ZIM-809-G11-H Towards universal access: in HIV prevention, treatment, care and support in Zimbabwe Annual Report 2220122012 31 May 2013 Table Contents 1 INTRODUCTION ............................................................................................................................................. 2 2 OVERVIEW OF THE GRANT ............................................................................................................................ 2 3 COORDINATION OF THE GRANT .................................................................................................................... 3 4. ACTIVITIES IMPLEMENTED .......................................................................................................................... 4 4.1 BEHAVIOUR CHANGE COMMUNICATION ................................................................................................................ 4 4.2 TESTING , COUNSELLING AND ART ........................................................................................................................ 4 4.3 PMTCT .......................................................................................................................................................... 6 4.4 CARE AND SUPPORT : SUPPORT FOR THE CHRONICALLY ILL .......................................................................................... 6 4.5 SUPPORT FOR ORPHANS AND VULNERABLE CHILDREN ................................................................................................ 7 4.6 TRAINING ......................................................................................................................................................... 7 4.7 PROGRAMMATIC MONITORING OF THE PROJECT ..................................................................................................... 7 4.8 MONITORING AND SUPERVISION ........................................................................................................................... 8 4.10 QUARTERLY JOINT REVIEW MEETINGS ................................................................................................................. 8 5.1 FOLLOW UP OF DATA QUALITY ASSESSMENT RECOMMENDATIONS (DQA) ......................................................... 8 5.2 REVISION OF PERFORMANCE FRAMEWORK (PF) ...................................................................................................... 9 5.3 GRANT PERFORMANCE ..................................................................................................................................... 10 6 FINANCIAL SUMMARY ................................................................................................................................ 12 7 PROCUREMENT AND SUPPLY MANAGEMENT ............................................................................................. 13 8 CAPACITY DEVELOPMENT PLAN ................................................................................................................. 13 9 CHALLENGES AND SUCCESS STORIES ........................................................................................................... 16 9.1 CHALLENGES ................................................................................................................................................... 16 9.2 SUCCESS STORIES ............................................................................................................................................. 16 1 1 INTRODUCTION This report highlights progress made in the implementation of program activities under the HIV Round 8 Phase 2 Year 3 Grant. It provides the status of achievement of project’s objectives, targets and linked activities, during the period from January to December 2012. There was a continued collaborative effort by CCM, PR, Sub-Recipients (SRs) and their Implementing Partners (IPs). These are mainly Health facilities under the Ministry of Health and Child Welfare in all the country’s districts, the Civil Society i.e. ZAN and AIDS Services Organisations (NGOs, CBOs) and the national HIV coordinating body, NAC selected as sub-recipients (SR) to implement community related HIV and AIDS interventions. Development and Technical partners provided technical assistance and additional funding to the programme. The role played by the CCM in providing oversight leadership and follow-up of implementation of the project and technical guidance has enabled smooth operation of the project. Working partnership between the PR and the SRs in devising strategies for implementation of the grant, coordination of capacity building, and monitoring and evaluation, collectively, have provided the basis for good performance, including exceeding most of the targets. This report highlights some of the challenges faced in implementation of the project as well as success stories. 2 OVERVIEW OF THE GRANT Zimbabwe continues to be one of the countries in the world with high HIV infection rates. However, the country is now experiencing a declining HIV epidemic that was first observed in the late 1990’s that has been supported by data from the population based surveys, i.e. the Zimbabwe Demographic and Health Survey 2010/11 and the Antenatal Clinic Surveillance data of 2009. The estimated HIV and AIDS prevalence in adults (age 15 to 49 years) in Zimbabwe was 16.28% (15.56 -16.87%) in 2008 and declined to 15.67% (15.05-16.3%) in 2009 and further declined to 14.56 (14.02-15.36) in 2012 according to the revised 2011 HIV Estimates. According to the ZDHS 2010/11 the prevalence rate declined from 18 % in 2005/06 to 15% in 2010/11. The HIV prevalence in children was estimated to be 3.51 (3.11-4.05) in 2012. According to MOHCW, the estimated number of people living with HIV was 1,242,768 (1,175,185 – 1,344,482) i.e. 1,053,535 adults and 189, 233 children living with HIV in 2012. The total number of people in need of ART in 2012 was 657,178 i.e. 545,757 adults and 111,421 children. The number of children orphaned and made vulnerable by the impact of HIV and AIDS in Zimbabwe remains high. Heterosexual contact is the principal mode of HIV transmission in Zimbabwe. The level of knowledge about HIV and AIDS prevention was high with 75.7% women (15-49 years) and 81.3% men (15-54 years) who knew that condoms could be used to reduce the risk of getting HIV according to the Zimbabwe Demography and Health Survey (2005/06). The second most important mode of HIV transmission is peri-natal and occurs when the mother passes HIV to the child during pregnancy, at birth or during breastfeeding (UNGASS, Zimbabwe – 2010 Country Progress Report). The grant supports national efforts to address critical gaps in the national response to achieve universal access to HIV prevention, treatment, care and support. The main goals of this grant are to reduce the rate of HIV incidence (prevent new infections), and reduce HIV related morbidity and mortality in Zimbabwe. The specific objectives of the grant are: 1. To increase adoption of safer sexual behaviour and reduction in risky behaviour (National BC Strategy Outcome 2). 2. To increase the number of children (18 months -15 years) and adults who have tested for HIV, including receiving results. 2 3. To reduce transmission of HIV from mother to child by providing comprehensive PMTCT services. 4. To expand provision of comprehensive HIV and AIDS care, treatment and support including ART services in public and private sector facilities. 5. To strengthen the involvement of communities in the provision of ART services. 6. To strengthen national institutional capacity to coordinate OVC interventions. 7. To strengthen mechanisms for coordination, collaboration and accountability among PLWHIV networks in the mainstreaming of MIPA within the national response. Another important component of the grant is the capacity building of the four SRs in the areas of Program Management, Financial Management, Procurement and Supply Management and Monitoring and Evaluation in preparation for them to become the Principal Recipients of GFATM grants in future . 3 COORDINATION OF THTHEE GRANT There was no change in the implementation and coordination mechanisms from Phase 1 (2010-2011) of the grants. The same SRs were maintained in Year 3 of the grant. In March 2012, the GF Board decided to discontinue funding for two Service Delivery Areas (SDAs) “Orphans and Vulnerable Children (OVC)” and “BCC -Mass Media”, in HIV/AIDS Phase 2 grant, as the activities proposed under these SDAs were not considered “High Impact” as per the UNAIDS HIV/AIDS Investment Framework. As a result organizations responsible for the implementation of these components - MoLSS and PSI/SAfAIDS – participated in the implementation of the activities only in the first 6 months of the year. The details of the activities implemented by these SSRs are included in end of project reports submitted to the CCM Secretariat on 30 April 2013. The SRs for the grant are: Ministry of Health and Child Welfare The Grant agreement between the Principal Recipient and the Ministry of Health and Child Welfare (MOHCW) was signed on 6th July 2012 MOHCW is responsible for the following objectives under the grant to (i) increase the number of children (18 months - 15 years) and adults who have tested for HIV, including receiving results, (ii) reduce transmission of HIV from mother to child by providing comprehensive PMTCT services, (iii) expand provision of comprehensive HIV and AIDS care, treatment and support including ART services in public and private sector facilities, and (iv) strengthen