Title: Research for building pro-poor health systems during the recovery from conflict (ReBUILD 2011-2017) – Multi-Country Initiative (Consortium) – Ongoing project
Principal Investigator: Shungu Munyati
Co-Investigators: Prof Peter Mason and Brian Chandiwana
Funder: UK Department for International Development (DFID)
- To deliver new knowledge to inform the development and implementation of pro-poor health systems in Zimbabwe as
it recovers from political and social crises
- To increase relevance of research in processes of improving health systems through broader participation of all
The ReBUILD project will inform the development of pro poor health systems to support effective delivery of services to the poorest people. The ReBUILD Consortium is a 6 year research partnership that includes the following six partners;
- Liverpool School of Tropical Medicine, United Kingdom (Lead Institution)
- Institute for International Health and Development, Queen Margaret University, Edinburgh, Scotland
- Makerere University, Uganda
- College of Medicine and Allied Health Sciences, Sierra Leone
- Biomedical Research and Training Institute, Zimbabwe
- Cambodia Development Resource Institute, Cambodia
The project seeks to improve the following key dimensions of the health system in Zimbabwe; health financing, governance, pharmaceutical management, health service delivery, health information systems and human resources, normally referred to as the WHO health systems building blocks.
The Global ReBUILD research project focuses on exploring management innovations, opportunities for relocating roles among health professionals, health reforms to improve service delivery and health financing. In this regard, BRTI is in the process of
developing protocols to guide research into four focus areas of the health system;
- Impact of user fees on poor households
- Health workers incentive research in Zimbabwe
- Rural Posting/Deployment of Human Resources for Health in Zimbabwe
- Assessment of aid effectiveness
Title: Role of Men in accessing PMTCT Services (January – June 2011)
Principal Investigator: Yotamu Chirwa
Co – Principal Investigators: Wilson Mashange and Malvern Munjoma
Funded by: National AIDS Council Zimbabwe (NAC)
- Assess the knowledge, attitudes, behaviour and practices on PMTCT among men and how this affects uptake of
- Identify roles that men play in accessing PMTCT services.
This study was conducted in Kwekwe district among pregnant mothers enrolled for Antenatal Care (ANC), breastfeeding mothers attending Post Natal Care (PNC) sessions and women who have been pregnant in the year prior to the study. The study also targeted married men, and men co-habiting with a woman who has once been pregnant or was pregnant during the time of the study. Community leaders, community health workers, and MoHCW staff involved in PMTCT were also recruited. The study sites were Kwekwe General, Zhombe Mission and Silobela district hospitals, Gomola and Sidakeni clinics in Zhombe, Simana and Dambridge clinics in Silobela and Mbizo eleven and Amaveni clinics in Kwekwe urban.
The study established that men’s level of knowledge on PMTCT is a key determinant in uptake of PMTCT by their spouses. It was observed that acceptance of PMTCT is contingent upon knowledge of HIV status among men. Prejudices about women affect men’s participation in PMTCT at community level and this is also extended to FCH facility level, with the female nurses being viewed as unsuitable to provide HIV testing to men. Men saw their roles in PMTCT and ANC as being confined to provision of funds to enrol for the programme, transport to and from FCH facility and buying sundries. Accompanying spouse to the FCH centre was mentioned but men do not cherish it.
Title: The Global School Personnel Survey (GSPS) Zimbabwe 2008
Principal Investigator: Shungu Munyati
Co-Investigators: Auxillia Nyagadza and Maxwell Chirehwa
Funder: Centre for Disease Control & Prevention (CDC), Atlanta and World Health Organisation (WHO-Afro)
The World Health Organization (WHO), the Centre for Disease Control and Prevention (CDC), and the Canadian Public Health Association (CPHA) began development of the Global Tobacco Surveillance System (GTSS) in 1999 to track tobacco use across countries using a common methodology and core questionnaire. The GTSS includes the collection of data through 3 surveys: the Global Youth Tobacco Survey (GYTS) for youth; the Global School Personnel Survey (GSPS); and the Global Health Professions Students Survey (GHPSS) for adults. The GTSS is intended to enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs and to monitor the key articles of the WHO Framework Convention on Tobacco Control (WHO-FCTC).
The purpose of the survey was to develop priorities, establish programmes and advocate for resources for school and youth health programmes and policies that are comparable across countries. The GYTS was a school-based survey conducted among children aged 13-15 years. The survey consisted of seven modules which covered:
a. Prevalence of tobacco use
b. Knowledge and attitudes towards tobacco use
c. Exposure to second hand tobacco smoke
d. Young people’s access to tobacco products
e. Desire for smoking cession among youths
f. Exposure to pro-tobacco media and advertising
g. School curriculum
It was noted that users of other tobacco products was significantly higher in all provinces although the number of cigarette smokers among students was low. In Zimbabwe, there has been a general decline in the number of factors influencing tobacco use. This could be due to economic challenges that may be contributing to the reduction in exposure to tobacco smoking in homes. The GYTS results from Zimbabwe showed that boys were more likely to smoke cigarettes than girls.
Exposure to Second Hand Smoking (SHS) is high in Zimbabwe with 29.8% of students in Manicaland and 40.1% of students in Harare reporting having been exposed to SHS during the week prior to the survey. About 23% of students in Manicaland and 21.5% of students in Harare reported that their parents smoke.
The GSPS was a school based survey conducted among school personnel to collect information concerning their use of tobacco and their tobacco related school policies and programs. In Zimbabwe GSPS was also conducted by BRTI using the same sample of schools that were selected for the GYTS 2008 in Harare, Bulawayo and Manicaland provinces of Zimbabwe. In each region, 25 schools were selected.
The survey covered the following modules:
· Knowledge and attitudes
· School policy
· School curriculum
Data from the survey showed a high percentage (43% in Manicaland) of school personnel who had ever smoked cigarettes. The percentage of school personnel who smoked tobacco products other than cigarettes was high in all provinces. The results also showed that more than three quarters of the schools in the three provinces had some policy restricting tobacco smoking among the students and also the school personnel.
Title: A Baseline Survey on Knowledge, Attitudes, Behaviour and Practices on Avian Influenza in
rural and urban districts in Zimbabwe (2008)
Principal Investigator: Junior Mutsvangwa
Co-investigators: Stanford Mahati, Stephen Buzuzi, Pakuromunhu Mupambireyi and Dr Pius Makaya
Funder: Funded and coordinated by Ministry of Health and Child Welfare and
· To collect the baseline Knowledge, Attitude, Behaviour and Practices of farmers, vendors, health workers, veterinary extension officers, consumers, school children and teachers on Avian Influenza.
· To determine level of previous dissemination of the information from MoHCW, the Department of Veterinary Services and Ministry of Education within the target group.
· To recommend strategies for improvement with regards to handling of poultry and poultry products.
· To recommend strategies for a multi-sectoral response to Avian Influenza.
The study explored the existing situation pertaining to knowledge, attitudes, behaviour and practices regarding the spread of Avian Influenza. The study was conducted in six provinces of Zimbabwe namely Bulawayo, Harare, Midlands, Matabeleland South, Manicaland and Mashonaland West. The study population were people at most risk of Avian Influenza infection.
There was generally lack of knowledge of Avian Influenza among the various categories of people interviewed even though poultry production was a widespread economic activity. Respondents were more aware of Newcastle disease. A significant number of both children and adults were generally unaware of how Avian Influenza could be transmitted from poultry to humans as well as the symptoms of the disease in humans. The study established that the knowledge level among participants was low with regards to Avian Influenza.
Principal investigator: Stephen Buzuzi
Co-Investigators: Prof Lucy Malaba, Wilson Mashange and Dr. Mbuya Mduduzi
Funder: Funded and coordinated by the Ministry of Health and Child Welfare and United Nations Children’s Fund (UNICEF).
The objectives of the study were to assess knowledge, attitudes, behaviour and practices of the target groups in the following areas:
- Exclusive breastfeeding for six months
- Complementary feeding after six months
- Appropriate nutritional care for the sick
- Vitamin A intake among women and children
- Iodine intake by all household members
- Breastfeeding options for HIV positive mothers who know their status
The general purpose of the study was to collect data for assessing nutrition-related knowledge, attitudes, behaviour and practices in six districts of Zimbabwe where the community-based nutrition care programme was being implemented.
Key findings from the study revealed that knowledge regarding the priority nutritional interventions that were associated with improved child nutrition and health was fairly high among the service providers. Communities in the study districts were aware of the critical part played by the various components enshrined in the Essential Nutrition Actions (ENA) framework in ensuring a good nutritional status for children. The study established that the CBNCP was a success.
Title: Responses to HIV and AIDS and Gender Based Violence needs of cross-border mobile populations at the
Zimbabwe-South Africa border (2007 – 2008)
Principal Investigator: Stanford Mahati
Co-Investigators: Pakuromunhu Mupambireyi and Stephen Buzuzi
Funder: International Organization for Migration (IOM) in partnership with United Nations Population Fund, United Nations
International Children’s Fund & Save The Children- Norway
The specific objective of the baseline survey was to collect information which will assist in the following:
- To provide baseline information on the prevention of Sexual and Gender Based Violence (SGBV) among irregular migrants
- To determine the support needs of victims of SGBV among vulnerable cross-border mobile populations
- To establish current capacity of protection and health services as well as a referral mechanism regarding SGBV among vulnerable cross-border mobile populations
The study was designed to establish and document the gender based violence and support needs among irregular migrants and vulnerable populations specifically women, adolescent girls and boys. The study was carried out at the Zimbabwe – South Africa border post of Beitbridge among men, women and 12 – 17 year old adolescent boys and girls.
The key findings were that, cross-border movements between Zimbabwe and South Africa were necessitated by economic reasons such as trade, shopping, commercial sex work and labour migration which could last a few weeks, some months and or even years. The study found out that illegal crossing of the border was associated with increased risk of sexual abuse and rape for women and young girls.
Perpetrators of SGBV were generally identified as men, particularly omalayitsha (formal transport operators), magumaguma (people who assist irregular migrants cross the border at illegal points), truck drivers and other government officials on both sides of the border. The majority (83%) of the respondents were not aware of any care and support programmes for survivors of SGBV. The study noted that the process of getting justice for victims of SGBV was cumbersome and emotionally draining.
Title: Utilizing the PLACE Method in the Development, Implementation and Evaluation of HIV Prevention Efforts for the Orphan Girl Child in three Priority Prevention Areas (3 Districts) in Zimbabwe: National Action Plan for Orphans and Vulnerable Children (2007 – 2010)
Principal investigators: Brian Chandiwana and Alfred Chingono
Co- Principal Investigators: Stanford Mahati and Stephen Buzuzi
Funder: Programme of Support for OVC coordinated by the Ministry of Labour and Social Services, with the fund managed by United Nations Children’s Fund (UNICEF).
· To identify places where young girls particularly the orphaned girls and their partners meet new sexual partner(s) in the three PPAs
· To characterize sites where young girls and their partners meet new sexual partner(s).
· To increase HIV/AIDS awareness campaigns among adolescent girls.
· To reduce factors associated with high risk sexual behaviour and exposure to sexual abuse of adolescent girls.
· To ensure continuation of schooling, access to food and health care services by vulnerable girls especially orphaned girls.
. To assist families on how to protect and care for young girls especially orphaned ones.
. To strengthen community support systems to support girls especially the orphaned in terms of material and psychosocial support.
The Zimbabwean government over the last few years has been putting in place national policies, such as the National Orphan Care Policy (1999) to mitigate the HIV and AIDS epidemic’s impact on children, particularly the situation of OVC. The National Orphan Care Policy led to the development of the National Action Plan (NAP) for Orphaned and Vulnerable Children whose vision was to reach out to all OVC in the country with basic services.
BRTI was awarded a 3-year grant to implement research informed HIV/AIDS prevention and mitigation interventions in three Priority Prevention Priority Areas (PPAs), namely Hwange, Bindura and Gweru districts. BRTI worked with two implementing partners in Hwange which were Lubhancho House and Hwange Aids Project (HAP), two partners in Bindura which were Development Aid from People to People (DAPP) and Farm Orphan Support Trust of Zimbabwe and Midlands AIDS Service Organisation in Gweru.
After the three year implementation cycle, an end of term evaluation of the programme was done to assess the effectiveness and impact of the interventions. The evaluation used a combination of quantitative, qualitative and participatory methods. The evaluation indicated an improvement in child health, behaviour, school attendance and performance, epitomised by good grades.
Title: Priorities for Local AIDS Control Efforts (PLACE) in Zimbabwe (2006 – 2007)
Identifying Gaps in HIV Prevention among Orphans and Young People in; Hwange District, 2006; Bindura District, 2007 and Gweru District, 2007
Principal investigators: Brian Chandiwana and Shungu Munyati
Co- Principal Investigators: Stanford Mahati, Stephen Buzuzi, Yotamu Chirwa and Wilson Mashange
Funder: University of North Carolina and UNICEF
- To identify places where young girls – particularly orphaned girls – meet new sexual partner(s)
- To characterize sites where young girls meet new sexual partner(s).
The PLACE method is a rapid monitoring tool to identify Priority Prevention Areas (PPAs), and specific venues within these areas where HIV and AIDS prevention programmes should be focused. The method focused on places where new sexual partnerships are formed, because the pattern of new partnerships in a community shapes its HIV epidemic. The studies were done in three districts of Zimbabwe namely, Hwange, Bindura and Gweru between August 2006 and September 2007. The study design was cross sectional and focused on households, prospective venues and events where young people (especially orphaned girls) meet new sexual partners. The key findings were that there were gaps in existing HIV prevention programmes at venues, but there was a strong willingness to improve HIV prevention programmes at these places. The average age of sexual debut was 15 years. It is important to continue to encourage young people to delay sexual activity, since early sexual debut is risk factor for HIV. The detailed findings of the three studies can be found in the district reports.
Title: The Development, Implementation, and Evaluation of Interventions for the Care of Orphans and Vulnerable Children in
Zimbabwe, South Africa and Botswana. (2002 – 2006)
Principal Investigator: Shungu Munyati
Co-Investigators: Brian Chandiwana, Stanford Mahati and Prof Simbarashe Rusakaniko
Funder: WK Kellogg Foundation
- Improve the social conditions, health, development and quality of life of vulnerable
children and orphans.
- Support families and households coping with an increased burden of care for affected and
- Strengthen community based support systems as an indirect means to assist vulnerable
- Build capacity in community based systems for sustaining care and support to vulnerable children and households over
the long term.
This was a multi-country project commissioned and coordinated by the Human Sciences Research Council, Cape Town (Dr Olive Shisana & Prof Leickness Simbayi) that included Zimbabwe, South Africa and Botswana, with Mozambique and Lesotho coming on board later during the implementation of the project. The project involved baseline studies conducted in 2003 and 2004 in Manicaland and Matabeleland South Provinces in Zimbabwe. Six studies were carried out in the following
- Defining Orphaned and Vulnerable Children
- A Census of Orphans and Vulnerable Children in two Zimbabwean Districts
- A qualitative assessment of Orphans and Vulnerable Children in two Zimbabwean Districts
- Situational analysis of Orphans and Vulnerable Children in eight Zimbabwean Districts
- Psychosocial conditions of Orphans and Vulnerable Children in two Zimbabwean districts
- Household survey of HIV-prevalence and behavior in Chimanimani District, Zimbabwe, 2005
In each of the six studies the emphasis was to gather information on a defined aspect of OVC. The study on defining Orphans and Vulnerable Children established that the definition of orphan hood varied according to context. However, the most accepted definition of an orphan from the study findings was that an orphan is a child who has lost both parents through death. A vulnerable child according to the study was a child with no or very restricted access to basic needs. The key finding was that, a child may have both parents, but their rights may be denied.
In the Census of Orphans and Vulnerable Children in Chimanimani and Bulilimamangwe, prevalence of orphanhood (only in those 18 years and below) was 30.5% out of a population 107 120 in Chimanimani, 27.6% out of a population of 81 984 in Bulilima, 24.5% out of a population of 9 012 in Plumtree and 23.7% out of a population of 62 324 in Mangwe. The census data highlighted the extent of the OVC problem in the districts and their conditions of living.
In the qualitative assessment of Orphans and Vulnerable Children in the two districts, the main aims of the study were to introduce the OVC project to stakeholders in the area and to collect comprehensive information on the living situation of OVC and their caregivers, together with the challenges they faced. The key finding was that, death of parents led to increased vulnerability of children which then influenced guardians to take in OVC. A large number of families were therefore taking care of children with community members providing moral and to a lesser extent material support to OVC. A Situational analysis was done in eight districts of Zimbabwe to assess existing services and support systems for OVC. The conditions under which OVC
were living, were generally unfavorable and difficult. Food was the main need that was cited by OVC. Some children as young as 12 years old were heads of households. Various intervention agencies, such as government ministries, NGOs, CBOs, FBOs and the community at large, are making tremendous efforts in caring for OVC. However, the efforts of these agencies were being hampered by various challenges.
The general objective of the survey on psychosocial conditions of OVC in two districts of Zimbabwe was to develop a comprehensive understanding of the challenges faced by OVC which make them vulnerable and experience psychosocial problems. In Chimanimani, the prevalence of orphanhood among the 15-18 year olds was 51% while in Bulilimamangwe it was 52.9%. In Chimanimani, over 60% of the orphans in this age group reported that they were still bothered by their parents’ death with Bulilimamangwe recording around 50% of orphans having similar experiences at the time of the study. The study established that there was need to provide comprehensive psychosocial support for OVC.
The key objectives for the household survey of HIV-prevalence and behavior in Chimanimani district were to determine the magnitude of HIV and AIDS problem, especially among children and to assess the HIV and AIDS knowledge, attitudes, behavior and practices of the general population. The HIV prevalence was 9.7% and generally increased with age and was consistent with national statistics. Prevalence was highest in the urban sector (14.6%) followed by large-scale commercial farms at 12.2% and was lowest in communal and small scale commercial sectors both at 8%. The study indicated the need to roll out comprehensive interventions to address the orphanhood problem as well as addressing the issue of infected children. The study also pointed out the need to prepare communities to deal with HIV transmission dynamics for the various age groups.
The second phase of the project involved the translation of the operations research outcomes into interventions. BRTI worked with 8 community-based organizations in implementing HIV and AIDS interventions in eight districts in Zimbabwe, namely FACT Nyanga, Development Aid from People to People (DAPP) Kukwanisa, Nzeve Deaf Children Centre, Intermediate Technology Development Group (ITDG) Southern Africa which is now Practical Action, Integrated Rural Development Program (IRDP) – Tjinyunyi Babili Trust, Midlands AIDS Service Organization (MASO), Batsirai Group and Farm Orphans Support trust of Zimbabwe (FOST).