Measuring Regional Policy Change and Pro-Poor Health Policy Success: A PRARI Toolkit of Indicators for the Southern African Development Community (SADC)

PRARI is a social development research project that looks at world-regional social governance, politics, and policy. PRARI brings together an international team of researchers studying the scope for enhancing the effectiveness of the contributions of Southern regional organisations to poverty reduction. It receives funding from the ESRC

Within-Gender Changes in HIV Prevalence among Adults between 2005/6 and 2010/11 in Zimbabwe

INTRODUCTION: Zimbabwe has reported significant declines in HIV prevalence between 2005/06 and 2010/11 Demography and Health Surveys; a within-gender analysis to identify the magnitude and factors associated with this change, which can be masked, is critical for targeting interventions. METHODS: We analyzed change in HIV prevalence for 6,947 women and 5,848 men in the 2005/06 survey and 7,313 women and 6,250 men in 2010/11 surveys using 2005/06 as referent. The data was analyzed taking into consideration the survey design and therefore the svy, mean command in Stata was used in both linear and logistic regression. RESULTS: There were similar proportional declines in prevalence at national level for males (15% p=0.011) and females (16%,p=0.008). However, there were variations in decline by provincial setting, demographic variables of age, educational level and some sexual risk behaviours. In logistic regression analysis, statistically significant declines were observed among men in Manicaland, Mashonaland East and Harare (p<0.01) and for women in Manicaland, Mashonaland Central and Harare (p<0.01). Although not statistically significant, numerical increases were observed among men in Matebeleland North, Matebeleland South, Midlands and for both men and women in Bulawayo. Young women in the age range 15-34 experienced a decline in prevalence (p<0.01) while older men 30-44 had a statistically significant decline (p<0.01). Having a secondary and above education, regardless of employment status for both men and women recorded a significant decline. For sexual risk behaviours, currently in union for men and women and not in union for women there was a significant decline in prevalence. CONCLUSION: Zimbabwe has reported a significant decline among both men and women but there are important differentials across provinces, demographic characteristics and sexual risk behaviours that suggest that the epidemic in Zimbabwe is heterogeneous and therefore interventions must be targeted in order to achieve epidemic control

Success in Revitalizing Weekly Disease Surveillance System in Zimbabwe Using Cell-phone Mediated Data Transmission, 2009-2013

Innovative approach to revitalizing Disease Surveillance System in Zimbabwe using cell-phone mediated data transmission has been a huge success. Cell phones have been successfully integrated into disease surveillance system resulting in expansion of surveillance coverage, improved completeness and timeliness. Decision makers are now able to access disease surveillance data in near real-time

Patient and health-care worker experiences of an HIV viral load intervention using SMS: A qualitative study.

BackgroundMobile Health or mHealth interventions, including Short Message Service (SMS), can help increase access to care, enhance the efficiency of health service delivery and improve diagnosis and treatment for HIV. Text messaging, or SMS, allows for the low cost transmission of information, and has been used to send appointment reminders, information about HIV counselling and treatment, messages to encourage adherence and information on nutrition and side-effects. HIV Viral Load (VL) monitoring is recommended by the WHO and has been progressively adopted in many settings. In Zimbabwe, implementation of VL is routine and has been rolled out with support of Médecins Sans Frontières (MSF) since 2012. An SMS intervention to assist with the management of VL results was introduced in two rural districts of Zimbabwe. After completion of the HIV VL testing at the National Microbiology Reference Laboratory in Harare, results were sent to health facilities via SMS. Consenting patients were also sent an SMS informing them that their viral load results were ready for collection at their nearest health facilities. No actual VL results were sent to patients.MethodsA qualitative study was conducted in seven health-care facilities using in-depth interviews (n = 32) and focus group discussions (n = 5) to explore patient and health-care worker experiences of the SMS intervention. Purposive sampling was used to select participants to ensure that male and female patients, as well as those with differing VL results and who lived differing distances from the clinics were included. Data were transcribed, translated from Shona into English, coded and thematically analysed using NVivo software.ResultsThe VL SMS intervention was considered acceptable to patients and health-care workers despite some challenges in implementation. The intervention was perceived by health-care workers as improving adherence and well-being of patients as well as improving the management of VL results at health facilities. However, there were some concerns from participants about the intervention, including challenges in understanding the purpose and language of the messages and patients coming to their health facility unnecessarily. Health-care workers were more concerned than patients about unintentional HIV disclosure relating to the content of the messages or phone-sharing.ConclusionThis was an innovative intervention in Zimbabwe, in which SMS was used to send VL results to health-care facilities, and notifications of the availability of VL results to patients. Interventions such as this have the potential to reduce unnecessary clinic visits and ensure patients with high VL results receive timely support, but they need to be properly explained, alongside routine counselling, for patients to fully benefit. The findings of this study also have potential policy implications, as if implemented well, such an SMS intervention has the potential to help patients adopt a more active role in the self-management of their HIV disease, become more aware of the importance of adherence and VL monitoring and seek follow-up at clinics when results are high

Success in Revitalizing Weekly Disease Surveillance System in Zimbabwe Using Cell-phone Mediated Data Transmission, 2009-2013

Innovative approach to revitalizing Disease Surveillance System in Zimbabwe using cell-phone mediated data transmission has been a huge success. Cell phones have been successfully integrated into disease surveillance system resulting in expansion of surveillance coverage, improved completeness and timeliness. Decision makers are now able to access disease surveillance data in near real-time

Change in HIV prevalence in Zimbabwe by sex between the 2005/6 and 2010/11 surveys by different socio-demographic characteristics (weighted).

<p>Change in HIV prevalence in Zimbabwe by sex between the 2005/6 and 2010/11 surveys by different socio-demographic characteristics (weighted).</p

Logistic regression of the factors associated with change in HIV prevalence among adults aged 15–49 years who were tested for HIV, ZDHS 2005/6 and 2010/11.

<p>Logistic regression of the factors associated with change in HIV prevalence among adults aged 15–49 years who were tested for HIV, ZDHS 2005/6 and 2010/11.</p