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Rumbidzai Zinyuke in Victoria Falls
Located in south-western Zimbabwe, Bulilima district lies close to the border with Botswana.
One peculiar fact about the district is that the majority of its adult male population has relocated to Botswana or South Africa in search of job opportunities, leaving behind many child-headed families.
This has left the area open to a lot of sexual and reproductive health challenges that include early pregnancies and parenthood, difficulties accessing contraception and safe abortion, and high rates of HIV and sexually transmitted infections.
According to statistics from the National Aids Council, the district has the highest HIV prevalence rate of 22,8 percent, much higher than the national HIV prevalence of 11,58 percent.
Owing to these challenges, the district was chosen to benefit from a Sexual Reproductive Health and HIV linkages programme (SRH/HIV), which sought to provide communities with integrated health services.
The initiative was introduced through the 2gether4SRHR programme aimed at improving the sexual and reproductive health and rights of all people in 12 countries in East and Southern Africa, particularly adolescent girls, young people and key populations, by promoting an integrated approach to SRHR, HIV and gender-based violence.
It is being run with funding from the regional SRHR team of Sweden and implemented jointly by UNAIDS, UNFPA, UNICEF and the World Health Organisation in partnership with Regional Economic Communities, civil society organisations among other partners.
According to a health worker from the district, Sister Buhle Maphosa, the need for integrated services was very high as access to health care was being limited by the need to visit different centres for different services.
“Because of this, we had to create SRH and HIV linkages and we saw an improved service delivery as we are now offering a combined service,” she said. “We have also seen a reduction in the maternal and child mortality rates and morbidity as the cadres that offer integrated services have been trained.”
In Bulilima, the programme created linkages between communities through the health centre committees, the ward health teams and the community-based health workers, leading to its success as community participation was prioritised.
Sister Maphosa said as a result, no clients were being missed as the programme had the community buy-in.
“On a monthly basis, we also have integrated outreach activities to reach out to areas which we would have identified that need the services,” she said. “We have seen the rate of anti-retro viral initiation increase because once the client comes in they can be tested for HIV and get started on ART at the same time if they test positive.”
The district is now embarking on contact tracing for HIV in a bid to reduce the risk of reinfection. However, since most of the men are in South Africa or Botswana, this has proved to be a challenge for health care workers.
“For contact tracing, we have realised that doing this during the festive season when the men are at home yields better results,” she said.
The Bulilima District case study was presented and extensively discussed this week at the on-going regional SRHR symposium being held in Victoria Falls.
At the symposium, east and southern African countries sought to take stock of the challenges faced in providing SRH services during the Covid-19 pandemic and how they could strengthen SRHR outcomes going forward.
Although Zimbabwe has made significant progress in implementing comprehensive SRHR services through the 2gether4SRHR programme, the Covid-19 pandemic had some negative effects on these services.
Ministry of Health and Child Care deputy director monitoring and evaluation Mr Lloyd Machacha said access to SRH, GBV and HIV services declined during the pandemic.
“We saw issues around teenage pregnancies increase,” he said. “When we were doing our analysis we realised that there was a 13 percent increase (in teenage pregnancies) from the previous year.
“However, Government and partners implemented some interventions to curb this, including engagements with the churches and also traditional leaders.
“Currently, we are seeing a downward trajectory, the numbers are going down because of the efforts that are ongoing, especially after opening up where access in terms of other services have been generally improved across the country.”
Mr Machacha said although offering comprehensive sex education had been a challenge in the past, some churches and traditional leaders were now taking the lead in raising awareness around the issues.
The 2gether4SRHR programme was launched in 2018 with the aim to create an enabling legal, policy and financial environment, to scale up provision of integrated services, empower all people to exercise their SRHR rights and also amplify the lessons learnt.
UNFPA-ESARO programme specialist monitoring and evaluation Ms Elizabeth Zishiri said countries in the region had faced similar challenges which called for strengthening of SRHR for all people.
“Integration is the process of bringing together, in a holistic manner, different kinds of related SRHR/HIV interventions at the levels of legislation, policy, programming and service delivery to ensure access to comprehensive integrated services in efficient and effective ways. In the 2gether4SRHR programme, integration was more around SRHR, HIV and GBV and this was building on the linkages programme which initially spoke of the linkages between SRHR and HIV but this time we realised that GBV was left behind so we included it in the package,” she said.
Ms Zishiri said a lot of work had gone into the development of regional and national SRHR policies that incorporated the principle of integration.
Through the project, three GBV laws, three comprehensive abortion care laws and two laws on adolescent health were supported.
Another 20 policies, 27 strategies and 46 guidelines were also developed, while 44 704 health care workers (including community HCWs) had their capacity built in providing integrated services across the 12 countries.
“There have been significant policy shifts at country level, some of the laws and policies have been implemented in various countries,” said Ms Zishiri. “Conversations relating to difficult SRHR issues have been heard.
“We underestimate the fact that we can sit and talk about child marriages, abortion and how these conversations have led to prioritisation of key areas. It has also reduced duplication and competition due to strengthened coordination and partnerships.”
Ms Zishiri said there had been increases in the number of women accessing family planning, testing for HIV and STIs, among other positives.
While the Covid-19 pandemic had caused disruptions, she said integrated services had helped to reduce trips to facilities, reduced time spent at facilities, reduced patient load on health staff, increased case identification, especially in GBV and ultimately increased uptake in SRHR services.
Director and maternal reproductive health in the national Department of Health in South Africa, Dr Manala Makua, said there was need to protect the gains around SRH in order to achieve Universal Health Coverage.
“When Covid-19 came in Africa, South Africa experienced the most devastating effects,” she said. “During the first phase, the SRH space was affected by the fact that somehow, somewhere, it was not clearly defined as an essential service for some reason. When that happened, it called for advocacy, we needed to respond and respond very quickly.”
Dr Makua said the pandemic had hit at a time South Africa was on the verge of attaining the SDG goal on reducing maternal deaths and had taken the progress back.
“We were at 88 per 100 000 live births in South Africa and we were almost seeing 70 just in a few months,” she said. “However, SRH was the collateral damage of Covid-19 because at that point, while everyone was still focused on generating evidence, one thing that was clear was that the severity of Covid-19 was worse in the maternal unit health space. We need to protect the gains that have been achieved in SRHR.”
Ms Tuwilika Kamati, from the Ministry of Health and Social Services (MoHSS) in Namibia, said her country had faced similar challenges during the Covid-19 pandemic and had overcome through the integrated services model.
“Covid-19 had an impact on human resources and this affected the continuation of integration in facilities,” she said. “However, in Namibia at the start of the pandemic, we identified decongestion centres in the communities to make space for Covid-19 services in facilities so most of the SRH services were moved to these centres.
“This then increased uptake of SRH services as people were more comfortable going to the decongestion centres than the health facilities.”
Online Reporter