N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 18648

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18648 18648.08 U.S. Agency for Partnership for 8143 8143.08 USAID/PFSCM/ $3,230,000

International Supply Chain ARV

Development Management Drugs/GHAI

Program Budget Code: 19 - HVMS Management and Staffing

Total Planned Funding for Program Budget Code: $2,347,652

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

USG PEPFAR Zimbabwe Team

The USG team in Zimbabwe comprises: US Department of Health and Human Resources (HHS) Centers for Disease Control

(CDC); US Agency for International Development (USAID); US Department of Defense - Defense Attaché Office (DAO); and US

Department of State - Public Affairs Section (PAS). The HHS National Institutes of Health (NIH) have headquarters funding for

Zimbabwe but do not participate actively in PEPFAR planning or management at post.

The USG PEPFAR team in Zimbabwe consists of a seasoned group of skilled professionals with numerous years of experience

working in HIV/AIDS in the US, Zimbabwe, and other countries. The team is recognized by the broader HIV community in

Zimbabwe for its leadership and technical skills. As shown in the previous Program Area Context sections of this COP, for FY09

the team plans to again leverage funds exceeding a 1:1 ratio, thus fulfilling the "catalytic leveraging" scenario of the 5 Year

Strategy.

CDC brings to the PEPFAR Zimbabwe team technical expertise in clinical care and treatment -- including PMTCT, TB/HIV, adult

and pediatric care and treatment, and laboratory infrastructure - as well as strategic information, surveillance, policy, and human

capacity development. CDC Zimbabwe has reduced total staff numbers in the last 12 months, from 38 to 24 positions, due

primarily to greater use of ICASS administrative services. These 24 positions comprise 3 US Direct Hires (USDH) and 21 Locally

Employed Staff (LES). Within the USDH, while the position of Country Director is filled, the positions of Deputy Director for

Operations and Senior Public Health Advisor (Deputy for Science) are currently vacant but are expected to be filled in FY 09.

Under LES, there are 13 technical staff in the following areas, two Public Health Specialists (PHS) in Care and

Support/Treatment, one PHS in Laboratory Infrastructure Support, one in Laboratory IT, one PHS in Human Capacity

Development (HCD), one Finance and Coordination Specialist, two PHS in Data and Surveillance, one Program Assistant, and

four Administrative Assistants. There are also nine administrative staff who spend 100% time on support activities. Two staff

members split their time between administrative and technical activities: the Director and the Administrative Specialist.

USAID brings to the PEPFAR Zimbabwe team technical expertise in PMTCT, sexual prevention, OVC, counseling and testing,

ART drugs and logistics, strategic information, policy, and organizational capacity development. USAID's HIV/AIDS office has

shifted in composition in the last 12 months. The current staffing pattern includes 1 USDH, 1 Cooperative Assistance Support Unit

(CASU) Senior Technical Advisor, 2 LES medical doctors, 1 LES Strategic Information Officer, 1 Monitoring and Evaluation

Officer, 1 OVC Specialist, and 2 administrative support staff. USAID GHCS funds also support 55% time of the Chief Accountant

and 1 full-time driver.

Both DOD and PAS manage their HIV/AIDS activities through staff funded by their respective agencies, estimated at 10%-25%

time. DOD in Zimbabwe did not request FY09 funding due to the Zimbabwe Defense Force's well-documented participation in

committing gross human rights violations to influence the outcome of Presidential and Parliamentary elections in Zimbabwe.

Despite this, the military will have access to the broad spectrum of USG supported public health programs outlined above, and

DOD staff will continue to participate in USG PEPFAR team events.

PAS provides journalism training and other media outreach, and provides technical expertise in positioning for the overall USG

PEPFAR program.

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. A number of USG-supported community outreach activities were either suspended to protect staff and

potential participants, or shifted to urban areas that required less travel and exposure.

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. 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.

The impact of these stressors on the PEPFAR Zimbabwe program is summarized briefly in each of the program area narratives

earlier in this COP. The impact on human resources essential to management is severe: as of December 2007, the Ministry of

Health and Child Welfare reported a 68% vacancy rate in senior management positions, a 63% vacancy rate for doctors, and a

39% vacancy rate for nurses. These rates have certainly increased since that time. PEPFAR partners and USG agencies are also

struggling to recruit and retain staff. Given the deteriorating environment, however, the desire of Zimbabweans to seek greener

pastures is difficult to deny.

Staffing For Results

As reported in COP08, the PEPFAR Zimbabwe team began initial steps in its staffing for results (SFR) implementation plan in

fourth quarter FY07. In May 2008, the team built on these initial efforts and held its first Joint Portfolio Review (JPR) on May 20-

21, 2008. The participants represented the four USG agencies implementing PEPFAR in Zimbabwe: DAO, PAS, CDC and

USAID.

The first JPR served both as a learning experience as well as a team building, a time for the PEPFAR Zimbabwe technical

personnel to come together and share experiences on how the various activities were performing mid-way through the year. The

review used a portfolio review template derived from the OGAC template, as modified and informed by templates used in Nigeria,

Malawi, and Botswana. During the course of the review, the team identified necessary modifications and improvements for the

next JPR. All agreed it was a valuable experience that should be repeated no less than annually.

The team reviewed the status of on-going and new PEPFAR activities for the period October 1, 2007 - March 31, 2008. The team

found that in spite of the increasingly difficult operating environment for most of the reporting period, in terms of meeting planned

targets the Zimbabwe portfolio was solidly on track. The team shared a written report-out of the JPR, and discussed the

experience with the Core Team in a conference call. There were no significant issues raised.

The JPR and subsequent all-partner meetings (a new initiative of the inter-agency team) have greatly enhanced the information

available for, and quality of, the COP09 planning process. All team members and partners completed activity planning templates,

even though they are not required for a Mini-COP. Partners and USG staff have a much better understanding of PEPFAR

objectives and operations. The PEPFAR Zimbabwe team hopes to continue to hold JPRs annually, in April, to maintain inter-

agency collaboration.

Unfortunately, shortly after the FY08 JPR, 4 senior CDC staff departed post (an additional person had departed a month earlier),

followed by the USAID LES medical doctor a month later. These departures, on top of a number of existing staff vacancies, left

the USG PEPFAR Zimbabwe team with what can only be described as skeleton staff. CDC was left with one USDH (the Director)

and two LES technical staff for its $6 million program, and USAID has operated its $20 million (including USAID Population and

TB wraparounds) program with 2 technical staff - the USDH Health Officer and the SI Advisor. (The SI Advisor has announced

that he will depart Zimbabwe in December 2008). CDC has recently hired 3 LES consultants to fill critical gaps, and is benefiting

from short-term assistance from CDC Ethiopia. USAID expects to fill the OVC Specialist and one medical doctor position soon.

Conditions in Zimbabwe continue to deteriorate, so that recruiting expatriates and/or retaining professional national staff are both

time-consuming and often fruitless tasks. For the USG PEPFAR team and its implementing partners, recruitment has become a

top priority that must be balanced with on-going program implementation issues.

The current team of six (6) active full-time technical professionals (1-PAS; 3-CDC; 2-USAID), with as-indicated participation of

DOD, can thus be considered one Technical Working Group (TWG) for the purposes of SFR to implement the $26.5 million

(without wraparounds) country program. As and when new positions are filled, this team foresees forming and working through

three TWGs: Prevention, Care & Treatment, and Cross-Cutting. Given recruitment problems and the accelerated pace of

hyperinflation, infrastructure failure, and political uncertainties, the team is not able to predict when this functional structure will be

launched.

Coordinator

Zimbabwe has not to date had a full-time Coordinator due to its low level of funding (total COP09 $26.5 million, of which $3.3

million is GHCS-State funding) and to the ease of communication among the agencies at post. Based on discussions with OGAC,

however, this COP09 includes a funding allocation within the USAID budget, with GHCS-State funds, for a Coordinator position.

Recruitment is expected to begin in 3rd or 4th quarter FY09 when funds become available.

Table 3.3.19: