This report comprehensively summarizes the FHI/AIDSCAP program in Zimbabwe (1992-1997). The report includes a country context description, accomplishments, constraints, and outcomes of the program, and a series of lessons learned and recommendations.

Table of Contents

I.Executive Summary

II.Country Program Description

A.Introduction

B.Country Context

C.Accomplishments and Outcomes
  -Page 1
  -Page 2
  -Page 3
  -Page 4

III.Lessons Learned & Recommendations

IV.Subproject Highlights
  -Page A (See Below)
  -Page B
  -Page C

V.Non-Subproject Highlights

VI.Attachments

 

IV. Subproject Highlights

STD/AIDS Education Program of the Commercial Farmers Union
Commercial Farmers Union (CFU)
Zimbabwe AIDSCAP
FCO:53584
Implementing Agency Type; NGO
Contract Type: Subagreement
Life of Project: 01/15/95 - 07/31/97

Commercial farmers constitute Zimbabwe's second largest employer of labor after the government itself, with an estimated workforce of 270,000 to 300,000. Virtually the entire workforce lives on-site with their dependents, constituting a total on-farm population of around 2 million people, approximately 17 percent of the population of Zimbabwe. Communal farms and resettlement areas surrounding the commercial farms are also inhabited by the extended family as well as commercial sex workers (CSWs). Laborers and security guards employed on the farms who have expendable income are often clients of CSWs.

CFU is the coordinating body for the commercial farming sector. The CFU represents four, 600 licensed farms and farming companies. The original project (1987-1995) covered 25 percent of the CFU's membership. This project extended the coverage to 94 percent of the membership.

The project goal was to stabilize or reduce STI prevalence among the farm population on CFU farms nationwide. The purpose was to reduce high risk behavior among the target population. To achieve this, CFU:

1. Implemented behavior change communication interventions.
2. Established/expanded condom distribution system on the CFU farms.
3. Established/enhanced STI referrals from farm workers and their sex partners.
4. Promoted sustainability of CFU project through coordinators and peer educators, farmers paying for training costs of farm personnel, monitoring and evaluation, and conferences held.

Leveraging

Not only do CFU farmers support most of the training costs of farm personnel, but farmers wives volunteer their time to act as coordinators.

Accomplishments

• Decline in the stigma associated with HIV/AIDS as more open discussion between people has been adopted. There is more compassion for people with AIDS. Also training men and women together breaks down the barriers to discussing sexual issues together.

• High level of awareness in the target population and a growing concern over the socioeconomic impact of AIDS.

• Increased acceptance and use of condoms and better access to them (transported by farmers, bakery delivery vans, water bailiff on bicycles, etc.)

• Greater interest in implementing self-help projects as women come to terms with their vulnerability.

• Enhanced community participation. Rural telephone operators, electricity workers, and policemen are now trained with the farm workers as peer educators.

• Increased respect as an organization participating in AIDS control and prevention. When a one day AIDS Workshop was held in Harare in November 1996, it was opened by The Honorable Dr. S.T. Sekeremayi, Minister of State for Security, who also stayed to hear the keynote speaker. Additionally it was attended by GOZ, donors and wide variety IAs, and media representatives.

• AIDS coordinators invited to participate on national, regional and district child forum committees organized by the Ministry of Social welfare and the district branches of the Ministry of Education.

• Farm Orphan Support Trust (FOST) initiated by one of the project coordinators

• Established HIV/AIDS information booths at the Harare Agricultural Show and various provincial agricultural shows.

Constraints

• Access to enough IEC materials such as pamphlets, booklets, etc. and videos in vernacular.

• Unreliable communication channels and difficult transport, especially after the rains.

• Burn out of volunteers.

• At times, lack of understanding and support from the GOZ.

• Difficult to reach children, need a different approach and more involvement from parents and teachers.

• Low self-esteem of women in rural areas

• No hotline or central data base for HIV/AIDS

Recommendations

The CFU Project plans to focus and channel its considerable energies to the following areas where they think they can make a meaningful difference:

• Implement retraining workshops for trainers, peer educators and coordinators;

• Concentrate more on women and youth, support clubs for women in the community and youth at school to facilitate discussions and AIDS prevention and control activities;

• Increase distribution and access of condoms;

• Reproduce and distribute literature to target groups.

Country Office Comments

The CFU project is sustainable as it is implemented by committed farmers and their wives who already donate time, energy and funds to make the project a success. Because of the vastness of the areas to be covered and the population to reach, outside support for strategic planning and narrowing the focus would compliment the efforts of the volunteer farmers and their wives, as would further decentralization of responsibility.

Process Indicators	Target	Actual	% of Target
People trained	10,000	20,615	206%
People educated	500,000	1,046,725	209%
IEC materials produced/distributed	210,000	223,975	107%
Condoms distributed	2,000,000	11,772,600	589%

STD/AIDS Education for NECTOI Transport Workers
National Employment Council for Transport Zimbabwe
Operating Industry (NECTOI)
Zimbabwe AIDSCAP
FCO: 53585
Implementing Agency Type: NGO
Contract Type: Subagreement
Life of Project: 01/15/95 - 07/31/97

The transport industry is labor intensive and spread across the country. Sentinel studies indicate that HIV seropositivity is highest in such trucking towns like Masvingo and Rusape. Ethnographic studies of this population indicate that trucking and commercial sex workers are closely connected.

NECTOI is a nonprofit statutory body established under the National Labor Relations Act No. 16 of 1985 which represents both labor and management. In response to its members, NECTOI began an AIDS prevention peer education program for the transport industry in 1992. It was directed at truckers and other personnel, with the ultimate objective of providing AIDS education nationwide. Phase One (previous to AIDSCAP support) promoted and designed AIDS prevention interventions for individual operators. Phase Two (funded under AIDSCAP) targeted long distance truck drivers and their associates who were not reached during the first phase.

The project goal was to stabilize or reduce STI prevalence among truckers, their assistants and their sexual partners along the three major highways in Zimbabwe. The purpose was to reduce high risk behavior among the target group. To achieve this, NECTOI implemented targeted peer education and outreach behavior change interventions. While truck drivers were the primary target population, secondary target populations included the drivers' associates: bar attendants, commercial sex workers, waitresses, service station personnel, and customs and immigration officers.

Leveraging

NECTOI provided office support, hotel and transport costs as well as a yearly salary increase not covered the subagreement with AIDSCAP. They also leveraged both money and trucks for condom distribution from the trucking organizations that make up part of NECTOI's constituency.

Accomplishments

• Twenty one (140% of target) project sites were established along major highways and at border crossings.

• Both demand for and availability of condoms has dramatically increased during the LOP.

• Channels of communication have been established between commercial sex workers and health care personnel; commercial sex workers, who were marginalized prior to the project, have become a major means of promoting (and improving) early STI seeking behavior.

• Twenty one drama groups were established at project sites and a total of 266 performances given, with large and enthusiastic audiences in attendance.

• Weekly radio programs were established, with 132 programs aired by the end of the project.

• A first annual peer education conference was organized and conducted in February 1997 for all the peer educators.

• The project was given a merit prize by FHI in November 1996 at the International HIV/AIDS/STI conference in Vancouver in recognition of the work they accomplished.

• The project received a great deal of support from the industry and has developed an experienced staff with a high level of technical ability. The program is expected to continue after donor funding ceases.

• Company commitment and support for employees has increased through the introduction of a code of practice using the draft policy guidelines on AIDS and employment.

• The following materials were produced:

• 20,100 posters
• one comic book (Adventures of a Truck Driver)
• 1,250 of two types of T-shirts
• 2 banners, one for World AIDS Day 1995 and one for the 1996 Peer Educators conference
• 4,000 copies of 4 issues of a newsletter
• 10,000 license disc holders (Warning-avoid casual sex)
• 5,000 bumper stickers (Warning-avoid casual sex)
• 3,000 carrier bags
• 8,000 AIDS booklets in English, Shona and Ndebele
• 150 training manuals

• The People's Road Show, which advertises commercial products from different companies through drama presented countrywide, collaborated well with NECTOI. They obtained materials from NECTOI offices for distribution and allowed peer educators to use their stage for drama presentations during the course of their advertisements.

• Support given from community leaders for CSWs, who are a despised group of people in the community, was tremendous.

• Peer educators traveled from all corners of Zimbabwe to attend the peer educators conference, with nearly all trained peer educators attending.

Constraints

• It was difficult obtaining local statistics on STIs in some health institutions as it required authority from senior officials. Some health workers were not as cooperative as expected as they felt the project was increasing their workload.

• The vast distances between project sites and the small number of staff made it difficult to monitor the project well.

• Date collection was difficult due to the low literacy of the peer educators. In some projects NECTOI peer educators worked alongside peer educators from other organizations who were receiving allowances, which worked as a disincentive. Also, accountability was sometimes difficult when working with these volunteers.

• Public relations consultants who were contracted to provide technical assistance in material production died as the project was taking off, hence the delay in material production.

• Condom availability and accessibility were a problem until NECTOI started paying for transportation to all its project sites.

• A financial system that works on reimbursement was difficult to work with and caused some delays in reimbursement, resulting in delays in implementation.

Recommendations

• Introducing an incentive allowance for peer educators to cover , meals, transport, etc. would act as a motivating tool.

• An increase in on-site part-time or full time staff would result in improved project monitoring.

• Designing a simple data collection tool for peer educators and (reviewing the PIF form) would make data collection easier and more accurate.

• There should be more emphasis on setting up coordination structures at project sites for AIDS service organizations and integrating AIDS education and prevention with existing programs.

• Project staff development should be increased with more workshops and seminars

Country Office Comments

• Because this project was designed to respond to needs and the workers were very involved, activities went far beyond the workplace. They have responded to client needs by setting up assistance in counseling, home care and income generation. NECTOI works closely with surrounding communities in their outreach programs and networks very efficiently with other organizations working in AIDS and the health sector in general.

• They are ready to work toward total self-sufficiency and would benefit from a gradual weaning in funds and a shift in the type of technical provided to them.

Accomplishments

The steps to be taken to reach a wide range of people within and outside Delta were:

• Hold seminars for senior management to educate and increase awareness about AIDS and its social and economic effects and also to solicit support and company commitment for AIDS prevention project;

• Hold seminars and workshops about AIDS and its social and economic effects for mid-level managers;

• Identify and train a cadre of employees as trainers of AIDS peer educators and develop a peer education strategy to be implemented by Delta that would include condom promotion and;

• Identify and collect locally available training materials for use in the workshops planned under the letter of agreement.

Constraints

• All training tasks were placed on the medical officer and other medical personnel who were not able to cope with the added responsibilities.

• Delays in funding from AIDSCAP hindered some of the plans.

Country Office Comments

Because of the strategic role Delta plays as a large employer with branches in many parts of the country and its great potential to sustain an AIDS prevention project, negotiations should continue to help them revise their program and take advantage of the Private Sector AIDS Policy Program (PSAPP).

USAID regulations do not permit direct funding to government agencies therefore an intermediary is required to work with the armed forces. CONNECT was the recipient of the subagreement due to its previous experience in conducting training in HIV/AIDS prevention and in working with armed forces. CONNECT is a registered non-governmental organization which promotes self-help for families, communities and organizations to adapt to social and economic change. They have extensive experience in counseling and training.

The goal of the subproject was to stabilize or reduce STI prevalence among the armed forces. The purpose was to reduce high risk sexual behavior. To accomplish this, BCC interventions were implemented for the Zimbabwe National Army (ZNA) and the Air force of Zimbabwe (AFZ).

The target areas of the program were all the bases for ZNA and AFZ. The target groups were the serving members and their spouses and children. There was natural spill-over into the surrounding communities as peer educators made a point of working with CSWs who were often found living on surrounding farms and other settlements.

This review is divided into three sections for Connect, ZNA and AFZ.

CONNECT

Accomplishments

• One three day workshop was held for 11 Army/Air force coordinators.

• Two program development workshops were held for 32 Army/Air force coordinators.

• Program review workshops were held for 17 coordinators

• 8 Air force coordinators were trained in counseling

• Several joint monitoring visits were carried out.

• Monthly meetings were held, which included AIDSCAP personnel.

Constraints

• Project assessment and monitoring were difficult due to the distance between bases.

• Delays in reimbursement of funds inhibited the smooth running of the project.

• Reallocation of line items took too long to process.

• Due to lack of adequate time for training, topics could not be covered thoroughly.

Lessons Learned/Recommendations

• Mapping and remapping is important for resource allocation and coverage. Remapping illustrated the problem of covering all bases adequately with the funds allowed.

• Development of an MIS is essential to capture all information.

• Decentralization of training was essential especially when there is a time limit for a project.

• Motivation plays an important role in programs using volunteers. Things that give them a sense of identity, like T shirts and badges, are essential.

• If communities are given responsibility for their own health, they take it.

Zimbabwe National Army (ZNA)

Accomplishments

• One two-day sensitization workshop was held for senior officers. The purpose of the workshop was to elicit the commanders commitment and support and to educate them on HIV/AIDS prevention and control.

• Three three-day workshops were held for primary and secondary school teachers, 140 were trained, in conjunction with CDU personnel on how to implement AIDS education in schools.

• 52 peer educator workshops were held during which 2,080 serving members and 180 spouses were trained.

• Two ten-day drama training workshops were held for 82 artists with assistance from ZBC.

• A total of 72 drama performances were held at all army units.

• The following materials were produced and distributed:
  • 15,000 poster
  • 5,000 board games (Snakes and Ladders)
  • 50,500 booklets
  • 12,500 T shirts

• Commanders pledged their support of the project by providing manpower, time and transport.

• Commanders agreed that peer education was the best strategy for AIDS prevention because: (1) STI/HIV issues are sensitive and intimate and difficult to discuss; (2) Members of ZNA are at different levels of the social and behavioral change process.

Based on the results of KABP data collected by the Army and self monitoring of STI cases, condoms distributed, and general observation, the following conclusions were presented in the project EOP report:

• High knowledge level of HIV/AIDS (99.1 percent of the 801 surveyed in KABP could identify 2 ways by which HIV could be prevented.)

• Downward trend in STIs treated on base although it is not known exactly what role this project played or whether this indicates that more people are being treated off-base Those who do report to the camp hospital for STI treatment are coming as soon as they observe signs and symptoms.

• More people approaching peer educators for information on AIDS and an increased demand for condoms.

• Soldiers reported a sharp decline in numbers of CSWs frequenting camps on pay day.

Constraints

• Training period for peer educators was not long enough to either impart the information or acquire the skills.

• Shortage of transport made peer education difficult at times.

• Activities under the subagreement could not be refocused.

• Some school teacher were reluctant to implement AIDS prevention activities in their schools. When this happened, there was no activity to target youth apart from schools so they were not reached.

• No end of project KABP was conducted so it was difficult to measure impact.

• A ZNA audit for all donor funded projects coincided with the second phase of the project, making it difficult to carry out all planned activities.

Lessons Learned/Recommendations

• While senior staff were targeted at project start, middle managers who were the immediate supervisors of the peer educators were not targeted till much later which created problems for the peer educators. Middle managers should be sensitized before the peer educators are trained.

• The cascade model is too slow when dealing with schools because many of the teachers have negative attitudes towards teaching students about AIDS prevention. There should be a mechanism to train peer educators among the students and the out-of-school youth.

• Quarterly meetings held for all the IAs provided a forum to exchange ideas and emulate useful strategies being employed by other colleagues.

• It was difficult to select true volunteers particularly after the training of the first batch of PEs when people realized that there were monetary gains to be had.

• Military duties place the members at risk. A supportive policy in relation to tours of duty needs to be sought.

Air force of Zimbabwe (AFZ)

Accomplishments

• One sensitization workshop was held for 35 commanders with the purpose of eliciting the commanders commitment and support and to educate them on HIV/AIDS prevention and control.

• One 5-day training of trainers workshop was held for 35 air force personnel from the three air bases to impart skills necessary to train other personnel as peer educators.

• Nine workshops plus refresher courses were held to train 305 peer educators.

• Three workshops were held to train 140 women spouses as community-based peer educators.

• Two three-day workshops were held for 55 school teachers who were trained in using the Ministry of Education/UNICEF HIV/AIDS cascade model curriculum.

• One 15-day drama training workshop was held for 27 AFZ personnel, nine from each base, with the purpose of creating three drama groups and equip members with theater skills in HIV/AIDS education.

• Three videos, one from each drama group, were produced and distributed to air bases across the country.

• Results of a baseline KABP study revealed high knowledge levels but continued high risk behavior. Educational interventions therefore shifted to increased accuracy of perceived self risk and encouragement of behavioral change.

• Condom consumption increased, however it is not known if use is correct and consistent.

• Fewer STIs are being treated at base facilities, however many air force personnel seek treatment off base.

• There is self reported behavior change on reducing partners and using condoms with all sexual partners.

• The following IEC materials were produced:
  • 1,000 posters on risk perception
  • 1,000 posters on condom use
  • 500 booklets
  • 3 videos

• New outlets for free condom distribution include peer educators, all toilets in the squadrons and mess halls, condom contact person in every section, and AFZ canteen check-out counters.

• Condom demand has increased from 2,000 to 5,000 per month, with more distributed on weekends and at month end.

Constraints

• Training period for the training of trainers and peer educators was too short thus PEs did not acquire adequate skills to carry out their prevention activities as well as they might have.

• Lack of time to perform end of project KABP surveys to measure impact.

• No specific program for youth, apart from school-based education.

• Failure to plan HIV/AIDS prevention activities with a gender perspective as there are significantly more men than women in the AFZ. Women who make up half of all adults infected with HIV do not have the power to insist on safe sex and have little access to information and services for prevention and treatment.

• A high turnover of PEs due to transfers, fatigue, and retirement.

Recommendations

• Peer training should be ongoing and more women spouses should be trained.

• AFZ school teachers require further training so they will be comfortable educating school children on HIV/AIDS.

• More counselors should be trained as both the infected and the affected need support.

• More IEC materials should be produced to keep up with changes.

Country Office Comments

These projects were well planned and designed and were among the most successful of those supported by AIDSCAP. (The AFZ and ZNA were the only organizations to work through an intermediary, CONNECT.) By the end of the project, the project was considered important enough by the military to warrant AFZ and ZNA top brass each spending two days discussing the way forward.

 

Contact   |   Terms of Use   |  Accessibility  |  Site Map   
Visit fhi.org in: Español | Français | Русский | عربي

© Copyright 2009, Family Health International (FHI)