Over the years, HIV control strategies and approaches in Zimbabwe have evolved to address the changes in the epidemic and according to new evidence. Due to this evolution, the country has ended up with many vertical sub-programs under the HIV program including Care and treatment, HIV Testing Services, Voluntary medical male circumcision (VMMC), Sexually transmitted infections (STIs) and Prevention of mother-to-child transmission (PMTCT) among others. Until now, each of these programs has had separate planning including own program reviews and development of own strategic plans with no synchrony. In November 2017, WHO led the review of the Care and Treatment program. It was noted during this review that this approach reduced coordination and integration and was inefficient. One of the key recommendations made was that the country should consider reviewing the HIV programs together and develop a joint strategic plan. In addition to improving coordination this would also improve efficiency by avoiding duplication of activities across the sub-programs. WHO participated in several meetings to discuss operationalization of this recommendation, and it was agreed by the Ministry of Health and Child Care (MOHCC) leadership that the recommendation would be implemented in 2019.
The joint review was conducted from 16th to 26th September 2019. The activity was supported by reviewers from all three levels of WHO including from other country offices in the African region (Liberia and South Africa). In a clear demonstration of partner commitment, the other reviewers were drawn from UN agencies, World Bank, Global Fund, PEPFAR and other implementing partners. The review will be followed by the development of the joint HIV Health Sector strategic plan which is planned for the fourth quarter of 2019. The evaluation will provide a situational analysis for this strategic plan and will inform the design and implementation of the new strategies. The strategic plan will also inform the development of the Global Fund application in March 2020.
Speaking at the launch of the program review mission, WHO Representative Dr Alex Gasasira remarked that "The goal to end AIDS by 2030 and Universal Health Coverage can only be achieved through strong partnerships that promote synergy as we are seeing in this review"
Activities conducted during the review included interviews with MOHCC leadership, key implementing partners, service providers and civil society organizations (CSOs). Field visits were conducted to health facilities and communities in all the 10 provinces of the country to understand the programmatic successes and gaps as well as suggestions for implementation strategies. During the same time an HIV epidemiology and program impact review was conducted. Reports on the two components are being developed.
Director of the AIDS and TB Program in the MOHCC Dr Owen Mugurungi during the final debriefing meeting expressed the desire to enhance coordination across all programs "This review and strategic plan development is an important learning point as we seek to improve our planning and integration across all our programs".
In addition to the review involving all stakeholders and allowing ownership of the outcome, this approach appears to be more efficient since all data collection was conducted in ten days. Additionally, all partners pooled their resources including human and financial towards this exercise creating efficiency from the synergy.
The Joint program review and strategic planning will contribute to WHO's leadership role in global efforts to achieve universal health coverage specifically to GPW13 Outcome 1.1. Improved access to quality essential health services.