PAN AFRICAN POSITIVE WOMENS COALITIONZIMBABWE ANGLOPHONE AFRICA CS

PAN AFRICAN POSITIVE WOMEN’S COALITION-ZIMBABWE ANGLOPHONE AFRICA CS AND CG LEARNING AND EXPERIENCE SHARING FORUM 2 -3 OCTOBER 2019 NAIROBI, KENYA Experience sharing of accessing GF related TA PRESENTER: TENDAYI WESTERHOF COUNTRY COORDINATOR “amplifying the voices of women and adolescent girls living with HIV in Zimbabwe”

MISSION AND VISION A Zimbabwe where empowered HIV positive women in our diversity and adolescent girls work together with other stakeholders towards achieving a comprehensive health agenda. MISSION Our mission is to promote, employ and apply rights‐‐based approaches and partnerships that contribute to the improvement of the health, productivity and quality of life of women and adolescent girls living with HIV in Zimbabwe.

OVERVIEW OF THE CRG TA PROCESS , IMPLEMENTATION Inception; how we started the process; § Reference is made to the Ghana Anglophone Africa Meeting in March 2018 and after the TA CRG presentation from the GF Geneva team. • This is when we realized that there was a gap in the level of meaningful involvement of women living with HIV during the development of programmes is very limited. • Women living with HIV lack information on current Global Fund’s grants and have limited opportunities to provide feedback to the CCM Civil Society representative in regards to programmes for women in all their diversity. • In addition, there is no representation of women living with HIV on the CCM • As a result, there is limited or no engagement of women living with HIV in grant oversight, implementation and monitoring.

THE PROCESS OF APPLICATION • PAPWC‐ZIM requested CRG TA after the realization that while civil society is consulted with regards to programming and advocacy, there has been limited consultation with women living with HIV in all their diversity particularly in rural areas. • The CCM civil society representative and the CCM PLHIV representative further requested support towards institutionalizing an effective communication system to ensure voices of women living with HIV from the rural areas are heard. • We accessed the application form and started the process of application with the assistance of EANNASO, Gemma Oberth, Frontline AIDS and our CCM representatives. This helped us to write a winning proposal that we submitted to the CRG TA at GF.

PURPOSE AND SPECIFIC OBJECTIVES OF THE TA PURPOSE • The process was initiated in order to maximize the responsiveness and impact of Global Fund investments to women living with HIV in all their diversity. SPECIFIC OBJECTIVES • To enhance the knowledge and technical skills of organizations of women living with HIV in Global Fund processes; and • To meaningfully engage these organizations in multiple phases of the Global Fund grant and related national processes (e. g. grant making, monitoring of grant implementation and relevant national dialogue meetings).

TURN-AROUND TIME § It took us over 5 months to get approval and to receive the grant and in between there was communication with the CRG TA – Geneva and EANNASO, § The identification of a fiducial partner (ASAP) and the consultant (Victoria James from NEDICO). § This process of selecting the two did not have external influence so we had full ownership. § This was followed by the drafting of the TA with clear objectives, timeframe, deliverables, budget and roles of each party.

The implementation/process • The implementation process was guided by the TA agreement; • The title of the consultations was “Systematic Engagement of Women Living with HIV in Global Fund In Country Processes” • The process started with a meeting with Zimbabwe Women Living with HIV National Forum planning committee , followed by a stakeholder meeting from the local authorities, NAC, Mo. HCC and other stakeholders to get buy in. • Focus group Discussions with groups of women living with HIV in the five targeted districts. • Consultations focused on knowledge of the Global Fund and its related processes in Zimbabwe. • The process consulted a total of 160 women from Chegutu (34), Mhondoro‐Ngezi (35), Kariba‐ Nyaminyami (28) and Sanyati (28) and Zvimba. • The majority of respondents were aged 18‐ 24 years while the rest were aged 25 years and above. • There was an all stakeholders meeting including CCM Reps, Mo. HCC and WLHIV and PLHIV networks to report on the findings and validate the report. • Then there was an evaluation meeting with the planning committee.

FINDINGS • Support group membership is low with the majority (63%) of respondents within the assessment reporting not being members of support groups. • There is limited knowledge of the Global Fund in general with more than half (56%) of respondents reported never having heard of the global fund. • The majority of respondents (81%) reported having no knowledge of people who represents them in Global Fund processes while 19% reported knowing the people who represent them in Global Fund processes. • Among those who reported knowing representatives, none could name the representative showing the absence of knowledge.

Coordinating Structures for PLHIV in Zimbabwe • Systematic coordination and engagement of WLHIV is highly likely to succeed if investments are made towards strengthening coordination of PLHIV as a constituency of which WLHIV is a sub‐set. • Beyond overall coordination of the overall sector, the Zimbabwe Women Living with HIV Forum has been constituted to coordinate all Women and girls Living with HIV, Women living with HIV Led Organizations, Support Groups, Community Based Organizations and Networks of women living with HIV.

Entry points for engaging women living with HIV in Global Fund Processes • OI/ART Clinics • Being on treatment means they interact with health staff within the OI/ART clinic when they are collecting their medication. There are opportunities for ensuring that health service providers provide information of the Global Fund at their point of contact with WLHIV. • Community Health Workers are critical in providing information and some SRH commodities to communities. They are trained, are trusted by communities they serve and have linkages with health workers. • Behaviour Change Facilitators • The country includes Behaviour Change Facilitators (BCFs) who are responsible for supporting community‐based demand creation for HIV and AIDS related services. Their strategies include door‐to‐door visits along with community‐based edutainment. Behaviour Change Facilitators are based in communities, already deal with HIV and AIDS related issues, have relations with the constituency of PLHIV and have linkages with health facilities and other NGOs involved in the response.

Entry points for engaging women living with HIV in Global Fund Processes • Community ART Refill Groups • Community ART refill groups (CARGs) were piloted by MSF in partnership with the Zimbabwe Mo. H. There are possibilities of utilising CARGs as entry points for proving information on Global Fund processes as well as mobilizing WLHIV to be involved in processes that includes consultations on development/review of National HIV and AIDS Strategic Plans, constituency consultations in Global Fund concept note development, Global Fund monitoring visits as well as reviews. • Support Groups • There is evidence showing that support groups can be a key source of psychosocial support to PLHIV within communities. The strength of support groups is the safety and comfort emerging from the fact that all members are usually living with HIV hence there is sharing of lived realities. • Sista to Sista Mentors • Launched in September 2013, the Sista 2 Sista girls’ only clubs create safe spaces for mentoring vulnerable adolescent girls, a space where they can speak with mentors and each other about their problems and receive information, counselling and support. Female mentors manage the clubs targeting girls vulnerable to negative sexual and reproductive health outcomes. • Community Adolescent Treatment Supporters (CATS) • Community Adolescent Treatment Supporters are young HIV‐ positive people (aged 18‐ 24 years) who work between health facilities and homes of youth living with HIV (YLHIV) to increase uptake of testing, linkage and retention in care, adherence, and, services related to sexual and reproductive and mental health.

Priority/Issue related entry points • Monitoring Pre-ART including ensuring mechanisms are put in place to strengthen linkage with HTS, minimize leakage of identified PLHIV, confirmation of HIV status before ART initiation to reduce mis‐classification and causing unnecessary harm to the patients, treatment preparedness and baseline investigations. • Community monitoring to ensure ART scale using differentiated models of care for people already on treatment, strengthening toxicity monitoring, conducting operational research (e. g aging and HIV), with scaling up provision of ART envisaged at reducing community viral load and acting as prevention (Treatment as prevention‐ Ta. SP). • Mobilizing WLHIV to demand investment towards strengthening adherence and retention of PLHIV in care and treatment through scaling up of different models (treatment refill groups, treatment supporters, mother mentors/support groups among others), enhancing mechanisms for tracking clients lost to follow up; strengthening treatment monitoring as well as decentralization of viral load testing capacity; prevention and monitoring of HIV drug resistance (HIV DR) through quality improvement (QI) initiatives.

Priority/Issue related entry points • Strengthening WLHIV capacities to monitor and report challenges around identification and management of common opportunistic infections and related morbidities. This will be framed in the context of ensuring that service users (WLHIV) understand can demand holistic service provision. • Enhancing WLHIV capacities to demand enhancement of skills and capacity of health workers trough mentorship, blended learning among others to deliver a comprehensive care package grounded in human rights

RECOMMENDATIONS : STRATEGIC LEVEL • Prioritize strengthening coordination of the PLHIV sector to ensure collective prioritization and limit conflict and contestations for space. • Strengthen linkages between PLHIV with broader civil society to allow for coalescence of ideas and amplification of advocacy issues. • Explore possibilities of ensuring enhanced involvement of WLHIV in quarterly monitoring visits conducted by the CCM Secretariat. • Review existent communication structures to ensure that representatives of PLHIV within the CCM effectively consult the constituency, provide timely feedback and keep the broader constituency aware of developments.

RECOMMENDAITONS: OPERATIONAL LEVEL • Review existing structures for support groups to understand why they are failing to thrive. • Based on evidence from the review; adjust, revamp or re‐orient support groups to ensure they evolve in line with current epidemic trends and are consistent with holistic needs of WLHIV. • Strengthen linkages between WLHIV, Health Service Providers and Community based structures/cadres including Community Health Workers, Community ART Refill Groups along with Behavior Change Motivators.

LESSONS LEARNED ON ENGAGING WOMEN LIVING WITH HIV • Broader constituency coordination is a key determinant in successful coordination of sub-constituencies. The technical assistance process focused on exploring ways of enhancing involvement of WLHIV in Global Fund processes. However, WLHIV are part of the broader constituency of PLHIV which needs to be well coordinated to facilitate mobilization, coordination and systematic engagement of WLHIV. • The likelihood of success in engagement of WLHIV is enhanced by utilizing existing structures. The consultative process was successful as it leveraged on existing structures and cadres including Nurses, the District Action Committees, District Administrators, District Youth Officers and Department of Social Welfare Officers. Existing structures and cadres have relations with communities, are well trusted and their credibility facilitates smooth mobilization. • Sustainable, systematic engagement of WLHIV is likely to be achieved if focus transcends the Global Fund to focus on appreciating the epidemic, the response and different areas of involvement along the continuum. Although the process focused on the Global Fund, it is critical to ensure an understanding of the fact that Global Fund concept notes are derived from National Strategic Plans. This raises the importance of understanding the range of processes involved in the Global Fund grant application, implementation along with monitoring and evaluation. The understanding should be coupled with the identification of entry points that provide highest potential for optimum results. • Constituency mobilization and engagement is highly likely to succeed if there is a transition from a focus on structures towards prioritization of issues. Throughout the consultative process WLHIV could not identify any structures that represents them despite there being many networks representing PLHIV. Although they did not know structures and people who represent them, WLHIV could clearly articulate the issues affecting them with regards to their status and their access to relevant services.

LESSONS LEARNED ON ENGAGING WOMEN LIVING WITH HIV • The constituency of WLHIV is constituted of diverse women with a diversity of capacities. The process was designed to include completion of a self‐administered questionnaire. The approach assumed that WLHIV would be literate and in one community more than half of the women could neither read nor write and required additional support. The process provided key lessons around stronger methodological targeting and ensuring interventions are cognizant of the individual capacities of WLHIV. • Advocacy for stronger engagement should be built on a clear understanding of existing structures, systems and processes. The consultative processes aimed to enhance stronger involvement of WLHIV in Global Fund processes. However, engagements with the CCM demonstrated that WLHIV were represented by the PLHIV seat, that the current representative(s) was voted in by constituency members and that current CCM members were going to be in place for the next three years. This meant that even if there was going to be advocacy for a seat for WLHIV on the CCM, this would be a strategic advocacy item since there were minimal opportunities for that to happen in the current cycle. • Processes need to be built on an acknowledgement of existing capacities, capacity gaps as well as identification of capacity enhancement opportunities. Involvement in different processes for the Global Fund and the overall response will require different competencies. Processes like technical writing require specific skills and individuals who will represent the constituencies should be chosen based on their competencies and their potential to fully ensure their involvement brings maximum returns for their constituency.

CONCLUSION • The opportunity presented a good platform for WLWH in Zimbabwe. • This motivated us to reapply for a second TA in 2019 which has since been approved and about to be implemented. • We opted to collaborate with the same team (comprised of ASAP and NEDICO and as a result of excellent collaboration in the first TA in 2018.

THANK YOU ASANTE SANA THANK YOU CONTACT: papwcz@gmail. com