the World Bank leaves the communities in implementation as it became more difficult to withdraw limbo as they relied on RBF grants to implement their funds from the bank and pay suppliers for services community action plans. It is not clear who will take over rendered. To mitigate this, CWGH continuously after RBF. However, suggestions for Crown Agents to engaged the bank and submitted timely cash forecasts take over are welcome, although with dire implications in order to secure sufficient funds timely. Most goods on the resource envelope. 13 and services were settled using bank transfers. However, cash was required to meet participants' the MoHCC and the local authorities were key transport reimbursements and facilitation costs. stakeholders in the success of the project. The local leaders such as headmen, chiefs, councillors, village The payment of hefty allowances for other community heads were key in the project as gatekeepers and programmes mainly by international NGOs in the community mobilisers. They were also beneficiaries in same areas which could not be matched by CWGH improved quality of services. It was crucial to involve MPs as they were able to interrogate certain issues and undercut the success of the project, particularly in advocate on behalf of the communities in parliament. Kwekwe urban district. This undermined progress as For example, the MP for Chiwundura constituency took cadres selected to work with organizations which community issues and advocated for the speedy offered higher allowances. passing of the Public Health Act Amendment Bill and more money for health. Drought and Food insecurity The El Nino-induced drought that ravaged southern The CWGH noted the need to continuously strengthen Africa has created food insecurity in the country. This, structures in the community and mobilization of local coupled with the current economic meltdown resources for sustainability of community projects. characterized by cash crisis, has resulted in less and Further, capacity building initiatives, such as budget less people participation in voluntary community advocacy, should include community gatekeepers activities opting for food-for-work programmes. especially village heads to ensure success.

IMG_6710

38 Community Working Group on Health Community Working Group on Health 39 CHAPTER t 2016 t 2016

epor 13 Strengthening Social Accountability Monitoring and epor Responsiveness to Sexual and Reproductive Health Annual R Annual R Rights (SRHR) in the Matabeleland and Midlands region Organizations such YTT and HOCIC have opened attitudes as some of the major obstacles to accessing their doors for the media and this has widened the SRH services. Programme Manager: Nonjabulo Mahlangu Activities in 2016 spaces for advocacy on SRHR and HIV/AIDS issues. YTT has also been able to engage with the media and The public dialogue provided an opportunity for CSOs Programme Officer: Mongi Khumalo share the plight of the girl child raising awareness on to engage with service providers on issues and Other Personnel: Caiphas Chimhete and CSOs and Media engagement challenges faced by youths in accessing health challenges faced by young people in the region. services and also discussed the role of young people Esther Sharara Meeting Through engagement with the media, CWGH was The CWGH recognizes the key role played by the in achieving 90-90-90 targets. Recommendations able to produce a documentary to showcase some of media in informing, educating and raising included the need to strengthen dialogue between initiatives in the region on national TV under the Background awareness on various issues affecting young people and service providers, intensification of As the World intensifies the fight Communities in Action programme. Use of media to communities. Media advocacy efforts on educating communities on health rights and against the spread of HIV/ AIDS, it raise awareness on health issues has also resulted in remained an integral part of the entitlements as well as strengthening accountability is the responsibility of the State to combined efforts by various stakeholders to respond to organisations work particularly in monitoring mechanisms. ensure that its citizens have health concerns. the project. Different media access to HIV services. To end platforms have been used to raise Support to CSOs AIDS by 2030 as envisaged, Public Dialogue awareness on topical issues and As a result of the training and the support from the accessibility of services should During the course of the year a public dialogue under also to push advocacy agendas. CWGH, YTT have managed to identify relevant be a key priority. The State has a the theme “Accelerating young people access to SRH stakeholders and structures to best engage in their responsibility of ensuring that and HIV services towards ending AIDS by 2030” was The CWGH held a CSOs and Media advocacy work. It has conducted sessions on the individuals have access to health which Mongi Khumalo organized by CWGH in collaboration with YTT. Various meeting on the 6th of May 2016, to inform Patients' Charter in ward 10 and 19 of Matobo district is affordable, acceptable and of high quality. stakeholders including AIDS Service organizations journalists on current health trends especially HIV reaching out to more than 200 young mother's. It is against this background that CWGH is (ASOs), youth organizations and CSOs participated in and its implications to SRHR. A total of 20 journalists Continuous capacity building of youths has therefore implementing a project on Strengthening Social the activity. The Zimbabwe National Family Planning and 5 CSO representatives attended the meeting enabled them to engage different service providers, Accountability Monitoring and Responsiveness to Council (ZNFPC) gave a presentation on enlightening which aimed at creating a lasting relationship between are able to demand improvement in services provision Sexual Reproductive Health Rights (SRHR) which youths on their sexual reproductive health rights which CSOs and journalists for improved rights based and change in attitudes of health workers. seeks to strengthen influence from local to national they said were not being fulfilled or respected by most reporting on SRH and HIV. This therefore informed a level on provision of HIV/AIDS services. service providers. The youths highlighted that stigma HOCIC has continued to open spaces of advocacy for right-based approach to reporting by trained and discrimination still existed as some service themselves and their target community. The The second phase of the SRHR project continues to journalists who had been reporting poorly on SRH and providers continue stigmatize YPLWHIV. A lot still organisation has equipped a group of women on their support the five SRP partners namely YTT, UAN, HIV as was noted from the abusive words which were needs to be done in educating communities to end rights and responsibilities using the Patients' Charter. HOCIC, MACO and MMPZT, journalists and youths used in their reporting. It was noted that CSOs were stigma and discrimination. living with HIV. The project has promoted citizen avoiding the media as they feared being misquoted by Capacity Building of YPLWHIV engagement for the attainment of SRHR and journalists. Another presentation on “The role of youths towards A group of 20 young people living with HIV selected ensured responsiveness to the needs of people achieving the 90-90-90, and ending AIDS by 2030,” from a pool of young people under the MMPZ project living and affected by HIV. It also focuses on Media support by NAC Bulawayo Provincial AIDS Coordinator, were trained on SRHR, life skills and advocacy. The reviewing of SRH policies, empowering youths living The continuous engagement with the media has Sinatra Nyathi noted that the city was a HIV hot spot youths were empowered with information and skills on with HIV with information and skills on SRHR, life created increased knowledge for CSOs on how the due to high mobility. The HIV prevalence figures are SRHR and life skills including communication, skills and advocacy to enable them to better engage media works and this has created a lasting higher especially among young people. The negotiation skills and advocacy to enable them to with various stakeholders on their priority health relationship between the two. CSOs are now openly emergency of vuzu parties (sex parties) in the city is a better engage with various stakeholders on their needs. The engagements between CSOs and interacting with the media to get community issues cause of concern as this may derail efforts of achieving the three 90s as well as ending AIDS by 2030. priority health needs. media have provided platforms for dialogue on published in both print and electronic media as Accessibility of most services in Bulawayo is still a positive and effective reporting of SRHR and HIV evidenced by the increased number of positive health challenge to most young people in the city with SRH The trainings emphasized on the need for YPLHIV to stories. Public dialogues were held were also held to stories published by the targeted journalists. services such as ANC and STI treatment still adhere to treatment as this is only way to reduce their increase spaces for dialogue between youths and expensive and beyond the reach of many unemployed viral load to undetectable levels. Sex parties emerged services providers. youths. Youths cited staff shortages and poor staff to be a topical issue amongst these youths.

40 Community Working Group on Health Community Working Group on Health 41 CHAPTER t 2016 t 2016

40 Community Working Group on Health Community Working Group on Health 41 t 2016 t 2016 epor epor Annual R Annual R This poses threat to interventions to end AIDS by Iminyela suburb in Bulawayo. During the ii. National commemorations highlighted by many speakers as a major hindrance to 2030. The youth noted that despite knowing their HIV commemorations, an HIV prevention soccer The CWGH supported the National WAD ending AIDS by 2030. During the event, the CWGH positive status, it was still difficult for them disclose to tournament final was held as a way of involving men in commemorations held on December 1, 2016 at Mbizo managed to disseminate information and shared its anyone for fear of being discriminated against or the fight against HIV. The main aim of the tournament stadium in Kwekwe. The event was held under the work on the Securing Rights programme. Young breaking up with their partners. Some youths was to raise awareness on HIV among men who are theme “Closing the tap of new HIV infections”. It people who visited the stand said they encounter challenges in accessing SRH and HIV services. User especially those who were born with HIV are still normally left in most HIV programmes. The event also emphasised on the need to end new HIV infections fees were highlighted to be a hindrance for youths as leaving with bitterness as to why their parents did not provided the CWGH with an opportunity to showcase through ending discrimination, VMMC, HIV testing PMTCT, condom use and zero tolerance to most of them are unemployed and have no source of prevent them from getting the virus. During its work and to disseminate information on sexual discrimination. income. discussions it emerged that some HIV positive youths reproductive health. CWGH partnered with Youth vowed to continue indulging in unprotected sexual Creative Ideas, Restless Development and SAfAids to The organisation had an opportunity to exhibit its work, Post budget meeting activities as “they will die someday” and are not scared support the event. programmes and also shared more on the work done A Post Budget Analysis meeting was held on the 12th of re-infections. under the Securing Rights programme on of December 2016 to review the 2017 health budget Strengthening of CSOs Social Accountability allocation. The meeting was attended by different The youths said they had challenges in accessing Monitoring and Responsiveness to Sexual and partners including UNICEF, DFID, USAID, youth centres where they would meet as support Reproductive Health Rights. Visitors to the stand were parliamentarians and CSOs. Delegates at the groups hence the need to engage BCC to avail such interested particularly on the strengthening of CSOs meeting expressed disappointment on the $282 facilities to the youths. They also highlighted that they capacities. Most CSOs expressed interest on joining million allocated to the health sector and urged the are facing challenges in accessing and utilization of the CWGH network so as to strengthen their advocacy PPCH to lobby the Ministry of Finance to review the health services but were afraid of raising alarm for fear at community level. The need to intensify lobbying and allocation upwards. The allocation represents 8.2% of victimization in future when seeking treatment. advocacy around health financing was emphasized, of the total budget which is way below the Abuja Discrimination continues to be a challenge for many people expressed disappointment on lack or failure by Declaration target of 15%. Due to poor health young people resulting in most of them defaulting on the government to allocate enough funds towards financing, the country has continued to experience health. Concern was expressed on the high donor their medication. challenges in service provision because of staff dependency on medicine and drugs, (90% of drugs shortages, ambulances and medicines at most are from donors) a situation which was described as a district and central hospitals. Partners applauded the World AIDS Day Commemorations security threat. government for the 5% tax on airtime and mobile data to finance the purchase of drugs and equipment. It i. Bulawayo World AIDS day pre-event It was highlighted that health should be given the was noted that it was only way that government could A pre-World AIDS Day (WAD) commemoration event Members of Parliament at the CWGH priority if the country is to end “Close the tap of new ensure sustainability of current programmes in the pre-budget consultation meeting was held on the 8th of December at Ndoda stadium at HIV infections”. For the Test and Treat Strategy which event that external partners pull out or reduce their the country adopted recently to be sustainable, there funding commitments in Zimbabwe. is need for health facilities to be well supported financially, it was noted. Future Plans iii. Bulawayo WAD commemorations Major activities in 2017 Soon the national celebrations, Bulawayo province The CWGH will continue promoting dialogue and also commemorated the WAD event on the 9th of engagement at various levels with duty bearers December 2016 under the same theme. The event and CSOs will also be supported to utilize already provided an opportunity for sharing the current HIV existing advocacy platforms at local and national situation in the province. It was noted that Bulawayo levels. The organization will also create and build (PVO 01/2014) has an HIV prevalence of 22% which is above the synergies with other HIV/AIDS players where national prevalence. The need to strengthen HIV commonalities exist. prevention strategies was emphasized, with a particularly focus among young people who were Participation in Pre and Post Budget meeting identified to be at high risk of HIV infection. The remains the organisation's key space of influence Website: www.cwgh.co.zw Twitter Account: @CWGH-ZIMBABWE Facebook: CWGH emergency of Vuzu (sex parties) in the city was at national level. The CWGH will host a pre- budget

42 Community Working Group on Health Community Working Group on Health 43 t 2016 t 2016 epor epor Annual R Annual R This poses threat to interventions to end AIDS by Iminyela suburb in Bulawayo. During the ii. National commemorations highlighted by many speakers as a major hindrance to 2030. The youth noted that despite knowing their HIV commemorations, an HIV prevention soccer The CWGH supported the National WAD ending AIDS by 2030. During the event, the CWGH positive status, it was still difficult for them disclose to tournament final was held as a way of involving men in commemorations held on December 1, 2016 at Mbizo managed to disseminate information and shared its anyone for fear of being discriminated against or the fight against HIV. The main aim of the tournament stadium in Kwekwe. The event was held under the work on the Securing Rights programme. Young breaking up with their partners. Some youths was to raise awareness on HIV among men who are theme “Closing the tap of new HIV infections”. It people who visited the stand said they encounter challenges in accessing SRH and HIV services. User especially those who were born with HIV are still normally left in most HIV programmes. The event also emphasised on the need to end new HIV infections fees were highlighted to be a hindrance for youths as leaving with bitterness as to why their parents did not provided the CWGH with an opportunity to showcase through ending discrimination, VMMC, HIV testing PMTCT, condom use and zero tolerance to most of them are unemployed and have no source of prevent them from getting the virus. During its work and to disseminate information on sexual discrimination. income. discussions it emerged that some HIV positive youths reproductive health. CWGH partnered with Youth vowed to continue indulging in unprotected sexual Creative Ideas, Restless Development and SAfAids to The organisation had an opportunity to exhibit its work, Post budget meeting activities as “they will die someday” and are not scared support the event. programmes and also shared more on the work done A Post Budget Analysis meeting was held on the 12th of re-infections. under the Securing Rights programme on of December 2016 to review the 2017 health budget Strengthening of CSOs Social Accountability allocation. The meeting was attended by different The youths said they had challenges in accessing Monitoring and Responsiveness to Sexual and partners including UNICEF, DFID, USAID, youth centres where they would meet as support Reproductive Health Rights. Visitors to the stand were parliamentarians and CSOs. Delegates at the groups hence the need to engage BCC to avail such interested particularly on the strengthening of CSOs meeting expressed disappointment on the $282 facilities to the youths. They also highlighted that they capacities. Most CSOs expressed interest on joining million allocated to the health sector and urged the are facing challenges in accessing and utilization of the CWGH network so as to strengthen their advocacy PPCH to lobby the Ministry of Finance to review the health services but were afraid of raising alarm for fear at community level. The need to intensify lobbying and allocation upwards. The allocation represents 8.2% of victimization in future when seeking treatment. advocacy around health financing was emphasized, of the total budget which is way below the Abuja Discrimination continues to be a challenge for many people expressed disappointment on lack or failure by Declaration target of 15%. Due to poor health young people resulting in most of them defaulting on the government to allocate enough funds towards financing, the country has continued to experience health. Concern was expressed on the high donor their medication. challenges in service provision because of staff dependency on medicine and drugs, (90% of drugs shortages, ambulances and medicines at most are from donors) a situation which was described as a district and central hospitals. Partners applauded the World AIDS Day Commemorations security threat. government for the 5% tax on airtime and mobile data to finance the purchase of drugs and equipment. It i. Bulawayo World AIDS day pre-event It was highlighted that health should be given the was noted that it was only way that government could A pre-World AIDS Day (WAD) commemoration event Members of Parliament at the CWGH priority if the country is to end “Close the tap of new ensure sustainability of current programmes in the pre-budget consultation meeting was held on the 8th of December at Ndoda stadium at HIV infections”. For the Test and Treat Strategy which event that external partners pull out or reduce their the country adopted recently to be sustainable, there funding commitments in Zimbabwe. is need for health facilities to be well supported financially, it was noted. Future Plans iii. Bulawayo WAD commemorations Major activities in 2017 Soon the national celebrations, Bulawayo province The CWGH will continue promoting dialogue and also commemorated the WAD event on the 9th of engagement at various levels with duty bearers December 2016 under the same theme. The event and CSOs will also be supported to utilize already provided an opportunity for sharing the current HIV existing advocacy platforms at local and national situation in the province. It was noted that Bulawayo levels. The organization will also create and build (PVO 01/2014) has an HIV prevalence of 22% which is above the synergies with other HIV/AIDS players where national prevalence. The need to strengthen HIV commonalities exist. prevention strategies was emphasized, with a particularly focus among young people who were Participation in Pre and Post Budget meeting identified to be at high risk of HIV infection. The remains the organisation's key space of influence Website: www.cwgh.co.zw Twitter Account: @CWGH-ZIMBABWE Facebook: CWGH emergency of Vuzu (sex parties) in the city was at national level. The CWGH will host a pre- budget

42 Community Working Group on Health Community Working Group on Health 43 t 2016 t 2016 epor epor Annual R Annual R

meeting with various stakeholders including the awareness on any current topical issues in the PPCH, MoHCC, MoF, civil society and the media. health sector. A bi-annual health bulletin will be These are platform to engage with duty bearers on developed where journalists will be encouraged to public health concerns and issues of public health write health related stories. Prizes will be given to the financing in Zimbabwe. The organisation will also best health journalists and also those showing take the opportunity to present its pre-budget progress in rights-based reporting for health. The position paper which will be developed in organisation will also support journalists to consultation with OXFAM partners. participate in some health events such as the World 14 AIDS day so that they write articles on the events. The CWGH continues to recognize the key role that CWGH will continue to work media houses in the the media play in informing, educating and raising Southern part of the country and selected awareness on various issues affecting communities stakeholders to ensure that advocacy issues will in and also to push advocacy agendas. Quarterly future be clearly be articulated. The CWGH has a review meetings will be held with media Memorandum of Understanding (MoU) with Health representatives to share and document best Journalists Association of Zimbabwe (Hejaz) to practices. These meetings will also be used to raise make sure that advocacy issues reach the intended targets.

HCC as a Vehicle for Social Participation in Health in East and Southern Africa

The Permanent Secretary of Health, Brigadier General Dr. Gerald Gwinji at the CWGH pre-budget consultation meeting

44 Community Working Group on Health Community Working Group on Health 45 t 2016 t 2016 epor epor Annual R Annual R meeting with various stakeholders including the awareness on any current topical issues in the PPCH, MoHCC, MoF, civil society and the media. health sector. A bi-annual health bulletin will be These are platform to engage with duty bearers on developed where journalists will be encouraged to public health concerns and issues of public health write health related stories. Prizes will be given to the financing in Zimbabwe. The organisation will also best health journalists and also those showing take the opportunity to present its pre-budget progress in rights-based reporting for health. The position paper which will be developed in organisation will also support journalists to consultation with OXFAM partners. participate in some health events such as the World 14 AIDS day so that they write articles on the events. The CWGH continues to recognize the key role that CWGH will continue to work media houses in the the media play in informing, educating and raising Southern part of the country and selected awareness on various issues affecting communities stakeholders to ensure that advocacy issues will in and also to push advocacy agendas. Quarterly future be clearly be articulated. The CWGH has a review meetings will be held with media Memorandum of Understanding (MoU) with Health representatives to share and document best Journalists Association of Zimbabwe (Hejaz) to practices. These meetings will also be used to raise make sure that advocacy issues reach the intended targets.

HCC as a Vehicle for Social Participation in Health in East and Southern Africa

The Permanent Secretary of Health, Brigadier General Dr. Gerald Gwinji at the CWGH pre-budget consultation meeting

44 Community Working Group on Health Community Working Group on Health 45 CHAPTER t 2016 t 2016

epor 14 HCC as a Vehicle for Social Participation in Health epor in East and Southern Africa Annual R Annual R

Programme Manager: Tafadzwanashe Nkrumah Activities in 2016 Photovoice After a 3-day training of trainers' Other Personnel: Edgar Tatenda Mutasa workshop of representatives from HCC Exchange Visit CWGH, LDHMT and UCT done in 2015 An in-country HCC exchange visit was held at participants came to a collective Background Mudanda clinic in Buhera, Zimbabwe on the 31st of understanding of Photovoice and how The CWGH in partnership with the Training March 2016. The meeting was attended by they plan to use this approach in their and Research Support Centre d i s t r i c t a u t h o r i t i e s i n c l u d i n g work with HCCs at country level. It was (TARSC), University of Cape Town representatives from the Social agreed that Photovoice is a (UCT) - School of Public Health Services Department for Buhera participatory action research (PAR) and the Lusaka District Health Rural District Council and District strategy that puts the camera into the Management Team (LDHMT) Health Executive. A total of 4 HCCs hands of community participants and gives them, through the process of under the auspices of the namely Mudanda, Nerutanga, taking photographs, the freedom to Regional Network for Equity in Mudawose and Chirozva took part identify and document community Health in East and Southern in the visit. The exchange visit perspectives, experiences and actions Africa (EQUINET) are working on programme included a site tour, related to their everyday lives. The a regional programme, 'Health HCCs sharing experiences and lessons Tafadzwanashe Nkrumah focus as agreed would be on the Social Sister Nobula showing outpatients area including the notice Centre Committees (HCCs) as a learnt including challenges and successes Determinants of Health (SDH) board where the CBMI board is hung for all to see vehicle for social participation in health in executing their duties and responsibilities. Key especially water, sanitation and systems in East and Southern Africa'. This issues that emerged from the visit included the hygiene issues. All partners successfully identified the Brief information on the HCCs are as follows: programme is being supported by the Open Society important role of HCCs in improving health HCCs they would be working with in this programme Initiative for Eastern Africa (OSIEA). It is a result of a governance at facility level through development of based on an agreed set of criteria. 1. South Africa – Max Madlingozi, Soweto- regional meeting held by EQUINET in February operational plans that are sensitive and prioritize on-Sea, Lunga Kobese (all urban with 2014 involving organisations working with HCCs in community health needs, increasing utilization of varying degrees of organization). East and Southern African (ESA) countries to health services at the clinic, improving relationship exchange experiences and information on the laws, between the community and health workers at the 2. Zambia – Kanyama (peri-urban; high population density); Matero Ref (urban); roles, capacities, training and monitoring systems clinic. They also mobilise resources from various previous involvement in the Health that are being applied to HCCs in the ESA region. stakeholders including from the local MPs and NGOs Literacy programme. for the development of the clinic. 3. Zimbabwe – Nyamhunga Clinic (in Kariba, a tourist town); Rujeko Health Committee (in Masvingo urban) and Arcturus Health Committee (a mining community).

Each of the 3 partners undertook and reported on a 2-3 day HCC training on Photo voice with representatives from respective HCCs. A least 15 participants attended each training. As part of the training, HCCs completed a pre-test questionnaire (wheel chart) based on 10 output indicators. The training set the ground for project implementation in the respective countries. Training in photography at Soweto-on-Sea Community Centre, Mudanda clinic (Buhera) Health Centre Committee member giving an example of a story of significant change Port Elizabeth. South Africa

46 Community Working Group on Health Community Working Group on Health 47 CHAPTER t 2016 t 2016

epor 14 HCC as a Vehicle for Social Participation in Health epor in East and Southern Africa Annual R Annual R

46 Community Working Group on Health Community Working Group on Health 47 t 2016 t 2016 epor epor Annual R Annual R Policy Dialogue Meeting The CDHMT in the Ministry of Health in Zambia held a policy dialogue meeting as a component of the regional programme where it engaged policy makers, provincial and medical doctors, stakeholders and the community. The aim was to explore ways of formulating policy guidelines and Laws for the legal recognition of HCCs. The expected outcome was to come up with recommendations and actions for 15 various stakeholders to support development of policy to inform operations of HCCs within appropriate structures. The stakeholders included public sector, civil society, NGOs, faith-based organizations, private sector, communities and its leadership. Key issues discussed by delegates regarding policy development An HCC policy dialogue meeting in Lusaka, Zambia include the criteria for HCC selection of members i.e. through election rather than appointment, issues of to training HCCs is reflected in policy. community representativeness in the committee as well as roles and responsibilities. Some preliminary findings noted challenges such as political appointment of committees, high turnover and Strengthening HCC training tools lack of financial allocations ear-marked for training of Using a mapping tool developed in 2015, the UCT has HCCs. However, it was noted that health centre since received responses from across the region and committees were improving the health service quality, is now analysing feedback from organisations working accessibility, equity and instilled a sense of ownership with HCCs. Focus area for analysis has been around of the health services by the community. As part of identifying the training targets?; What the training fiscal decentralization, the health committee has been addresses?; What has worked well in training?; and included in resource mobilisation, planning and tools being used to train and whether the commitment governance of the facility.

Future Plans A regional exchange visit will be held in the year 2017 in order to facilitate country exchange experiences and consolidate progress made by each partner in as far as the programme is concerned. There will be identification of cases of good practice with respect to training and capacity development. Work done in developing model training tools, policy, guidelines and law will be documented and posted on a website to be accessed as a resource by anyone interested in contextualizing the material to suit their respective country environments. Revitalising and Strengthening Primary Health Care and Public Responsibility for Health in Zimbabwe

48 Community Working Group on Health Community Working Group on Health 49 t 2016 t 2016 epor epor Annual R Annual R Policy Dialogue Meeting The CDHMT in the Ministry of Health in Zambia held a policy dialogue meeting as a component of the regional programme where it engaged policy makers, provincial and medical doctors, stakeholders and the community. The aim was to explore ways of formulating policy guidelines and Laws for the legal recognition of HCCs. The expected outcome was to come up with recommendations and actions for 15 various stakeholders to support development of policy to inform operations of HCCs within appropriate structures. The stakeholders included public sector, civil society, NGOs, faith-based organizations, private sector, communities and its leadership. Key issues discussed by delegates regarding policy development An HCC policy dialogue meeting in Lusaka, Zambia include the criteria for HCC selection of members i.e. through election rather than appointment, issues of to training HCCs is reflected in policy. community representativeness in the committee as well as roles and responsibilities. Some preliminary findings noted challenges such as political appointment of committees, high turnover and Strengthening HCC training tools lack of financial allocations ear-marked for training of Using a mapping tool developed in 2015, the UCT has HCCs. However, it was noted that health centre since received responses from across the region and committees were improving the health service quality, is now analysing feedback from organisations working accessibility, equity and instilled a sense of ownership with HCCs. Focus area for analysis has been around of the health services by the community. As part of identifying the training targets?; What the training fiscal decentralization, the health committee has been addresses?; What has worked well in training?; and included in resource mobilisation, planning and tools being used to train and whether the commitment governance of the facility.

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epor 15 Revitalising and Strengthening Primary Health Care and epor Public Responsibility for Health in Zimbabwe Annual R Annual R Activities in 2016 On completion of phase 3 of the project, the waiting “Partial Handover Certificate” at a function organised Project Coordinator: Edgar Tatenda Mutasa mothers' home will accommodate 3 nursery beds and by CWGH to enable the community to use the home. Other Personnel: Kowo Faith 10 adult beds for the mothers. The commitment of both The certificate was awarded following the completion Mwanza RHC Waiting Mothers' the HCC community towards the construction of this of phase 1 & 2 of the project at a function attended by Home & Kitchen home has instilled a sense of ownership of the facility. officials from MoHCC and Ministry of Education, the Background This sense of ownership ensures the project's Zimbabwe National Army (ZNA) contractors, CWGH The CWGH with support from BMZ-Medico sustainability of the project. Waiting Mothers' Homes secretariat, traditional leaders and community International implemented a three year The construction of the Mwanza Clinic have proved to be effective in stemming maternal representatives. public health care programme from Waiting Mothers' Home continued in deaths because they reduce deaths that emanates 2010 to 2013. The programme on 2016 with the building of a temporary from delays in reaching the facility. Statistics indicate The final certificate will be issued upon completion of “Revitalizing and Strengthening kitchen as recommended by the that at least 10 women die of pregnancy related the phase 3 section of the project by the community. Public Health Care and Public Ministry of Public Works & National illnesses every day in Zimbabwe. Speaking at the handover ceremony, CWGH executive Responsibility for Health in Housing inspectors. Supervision director, Mr Itai Rusike highlighted how maternal Z i m b a b w e ” s u p p o r t e d and inspections were facilitated Partial Hand-Over Ceremony homes have helped reduced the country's maternal community health initiatives regularly by the CWGH. Phase 1 & 2 through HCCs. HCCs are a The Ministry of Local Government, Public Works and and child mortality rates through bridging the distance of the project was finally completed mechanism through which National Housing on October 28, 2016 officially gave gaps that expecting mothers have to travel to give birth. on October 4, 2016. See picture below. community participation can be Edgar Tatenda Mutasa effectively integrated to achieve sustainable people-centered health system at the primary care level of the health system.

According to World Health Organisation (WHO) maternity waiting homes are residential facilities where women who live remotely can wait before giving birth at a hospital or health care. Under the BMZ-Medico supported programme, HCCs in the 32 CWGH districts across Zimbabwe have been collaborating with Village Health Workers (VHWs) to mobilize expectant mothers to deliver at health facilities nearest to them in an effort to reduce the high maternal and child mortality rates since 2010.

In 2016, the BMZ-Medico project activities centered on construction Partners inspect a Waiting Mothers' Home Kitchen of a kitchen, “partial handover” ceremony and built by Mwanza community & HCC in 2016 continued capacitation of HCCs, HLFs and CMs so Mwanza clinic WMH inspections for Partial Handover by Min of Local Government & Public Works that they continue raising community awareness on health literacy issues at the same time cementing the culture of community ownership and responsibility.

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Future Plans CWGH will continue to strengthen the work of HCCs at Mwanza Clinic and other surrounding health facilities as well as encourage the committees at different centres to share experiences on community health initiatives. 16

CWGH Executive Director Itai Rusike, Headman Mwanza and the nurse in charge for Mwanza Clinic in Goromonzi District at the waiting mothers home hand over ceremony.

Big Lottery Collaborate Project – Zimbabwe Community HIV Care Project

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CWGH Executive Director Itai Rusike, Headman Mwanza and the nurse in charge for Mwanza Clinic in Goromonzi District at the waiting mothers home hand over ceremony.

Big Lottery Collaborate Project – Zimbabwe Community HIV Care Project

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epor 16 Big Lottery Collaborate Project – Zimbabwe Community epor HIV Care Project Annual R Annual R

Activities in 2016 Through the presentations and group work done (ISALS). To ensure adherence, one member of the Project Coordinator: Edgar Tatenda Mutasa during the meeting, HCCs reported that they now support group collects medication on behalf other Other Personnel: Tafadzwanashe Nkrumah and Building Capacities for HCCs on receive regular reports from CHBC givers taking note members thereby avoiding prohibitive transport costs Tanyaradzwa Munouya of the challenges and support needed in executing that would have otherwise disturbed adherence. Palliative Care their roles. Some HCCs have also now incorporated A one-day workshop for HCCs on palliative care CHBC givers into the committees to ensure they are It was agreed at the workshop that HCCs should work Background was held at Bahai Faith in Goromonzi and always updated on palliative care issues within the directly with and within the community in order to The Zimbabwe Community HIV Care was attended by 22 HCC members community. On the issue of child abuse, most HCCs strengthen the local awareness of the need for and is a collaborate project which aims value of palliative care services. Palliative care is representing 8 clinics. This was in line liaise with the ZRP's Victim Friendly Unit and child care to improve the quality of life for indeed an important aspect of health within a with a recommendation from a mid- workers when they get tip-offs from the general people living with and affected by community. Both patients and CHBC givers need term review report of the project community of child abuse cases. HCCs have also HIV in eight wards of Goromonzi support from the community as the process of that indicated that HCCs still been working with support groups which they said are palliative care can be quite tiresome especially in the district through a palliative care needed capacity building on doing a lot of wonderful work in ensuring adherence of case of young caregivers. HCCs agreed to take a approach. The lead organisation, palliative care. As such the purpose ART patients as well as contributing to financial stronger role in ensuring that palliative care is provided Island Hospice and Healthcare of the workshop was to capacitate stability through Internal Savings and Lending System well within their communities. (IHH) was working in partnership HCCs with the requisite knowledge on with CWGH and an Internal Savings Tanyaradzwa Munouya palliative care in order for them to play and Lending's training consultant on the their supportive role to the community and CHINAMORA CLINIC project. the various key cadres such as support groups, child care workers and community home based care An exchange visit was done on the 18th of August 2016 at Chinamhora clinic in Goromonzi under the Big IHH was focusing on strengthening palliative care (CHBC) givers. Lottery Collaborate Zimbabwe HIV Community Care project. The exchange visit was attended by HCC within the communities, CWGH was strengthening representatives from Joan Rankine, Chinamhora, Nyaure, Pote, Bosha, Kowoyo, Makumbe and Chikwaka. The existing Health Centre purpose of the exchange visit was to strengthen HCC activities in palliative care through sharing of ideas, to Committees (HCCs) allow for practical peer to peer exchange and to provide an opportunity for HCCs to network and learn from through training them each other. The HCCs shared experiences and lessons learnt including challenges and successes in and monitoring their executing their duties and responsibilities regarding palliative care. The host HCC Chinamhora clinic chaired activities while Internal all sessions and took the visiting HCCs for a site tour after plenary discussions. Savings & Lending Systems (ISALs) was providing the community with financial resources. Target beneficiaries included people living with HIV/AIDS (PLWHA), orphans and vulnerable children (OVCs), young c a re rs , c o m m u n i t y c a r e g i v e r s , f a m i l y members and health Bosha HCC having a group discussion professionals.

Chinamhora clinic has two sign posts at its gate that clearly indicate the working hours

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Chinamhora clinic has two sign posts at its gate that clearly indicate the working hours

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Sites toured include the maternal wing, Waste Zone, Opportunistic Infection (OI) clinic, ANC ward, labour ward, PNC ward, Outpatients department and medicine storeroom.

Under “Building Alliances for 17 health module” Chinamhora HCC is networking with partner o r g a n i s a t i o n s f o r t h e development of the facility .e.g. Love Zimbabwe, a community- based organisation that has rehabilitated the water system for the benefit of clients and staff. Apart from that Love Zimbabwe has donated babies' clothes for pregnant mothers, curtains for labour ward and some medicines. Participants being shown the water tank that the clinic bought through RBF funding & extension of taped water to staff houses by Love Zimbabwe. Among key issues that emerged from the visit was the importance of HCCs having a database of clients in the palliative care programme especially when there are food disbursements such that some people left out are not or overlooked in those projects. Challenges that were discussed included the fact that some support groups are not comfortable to be known and thus making the work of HCCs in working with them a challenge. There is need for building rapport to ensure good communication.

Future Plans Accountability Loop Budget Advocacy (ALBA) The project ended in November 2016. CWGH will continue to build partnership in strengthening palliative care in communities as a key aspect to improving health outcomes.

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Sites toured include the maternal wing, Waste Zone, Opportunistic Infection (OI) clinic, ANC ward, labour ward, PNC ward, Outpatients department and medicine storeroom.

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epor 17 Accountability Loop Budget Advocacy (ALBA) epor Annual R Annual R Activities in 2016 CSO Project Coordinator: Tafadzwanashe Nkrumah Partnership Other Personnel: Penelope Mandeya Production of a policy brief: Gather Meeting and Build evidence on RMNCH The CWGH, Save the Children and The ALBA consortium began with collecting and Background ActionAid held a one collating information from the various In January 2015, the World Health day meeting under projects that members were involved in Organisation (WHO) supported a the theme “Pushing regarding RMNCH. This included a regional meeting on Accountability Z i m b a b w e ' s desk review of documents provided Loop Budget Advocacy (ALBA) RMNCH agenda by the Ministry of Health and Child held in Harare. The meeting was forward” on July 20, Care and its external partners. a t t e n d e d b y c o u n t r y 2016 to discuss key Some of the key findings representatives of CSOs, issues affecting highlighted in the policy brief are journalists, researchers, health w o m e n a n d economists, parliamentarians that although major milestones were children's access to and government officials from achieved in the reduction of maternal healthcare, to have a Ghana, Nigeria, Zambia, Malawi and Penelope Mandeya and child health deaths, Millennium united voice in Zimbabwe. One of the main objectives of Development Goals (MDGs) 4 and 5 targets advocating for the the meeting was to strengthen the capacity of civil were not met and that while funding for RMNCH full implementation society, parliamentarians and the media, so that increased in absolute terms between 2009 and 2015, of the user fee policy Delegates during a group work at the ALBA the largest share of the increase however went to they are confident to initiate and implement in- a n d i n c r e a s e d CSO partnership meeting country health budget advocacy working through employment costs. The policy brief urges the funding towards government to ensure sustainable domestic financing existing networks and platforms . RMNCH services. The meeting, which was supported It was noted that communities in resettled farming for RMNCH services and thus stop the high donor by WHO, brought together various representatives areas were not receiving adequate health care and so dependency that currently exists. from CSOs that are actively involved in RMNCH work there is need to improve access to healthcare in these in their geographical areas. The meeting also attended areas. A recommendation was made for the MoHCC by government officials was a precursor to the meeting to work closer with the Ministry of Primary and with parliamentarians where CSOs gave a collective Secondary Education to ensure better SRHR message regarding RMNCH for input into the 2017 outcomes among students. budget. The meeting acknowledged that CSOs were doing a lot Issues discussed during plenary included the user fee of work around RMNCH issues across the country but policy which is still not being implemented in all there is still need for a more coordinated approach to districts in the country and the need for communities to increase coverage and avoid repetitive efforts in the continue mobilizing resources for health since the same areas. The areas of project implementation are government is struggling to do so due to the current usually determined by donors, which is an anomaly as economic downturn. Of concern was the late it must be dictated by needy. disbursements of funds under Results-Based Financing (RBF) which seriously affected the Pre-budget meeting with Parliamentarians execution of plans by HCCs as well as the issue of As a follow-up to the CSO partnership meeting, a pre- religious objectors who continue to shun modern budget meeting was held with Parliamentarians and medical care. MoHCC officials on September 21, 2016. CSOs used

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the platform to push parliamentarians to consider notes. Interaction among CSOs, MPs and MoHCC RMNCH issues so that they can be included in the officials was seen as crucial to improve health national budget. The meeting was part of the ALBA outcomes. It was noted that joint advocacy was project. necessary for increased funding towards health to the government especially the Ministry of Finance. The meeting brought out some important areas of concern with delegates agreeing that there is need to Health insurance was a topical issue of concern have a more simplified budget that is easier to among delegates with some saying the medical aid 18 comprehend in order to have meaningful participation industry is no longer reliable and is operating under by the citizenry unlike the current situation whereby poor regulation thus resulting in many violations of the Blue Book is filled of figures without explanatory members' entitlements.

Future Plans The results of the project include the creation of a platform for engagement among CSOs, MPs and MoHCC officials to deliberate on RMNCH issues. CSOs got an opportunity to advocate for the full implementation and adherence to government's policy of no user fees for MNCH through the media and engagement with Parliament and MoHCC officials. CSOs have agreed to continue engaging parliament by giving evidence of community experiences regarding RMNCH services so as to ensure that concerns are included and addressed in the national budget.

Adolescent Sexual Reproductive Health Programme

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Adolescent Sexual Reproductive Health Programme

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epor 18 Adolescent Sexual Reproductive Health Programme epor Annual R Annual R Activities in 2016 Entrepreneurship, Business Management Psycho- Social (PSS) Trainings Program Officer: Mandy Mathias and Livelihood Projects Trainings Seventy participants, 47 of which were youths and 23 Other Personnel: Mongi Khumalo Two trainings on entrepreneurship and livelihood adults, were trained in PSS and life skills during the year. Life skills included communication, goal setting Peer Education Trainings projects were held in Bulawayo and Mangwe Background respectively. These equipped youths with information and conflict resolution that mainly targeted youths with Two peer education trainings were held, one in the aim of capacitating them to effectively participate in The CWGH youth project aims to promote and skills on business management including each area which equipped youths with community and district processes. Goal setting was the attainment of Sexual and resource mobilisation, record keeping, formation of information and skills on SRH, peer identified as a personal development indicator aimed Reproductive Health (SRH) and self-help groups, proposal and constitution writing, at assisting youths to focus on improving their lives and Psycho-Social (PSS) wellbeing for education and life skills. A total of 97 internal savings and lending and skills in chicken and setting smart goals. Youths trained from previous youths the 15 - 25 age range. It is youths were reached through the goat rearing. At least 75 youths benefited from these sessions have returned to school to further their being run in two areas of trainings of which 44 were males trainings disaggregated as 35 males and 40 females. education while some and sought internship and Bulawayo and Mangwe. The and 53 females. At least 15 The trainings were aimed at capacitating youths so employment opportunities after receiving assistance project sought to address a gap representatives from community that they can identify, establish and manage their own in setting feasible short and long-term goals. For adults that existed in knowledge levels structures such as residents livelihood initiatives to address challenges related to included an introduction to PSS and the use of amongst youths on SRH issues in poverty and unemployment in areas they resided. The associations, Child Protection different tools such as the Journey of Life, Memory the two areas by equipping youths CWGH worked with a number of entities including Mandy Mathias Committees, District AIDS Action Work, the Gift Box and the Tree of Life. These were with information and skills that enable Plumtree AIDS Project, Ministry of Youth, Ministry of Committees, Village Health Workers designed to assist the participants to resolve personal them to make informed decisions and Small and Medium Enterprises, Mangwe Rural District (VHWs), Behaviour Change Facilitators, GBV issues they may have and capacitated to provide contribute positively towards community and Council, Mangwe Livestock, Hand in Hand and a support to the children and youths they work with. national development. The project builds upon the facilitators as well as representatives of other CBOs private consultant. From the trainings four viable pilot phase implemented in 2013 that aimed to and NGOs were also targeted. Community level project were established in Mangwe. These are two address needs raised by initial assessments representatives of line ministries are also part of the chicken rearing projects, a retailing business and a Training in Leadership, Documentation conducted in 2009 and 2012. The project uses a trainings and they provided support on different goat rearing venture. and Youth Participation three pronged approach that: equips youths with technical issues. Issues that emerged from the Sixty-two participants from Mangwe were trained in basic leadership, documentation and youth information and life-skills in SRHR, HIV and AIDS trainings included the urgent need to address socio- Solution Focused Approach (SFA) that will enable them to adopt and maintain positive participation to equip youths with skills to enable them cultural beliefs, poverty, unemployment, limited Trainings health behaviours whilst also building the capacity to accurately document and share their work with educational opportunities and lack of SRH services Twenty-two youths from Mangwe -- 10 males and 12 of the community to provide life-skills and PSS to females -- were trained in basic counselling using the various stakeholders and gain basic leadership skills. from the clinics due to distances as they hinder youths youths through the use of different tools. The project Solution Focused Approach (SFA) that emphasises The trainings also helped participants identify spaces from accessing services. Previously trained youths also creates platforms for youths to discuss SRHR the importance of highlighting the strengths and and platforms they can use to advocate for increased showed that they were more knowledgeable and identify areas of concern that can influence abilities of youths and children as a strategy to and improved SRH services from different service SRHR programming and policy formulation and especially on issues related to sexuality and life-skills. increase their resilience. It also identifies the inner providers. Youths were encouraged to take advantage lastly aims to improve the economic status of youth They were able to effectively facilitate sessions on strengths of an individual that can assist him/her to of available spaces whilst also identifying potential through trainings and support of livelihood projects. different topics under peer education and lead address the challenges at hand. Three spaces they can claim in order to raise their concerns, The year 2016 was the last phase of the three-year discussions with different members of the community. representatives of community structures also attended share information, get additional support from project. the trainings as a strategy to ensure peer educators community and district level as well as documenting receive support and mentoring from community level. and sharing best practices. After the training, there has Youths that had been previously trained in this been a marked increase in the number of youths approach said the strategy was effective in helping attending and being active in ward assemblies, youths to address own issues. Peer educators are now community work and meetings as well as holding regular peer counselling sessions as part of developmental projects. Youths are also now active in their roles and do referrals to different community structures such as the Young People`s Network on support structures such as the police, the health SRH, the District AIDS Committees and Child facility and VHWs among others. Protection Committees and others.

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Youth Led Initiatives Sports Galas Trained peer educators and youths plan, implement Eight sports galas were held during the year under and monitor small activities at community level in a bid different topical themes reaching out to a total of 1030 to disseminate information to other youths in particular youths. Three galas were held in Mangwe and five in and the community in general. Different activities such Bulawayo. Sports is used to mobilise youths who get to as sports galas, talk shows, theatre, talent shows, road enjoy different disciplines whilst also receiving shows, debates, quiz, clean up campaigns and information using one on one discussions, spot modelling are used to reach out to as many youths as quizzes, focus groups discussions and mini possible with different information related to SRHR presentations. Additional services such as voluntary and life skills. Through the activities, 1830 youths and counselling and testing (VCT), Voluntary Medical Male 300 community members, including children were Circumcision (VMMC), screening for non- reached. These activities promote community communicable diseases, counselling and distribution cohesion, give the project visibility and promoted of contraceptives are also available during the galas. networking with other organisations such as the Galas have been successful in giving visibility to the Zimbabwe National Family Planning Council project and raising awareness on different topical (ZNFPC), Population Services Zimbabwe (PSZ), Girls themes such as substance abuse, age of consent to Legacy, Restless Development, SKIT and National sex, peer pressure, 16 days of activism and World AIDS Council (NAC). AIDS Day (WAD).

Networking Advocacy Youths in Mangwe have engaged various stakeholders Youths in Bulawayo were active in advocacy including all ministries that promote and support campaigns using different activities under the theme of economic initiatives of youths. Mangwe local authority the Global Action Month of promoting ecological rights WAD Commemorations in Kwekwe always supports of youth activities and has provided of children in Zimbabwe. At least 480 participants of continuous technical support to the youths under the which 63 were adults were reached through the programme. Plumtree AIDS Project, Hand in Hand, different activities that included quizzes, discussion Commemorations, Exhibitions and community dialogues aimed at breaking the silence on TBT and SKIT have complemented CWGH efforts by forums, tree planting, awareness campaigns and a Conferences Gender-Based Violence (GBV) that reached out to 220 equipping youths with information and skills on clean-up campaign. The youths also took part in the Youths in Bulawayo were active in different exhibitions participants of which 160 were youths. WAD different issues related to health, economic annual sponsored walk that promotes environmental such as the Zimbabwe International Trade Fair (ZITF) Commemorations were held in collaboration with NAC empowerment and community development. in both areas with youths being at the forefront of the preservation and management where participants where they represented the ZNFPC and the YPNSRH and disseminated information on SRH and youth activities. Eight of the youths were active in the In Bulawayo, youths have benefited from trainings they were advocating for communities to be more development to the public. Youths commemorated the preparations. The Annual Youth Conference was held received from ZNFPC, Ministry of Youth, YMCA, PSI, responsible and promote environmental management. Day of the African Child under their different districts. in Bulawayo under the theme “Leaving No one RAPT, NAC and the BCC-Youth Services Department. They also utilised available spaces to advocate for the Cancer awareness was commemorated with support Behind – Youth Contribution towards Universal A district review meeting was held in Mangwe for harmonisation of the existing laws related to children from RAPT, the Cancer Association and the Bulawayo Health Coverage” and reached out to 64 participants different stakeholders to apprise them of project and youth with the constitution and are still advocating City Council (BCC) health services department from various stakeholders, line ministries progress and to get their insights into future for the increase in the age of consent to sex from 16 to reaching out to 240 youths. Youths in both areas representatives, youths from the different centres. programming. It was recommendations that there is 18 years. Ten community dialogues were held in both commemorated the 16 Days of Activism by holding need to focus on teenagers and early teens in school areas serving as a platform to promote communication as they are the “vulnerable age”. The importance of between youths and adults as well as to raise encouraging youths to actively work with their awareness on the challenges youths face. The community structures and the need to hold more dialogues were also meant to draw up solutions to the outreach activities targeting youths who have not been challenges youth face in a bid to promote the multi- trained was emphasised.

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Future Plans Associated Mineworkers Union of Zimbabwe (AMWUZ) Knowledge levels on SRHR, HIV, life skills, PSS and IGAs among youths have increased as evidenced by Bulawayo Health and Community Welfare Task Force (BHCWTF) responses during sessions, the depth of the questions they pose and the quality of reports they produce. Bulawayo United Residents Association (BURA) And because of their assertiveness, high level of communication skills and the high self-esteem, such youths are regularly selected to represent their areas by organizations such as the NAC and ZNFPC. The CARELITE Counsellors increasing number of adults attending youth activities also shows the appreciation that adults have of the Combined Harare Residents Association (CHRA) project and this is largely through the appreciation of the spaces provided to engage with youths and the Chinhoyi Residents and Ratepayers Association (CRRA) training received by both parties in communication, PSS and life skills. The youths have shown the Conference of Religious RC Zimbabwe conversion of information into action by seeking further education, adopting safe sex practices such as the Consumer Council of Zimbabwe (CCZ) reduction of multiple concurrent partnerships, the use of condoms correctly and consistently, the seeking of HCT, VMMC, contraception and other preventative services. Although the project ended in 2016, there is Counselling Services Unit (CSU) hope of future funding which will focus on expanding the current project focus and widening target reach to General Agriculture Plantation Workers include in school youths through working closely with the Ministry of Education and the Department of Union of Zimbabwe (GAPWUZ) Social Services. Gweru Residents and Ratepayers Association (GRRA) Harare Residents Trust (HRT) Informal Traders Association of Zimbabwe (ITAZ) Marondera Residents and Ratepayers Association (MRRA) Mutare Residents and Ratepayers Association (MRRA) National Council for the Disabled Persons of Zimbabwe (NCDPZ) Plumtree Aids Project (PAP) Public Service Association (PSA) Rusape Residents and Ratepayers Association (RRRA) Shilloh Zimbabwe The AIDS and ARTS Foundation (TAAF) Women and AIDS Support Network (WASN) Women's Action Group (WAG) Zimbabwe Aids Aid Organisation (ZHAAO) Zimbabwe Commission for Justice and Peace in Zimbabwe (CCJPZ) Zimbabwe Confederation of Midwives (ZICOM) Zimbabwe Congress of Trade Unions (ZCTU) Zimbabwe Council of Churches (ZCC) Zimbabwe Diabetic Association (ZDA) Zimbabwe Farmers Union (ZFU) Zimbabwe Homeless People's Federation (ZHPF) Zimbabwe Network of HIV Positive Women (ZNPW) Zimbabwe Network of People Living with HIV/AIDS (ZNNP+) Zimbabwe Women's Resource Centre and Network (ZWRCN) Zimbabwe Young People Development Coalition (ZYDPC) Peer Educators after a community meeting in Mangwe District in Matabeleland South Province. ZimRights

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Buhera, Bubi, Matopos, Mutasa, Arcturus, Bulawayo, Chikwaka, Chimanimani, Chinhoyi, Chipinge, Hwange, Kariba, Chiredzi, Chirumanzu, Chitungwiza, Chiwundura, Filabusi, Insiza, Gweru, Kwekwe, Masvingo, Marondera, Mutare, Plumtree, Rusape, Tsholotsho, Chikomba, UMP, Victoria Falls, Zhombe, Bindura, Nyava and Zvishavane

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72 Community Working Group on Health Community Working Group on Health

312 Samora Machel Avenue, Harare PO Box BE 1376, Belvedere Harare, Zimbabwe Tel: +263 4 498692, 498983, 498926 Email: [email protected] Website: www.cwgh.co.zw

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