N/A

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 17 - HVSI Strategic Information

Total Planned Funding for Program Budget Code: $752,293

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

USG has a well-developed and ongoing strategic information program built upon a strong commitment to the "Three Ones" and to

coordinating SI activities among all key stakeholders in Zimbabwe. USG works directly with the Ministry of Health and Child

Welfare (MOHCW), Ministry of Public Service, Labor and Social Welfare (MPOSLSW) and national AIDS Council (NAC) and plays

a leading role in providing technical assistance (TA) in the design and development of health management information systems,

including those for monitoring, evaluation, and logistics. USG's SI liaison, who represents USG in National M&E Advisory Group,

oversees the monitoring and reporting of PEPFAR indicators and has harmonized the various databases used by USG agencies

for PEPFAR planning and reporting. The challenge is to now effectively use this data for program improvement through regular

program area working group meetings.

Summary of USG Program

USG's Strategic Information program is built around the PEPFAR Zimbabwe 5 Year Strategy and maintains the strategy's 3-

pronged approach of: (1) systems strengthening; (2) development of tools and models for broad use; and (3) building the capacity

of local organizations to implement successful systems. USG is involved in several major, ongoing strategic information initiatives.

Since 2000, the USG has supported routine sentinel Antenatal Clinic (ANC) surveillance by providing extensive technical support,

purchase of necessary commodities, logistics planning and data analysis. USG involvement in ANC surveys helps ensure that

reliable trend data on HIV prevalence are available. The ANC survey scheduled for FY08 has been deferred. Participation in

population-based surveys has seen the USG leading the effort to carry out an extended analysis of the Demographic and Health

Survey (ZDHS) 2005-06, in collaboration with the MOHCW, UN agencies, DFID and NGOs. Analysis teams have been put

together and USG has provided extensive TA in the development of the analysis plans and in FY09 will conduct a workshop to

train team members in using statistical analysis software packages. Results of the extended analysis will serve as a framework for

planning for a Young Adult Survey. USG also supports the Early Warning Indicators Drug Resistance Survey (EWI) in conjunction

with MOHCW and WHO which will be completed in FY09 and the development of an OVC Quality Standards manual with the

Ministry of Public Service, Labor and Social Welfare (MOPSLSW).

USG provides extensive TA directly to the M&E department at the National AIDS Council (NAC) for strengthening the National

M&E System. In FY08, USG provided contract support and facilitated visits by M&E consultants through the Global Fund TA

mechanism to assist NAC in developing a National M&E Plan (2009 - 2014) and a National M&E Action Plan (2009) for all

HIV/AIDS programs. This TA will continue in FY09 and further TA will be requested through this mechanism to follow up on

implementation of the M&E Action Plan. Support also continued for the rolling out of the Country Response Information System

(CRIS) which National M&E System. An electronic medical health record project is also underway to support patient care and

information-gathering at USG-supported ART clinics. Data collected by these systems allows USG partners to better manage their

programs.

To fill critical gaps that have been left by the exodus of experienced and qualified professionals due to Zimbabwe's difficult social

and economic situation, in FY09 USG will continue to provide expertise in M&E, surveillance and HMIS to MOHCW and

MOPSLSW to support national SI capacity. The M&E position in the MOPSLSW National Secretariat for the National Action Plan

for OVC analyses the national OVC data so that it can be used to better coordinate the national response to OVS and advocate

for children. In addition, this position allows the Secretariat to lead development and dissemination of national standards of

service, develop tools to assess a child's well-being, and identify and document best practices. The surveillance position in the

MOHCW is responsible for coordinating all ANC surveys, National Estimates, DHS, DRTS and other routine M&E and

surveillance activities in the MOHCW. The IT position provides the routine IT support needs of the MOHCW AIDS & TB Unit. A

large computer training center at the University of Zimbabwe's Health Information Unit, which USG helped build and jointly

maintains with other donors, will host the ZHDS analysis workshops as well as other M&E workshops and trainings.

FY08 Social, Economic and Political Context

Implementation of the USG PEPFAR program in Zimbabwe during FY08 was subject to a number of severe stresses. From

January to March, during the run-up to the March 29, 2008 general elections, the highly charged political atmosphere led to a

number of disruptions and hampered implementation. The situation was even worse from April - June. Widespread Government

sponsored violence effectively closed most rural areas in the country and many urban areas. Hundreds were killed and tens of

thousands were displaced. On June 4, the Government of Zimbabwe suspended most NGO activity for almost 3 months, until

August 29, setting back many programs. Throughout the year, the continuing collapse of the Zimbabwean economy and inflation

that reached billions of percent put severe strains on programming and local partners, including NAC and government community

structures. In general, the unprecedented hyperinflation and eventual collapse of Zimbabwean currency, lack of public utilities

(water and electricity), widespread violence, and extreme political uncertainty created barriers to all programs.

USG HVSI Program and Prospects

With FY09 funding, USG will maintain its assistance to NAC and other partners to strengthen the National M&E System. Focus

areas for FY08 include: 1) training of 138 participants (85 DACs and 53 DAAOs) on M&E/CRIS as prescribed by the Zimbabwe

National Strategic Plan; 2) improve the management and reporting of data through the National M&E System including the use of

an electronic database; 3) develop a communication strategy surrounding the National M&E System; 4) strengthen the ability of

NAC national staff to monitor and support provincial and district staff, as well as local partners and stakeholders; 5) data

validation/verification of Program/ Project M&E data in light of the constraints in supervision in FY08.

Surveillance needs to be continued with expanded analysis to look at trend data from multiple sources over time and to ensure

data use for program planning. Key activities in this area include: 1) providing adequate M&E tools; 2) storing and using data

collected at facility level and upwards; 3) train HCW in use of M&E tools for data collection and on standardized patient and facility

numbering system in 20 district hospitals and 20 other health care facilities; 4) supportive supervision of facilities for ART and TB

sites in 40% of the districts (60% is covered by Global Fund and ESP) and 25% of comprehensive PMTCT sites; 5) pilot HIV/AIDS

program indicators database; and 6) complete an evaluation of ART outcomes; 7) implement HIV and syphilis prevalence in ANC

& HIV DR - TS to strengthen national surveillance and Information systems. The key result is an improvement in the reporting

rates of all OI/ART sites by 20% since reporting rates have generally been very low in FY08.

Wraparounds/Leveraging

Global Fund Round 5 includes funding to establish Service Availability Mapping, computerize the paper-based ART M&E system

in 22 districts, an annual revision of the M&E system, the development and implementation of operational research on key

national priority issues and support for development and implementation of the national ARV drug resistance surveillance system

in a sample of selected districts. Total budget is $848,500, where the main budget line is the ARV drug resistance surveillance

($696,400).

FY09 funding is also provided for direct USG technical expertise and staffing, and to the management firm Ernst and Young for

select technical assistance and audit requirements.

Table 3.3.17: