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Voluntary Counseling and
Testing Service - Good News out of Zimbabwe
It is estimated that 1.8 million Zimbabweans
are living with HIV, but approximately 90 percent are unaware
of their HIV status. Unfortunately, due to stigma associated
with HIV/AIDS, the epidemic has largely been "invisible."
Since 1994, USAID/Zimbabwe's HIV/AIDS strategy
has been to encourage responsible behavior change. In the
early phases of implementation strategy, USAID used a comprehensive
range of communications activities that targeted high-risk
populations. This strategy contributed to near universal awareness
of the epidemic. However, it met with limited success in reducing
the number of new infections because the awareness did not
lead to behavior change. The epidemic continued to spread
in both urban and rural communities.
In 1998, the Government of Zimbabwe (GOZ)
asked for USAID's help in identifying best practices from
countries that had achieved declining HIV infection rates.
It became clear that one missing element in Zimbabwe was voluntary
counseling and testing (VCT) services and sustained messages
on behavior change. Elsewhere, VCT had been shown to have
an important role in both HIV prevention and for people living
with HIV infection. It is an entry point for personal care
and responsible behavior. It provides people with an opportunity
to learn and accept their HIV status in a confidential environment
and provides counseling and referral for ongoing emotional
support and medical care. Those who test positive can benefit
from early and appropriate medical care and interventions
to treat and/or prevent HIV-associated illnesses. Pregnant
women who are aware of their HIV-status can take steps to
prevent transmission to their infants.
Ultimately, USAID believes that the powerful
self-knowledge conferred by VCT will create a critical mass
for more effective behavior change. VCT will thus initiate
a process to overcome stigma and, ultimately, break the silence
that now cloaks HIV/AIDS.
USAID, in collaboration with Population Services
International (PSI) and the GOZ, launched 10 New Start VCT
centers at strategic locations throughout the country. One
New Start objective is to test different VCT service delivery
models. The different service delivery models include: 1)
public sector clinics, 2) NGO providers, 3) private sector
providers, 4) public sector clinic and NGO partnership, and
5) one independently managed experimental site. The first
four service delivery models are integrated within institutions
that offer other AIDS and/or health services. The goal is
to determine which model has the greatest impact and to inform
decisions about which approaches should be replicated.
In Zimbabwe, USAID has achieved the highest
client return rate of any VCT program, in part, due to the
high quality of counseling and the nominal fee of $0.75 that
clients pay for pretest, post-test counseling, and three follow-up
visits. The newest independent VCT site is managed by PSI
using business franchise techniques. It is located in downtown
Harare near a bus terminal, open 12 hours a day, seven days
a week, including public holidays, with a focus on quality
counseling. It serves 150 clients per day-approximately the
same number as those that are seen at all the nine other sites
combined. USAID Zimbabwe is learning and thus improving on
this experiment in the fight against HIV/AIDS.
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Zimbabwe's Private Sector Housing
Program Evolves to Score More Successes
The USAID/Zimbabwe private sector housing
program continues to produce demonstrable results, even after
the formal conclusion of reporting to Washington. The housing
program was established to alleviate an overwhelming demand
for shelter while giving an asset base to low-income households.
The program has gone on to create momentum for local municipal
reform, providing valuation models for a business approach
to management of local authorities (LAs) and a basis for future
USAID involvement in increasing citizen participation in local
governments decision-making.
For the first time, government entered into
policy dialogue with local government and the private sector.
A private-public sector working group on expanding municipal
finance was established for this purpose. A policy framework
was developed by the three partners to manage the development
interface of local authorities with central government and
business. The framework addresses aspects of stimulating a
private capital market for municipal finance for infrastructure
requirements, an opportune intervention given central government's
inability to fund local authorities from the national budget.
As a direct result of collaboration with USAID/Zimbabwe,
local authorities, and the private sector, six LAs undertook
credit ratings in the past year, for a total of 12 credit
rated LAs. With USAID facilitation, a Fiscal Decentralization
Action Plan was produced to develop and promote policies and
practices that will strengthen LA financial autonomy, and
to resolve the issue of unfunded mandates in health, education,
and transport.
Years of investment in introducing and modeling
best practices, study tours, and interactive learning are
sending messages that are percolating to the highest levels
of government. The GOZ Cabinet accepted the working group's
proposals to liberalize LA borrowings, allow LAs the autonomy
to set tariffs and taxes when adequate consultation of the
residents is demonstrated, develop early financial warning
mechanisms and responses, and to set debt limitation guidelines.
Some LAs have already begun to implement this new autonomy
policy.
USAID/Zimbabwe's experience, credibility,
and comparative advantage in the sector are being exploited
in designing a local governance component of the democracy
program. A culture of democratic participation in decision
making and accountability at the local government level is
being cultivated. The positive results that emanate from this
model are significant in relation to the modest resources
invested by USAID.
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