The Impact Assessment of the Expanded Programme of Support (ESP) for HIV and AIDS aimed to determine the success of the ESP in achieving its targets, its cost effectiveness and how far it contributed to the overall achievements of the national response. The ESP aimed to support scale up of the national HIV and AIDS response in Zimbabwe through a Common Fund supported by five bilateral donors – Canada, Ireland, Norway, Sweden and the UK.
Engaging in a comprehensive and participatory process at national, provincial and district levels with all key stakeholders and acquiring an in-depth insight into the experiences gained by implementing partners and beneficiaries, the assessment provided recommendations to inform the future strategic direction of the programme. Recommendations included:
- The ability of the programme to respond to priority needs of the national programme within its areas of focus has been highly valuable and should be continued.
- The ESP should maintain its flexibility to ensure future alignment and response to emerging needs in the context of a changing epidemic.
- The Modes of Transmission study provides a comprehensive summary of the main ways to reduce HIV transmission in Zimbabwe and should be used as a reference for future programming decisions on prevention
- As the HIV prevalence is fairly homogeneous across the country at provincial and district level, there is a need to target resources more specifically to areas identified as hot spots and to most at risk populations
- The ESP should continue to support decentralisation but put in place measures to monitor the quality of implementation so that as activities are further spread into lower levels of implementation there are appropriate supervisory and monitoring arrangements put in place
- The government should be supported to develop policies that are supportive of the task shifting that is occurring, for example, nurses providing ART. With the extreme shortage of human resources in the health sector, it is important to use all people available to the best of their capacity: however, this needs a supportive legal environment to be implemented effectively.
- The ESP should facilitate systematic local capacity building for longer term sustainability (e.g. for procurement) as the situation in Zimbabwe gradually becomes more stable