Pitch

Decision makers/implementers demonstrate changed attitude towards KPs and AGYW on an issue or claim. Provision of health services and justice to AGYW particularly young sex workers improved significantly as most young people who fell sick or required services such as family planning have access to these services however the services are expensive and they require a lot of out of pocket expenditures. The law implementers demonstrated change towards the AGYW group because AGYW have participated and engaged with the policy makers to discuss ways in which Young People can access health care services without challenges, such as stigma and discrimination and have autonomy over their bodies.

The law does not recognise the importance of empowering young people below the age of 18 even if they are young parents or caregivers as they are still recognized as children. The research evidenced that with our continuous quarterly systematic monitoring at facility and community level through the use of a quality assessment questionnaires.

• One hundred and thirteen AGYW participated in all the 5 ZY+ PITCH districts. Twenty-five respondents (27%) indicated that they had in the last 12 months experienced stigma and discrimination because of their HIV status and/or their gender.
• Specifically, 40% had been verbally abused while 33% had been denied contraceptives or access to condoms.

Partners have utilised opportunities to share position papers and strategies to relevant stakeholders such as the clients/ recipients of care (AGYW, KPs) through community dialogues, Policy makers, law enforces these were done through dialogues, attendance to the country coordinating mechanism, through submissions to the parliamentary health committees or portfolios.

ZY+ had had an unclear advocacy strategy in the first and second quarter however the strategy was developed and adopted by ZY+ and other PITCH consortium group member like SAFAIDS.

There has been an improvement in ZY+’s capacity to capture evidence aligned to the advocacy actions under the PITCH project.

• All advocacy actions are aligned to the country Theory of Change. For instance,
• In terms of tools, ZY+ with support from ZNNP+ has managed to develop data collection tools for the District Focal Persons (DFPs). The Client satisfaction tool is being utilised by the DFPs in collecting information of rights violations and client satisfaction in service delivery. To influence evidence based advocacy and programming. The tool assesses the quality of services being provided to AGYW living with HIV, stigma and discrimination and SRHR awareness. The tool was rolled out in July 2018 and is still being used to date in the other districts. Other partners have shown interest like SAFIDS.
• The DFPs also use the advocacy issue tracking tool which was also developed with the support of ZNNP+. The tool is utilized by district advocacy teams, DFPs and national office staff to track advocacy issues.
• WE ZY+ have also developed the quantitative tool for Viral load and treatment and care tracking tools with the support from ZNNP+ This is used to track service uptake and viral suppression on clients. It also has opportunities to capture the models of care people in specific communities prefer or would recommend.

• With regards to ZY research capacity ZY+ seeks to strengthen its research capacity through closely participating and working with ZNNP+ driven researches. ZNNP+ rolled out the Stigma Index survey focusing on KPs and AGYW in October and November 2019 These advocacy focused researches will assist in skills transfer necessary for ZY+ to develop and commission research initiatives of its own.
• ZY+ continues to make use of evidence collected from communities to inform advocacy. However, ZY+ continues to look for more opportunities to maximise on the use of data collected from communities.

However, there are key gaps that the organization would like to focus on addressing in the next implementation year. These include:

• Strengthening the organization’s capacity to utilize the WANDA platform.
• Strengthen its capacity to utilize analysis software like SPSS especially in relation to the use and rolling out of the client satisfaction tool and pre and post-test questionnaires utilized during trainings.

Coalition Name: Advocacy Core Team

Coalition Description and overarching vision and objectives:

The coalition is a national grouping of 17 organizations which include ZNNP+, ZY+, Zimbabwe AIDS Network (ZAN), SAfAIDS, Jointed Hands Welfare Organization (JHWO), Pangea Zimbabwe AIDS Trust (PZAT), Ophid, GALZ and Youth Engage. The coalition is an advocacy focused coalition with advocacy asks targeting the creation of space for civil society to act as a watch dog and respond to issues where there are gross violations in terms of PLHIV and communities. The coalition’s key advocacy asks are around access to treatment, healthcare financing and de-criminalization of HIV transmission.

Changes in Strategy

There have been no changes in strategy since the last reporting period.

Lessons Learnt

Since ACT is a loose coalition, it has been difficult to enforce a code of ethics and participation is largely voluntary this at times results in response to some issues being erratic. With our country deteriorating service provision and, limited follow up to laws and policies, drug shortages for young people and adolescents.The level of influence has remained static even though advocacy and community mobilisation has remain the top priority for ZY+.Patner mapping and goal setting has heled the country coalitions in identifying relavant stake holders to influence the system that has been broken for a long time.

The ACT coalition has been effective in engaging in PEPFAR processes. ZNNP+ and ZY+ have managed to participate in PEPFAR processes including the development of the Country Operational Plan for 2019 (COP 19). The Zimbabwe National Strategic Plan review process is currently underway and ZNNP+ and ZY+ are part of the working groups.

ZNNP+ and ZY+ contributed to the development of submissions to the Ministry of Finance and Economic Development on the 2019-2020 Zimbabwe National Budget. The submissions had three key agreed asks which included the ask that government allocate at least 15% of the national budget towards health in line with the 2001 Abuja Declaration, the scraping of VAT on sanitary ware and the allocation of the 2% tax towards the procurement of essential medicines. During his budget presentation in November 2018 (when the advocacy started), the Minister of Finance acknowledged the need for government to work towards the attainment of the 15% threshold for health. The budget statement also outlined the removal of duties and levies on all inputs used in the manufacture of sanitary ware. However, this is still a challenge to get results as this is said to be governed by resources and is mainly affected by economical inflation. Under this outcome one of AGYW key advocacy ask was:

• The uncapping of age of consent in accessing health services
• Through this advocacy ask AGYW have managed to engage the parliament through a position paper submitted to the clerk of parliament requesting for the uncapping of the age of consent to accessing health services. The position paper was received and we still await actioning and review of the constitution and law.
• The submission was on the Uncapping of the age of consent to accessing Healthcare services
• Provision of unexpired ART medication the link HealthTimes
• Provision of DTG to all (women of child bearing ages were not allowed to get DTG as a ARV since it was believed that that it would cause defects to child bearing mothers and the children) the link to the statement HealthTimes

The ministry health through the minister of health and child care released a statement published in the Newsday Newspaper the link Newsday on provision of good quality medicines

Sexual willful transmition of HIV, lack of bodily autonomy amongst AGYW especially Young Women living with HIV. Under PITCH we have a mentorship program and an example is one of our young women who was assaulted by her partner because she received a stipend. She is more empowered to decide what she wants with her life. Three cases were reported and all of the cases were related to gender based violence

There have been no arrests made however there are young people who report cases and there still in pursuit with law enforcers

On the 1st December 2019 during world AIDS day the Minister of health Mr Obedia Moyo acknowledged the challenges faced by AGYW in accessing health care service and agreed that there are challenges in turning around services provision to the position of first class which is what the communities want. The law and constitution has limitation in term of supporting Zimbabwe also started roll out of DTG as a first line option, however with evidence recently released there was been retaliation from the members of the public requesting for the best medicines available. The position of ZY+ is that DTG should be the informed choice of AGYW on whether they use DTG or not as part of first line ARV therapy. DTG should be accessible to everyone willing to take the drug without condition.

Currently Zimbabwe through the ministry of Health and Child care has agreed to give DTG as a first line drug.The ministry also allowed young people to receive medication (DTG) to a person that have tested positive for the dfirest time.

On the 1st December 2019 during world AIDS day the Minister of health Mr Obedia Moyo acknowledged the challenges faced by AGYW in accessing health care service and agreed that there are challenges in turning around services provision to the position of first class which is what the communities want. The law and constitution has limitation in term of supporting AGYW, sex workers and young key populations in accessing health services.

Age of consent to accessing SRH uncapping of age consent is was done as a joint effort by you led networks with the same vision and aim to reduce the/uncap the age of consent. https://www.familyplanning2020.org/news/zimbabwe-should-promote-adolescent-access-sexual-health-services

Currently Zy+ is collaboration with ZNNP+ are currently in process to reviewing and are putting in place the gender policy for ZY+ as the organization is currently under organizational development. The process is also being assisted by VSO.

A success story that can be shared is that of access to viral load testing by adolescents and young people males and females. What was noticed from the data that was collected was that the males had a small service uptake. This was affecting gender stereo types where people always think that males do not have a health seeking behaviour and access to routine viral load testing by adolescents .The data also showed that among the general population people were missing out on routine viral load testing because of different dates of medicines resupply and sample collection most males will be at work than females thus the dates and service will mainly be aligned to females.. ZNNP+ and ZY+ engaged the service providers and highlighted these issues. They acknowledged that this is true and on their part they had not seen things that way. Going forward they promised to make sure that there are times and days specifically for adolescents and also to harmonize the medicines resupply dates and viral load sample collection on weekends and week days. Some follow up meetings and engagements are also going to be done to check whether these issues have been addressed.

Sexual orientation and Gender Identity training was conducted and the issues that came up were :

1. Limited politicawlwill by the government to provide equitable SRH services for key populations incuding AGYW
2. Limited budget allocations for AGYW commodities and health financing
3. Limited coordination between stakeholders to hold the government accwountablr in service provision for AGYW however the follow up mechanisms are enot gender sensive and the disabuility friendly

Systematic Community Monitoring:

1. This was a continuous process iof gathering data and evidence in service provision at facility and community level by the use of a toole which is named the client satisfaction tool. The tool measures service uptake and the disaggregate the recipients of care using community, gender and age, this activity was also used as and accountability system to monitor service uptake and the demand creation systems available,.
2. SAytematic monitoring also measured the cases of rights viuoletions reported and the ones that have been sent to cout and that have have being rules and sentaenced

The activitives Provide a base to our advocacy asks because they provide evidence and opportunity to create suastainable relations with the facilities,health care providers, policymakers, law enforcers, young people in their diversity.