Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized © International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington DC 20433 Internet: www.worldbank.org; Telephone: 202 473 1000 This work is a product of the staff of The World Bank. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the Executive Directors of The World Bank or other partner institutions or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colours, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. 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Translations – If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and should not be considered an official World Bank translation. The World Bank shall not be liable for any content or error in its translation. All queries on rights and licenses should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington DC, 20433, USA; fax: 202-522-2625; email: [email protected] ii Acknowledgements This report was prepared by the World Bank team comprised of: Marelize Gorgens (Task Team Leader), Melusi Ndhlalambi (Senior Public Health Specialist); Dr Gerald Shambira (Consultant); Chenjerai Sisimayi (Health Specialist/Consultant) and Caroline Mudondo (Consultant). Many others from inside and outside the World Bank provided input, comments, guidance, and support at various stages of implementation and reporting. These include: Dr Mhlanga (Director for Preventive Services, Ministry of Health and Child Care [MoHCC]); Dr Zizhou (Principal Investigator, Provincial Medical Director, MoHCC); Mr Amon Mpofu (Co-Principal Investigator, Director of Monitoring and Evaluation, National AIDS Council); Dr Kudakwashe Takarinda (Co-Investigator, MoHCC); Isaac Taramusi (Co-Investigator, National Aids Council, M&E Coordinator); Ms Fatima Mhuriro (National SRH & HIV linkages Program Coordinator, MoHCC); Mr Brilliant Nkomo (Interim Strategic Information Manager, MoHCC); and Ms Farai Sekeramayi Noble (World Bank Program Assistant, Harare Country Office). CordAid and Crown Agents provided incentives payment services for the intervention component. The Ministry of Health and Child Care and the World Bank task team would like to thank all the PHEs, DHEs and primary care facilities in the intervention districts for their participation and involvement: DISTRICT CONTACT PERSON ALTERNATIVE MASHONALAND Sanyati Rosemary Tsitsi Banda Alexio Denhere (Acting DNO) WEST Makonde Margaret Gavara Shleen Kanyenda PROVINCE Kariba Rusia Rashamira (DNO) Stephen Siachakanzwa PMD’s OFFICE PNO Farayi Marufu Majory Manjoro MASVINGO Masvingo Margaret Gumbo Annette B Breda PROVINCE Chivi Constance Chiteure Zhou Shumbayawonda Mwenezi Henry William Mataru Esther Dube Chiredzi Zitarei Leornard Bhasera Virginia Tapererwa Gutu Shepherd Kuchicha Eddies Joe PMD’s OFFICE PNO Afra Chiwanza Miriam Washaya Timirira Zindava MASHONALAND Marondera Marian Fadzi Dembezeko Regina EAST PROVINCE Mutoko Shingirai Masunda Lucy Dadirayi Dengezi Chikomba Esnath Mugumira Sunungurai Nyanhi Wedza Lucia Murima Alice Matiza PMD’s OFFICE PNO Eunice Takura Loice Mwedziwendira MATABELELAND Umzingwane Anelia Ndlovu Tsoelopele Dube SOUTH Beitbridge Farai Samson Khosa (CHN) Taurayi Chikutye Monica Miriam Mbawa (DNO) Matobo Norman Gideon PMD’s OFFICE PNO Joyce Sibanda-Dube Mildred Senda Special thanks to the following Provincial Medical Directors (PDMs): Dr Simukai Zizhou in Mashonaland East; Dr Amadeus Shamu in Masvingo; Dr Rudo Chikodzero in Matabeleland South and Dr Wenceslous Nyamayaro in Mashonaland West. iii List of Acronyms AIDS Acquired Immunodeficiency Syndrome ART Antiretroviral Therapy ASRH Adolescent Sexual and Reproductive Health CHN Community Health Nurse DFID Department for International Development (U.K. government) DNO District Nursing Officer HIT HIV training HIV Human Immunodeficiency Virus IUCD Intrauterine Contraceptive Device MoHCC Ministry of Health and Child Care NAC National Aids Council OI Opportunistic Infection PHC Primary Health Care PLHIV People Living with HIV PMD Provincial Medical Director PMTCT Prevention of Mother-To-Child Transmission PNO Provincial Nursing Officer RBF Results-Based Financing SOP Standard Operating Procedure SRH Sexual and Reproductive Health STI Sexually Transmitted Infection UNAIDS Joint United Nations Programme on HIV and AIDS UNFPA United Nations Population Fund VMMC Voluntary Medical Male Circumcision WHO World Health Organization iv List of Figures FIGURE 1: EXPENDITURE ON INCENTIVES. BY DISTRICT, ALL ROUNDS .................................................................. 11 FIGURE 2: PERCENTAGE PERFORMANCE ASSESSMENT SCORES BY ROUND IN MASHONALAND EAST PROVINCE (LEFT) AND MASHONALAND WEST PROVINCE (RIGHT) ............................................................................................. 12 FIGURE 3: PERCENTAGE PERFORMANCE ASSESSMENT SCORES BY ROUND IN MASVINGO PROVINCE (LEFT) AND MATEBELAND SOUTH PROVINCE (RIGHT) ............................................................................................... 12 FIGURE 4: PROPORTION OF HOSPITALS WITH UP TO DATE VERSIONS OF SPECIFIC SERVICE GUIDELINES OBSERVED AS AVAILABLE DURING VISITS FOR ROUNDS 2–4 .......................................................................................... 14 FIGURE 5: PROPORTION OF HOSPITALS WITH UP TO DATE VERSIONS OF SPECIFIC SERVICE GUIDELINES OBSERVED AS AVAILABLE DURING VISITS FOR ROUNDS 2–4 .......................................................................................... 14 FIGURE 6: STOCK-OUTS OF RAPID HIV TEST KITS, ARVS FOR ADULTS AND CHILDREN IN THE PREVIOUS 3 MONTHS ..... 15 FIGURE 7: STOCK-OUTS OF FAMILY PLANNING COMMODITIES .......................................................................... 15 FIGURE 8: MODEL OF PROVIDING HIV TESTING AND COUNSELLING AND MODERN CONTRACEPTIVE METHODS, BY ROUND ............................................................................................................................................ 17 FIGURE 9: PROPORTION OF HOSPITALS PROVIDING “INTEGRATED” HIV-SRH SERVICES, BY ROUND ......................... 18 FIGURE 10: PROPORTION OF CLIENTS WHO RECEIVED AN “INDEX SERVICE PLUS ONE” BY ROUND (PHC ONLY) ........... 18 FIGURE 11: EXTENT OF INTEGRATION BY PROVINCE BY ROUND (PHC ONLY) ....................................................... 19 v List of Tables TABLE 1: RBF DISTRICTS (HIV-SRH TRAINING AND INTERVENTION SELECTION STATUS) ......................................... 5 TABLE 2: SUMMARY SCORES FOR EACH PARTICIPATING DISTRICT ........................................................................ 10 TABLE 3: USE OF INCENTIVE PAYMENTS, ALL ROUNDS AND DISTRICTS ............................................................... 10 TABLE 4: SUMMARY OF HIV-SRH INTEGRATION CHECKLIST SCORES BY DISTRICT FOR SUPERVISION ROUNDS 1–4 ...... 11 TABLE 5: TYPE OF INTEGRATION AMONG PHC FACILITIES, BY ROUND ................................................................. 16 TABLE 6: TYPE OF INTEGRATION AMONG HOSPITALS, BY ROUND ........................................................................ 17 TABLE 7: INDICATORS OF HIV-SRH INTEGRATION AMONG HOSPITALS BY ROUND ................................................. 19 vi Table of Contents ACKNOWLEDGEMENTS ................................................................................................................. III LIST OF ACRONYMS ....................................................................................................................... IV LIST OF FIGURES ............................................................................................................................. V LIST OF TABLES ............................................................................................................................. VI EXECUTIVE SUMMARY ................................................................................................................... 1 1. INTRODUCTION AND BACKGROUND ....................................................................................... 4 2. IMPLEMENTATION ARRANGEMENTS ...................................................................................... 7 2.1 SUPERVISION CHECKLISTS .............................................................................................................. 7 2.2 TRAINING AND ORIENTATION WORKSHOPS