REPUBLIC OF ZAMBIA ZAMBIA COUNTRY REPORT Multi sectoral AIDS Response by armedman2

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									                       REPUBLIC OF ZAMBIA




      ZAMBIA COUNTRY REPORT
Multi-sectoral AIDS Response Monitoring and Evaluation
                    Biennial Report
                      2006-2007
                      UPDATE VERSION



SUBMITTED TO THE UNITED NATIONS GENERAL ASSEMBLY
              SPECIAL SESSION ON AIDS
               Declaration of Commitment

          Reporting period: January 2006–December 2007

                      JANUARY 31st 2008


                                                                  .




                                                          NAC
                                                         ZAMBIA


 MINISTRY OF HEALTH                            NATIONAL AIDS COUNCIL
Zambia Country Report - National M&E Report to UN General Assembly
Table of Contents
Indicators at a Glance                  ........................................................................................    iii
National Profile             ...................................................................................................    iv
List of Acronyms             ....................................................................................................   v
EXECUTIVE SUMMARY                       ………………………………………………………………..                                                                  vii
CHAPTER I: INTRODUCTION                              ............................................................................   1
1.1 Overview of UNGASS on AIDS Declaration of Commitments                                                       ................    1
1.2   2008 Zambia National Monitoring and Evaluation Report                                         ............................    2
1.3   2008 Zambia Country Report Structure                                  ....................................................    2
CHAPTER II: THE EPIDEMIC AND NATIONAL RESPONSE                                                      ............................    3
2.1   Status of the HIV Epidemic                    ............................................................................    3
2.2. Influencing Factors in the Spread of HIV                               ....................................................    6
2.3   Partnerships in the National Response ................................................................                        10
CHAPTER III: POLICY, STRATEGY AND IMPLEMENTATION ENVIRONMENT                                                                        16
3.1 Coordination and Management of the National Response                                            ............................    16
3.2 Progress Made in Policy Strategy and Programme Implementation Environment                                                       20
CHAPTER IV: PROGRESS IN NATIONAL PROGRAMME IMPLEMENTATION
                  AND OVERALL IMPACT ................................................................                               26
4.1   Intensifying Prevention Indicators                        ................................................................    26
4.2   Outcome Programme Indicators – Knowledge and Behaviour ............................                                           41
4.3   Impact Indicators of the National Programmes ....................................................                             52
CHAPTER V: BEST PRACTICES IN ZAMBIA                                         ....................................................    56
5.1   Best Practice I: The Mboole Rural Development Initiative                                      ............................    56
5.2   Best Practice II: Zambia Interfaith Network Group on HIV/AIDS                                             ................    61
5.3   Best Practice III: Network of Zambian People Living with HIV/AIDS                                                     ....    62
5.4   Best Practice IV: Zambia Private Sector’s Response to HIV & AIDS ................                                             63
5.5   Best Practice V: Churches Health Association of Zambia                                         ............................   65
5.6   Best Practice VI: Collaborative Approach to Scaling Up Comprehensive HIV
      and AIDS Intervention Programmes between the Civil Society Organization
      and the Private Sector …………………………………………………………                                                                                 67
5.7   Best Practice VII: Expanded Church Response to HIV/AIDS Trust                                             ………....             71
CHAPTER VI: MAJOR CHALLENGES AND REMEDIAL ACTIONS                                                               ................    74
6.1   Progress made on Key Challenges Reported in the 2005 UNGASS
      Report for Zambia     ........................................................................................                74
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6.2   Challenges Experienced in 2006-2007 Reporting Period                                            ............................    78
CHAPTER VII: SUPPORT FROM COUNTRY’S DEVELOPMENT PARTNERS                                                                              80
CHAPTER VIII: NATIONAL MONITORING AND EVALUATION SYSTEMS ....                                                                         83
ANNEXES            ................................................................................................................   89
      Consultation/ Preparation Process for the National Report                           ............................                90
      Checklist for National Progress Report ................................................................                         91
      Report of Civil Society Consultation and Participation in the Process ................                                          92
      NCPI Report ....................................................................................................                95
      Country Response Information System Report ...................................................                                  96
      List of Participants Interviewed During the NCPI                        ........................................                97
      List of Contributors to the Report              ...............................................................                 99




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INDICATORS AT A GLANCE
1. CORE INDICATORS
Indicator                                           2005                       2006                     2007
National Commitment & Action
Amount of national funds disbursed by               Kwacha 14 billion          US$203,824,914
governments in low and middle income countries      Note: 2.5% of PRSP
                                                    budget for 2004 was used
National Programmes:
% of transfused blood units screened for HIV
                                                             100%                     100%                     100%

% of adults and children with advanced HIV
                                                                                      32.9%                    50.5%
infection receiving antiretroviral therapy
% of HIV-positive pregnant women who
received antiretroviral to reduce the risk of             -                           29.7%                    39.1%
mother-to-child transmission
Estimated HIV-positive incident TB cases that
                                                          -                              -                     39.9%
received treatment for TB and HIV
% women and men 15-49 years who received an
HIV test in the last 12 months and who know             15.6%                                      15.4%
their results
% of schools that provided life-skills based
                                                                                       60%                         60%
HIV/AIDS education in the last academic year
% of orphans and vulnerable children whose              15.6%                                      15.7%
households received free basic external support
in caring for the child                         F = 13.4%, M = 12.5%
Knowledge, Sexual Behaviour and Orphans’ school attendance

% of young women and men aged 15-24 who               All (15-24) = 47.8%                    All (15-24) = 35.3%
both correctly identify ways of preventing the
                                                           M=51.2%                                M=36.9%
sexual transmission of HIV and who reject
major misconceptions about HIV transmission                F =45.2%                               F =34.0%
(Target: 90% by 2005; 95% by 2010)
% of young women and men aged 15-24 who                   All = 10.3%                            All = 14.6%
had sexual intercourse before the age of 15                 M = 10.5                              M = 16.0%
                                                             F = 10.2                              F = 13.5%
% of young women and men aged 15-49 who                All (15-49) = 6.4%                     All (15-49) = 7.2%
have had sexual intercourse with more than one              M=11.6%                                M=14.4%
partner in the last 12 months                               F = 2.1%                               F = 1.2%
% of young women and men aged 15-49 who                All (15-59) = 5.3%                    All (15-59) = 45.6%
had more than one sexual partner in the past 12
                                                        Males = (5.1%),                        Males = 50.0%
months reporting the use of a condom during
their last sexual intercourse                           Females (6.4%)                        Females=37.4%
Ratio of current school attendance among
                                                    1:5 or (507425:522,378)                          1:1
orphans to that among non-orphans, aged 10-14
Impact
% of young people aged 15-24 who are HIV                                    All (15-24 years) = 12.5%
infected
                                                                              15-19 years = 11.6%
Target: 25% by 2005; 25% reduction globally by
2010)                                                                         20-24 years = 17.8%
% of adults and children with HIV still alive 12                                    All=89.6%                All=87.6%
months after initiation of antiretroviral therapy                                  Male=87.8%               Male=87.0%
                                                                                  Female=90.7%             Female=89.9%
% of infants born to HIV infected mothers who
are infected                                                                          39%
(Target: 20% reduction by 2005; 50% reduction


Status at a Glance                                                                                                   iii | P a g e
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by 2010
1. National Profile
 Demographic indicators                                              2005           2006           2007
 Total projected population                                     11,441,461     11,798,678    12,160,516
 Population 15-64                                                   52.4%          52.5%         52.5%
 Total projected population 15-49                               5,842,187      6,033,674     6,227,228
 Male projected population 15-49                                2,903,249      2,999,581     3,098,592
 Female projected population 15-49                              2,938,938      3,034,093     3,128,636
 Total projected population 15-54                               2,328,040      2,392,706     2,458,646
 Male projected population 15-24                                1,145,459      1,178,500     1,212,481
 Female projected population 15-24                              1,182,581      1,214,206     1,246,165
 Total projected population 15-19                               1,254,720      1,290,059     1,326,424
 Male projected population 15-19                                  618,474        636,673       655,631
 Female projected population 15-19                                636,246        653,386       670,793
 Crude birth rate (births/1000 pop)
 Children 6-13 (basic)                                          3,980,049      4,095,115     4,212,916
 Children 14-17 (basic)                                         2,640,340      2,728,780     2,819,787
 Adult HIV population                                           1,200,000      1,300,000     1,482,228
 Paediatric HIV population                                         60,000         70,000        82,825
 Newly symptomatic adults                                          95,818         96,108        96,761
 Newly symptomatic children                                         5,500          5,700         6,086
 Adult HIV Deaths                                                  95,373         96,202        97,494
 Paediatric HIV deaths                                              6,000          7,000         8,283
 Epidemiological indicators
 Adult HIV prevalence (%)                                            13.9%        13.5%          13.1% 
 Pregnant women HIV prevalence (%)                                   19.1%        19.1%          19.3% 
 Other data - Not in RNM
 Number OVC                                                     1,197,867      1,241,368     1,291,079 
 Average family size                                                    5              5             5 
 Male Children 6-13 (basic)                                     2,029,825      2,088,509     2,148,587 
 Female Children 6-13 (basic)                                   1,950,224      2,006,606     2,064,329 
 Male Children 14-17 (high school)                              1,452,187      1,500,829     1,550,883 
 Female Children 14-17 (high school)                            1,188,153      1,227,951     1,268,904 
 Health Resources Indicators
 Physicians (number) – Estimated                                        646          646           646 
 Nurses (number) – Estimated                                          9,000        9,000         9,000 
 Other health workers (number) – Estimated                           13,000       13,000        13,000 
 Hospitals (number)                                                      97           97            97 
 Health Centers (number)                                              1,210        1,210         1,210 




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List of Acronyms

AIDS            Acquired Immune Deficiency Syndrome
ART             Anti-retroviral Treatment
ARV             Anti-retroviral
BSS             Behavioural Surviellance Survey
CBoH            Central Board of Health
CCM             Country Coordination Mechanism
CDC             United States Centers for Disease Control and Prevention
CHAZ            Churches Health Association of Zambia
COE             Center of Excellence
CPs             Cooperating Partners
CRAIDS          Community Response to HIV/AIDS
CSO             Central Statistical Office
DATFs           District AIDS Task Forces
DAZ             Drivers Association of Zambia
DBS             Dried Blood Spots
DFID            UK Department for International Development
DHMTs           District Health Management Teams
DNA             DeoxyriboNucleic Acid
DPO             Disabled People’s Organisations
ECR             Expanded Church Response to HIV and AIDS
EMIS            Education Management Information System
FBOs            Faith-Based Organisations
FNDP            First National Development Plan
FSWs            Female Sex Workers
FYO             Forum of Youth Organisations
GDA             Global Development Alliance
GRZ             Government of the Republic of Zambia
HBF             High Business Forum
HBV             Hepatitis B Virus
HCV             Hepatitis C Virus
HHV8            Human Herpes Virus 8
HIV             Human Immunodeficiency Virus
INGOs           International Non-Governmental Organisations
JASZ            Joint Assistance Strategy for Zambia
JFA             Joint Financing Arrangement
KCM             Konkola Copper Mines
KS              Kaposi’s Sarcoma
LBF             Lower Business Forum
LCMS            Living Conditions Monitoring Survey
LDTDs           Long Distance Truck Drivers
LMs             Line Ministries
MCDSS           Ministry of Community Development and Social Services
MCZ             Medical Council of Zambia
MIB             Ministry of Information and Broadcasting
MLSS            Ministry of Labour and Social Security
MOD             Ministry of Defence
MOE             Ministry of Education
MFNP            Ministry of Finance and National Planning
MOH             Ministry of Health

Acronyms                                                                   v|Page
Zambia Country Report - National M&E Report to UN General Assembly
MSYCD           Ministry of Sport Youth and Child Development
MTCT            Mother to Child Transmission
NAC             National HIV/AIDS/STI/TB Council
NARFs           National AIDS Reporting Forms
NASF            National AIDS Strategic Framework
NASA            National AIDS Spending Assessment
NASTAD          National Alliance of State and Territorial AIDS Director (USA)
NPCI            National Policy Composite Index
OVC             Orphans and Vulnerable Children
PEPFAR          United States President’s Emergency Plan for AIDS Relief
PLHA            People Living with HIV/AIDS
PMTCT           Prevention of Mother-to-Child Transmission
PPA             Private Practitioners Association
PRSP            Poverty Reduction Strategy Paper
SAG             Sector Advisory Group
SCGs            Self-coordinating groups
SHARe           Support for the HIV/AIDS Response Project (USAID/ JSI)
STIs            Sexually Transmitted Infections
TB              Tuberculosis
TDRC            Tropical Diseases Research Center
UNFPA           United Nations Population Fund
UNGASS          United Nations General Assembly Special Session
UNICEF          United Nations Children's Emergency Fund
UNZA            University of Zambia
USG             United States Government
ZACCI           Zambia Chamber of Commerce and Industry
ZBCA            Zambia Business Coalition on AIDS
ZCSMBA          Zambia Chamber of Small and Medium Business Associations
ZDHS            Zambia Demographic Health Survey
ZNAN            Zambia National AIDS Network
ZNBT            Zambia National Blood Transfusion Services
ZINGO           Zambia Interfaith Networking Group
ZNFU            Zambia National Farmers Union
ZSBS            Zambia Sexual Behaviour Survey
ZWAP            Zambia Workplace AIDS Partnership




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EXECUTIVE SUMMARY
Introduction
Zambia last reported to the UNGASS on HIV and AIDS in 2005. Since the last reporting period, the
country has made progress in a number of areas towards implementing the Political Declaration of
Commitments on HIV and AIDS which the Zambian Government together with 189 other member
states endorsed and adopted in June 2001. Recognising the need for multisectoral action on a range
of fronts, the Declaration of Commitments on HIV and AIDS addresses global, regional and
country-level responses to prevent new HIV infections, expand health care access and mitigate the
epidemic’s impact.
The vision of the declaration extends far beyond government sector to include the private industries
and labour groups, faith based organizations, non governmental organizations and other civil
society entities including organizations of people living with HIV and AIDS.

2008 Zambia National Monitoring and Evaluation Report
The information provided in this report represents the most comprehensive set of standardised data
on the status of the epidemic and progress in the response in Zambia, taking into consideration some
of the data gaps identified by the 2005 feedback report from UNAIDS.
The National AIDS Council in collaboration with the Ministry of Health, civil society organisations,
the private sector and other line ministries, coordinated the 2008 reporting process. A multi-
disciplinary and multi-sectoral taskforce of the National AIDS Council constituted the technical
team, which provided technical oversight and validation throughout the report generation process.
Based on the 2008 UNGASS Reporting guidelines on construction of core indicators, of the 33
indicators required to be responded to, this report adequately responded to 20 of them. The 13
remaining indicator cover issues on Men Who Have Sex with Men and Injecting Drug Users which,
although relevant to Zambia, no data was available.
General Overview
Zambia, a country with an estimated population of 12.2 million in 2007 based on a 2.9 percent
annual growth since 2000 has an estimated HIV prevalence of 15.6% among the 15-49 years age
group, making it one of the countries in Sub-Sahara Africa worst affected by the HIV and AIDS
pandemic. Sub-Sahara Africa has an estimated prevalence of 7%. In 2007, Zambia was one of the
countries with the highest dependency ratios in the world which was reported as 0.9 against 0.4
respectively. Unemployment is high and presents a serious social problem. A combination of high
dependency ratio and high unemployment presents a significant challenge for HIV and AIDS for
Zambia.
The National Response to HIV and AIDS
A multi-sectoral response has been adopted throughout the implementation of the programme with
partnerships established both at national and sub-national levels. At the national level, partners
involved in the response are organised using self-coordinating groups, theme groups, sector
advisory groups, partnership forums, cooperating partner groups, and the UN Joint Team. At sub-
national level, partnerships are organised through the District AIDS Task Forces (DATFs) and the
Community AIDS Task Forces (CATFs).


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Within the national response framework, government has maintained its political commitment to the
national response by establishing a Cabinet Committee on HIV and AIDS whose role has been to
provide policy direction and guidance to the National AIDS Council. The committee continues to
perform its critical role of informing the Head of State on important matters concerning HIV and
AIDS in the country.
Policy, Strategy and Implementation Environment
Zambia has made considerable progress in building national leadership and ownership in the
response to HIV and AIDS. Increasing numbers of national, political, religious and traditional
leaders are voicing their support for efforts to tackle the epidemic. The policy, strategy and
implementation environment entails a description of the institution arrangement findings from
National Composite Policy Index (NCPI) and the National AIDS Spending Assessment (NASA).
The Government of Zambia (GRZ) and the global AIDS community have recognised the need to do
more to effectively tackle AIDS. Zambia is a signatory to many important commitments related to
AIDS. One of these, the ‘Three Ones’ principles, provides a useful framework for development of
the Zambian AIDS response by ensuring that there is:
1. One agreed HIV and AIDS Strategic Framework that provides the basis for coordinating the
   work of all partners: Zambia has developed and disseminated a Fifth National Development
   Plan (FNDP 2006–2010) and a related National HIV and AIDS Strategic Framework (NASF
   2006–2010). These documents were developed with broad participation of key stakeholders,
   including the civil society to ensure ownership and have since been disseminated. Further,
   Zambia has started developing annual costed work plans based on the strategic framework.
2. One National AIDS Coordinating Authority, with a broad-based multi-sectoral mandate: The
   National HIV/AIDS/STI/TB Council (NAC) has been established through legislation and is
   comprised of broad representation from several government ministries and civil society. The
   strength of the NAC Board and Secretariat to oversee, drive and convene a multi-sectoral
   national response is at the heart of Zambia’s ability to turn the tide of the HIV crisis.
3. One agreed country-level Monitoring and Evaluation System: In tandem with the NASF 2006-
   2010, the NAC has also developed a Monitoring and Evaluation (M&E) Framework and Plan
   that was costed to ensure that it receives financial support in a predictable manner.

Progress Made in Policy, Strategies and Programme Implementation Environment
The National Composite Policy Index assessment was conducted in the latter part of 2007. The
NCPI is designed to assess progress in the development and implementation of national AIDS
policies and strategies. The assessment concluded that Zambia has made significant progress in the
development of AIDS strategies and policies, particularly in the areas of strategic planning,
prevention, treatment and mitigation. However, there remains the need to complete the development
of the prevention strategy; improve financial flows; address treatment access barriers and human
rights related issues; as well as strengthen the harmonization of M&E systems and data use.

Progress in National Programme Implementation and Overall
The national HIV prevention, treatment and care strategy is focused on prevention of HIV
transmission through blood, provision of ART services including prevention of mother to child


Executive Summary                                                                       viii | Page
Zambia Country Report - National M&E Report to UN General Assembly
transmission, voluntary counseling and testing and prevention of HIV transmission through health
care and other care settings including support for children affected by HIV and AIDS.
Since the last reporting period and based on the core national programme indicators outlined in the
2008 UNGASS reporting guidelines, Zambia maintained 100% screening for HIV of all blood units
collected in a quality assured manner for both 2006 and 2007 with the procedures and results
endorsed by an external quality assurance team from the Royal college of Pathologists of Australia.
This has been achieved despite increases in blood units collected from 61,584 in 2005 to 68,265 in
2007.
The number of adults and children with advanced HIV infection receiving antiretroviral therapy has
been moved from 39,351 in 2005 to 149,199 in 2007. In 2006, a total of 80,030 or 32.9% of all
adults and children with advanced HIV infection were receiving ART while the 149,199 accounted
for 50.6% for 2007. However, in terms of the programme implementation performance according
to set targets of 90,000 for 2006 was 88.9%, while in 2007 a 115% result was attained after reaching
as at September 2007 based on the estimated need of 130,000. The scaling-up of free ART was
continued in 2006, resulting in a significant increase in the numbers of centres providing both
ARVs for PMTCT and ART nationwide, from 62 in 2005 to 146 in 2006 and 320 at the end of
2007.
Since the last reporting period in 2005, the total number of HIV infected pregnant women who
received antiretrovirals (ARVs) to reduce mother-to-child- transmission increased from 14,071 to
25,578 in 2006 and by the end of 2007 the number reached had increased to 35,314. Based on an
estimated need of 86,232 for 2006, the percentage of HIV positive pregnant women who received
ARVs was 29.7%, while in 2007 Zambia increased this proportion to 39.1% based on an estimated
need of 90,252.
The percentage of estimated HIV-positive incident TB cases that received treatment for TB and
HIV was 34.8% out of a total need of 60,723 while in 2007 of the 12, 835 (or 66%) TB patients
tested positive for HIV a total of 5, 017 (or 39%) individuals were started on ART.
Vulnerability to HIV among the youth remains high with only 10.2% of young women and men age
15-19 receiving an HIV test in the last twelve months and knowing their results in 2007. This
situation was further compounded by the fact that only 33.6% of the youths of the same age group
were able to correctly identify ways of preventing the sexual transmission of HIV and who rejected
major misconceptions about HIV transmission. Youth vulnerability to HIV was also compounded
an increase in the proportion of 15-24 year olds who reported having sexual intercourse before the
age of 15 years from 10.3% in 2005 to 14.6% in 2007.
Similarly, the percentage of the most at risk populations, classified as sex workers who received an
HIV test in the last twelve month and know their results remained low at 17.3% for all sex workers
with the under 25 years scoring 17.9% while those 25 years and above scored slightly less at 16.5%.
During this reporting period it was established that 15.7% or 578 of the 3,671 orphans and
vulnerable children surveyed reported that their households had received free basic external support.
Zambia has an estimated number of 1.2 million orphans of which 75% are estimated to be orphans
due to HIV and AIDS.
Service delivery data in 2006 showed that for the age group 15 to 24 year olds, a total of 454,069
received life skills-based HIV/AIDS education out of which 234,058 were males while 220,010
were females. However, the UNGASS indicator revealed that 60% of school provided life skills-
based HIV education in the 2006 academic year.

Executive Summary                                                                           ix | Page
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Similarly, the number of women and men aged 15–49 who have had sexual intercourse with more
than one partner in the last 12 month remained low although with a slight increase from 6.4% in
2005 to 7.2% in 2007. Males scored much higher for this indicator at 14.4% against the 1.2% for
females in 2007.
Significant increased where also observed in the use of condoms at the last sexual intercourse
encounter for young persons who had more than one sexual partner in the last twelve months for all
categories when the 2007 results were compared to the 2005 findings. Composite (All 15-49) years
results showed an increase from 5.3% or 23 out of 430 in 2006 to 45.6% out of 2,573 in 2007.
Percentage of adults and children with HIV known to be on treatment 12 months after initiation of
treatment showed that overall, survival for both adults and children was 89.6 percent in 2006, but
dropped to 87.6 percent in 2007. Disaggregated data revealed that children (<15 years) scored the
highest (91.4 percent in 2006 and 92 percent in 2007) and was the only category that recorded an
increase in survival
Major Challenges and Recommendations
Stronger coordination mechanisms from national to the province and district were required to
ensure that stakeholders at various levels were regularly communicating and therefore able to
address specific, operational problems as they arose. Since the last UNGASS report, the
government has developed a new strategic framework with emphasis on more effective
coordination. The resource envelope increased from US$104 million in 2004 to US$223 million in
2007.
The analysis based on sentinel surveillance and population surveys indicate that the national
situation contains many smaller epidemics with their own dynamics in different geographical,
sectoral, and other population groups although the prevalence had stabilized at 16% between 1994
and 2004. Programming must take these into account with sound analysis and understanding of the
driving forces of the epidemic in different population groups, between genders and in different age
cohorts. In addition, there is need for tailor-made programmes to address specific issues. Since the
last reporting period
National Monitoring and Evaluation Systems
Since the last reporting period for Zambia in 2005, national commitment and funding dedicated to
fighting the HIV/AIDS epidemic have increased steadily as indicated above. Strong M&E is a
prerequisite for programme oversight and accountability. Governments, donor organizations, and
programme managers are making conscientious efforts to ensure that active and interactive
monitoring processes are in place at every level of the national response. M&E in Zambia is part of
the “Three Ones” Principles”.




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                                             CHAPTER I.  
                                        INTRODUCTION 
1.1.   Overview of UN General Assembly Special Session on AIDS
       Declaration of Commitment

At the close of the groundbreaking UNGASS on HIV/AIDS in June 2001, 189 Member States
adopted the Declaration of Commitment on HIV/AIDS. It reflects global consensus on a
comprehensive framework to achieve the Millennium Development Goal of halting and beginning
to reverse the HIV epidemic by 2015. Recognizing the need for multi-sectoral action on a range of
fronts, the Declaration of Commitment on HIV/AIDS addresses global, regional and country-level
responses to prevent new HIV infections, expand health care access and mitigate the epidemic’s
impact. Although it was governments that initially endorsed the Declaration of Commitment on
HIV/AIDS, the declaration’s vision extends far beyond the governmental sector to include private
industry and labour groups, faith-based organisations, and nongovernmental organisations and other
civil society entities, including organisations of people living with HIV.
Under the terms of the Declaration of Commitment on HIV/AIDS, success in the AIDS response is
measured by the achievement of concrete, time-bound targets. They call for careful monitoring of
progress in implementing commitments and require the United Nations Secretary-General to issue
progress reports biennially. These reports are designed to highlight progress, identify problems and
constraints, and recommend actions to accelerate achievement of the targets.
In keeping with these mandates, in 2002 the UNAIDS Secretariat collaborated with UNAIDS co-
sponsors and other partners to develop a series of core indicators to measure progress in
implementing the Declaration of Commitment on HIV/AIDS. The core indicators were grouped into
four broad categories:
           (i)    National commitment and action;
           (ii)   National knowledge and behaviour;
           (iii) National impact; and
           (iv)   Global commitment and action.
In 2005, Zambia was among the 137 Member States (72 percent) that submitted Country Progress
Reports to the UN General Assembly. Forty reports came from sub-Saharan Africa, 21 from Asia
and the Pacific, 32 from Latin America and the Caribbean, 21 from Eastern Europe and Central
Asia, 5 from North Africa and the Middle East, and 18 from high-income countries.




Overview of UNGASS Declaration of Commitment                                             1|Page
Zambia Country Report - National M&E Report to UN General Assembly
1.2.     2008 Zambia National Monitoring and Evaluation Report

The information provided in this report represents the most comprehensive set of standardised data
on the status of the epidemic and progress in the response in Zambia, taking into consideration some
of the data gaps identified by the 2005 feedback report from UNAIDS.
The National AIDS Council in collaboration with the Ministry of Health, civil society organisations,
the private sector and other line ministries, coordinated the 2008 reporting process. A multi-
disciplinary and multi-sectoral taskforce of the National AIDS Council constituted the technical
team, which provided technical oversight and validation throughout the report generation process.
The detailed roadmap of the process involved:
   • Review of the 2005 UNGASS report feedback;
   • Establishment of a UNGASS taskforce with clear roles and responsibilities;
   • Monthly taskforce meeting;
   • Identification of data gaps and quality related issues;
   • Development of data collection roadmap;
   • Consultation of key stakeholders;
   • Advocacy for the involvement of civil society organisations;
   • Recruitment of three consultants: overall consultant, NPCI consultant and consultant to
       disaggregate data;
   • Report writing retreat;
   • Report validation and consensus building meeting;
   • Final consensus meeting and report validation;
   • Report approval process by government.


1.3.     Report Structure

The Zambia Country Report 2008 to the United National General Assembly Special Session
includes the main report containing eight chapters. The annexes include two key reports:

    1.   National Composite Index Policy (NCPI) Report

    2.   Country Response and Information System (CRIS) Report

 




2008 Zambia National Monitoring and Evaluation Report                                    2|Page
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                                             CHAPTER II.  
                THE AIDS EPIDEMIC AND NATIONAL RESPONSE 
2.1.    STATUS OF HIV/AIDS EPIDEMIC
2.1.1   General Overview
Zambia is one of the sub-Saharan African countries worst affected by the HIV and AIDS pandemic.
The country’s population for the reporting period was estimated at 11.8 million in 2006 and 12.2
million in 20071, with a gender distribution of 50 percent unchanged from the previous reporting
period. With a dependency ratio of 0.9 in 2007, Zambia was one of the countries with the highest
dependency ratios in the world (global dependency ratio was 0.4 in 2007). According to the Living
Conditions Monitoring Survey (LCMS V) for 2006, approximately 64 percent of the population was
persons aged between 0 and 24 years, of which 44 percent were aged between 0 and 14 while
percent were youth aged between 15 and 24 years. With approximately 39 percent of the population
living in urban areas, Zambia is also one of the most urbanized countries in sub-Saharan Africa.
Unemployment is high and presents a serious social problem.
The economic activity status of the population was broken down into two categories: the labour
force and the inactive population. The labour force included the employed, unpaid family workers
and the unemployed, while the inactive population included full time students, homemakers,
retirees, and the elderly. Approximately 64 percent of the total population was in the labour force,
of which 43 percent were employed, 12 percent were unpaid family workers and 9 percent were
unemployed. The inactive population accounted for approximately 36 percent of the respondents of
which 27 percent were full time students, 6 percent were home makers and 2 percent were retired or
elderly.
A combination of a high dependency ratio and high unemployment presents a significant challenge
for HIV and AIDS for Zambia
2.1.2   HIV Prevalence in Zambia
Estimates put the prevalence of HIV at approximately 15.6 percent among the 15 to 49 years age
group2. Approximately one million Zambians are HIV-positive, of which over 295,2403 are in need
of antiretroviral therapy. Young people aged 15 to 24 years account for 7.7 percent of the HIV-
positive population, while the 2008 Ministry of Health report indicated that in 2005 less than 10,000
infants were born from HIV infected parents who were also HIV positive. The number reported for
2006 was 6,440 which increased to 15,631 in 2007. There was a steady increase in the percentage
of pregnant women testing positive for HIV for 17.2 percent or 15,285 out of 72,020 in 2005 to 19.0
percent or 31,972 out of 168,276 while in 2007, records showed that 21.2% or 52,846 pregnant
women out of 306,451 tested for HIV for positive.
Overall, the analysis of the sentinel surveillance (1994 to 2004) indicates a stabilisation of HIV
prevalence at 16 percent. However, this analysis indicates that the national situation contains many


1
  Zambia 2000 Census of Population and Housing, Population Projections Report, Central Statistical
office, November 2003
2
  Zambia Demographic Health Survey, 2001-2002, Central Statistics Office, 2003. Zambia
3
  Ministry of Health Reports

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smaller epidemics with their own dynamics within different age groups, geographical locations and
socio-economic strata.
The prevalence is significantly higher among women compared to men, especially for those below
the age of 35. Overall, women (with prevalence rates of 17.8 percent) are 1.4 times more likely to
be HIV-positive than men (with prevalence rates of 12.6 percent). Infection rates among young
women aged 15 to 24 years are 4 times higher than those for young men in the same age group.
Cross-generational and transactional sex leaves younger girls more vulnerable to HIV infection than
males their own age, while the physiology of young girls increases their susceptibility to infection.
2.1.3    Vulnerable Groups
a)      Youth
The percentage of young women and men who received an HIV test and knew their results
remained low for with the youths 15-19 years scoring only 10.2 percent in 2007 against 8.2 percent
in 2005. On the other hand only 33.6 percent or 1,004 out of 2,990 youths of the same age group
demonstrated comprehensive knowledge of HIV and AIDS by correctly identifying ways of
preventing the sexual transmission of HIV and rejecting major misconceptions about HIV
transmission in 2007 which was also a reduction when compared to the 45.6 percent achieved in
2005. Other indicators also revealed that youths remained vulnerable to HIV and AIDS such as an
increase in percentage of 15-24 years who reported having sexual intercourse before the age of 15
years from 10.3 percent in 20005 to 14.6 percent in 2007. However, a significant increase in
percentage of young persons reporting the use of a condom with their most recent partner was
achieved with the 15-19 years moving from 7.70 percent in 2005 to 45.6% in 2007.
b)      Prisoners
Prison confinement can increase vulnerability to HIV due to frequent unprotected sex in the form of
rape, non-availability and non-use of condoms, as well as a high prevalence of STIs.
Since the most important determinants of inequalities may reside in the broader social economic
environment, the major challenge for the HIV and AIDS programme will be to improve the
targeting of resources to disadvantaged districts and populations with higher gender inequities and
poverty levels.
c)      Discordant Couples
The most susceptible individual in Zambia is the sero-negative partner of a HIV discordant couple.
Based on modelling a straight distribution of HIV-positive people for Zambia, it is estimated that up
to 26.2 percent of all couples may be discordant. It is important to note, however, that this estimate
assumes a static and unchanging set of interactions among the population (CDC-Zambia).
A recent secondary analysis of the Zambia DHS 2001-2 indicates that culture and regional social
norms may be the most significant factors contributing to men engaging in extramarital sex and
being exposed to HIV infection.
2.1.4    Mode of Transmission of HIV
The major mode of HIV transmission in Zambia is heterosexual (2004), through which 78 percent
of the country’s HIV infection is transmitted. This mode of transmission is exacerbated by high-risk
sexual practices, poor socio-economic status of women and high prevalence of STIs. The remaining
20 percent is predominantly due to mother-to-child transmission during pregnancy, at birth or while

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breastfeeding. It is estimated that less than 1 percent is transmitted through contaminated blood and
blood products, use of needles and sharp instruments, and sex between men. 4
Other types of sexual practices, such as homosexual and bisexual practices, also exist in Zambia.
Even within one type of sexual practice, practices can vary to include vaginal and anal penetration,
as well as oral sex. Some of these routes of transmission in Zambia are not well recognised and/or
targeted yet they are drivers of the epidemic. For example, a 2004 study (Zulu, P.K., 2004)
identified 2,500 men who have sex with men (MSM) in only four provinces of Zambia (Copperbelt,
Lusaka, Luapula and Southern). The impact or potential impact of HIV and AIDS transmission
from MSM to or from their partners is significant, especially as approximately 50 percent also have
sex with women, sex workers and multiple concurrent partners.
Knowledge of these population groups and their behavior is limited. Research has not been
conducted on the interaction between different types of sexual practices (i.e. MSM and
heterosexual) and/or the behavior of their clients and networks in Zambia. This situation calls for
urgent re-dress.




4 The HIV/AIDS Epidemic in Zambia, NAC September 2004. Zambia

Status of the HIV/AIDS Epidemic                                                           5|Page
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2.2.     INFLUENCING FACTORS IN THE SPREAD OF HIV5

Understanding the various factors fuelling the spread of HIV is critical. In this regard, the
national response has been dealing with issues of poverty, gender and sexual violence, and
economic, socio-cultural, legal and physiological factors that are different for men and women.
In addition, the national response has also looked at factors such as inadequate access to
information on prevention, low levels of negotiation skills, and inadequate protection under
statutory and customary laws and traditions. A list (not hierarchical but interrelated) of key
influencing factors in the spread of HIV is illustrated in Figure 2.2.1 below.
        Figure 2.2.1: Key Influencing factors to the spread of HIV




2.2.1    Multiple Partners
In a ZSBS 2005 survey, as in previous sexual behaviour surveys, most married females (97.2
percent) indicated they had no non-marital partners. These percentages have remained consistent
since the 2000 survey. Similarly, the percentage of married males indicating they had no non-
marital partners in the twelve months preceding the 2005 survey (90.4 percent) differed little
from that reported in 2003.
The percentage of married males reporting no non-marital partner shows a large increase when
compared to 1998 (79.4 percent), and some of this is likely to be explained by the definitional
changes.
Among unmarried males and females, modest changes in the percentage reporting no non-
regular partner indicate a small decline for unmarried men, and a somewhat larger decline among
unmarried women. Overall, 59.5 percent of unmarried males and 68.5 percent of unmarried
females said they had no non-regular partners in the 2005 survey. The data indicated that 30.2
percent of unmarried males and 21.9 percent of unmarried females reported one non-regular

5
    3rd Joint Annual Programme review

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partner in 2005, and 7.0 percent of unmarried males and 2.7 percent of unmarried females
reported more than one non-regular partner.
2.2.2      Gender and Sexual Violence
Gender issues that perpetuate the dominance of male interests and lack of self-assertiveness on
the part of women in sexual relations put both men and women at risk. Women are taught to
never refuse their husbands sex regardless of the number of extra-marital partners he may have
or his non-willingness to use condoms. This is often the case even when he is suspected of
having HIV or other STIs.
Forced sex without the consent of the partner is a highly undesirable behaviour in any
circumstance, and is particularly risky in the context of the HIV/AIDS epidemic. In such
circumstances, there is no opportunity for negotiating safer sex, and the likelihood of additional
injuries that add to the risk of HIV transmission also increases. The ZSBS 2003 and ZSBS 2005
included questions for female respondents about forced sex. Even though it is likely to be under-
reported, obtaining information on forced sex is important because it serves as an indication of
the prevalence of sexual violence in Zambia and of females’ ability to refuse unwanted sex. The
questions on forced sex were administered only to female respondents. Overall, 15.1 percent of
females reported having experienced forced sex. This was a slight decrease from the 16.3 percent
of females who reported forced sex in 2003. In 2005, 17.7 percent of urban females (data not
shown) and 13.7 percent of rural females reported forced sex. Forced sex was most commonly
reported among the 20-24 year age group (18.5 percent).
The perpetrators most commonly reported are husbands or live-in partners (67.5 percent). Other
reported perpetrators are boyfriends (25.0 percent), male relatives (5.8 percent), former husband/
boyfriend (2.5 percent) and stranger (1.7 percent). From this data, it appears that the majority of
victims of forced sex knew their perpetrators. This data indicates that sexual violence against
females in Zambia is a problem which warrants attention.
2.2.3      Sexually Transmitted Infections
6
 Sexually transmitted infections (STIs) are among the most common causes of illness in Zambia,
affecting primarily adolescents and young adults. There are over 20 micro-organisms that are
transmitted by sexual activity. STIs are still a major public health problem in Zambia, as up to 10
percent of all out-patient attendances at health institutions are related to STIs. Figures could be
significantly higher if accurate reports were available for the age groups 15 to 44 years.
Gonorrhoea, syphilis and chancroid are among the most common infections. Chlamydia
trachomatis. Trichomonas vaginalis and yeast infection of candida albicans are common in
female patients, while men often experience an inflammation of the glans penis (balanitis) and
the prepuce (posthitis). The high prevalence of STIs in Zambia continues to make severe
demands on Zambia’s already stretched human and economic resources.

The presence of untreated STIs increases the chance of HIV transmission during unprotected sex
between an HIV-positive and a HIV-negative person. Because STIs facilitate the transmission of
HIV, the treatment of STIs is an important aspect in preventing the spread of HIV. Over 10
percent of reported attendance at clinics is due to STIs (Ministry of Health – Central Board of
Health Syndromic Guidelines). The 2001-2002 ZDHS shows that 7 percent of women and 8

6
    Ministry of Health

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percent of men in the 15 to 49 age groups have syphilis. The Ministry of Health has initiated
community and clinic-based interventions to help control the spread of STIs. Free treatment of
STIs is offered at all government clinics and health centres, complemented by efforts to raise
community awareness of the dangers of STIs, especially during pregnancy.
2.2.4   High Population Mobility
The high mobility of specific social and work-based groups puts them at risk of HIV infection.
Because they are away from the security and stability of home, there is a tendency to engage in
high-risk sexual behaviour, at times for monetary or material favours. Highly mobile groups
include refugees, long distance truckers, migrant workers, cross-border traders, fishmongers and
uniformed security personnel. It is anticipated that the growth of the mining sector will further
contribute to an increase in population mobility.
2.2.5   Alcohol and Drug Abuse
Drug and alcohol abuse enhances the risk of HIV infections either directly or indirectly by
lowering inhibitions, leading to risky behaviours. In particular, drug in-take through syringes (or
intravenous drug use) involving sharing of needles has been shown to be an extremely high risk
behaviour among this group, though less common in Zambia than the risks associated with
alcohol use.
A study by Professor Nkandu Luo, Alcohol and HIV, recommended the establishment of a multi-
sectoral task force to develop policies and guidelines that address issues around alcohol and other
substance abuse. This would include their impact on HIV transmission, disease progression and
ART within the national HIV and AIDS framework with the implementation to be executed
during 2008 and 2009.
2.2.6   Literacy and Communication
The average national literacy rate in 2001-02 was estimated at 65.1 percent (ZDHS 2001-02). In
all the age groups, literacy levels for men were higher than for women. The total literacy level
for men was 81.6 percent, against 60.6 percent for women. Literacy levels were also higher in
urban areas (79 percent for women and 91 percent for men) than in rural areas (48 percent for
women and 76 percent for men). Literacy levels for the 15 to 24 years age group stood at 59
percent for females and 71 percent for males. Poor literacy levels, especially among females and
rural dwellers, has adverse implications on service delivery as it presents difficulties in
communicating HIV and AIDS related messages and programmes, increasing both men’s and
women’s susceptibility to contracting HIV.
2.2.7   Poverty
Poverty levels in Zambia have remained high since the last reporting period with the overall
poverty incidence estimated at 64 percent. The link between HIV and AIDS and poverty has
been well established.
High levels of poverty directly or indirectly promote behaviours which create vulnerability to
HIV and AIDS. In turn, the consequences of HIV and AIDS can lead to poverty, resulting in a
complex and mutually re-enforcing inter-relationship between HIV and AIDS and poverty,
where the majority of the poor are women.


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As a result of poverty, preventable and treatable diseases have taken an enormous toll on the
poorest people in Zambia who do not have access to professional care, health information,
education, and secure employment. Table 2.2.8.1 presents statistics on the poverty situation in
Zambia.
Table 2.2.8.1: Poverty Situation in Zambia, (2002-2006)
Indicator                                             Measure          2002*            2004            2006

National Incidence                                       %              67.0             68.0            64.0

Incidence of Extreme Poverty                             %              46.0             53.0            51.0

Rural Poverty (% of Rural Population)                    %              72.0             78.0            80.0

Urban Poor (% of Urban Population)                       %              28.0             53.0            34.0

Source: Ministry of Finance and National Planning – Economic Report 2004 and LCMS Report, CSO,2004 & 2006 .
Note:   * The methodology used in 2002 was different from the other years

2.2.8       Harmful Cultural Beliefs and Practices
Socio-cultural beliefs and practices such as having concurrent and multiple sexual partners,
polygamy, cross-generational sex, transactional sex, dry sex, the traditional practice of sexual
cleansing and some practices during initiation ceremonies facilitate the transmission of HIV.
2.2.9       Stigma and Discrimination
Stigma leads to discrimination, silence, shame, denial and blaming others with the result that
there are unnecessary delays in diagnosis and/or treatment and care. As ART becomes more
widely accessible and acceptable, fear of the diagnosis of HIV will lessen while feelings borne of
shame and denial will play an increasingly important role.




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2.3.      PARTNERSHIPS IN THE NATIONAL AIDS RESPONSE

At the national level, partners involved in the response are organised using self-coordinating groups,
theme groups, sector advisory groups, partnership forums, cooperating partner groups, and the UN
Joint Team. At sub-national level, partnerships are organised through the District AIDS Task Forces
(DATFs) and the Community AIDS Task Forces (CATFs).
2.3.1     NATIONAL LEVEL PARTNERSHIPS
2.3.1.1      CABINET COMMITTEE ON HIV AND AIDS
Since 2000, government has maintained its political commitment to the national HIV response by
establishing a Cabinet Committee of Ministers on HIV and AIDS whose role has been to provide
policy direction and guidance to the National AIDS Council. The committee continues to perform
its critical role of informing the Head of State on important matters concerning HIV and AIDS in
the country.

The committee, which is chaired by the Minister of Health, includes the Minister of Finance and
National Planning; the Minister of Sport, Youth and Child Development; the Minister of Labour
and Social Security; the Minister of Mines and Mineral Development; the Minister of
Communications and Transport; and the Minister of Information and Broadcasting.

A study supported by the World Bank in 2005, however, observed that the Cabinet Committee
should ideally be functioning under the Cabinet Office and recommended that the Republican Vice
President chair this committee and act as the Minister responsible for the NAC Act. Under this
arrangement, the Minister of Health should be the Vice Chairperson of the Cabinet Committee.

2.3.1.2      NATIONAL AIDS COUNCIL
The National HIV/AIDS/STI/TB Council (NAC) draws its membership from a wide range of
stakeholders. These include Permanent Secretaries in the Ministries of Community Development
and Social Welfare; Sport, Youth and Child Development; and Education and Health. Other
members of NAC include:
• The Attorney-General’s Office;
• Network of People Living with HIV and AIDS (NZP+);
• Zambia National AIDS Network (ZNAN);
• Forum of Youth Organisations (FYO);
• Traditional Healers Association of Zambia (THAZ)
• Medical Council of Zambia (MCZ);
• General Nursing Council of Zambia; and the
• Media.

Principally, NAC is responsible for supporting the development and coordination of policies, plans
and strategies for the prevention and combating of HIV, AIDS, STI and TB. In this regard, NAC
advises the government on all matters relating to prevention, care, and treatment of HIV, AIDS, STI
and TB, including research in areas targeted at mitigating the socio-economic impact of these
diseases. The execution of this mandate is led by the NAC Secretariat that coordinates HIV and


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AIDS activities throughout the country and closely works with public, private and civil society
institutions engaged in the fight against the pandemic.

2.3.1.3      SELF-COORDINATING GROUPS
i.     Private Sector Self-Coordinating Groups
The private sector is represented through three separate mechanisms:
•     High Business Forum (HBF) - Representation is drawn from various self-coordinating groups
      (SCGs) including: Zambia Business Coalition on AIDS (ZBCA), Global Development Alliance
      (GDA) companies, Private Practitioners Association (PPA), Drivers Association of Zambia
      (DAZ), Zambia Chambers of Commerce and Industry (ZACCI), Zambia Chambers of Small
      and Medium Business Associations (ZCSMBA), and Zambia National Farmers Union (ZNFU).
•     Lower Business Forum (LBF) - Representation is drawn from the same SCGs as from the HBF,
      but membership comprises the Executive Directors of these groups. The LBF forum meets
      quarterly, and is concerned with the day-to-day issues around HIV mainstreaming, including
      workplace programme implementation. This forum is also responsible for advocacy and
      lobbying activities on behalf of the private sector.
•     Workplace AIDS Partnership (ZWAP) - These civil society networks provide training and
      technical assistance for private sector organisations, particularly in the design and
      implementation of workplace prevention, treatment, care and support programmes. Their line of
      work affords them the opportunity to represent the private sector in the various technical theme
      meetings to help coordinate the multi-sectoral response. These theme meetings comprise civil
      society organisations representing both civil society and the private sector. ZBCA coordinates
      the representation of ZWAP partners in the various theme meetings, which are held quarterly.
ii.    Civil Society Self-Coordinating Groups
For the purposes of coordination, civil society in Zambia is conceptualised in 4 levels:7
   Level 1. Community based organisations (CBOs), local and grassroots associations;
   Level 2. Formally constituted non-governmental organisations (NGOs), faith-based
            organisations (FBOs), human rights organisations and trade unions;
   Level 3. Umbrella organisations, networks, professional and church associations;
   Level 4. Consultation platforms and fora.

NAC tends to operate at level 4 but works closely with level 3 structures to support them in coordination,
networking and information exchange activities at levels 1 and 2. The following civil society platforms and
fora are convened by NAC on a quarterly basis:
•     The Forum on HIV and AIDS for Non Governmental Organisations (NGOs);
•     The Forum on HIV and AIDS for Youth;
•     The Forum on HIV and AIDS for Persons with Disabilities ;
•     The Forum on HIV and AIDS for Religious Organisations (including FBOs) ;

7
  see also Sanz Corella B et al. 2006. Institutional Analysis of Non State Actors in Zambia: Final Report. A research
study commissioned by the European Union and the Ministryof Finance and National Planning. Rome: STEM-VCR
Srl.


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•      The Civil Society Thematic Meeting on HIV and AIDS. (This includes a broader representation
       of civil society including the private sector, trade unions, the media, traditional healers,
       women’s groups and PLHAs and addresses implementation issues relating to the NASF 2006-
       10).
The principal purpose of the above civil society meetings is to:

a) support and strengthen civil society representation/participation in NAC and related structures
   (especially regarding policy dialogue and planning);

b) improve information sharing, networking and advocacy; and

c) facilitate the establishment of strategic partnerships (especially in relation to resource mobilisation
   and capacity development).

iii.    Cooperating Partners Self-Coordinating Group
The Cooperating Partners (CPs) Self-Coordinating Group is comprised of representatives from the
multilaterals and bilateral organisations which meet on a monthly basis. The establishment of this group
is linked to broader initiatives relating to strengthened donor coordination, including the Joint
Assistance Strategy for Zambia (JASZ) process. Under this process, UNAIDS has been given the role of
overall lead partner, with two co-leads–the US Government and the United Kingdom as represented by
DFID. The Cooperating Partners developed a division of labour and points of contact for key strategic
areas of support to the HIV/AIDS sector. They are also working on aligning their planning cycles with
government.

2.3.1.4       THEME GROUPS
Membership of the Theme Groups is drawn from multi-sectoral institutions based on mandates, interest
and technical expertise.

i.      Prevention Theme Group:
The Prevention Theme Group focuses on issues relating to prevention in the national response to
HIV and AIDS. Key strategic objectives addressed include counseling and testing, PMTCT, Safe
Blood, workplace programmes and prevention of sexual transmission of HIV.
ii.     Treatment, Care and Support Theme Group:
The Treatment, Care and Support Theme Group address strategic objectives relating to:
• Treatment;
• Care (including home based care, palliative care, hospice care, as well as other forms of care
   provided by the public, private and civil society sectors);
• Support provided to PLHAs by the public, private and civil society sectors, through support
   groups and other institutions.
The Sub-Committees working on these strategic objectives may meet independent of NAC. The
Treatment, Care and Support Theme Group meets quarterly to determine national targets (where
appropriate), report on plans for implementation, and report back on results. This theme group
focuses largely on service delivery, though not specifically on health service delivery.
iii.    Impact Mitigation Theme Group:

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The Impact Mitigation Theme Group focuses on people affected by HIV and AIDS. This theme
group addresses the strategic objectives relating to OVCs and families made vulnerable by HIV and
AIDS. Food security falls in this area, though there is a recognised overlap with food security for
PLHAs. Gender is also addressed through this theme group.
iv.   Decentralization and Mainstreaming Theme Group:
The Decentralization and Mainstreaming Theme Group supports the multi-sectoral response by
monitoring and providing technical inputs for public, private and civil society sector initiatives. This
includes strengthening of internal and external mainstreaming across all sectors. It also includes
extending the decentralised response through close collaboration with the Ministry of Local
Government and the DATF and PATF structures. An important role of this Theme Group is the
identification and sharing of best practices.
v.     Monitoring & Evaluation Theme Group:
The M&E Theme Group addresses the strategic objectives related to monitoring, evaluation,
research and information sharing. These components include the preparation of quarterly and annual
reporting as well as operational, behaviors and clinical research (including allopathic medicine,
traditional medicine and vaccine development), and the oversight of the NAC Resource Centre.
vi.    Advocacy and Coordination Theme Group:
The Advocacy and Coordination Theme Group addresses the Joint Financing Arrangement (JFA)
for NAC and resource tracking functions and links them to resource generation and allocation
through advocacy. This theme group also addresses policy and the regulatory environment to ensure
that appropriate advocacy is conducted to support policy transformation, as deemed necessary.
2.3.1.5      SECTOR ADVISORY GROUP
Under the Ministry of Finance and National Planning development of the Fifth National Development
Plan (FNDP), a sector advisory group (SAG) was established for gender and HIV. Since the completion
of the FNDP, the gender and HIV SAG has been separated.

The NAC Secretariat convenes meetings of the SAG on a twice-yearly basis (in advance of meetings of
the Committees of the Council). The purpose of the SAG meetings is to provide the Secretariat with
programmatic information that will inform the deliberations of the Council Committees. Membership of
the SAG includes the Chairpersons of the theme groups and SCGs, PACAs, selected Council Committee
members, as well as other selected technical advisers and stakeholders.

2.3.1.6      PARTNERSHIP FORUM
The Partnership Forum provides a high-level, formal and representative forum for all the partners from
government, private sector, co-operating partners, civil society (including international NGOs), people
living with HIV and AIDS (PLHAs), and those involved in the decentralised response to support the
national response to HIV and AIDS. The Partnership Forum provides for information sharing, technical
leadership and direction and promotes transparency and accountability with respect to the use of all the
resources coming into the country earmarked for HIV and AIDS.




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Figure 2.3.1

   Revised Institutional Structure with Expanded View of the Consultative Groups
                                                                                                                                           Partnership Forum                  Level 1
                                                     Cabinet Committee of Ministers on HIV & AIDS
                                                                               Council

                                                                                                                                               Level 2: Council and
                                                                      Sector Advisory Group                                                    Secretariat
                                                                                                                                               Functions include
                                                                                                                                               convening Theme Groups
                                                                                                                                               and the SAG
          Prevention         Treatment, Care              Impact           Mainstreaming &          Monitoring &      Coordination
                                & Support                Mitigation        Decentralization         Evaluation        & Advocacy

                                                                                                                                               Level 3: Theme Groups
                                                                                                                                               Key roles: monitoring of
                                                                                                                                               national response & task
                                                                                                                                               identification




                        Participation according
                        to meeting theme
                                                                        Theme Meetings                                                         Level 4:
                                                                                                                                               Sub-Committees
                                                                                                                                               Key roles: task completion &
                                                                                                                                               information exchange



               Cooperating                              Private                     Civil Society                     Public
                Partners                                Sector                         Sector                         Sector

                                                                                                                                               Level 5: Self-
                                                                                              Youth                                            Coordinating
                                                  ZWAP/ZBCA                                                                    Funders         Groups
                                                  (Represent PS in                             PLHA                            ZANARA,         Key roles: strengthening of
                                                  Theme meetings)                                                              GFATM,          the multi-sectoral response;
                                                                                                    NGOs                        SHARe          strengthening of
          Membership includes:                                                                                                                 coordination, consultation,
          GDA, PPA, DAZ,                                                                               Disabled                                representation/
                                                                                                                                               participation, networking &
          ZNFU, ZBCA, ZWAP,                    HBF            LBF                                                                              advocacy; formation of
                                                                                                      Religious              Line Ministries
          ZCSMBA, ZACCI                                                                                                                        partnerships & capacity
                                                                                                      Orgs                      Statutory
                                                                                                             Gender                            development.
                                                                                                                                 bodies
                  Feedback

                  Representation




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2.3.2   SUB NATIONAL LEVEL PARTNERSHIPS
The objective in the 2006-2010 NASF is to build capacity at all levels (national, provincial, district)
to manage and sustain a comprehensive response to the epidemic through efforts that create a more
enabling environment for community-based initiatives. In terms of decentralisation, Cabinet
established provincial and district level coordinating structures as subcommittees of the Provincial
and District Coordinating Committees which represent its interests at these levels (Zambia Cabinet
Memo Government of the Republic of Zambia (GRZ), 1995).

All provinces have been provided with Provincial AIDS Coordination Advisors (PACAs), 7 males
and 2 females. There are 70 District AIDS Coordination Advisors (DACAs), 13 females and 57
males. Among the roles of the PACAs and DACAs is to enhance decentralised coordination and
monitoring and evaluation mechanisms to ensure that NAC is able to use its resources properly; to
build capacity for HIV and AIDS mainstreaming in all district level planning; to identify
community-based initiatives for funding; to provide training and to distribute information.




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                           CHAPTER III.  
    POLICY, STRATEGY AND IMPLEMENTATION ENVIRONMENT 
3.1.    COORDINATION AND MANAGEMENT OF THE RESPONSE

Zambia has made considerable progress in building national leadership and ownership in the
response to HIV and AIDS. Increasing numbers of national, political, religious and traditional
leaders are voicing their support for efforts to tackle the epidemic. The policy, strategy and
implementation environment entails a description of the institution arrangement findings from NCPI
and the NASA.

The Government of Zambia (GRZ) and the global AIDS community have recognised the need to do
more to effectively tackle AIDS. Zambia is a signatory to many important commitments related to
AIDS. One of these, the ‘Three Ones’ principles, provides a useful framework for development of
the Zambian AIDS response by ensuring that there is:
    •   One agreed HIV and AIDS Strategic Framework that provides the basis for coordinating the
        work of all partners;
    •   One National AIDS Coordinating Authority, with a broad-based multi-sectoral mandate;
    •   One agreed country-level Monitoring and Evaluation System.

3.1.1   One agreed HIV and AIDS Strategic Framework that provides the basis for
        coordinating the work of all partners

Zambia has developed a Fifth National Development Plan (FNDP 2006–2010) and a related
National HIV and AIDS Strategic Framework (NASF 2006–2010). These have been developed with
broad participation of key stakeholders, including civil society to ensure dissemination, and have
now been finalised and approved for dissemination. Zambia has started developing annual costed
work plans based on the strategic framework.

3.1.2   One National AIDS Coordinating Authority, with a broad-based multi-
        sectoral mandate

The National HIV/AIDS/STI/TB Council (NAC) has been established through legislation and is
comprised of broad representation from several government ministries and civil society. The
strength of the NAC Board and Secretariat to oversee, drive and convene a multi-sectoral national
response is at the heart of Zambia’s ability to turn the tide of the HIV crisis. The coordination
framework is guided by the following strategic objectives in the NASF as shown on Table 3.1.2.1
below.




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Table 3.1.2.1: Strategic Objectives in the NASF
Strategic Objective             Core Strategies8
                                1. Adopt and effectively implement the “Three Ones” approach
Strengthen the institutional
and legal framework             2.   Strengthen the institutional capacity of the National AIDS Council, Secretariat
                                     and partnership mechanisms so as to enable it to effectively coordinate national,
                                     provincial, district and community efforts targeted at the prevention and control
                                     of HIV and AIDS, STIs and TB
                                3.   Establish and/or strengthen structures for effective coordination of the
                                     multisectoral response at national, provincial, district and community levels
                                4.   Ensure the effective implementation, monitoring and evaluation of the
                                     HIV/AIDS/STI/TB Act
                                5.   Amend and harmonise relevant pieces of HIV/AIDS/STI/TB policy legislation
                                1.   Continuously liaise with the Decentralisation Secretariat on the implementation
Improve coordination and
                                     of the decentralisation policy
resolve areas of duplication
and      gaps     in     the    2.   Review and strengthen the role and functioning of the DATFs, DHMTs, and
multisectoral response to            Councils in relation to the district HIV and AIDS response
HIV and AIDS to include
                                3.   Establish clear reporting mechanisms at district level in line with the National
resource management
                                     Monitoring and Evaluation Framework
                                4.   Establish a Resource Management Strategy including reviewing the feasibility of
                                     a National HIV/AIDS/STI/TB Trust Fund
                                5.   Provide specific budgetary allocations for HIV/AIDS/STI/TB interventions
                                6.   Improve capacity for donor coordination and realignment of HIV/AIDS/STI/TB
                                     resources
                                1.   Implement the Advocacy and Communication Strategy aimed at encouraging
Advocate               for
                                     universal access to prevention, e.g. voluntary counseling and testing for all
mainstreaming, effective
                                     persons; maintenance of confidentiality by health care providers and employers;
policy implementation and
                                     elimination of stigma and discrimination against PLHA
fighting     stigma   and
discrimination                  2.   Discourage anonymous (without consent) HIV testing, mandatory testing for
                                     scholarships and employment
                                3.   Encourage the insurance industry to develop and apply policies which take into
                                     account the insurance needs of persons with HIV/AIDS
                                4.   Support the mainstreaming of advocacy activities in the multisectoral response
                                5.   Integrate HIV and AIDS services required by people with different abilities in
                                     existing health and social welfare delivery systems
                                6.   Promote positive living among people living with HIV and AIDS
Promote             effective   1.   Establish leadership forums that involve the highest level of political, religious,
leadership      for       the        and traditional leaders in the country to promote key prevention, care and
multisectoral response for           treatment messages
HIV and AIDS
                                2.   Mobilise and support the media and journalists in the response on HIV and AIDS
                                3.   Involve influential celebrities from the arts, sports, entertainment, and politics in
                                     promoting key prevention, care and treatment messages




8
    National HIV/AIDS/STI/TB Policy, June 2005

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Figure 3.1.2.1 below illustrates the conceptual framework for coordination of the multi-sectoral
response in Zambia. Through the establishment of the NAC in 2002, a national coordinating
authority was established to facilitate and lead this development. Work is ongoing in the
establishment and development of the corresponding structures in keeping with the decentralisation
policy, and also among civil society and private sector networks.

Figure 3.1.2.1: Conceptual Framework for Coordination of the Multisectoral Response

                                     Community Structures


    Networks for                                                              Networks for
                                        District Structures
    Civil Society                                                             Private Sector
     Response                                                                   Response
                                      Provincial Structures


                                          Line Ministries                     Private Sector
    Civil Society

                            Thematic/Technical Working Groups


                                   National AIDS Secretariat


                                     National AIDS Council


                            Cabinet Committee on HIV and AIDS

The NAC and its decentralised offices are recognised as the national multi-sectoral coordinating
entity. Institutionally, however, the AIDS response falls under the Ministry of Health. The NAC
Secretariat has made progress over the past years. Staffing has improved and a number of important
initiatives have been undertaken. Capacity and systems for information management/ dissemination
and resource tracking do, however, remain key challenges. Provincial and District AIDS Task
Forces are now playing an active role in coordination of the decentralised response, however
sustainable institutional arrangements for these structures need to be agreed upon.

Another key structure within the coordination and management of the response is the Country
Coordinating Mechanism (CCM). The NAC Secretariat became responsible for the provision of
secretariat support to the CCM of the Global Fund to fight HIV and AIDS, Tuberculosis and
Malaria (GFATM). The CCM exists to review, approve and coordinate applications for the Global
Fund to Fight AIDS, Tuberculosis and Malaria; to monitor and guard the implementation of projects
approved by the Global Fund for Zambia; and to establish the working mechanisms of the CCM.



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The CCM is composed of 20 members, with a distribution of six from the government sector, seven
from Non-Governmental Organisations, one from People living with HIV and AIDS and/or TB
and/or Malaria, one from the private sector, and the remaining four from international organisations.

The CCM adheres to the principles of “openness and transparency, broad participation and efficient
operation” and seeks to contribute to the successful implementation of Global Funds in Zambia.

3.1.3   One agreed country-level Monitoring and Evaluation System
In tandem with the NASF 2006-2010, the NAC has also developed a Monitoring and Evaluation
(M&E) Framework and Plan.




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3.2.      PROGRESS MADE IN POLICY, STRATEGIES                                     AND
          PROGRAMME IMPLEMENTATION ENVIRONMENT

3.3.1     NATIONAL COMPOSITE POLICY INDEX
The National Composite Policy Index (NCPI) assessment was conducted in the latter part of 2007.
The NCPI is designed to assess progress in the development and implementation of national AIDS
policies and strategies. There was an attempt to engage the key stakeholders according to the
various categories and questionnaires specified in the UNGASS guidelines, responses to which
were further validated at a stakeholders’ consultative meeting. The key findings are summarised
below.
3.3.1.1     Strategic Plan
Zambia has a National HIV and AIDS Strategic Framework (NASF) for the period 2006-2010. This
is a successor to the Strategic Intervention Plan of 2002-2005. The NASF is a multi-sectoral plan
with 6 themes, that is:
•   Intensifying prevention of HIV and AIDS;
•   Expanding treatment, care and support for people living with HIV and AIDS;
•   Mitigating the socio-economic impact of HIV and AIDS;
•   Strengthening the decentralised response and mainstreaming HIV and AIDS;
•   Improving the monitoring of the multi-sectoral response;
•   Integrating advocacy and coordination of the multi-sectoral response.

The NASF was developed with input from some sectors of civil society. Some external
development partners have aligned and harmonised their HIV and AIDS programmes to the NASF.
HIV is clearly articulated in the Fifth National Development Plan as well as other development
plans. The police and prisons are developing HIV and AIDS policies and strategic plans while the
military has a policy but no strategic plan.
3.3.1.2     Political Support
High officials, including the Republican President, regularly speak publicly and favourably about
HIV and AIDS efforts.
Zambia has a functional National AIDS Council to coordinate the multi-sectoral response, set up in
2002 by an Act of Parliament. Achievements of NAC include:

•   Compliance with the “Three Ones Principle”;
•   Development of the National HIV & AIDS Strategic Framework and Monitoring & Evaluation
    Plan 2006-2010;
•   Four Joint Annual Programme Reviews;
•   Establishment of Districts AIDS Task Forces;
•   Establishment and operationalisation of Thematic Groups.



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Challenges of NAC include:

•   Fluctuating funding flows;
•   Inadequate capacity of some implementing partners.

3.3.1.3     Prevention
A comprehensive prevention strategy is still under development. However, there currently exist
specific strategies that promote information, education and communication (IEC) on HIV and AIDS
to the general population as well as to expand access to essential preventive commodities. Zambia
also has a strategy promoting HIV- and AIDS-related reproductive health education for young
people and HIV education is part of the curriculum in primary, secondary and teacher training
institutions. Family Health Education is also being conducted for school drop-outs and out-of-
school youth by the Ministry of Sport, Youth & Child Development. There are limited prevention
programmes for population sub-groups such as prisoners and sex workers. There are no prevention
programmes for injecting drug users and men who have sex with men. However, it has been noted
that this needs to be researched to allow for an evidence-based response. Prevention of Mother-to-
Child Transmission is now more widely available.
With regard to testing, the National AIDS Policy prohibits HIV screening for general employment
purposes.
3.3.1.4     Treatment
Zambia has a strategy and policy to promote equal access for women and men for comprehensive
HIV and AIDS treatment, care and support. The districts in need of HIV and AIDS treatment, care
and support have been identified. Since 2005, there has been an increase in the number of people on
ART. This is due to the increase in funding from the Government of Zambia, PEPFAR, Global
Fund, the World Bank & others. This has made it possible for the government to provide free
treatment in government health facilities. However, long distances to health facilities, human
resource shortages and poor nutrition continue to be barriers to accessing treatment. In addition, it is
only the first line drugs that are widely available. Another challenge that remains is that of ensuring
access to specific drugs and commodities for quality paediatric ART.
3.3.1.5     Civil Society Participation
To a large extent, civil society has contributed to strengthening the political commitment of top
leaders and national policy formulation. Civil society has been involved in the planning and budget
processes of the National HIV and AIDS Strategic Framework. However, some civil society
organisations consulted suggest that, more generally, civil society’s participation in national
consultation processes is tokenistic and ad hoc. Moreover, there appears to be no systematic process
in place for transparent election of civil society representatives and few resources available for
consultation processes.
Despite these challenges, there appears to have been a marked increase in the involvement and
engagement of a diverse range of civil society organisations in national HIV and AIDS work since
2005.




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Access to financial and technical resources for implementing HIV and AIDS programmes continues
to be a significant challenge for national civil society organisations and, indeed, may shortly
become critical (see civil society’s contribution to Chapter VII).
3.3.1.6        Human Rights
Zambia has general anti-discrimination legislation in place, contained in Article 23 of the
Republican Constitution. However, the grounds listed do not provide sufficient protection against
HIV-based discrimination. The Industrial & Labour Relations Act as well as the Disabilities Act
prohibits discrimination. Before and since 2005, there have been efforts around HIV legal reform by
the Labour movement and organisations like the Zambia AIDS_Law Research & Advocacy
Network (ZARAN), the Zambia Law Development Commission (ZLDC) and the Support to the
HIV and AIDS Response in Zambia Project (SHARe). This includes an audit of all legislation with
a bearing on HIV with a view to making recommendations for law reform as well as working with
members of the Zambian Judiciary.
In 2006, a new Act called the Citizens Economic Empowerment Act was enacted. It prohibits HIV-
based discrimination in the citizen economic empowerment at workplaces. However, it is unclear
whether it applies to all workplaces.
There are some laws that present obstacles to effective HIV and AIDS prevention, treatment, care
and support for vulnerable population sub-groups such as the laws on homosexuality, prostitution
and injection drug use.
The promotion of human rights is explicitly mentioned in the National AIDS Policy and strategy.
However, there are no clear mechanisms for recording, documenting and addressing cases of
discrimination experienced by PLHA at a national level. Zambia has independent national
institutions for the promotion of human rights yet funding, relevance and credibility remain
challenges.
In terms of legal support for HIV and AIDS case work, some support is provided by ZARAN and
the Legal Resources Foundation.
With regard to promoting the rights of participants in research, a Research Ethics Committee is in
place but does not include civil society. Given the increase in AIDS-related research on human
subjects in Zambia, there is a need to strengthen this committee.
3.3.1.7        Monitoring & Evaluation
Zambia has one National Monitoring & Evaluation (M&E) Plan for the period 2006-2010. The plan
was developed in consultation with civil society and has been endorsed by key partners in M&E.
However, only some partners have harmonized their M&E requirements with the national M&E
plan. The funds for the M&E budget for the 2006 and 2007 were secured from both government and
donor sources.
An M&E and Research Directorate9 is based at the NAC with a compliment of five full-time staff.
An M&E Theme group meets monthly and has civil society representation. This theme group has
three sub-committees: Reporting and Researching, Capacity Building, and NACMIS on data
systems. The M&E and Research Directorate manages a central database. M&E data is used for
decision making, advocacy, policy direction, better targeting of resources and planning.


9
    In Zambia, the M&E Unit at the National AIDS Council is referred to as the M&E and Research Directorate

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Some of the challenges have been poor data-use culture at a sub-national level; more focus on donor
targets than data use; financial and technical constraints; inadequate M&E knowledge, especially
among the implementing partners; late reporting; ensuring data quality; and limited harmonization
of data collating systems.
Conclusion
Zambia has made significant progress in the development of AIDS strategies and policies,
particularly in the areas of strategic planning, prevention, treatment and mitigation. However, there
remains the need to complete development of the prevention strategy; improve financial flows;
address treatment access barriers and human rights related issues; as well as strengthen the
harmonization of M&E systems and data use.

3.3.2   NATIONAL HIV/AIDS SPENDING ASSESSMENT
The National HIV/AIDS Spending Assessment (NASA) is a comprehensive and systematic
methodology used to track and determine the flow of resources intended to combat HIV/AIDS. It
tracks the actual expenditures of resources from their origin (sources) down to the end point of
service delivery (beneficiary populations), among the different institutions dedicated in the fight
against the disease.
UNAIDS attempts to promote the transfer of knowledge and the development/strengthening of
national capacities that may be applied to designing proposals to increase the level and improve the
use of resources allocated to tackle the disease. Much effort has been made to develop and enhance
the methodology and tools of the National AIDS Spending Assessment (NASA).
There are increasing efforts at the national level to track the expenditure on HIV/AIDS so as to
inform improved resource mobilisation, allocation and utilisation. In addition, the data collected
will allow for reporting on the UNGASS Financial Indicator.
The NASA-NHA in Zambia included tracking actual expenditures from the public and external
sources, NGOs service providers, health facilities and hospitals, employers, pharmacies, insurance
companies and expenditures from PLHA. The period under study covers the 2005 and 2006
financial years.
The overall goal of NASA is to contribute to strengthening the comprehensive tracking of actual
spending (from international, public and private sources) that comprise the National Response to
HIV and AIDS in Zambia, to leverage both technical and financial support for the development,
implementation, management, monitoring and evaluation of the national HIV response.
NASA provides data for the National Commitment and Action indicators for the UNGASS process.
At the global level this helps the international community to evaluate the status of the response in
the fight against HIV and AIDS.
NASA reports on actual expenditures on AIDS as classified by eight AIDS Spending Categories
(i.e. Prevention, Care and Treatment, OVCs etc) by financing sources (domestic and international).
In 2006, government commenced the process of tracking expenditures in health through the public
expenditure tracking survey (PETS). This survey was aimed at strengthening capacity in the area of
resource mapping, financial tracking, and outcomes monitoring in the health sector.


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For the fiscal year January to December 2006, total AIDS expenditure amounted to
US$203,824,914 of which 15% or US$30,662,233 was wholly financed from domestic public
resources while the remaining 85% or US$173,162,681 was funded from international sources
which comprised the bilateral, multilateral partners and other International NGOs including the
Global Fund. Figure 3.3.2.1 illustrates the expenditure distribution by thematic area and financing
sources.
Figure 3.3.2.1: Distribution of AIDS Expenditure by Thematic Area and Financing Sources, 2007




Source: National AIDS Spending Assessment Tool, 2007.
The treatment, care and support theme accounted for 42.8% or US$87,294,522 of the total actual
expenditure. The prevention theme scored second at 27.4% or US$55,746,765 followed by the
programme management and administration strengthening which accounted for US$32,445,349 or
14.9%. Expenditure on research amounted to US$12,754,518 or 6.3% of the total expenditure in
2006, all the funds for this category were reported to have been financed from international sources.
The least AIDS spending theme was social protection and social services10 which accounted for
only 0.3% or US$608,715 while slightly above it was expenditure on incentives for human
resources category which amounted to US$2,961,715. Figure 3.3.2.2 below further shows the
percentage distribution of the AIDS spending by thematic area for the fiscal year 2006.




10
     Excluding orphans and vulnerable children

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Figure 3.3.2.2: Percentage distribution of AIDS Spending by Thematic Area




Source:National AIDS Spending Assessment Tool


Challenges
The prospects of improving health service delivery in 2007 were threatened by many challenges.
These challenges included poor infrastructure, inadequate human resources, the heavy disease
burden and inadequate medical equipment and drugs.
Notwithstanding the above challenge, in 2007 government scaled-up support to the health sector in
the areas of primary, secondary and community health care and in the multi-sectoral response to
HIV and AIDS.

 




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                              CHAPTER IV.  
         PROGRESS IN NATIONAL PROGRAMME IMPLEMENTATION AND 
                           OVERALL IMPACT 
4.1     INTENSIFYING PREVENTION INDICATORS

The national prevention strategy is focused on preventing sexual transmission of HIV; prevention of
mother to child transmission (PMTCT), voluntary counselling and testing (VCT), prevention of
transmission through blood, and prevention of HIV transmission in health care and other care
settings (Zambia National HIV/AIDS/STI/TB Council, 2006a).

Significant increases since the last reporting period (2005) in the utilization of condoms with non-
cohabiting partner were attained with males scoring 50.0% while females scored much less at
37.4% in 2007. In 2005, only 5.1% males and 6.4% females among higher sex population indicated
using a condom during their last sexual intercourse.

The number of people accessing ART has almost tripled since the last reporting period from 39,351
at the end of 2005 to 149,199 at the end of 2007. Out of total estimated need on 29,260 children
under 15 years with advanced HIV infection, only 34.5% were receiving ART in 2007, an increase
from 13.7% in 2006.

Vulnerability to HIV among the youth remains high with only 10.2% of young women and men age
15-19 receiving an HIV test in the last twelve months and knowing their results in 2007. Further
only 33.6% of same age group were able to correctly identify ways of preventing the sexual
transmission of HIV and who rejected major misconceptions about HIV transmission.

Access to VCT and PMTCT services has continued to increase from 450 to 1,023 and from 64 sites
to 678 sites respectively currently offering these services. Increases in the number and percentage of
HIV infected pregnant women accessing ART to prevent mother to child transmission were
reported from 25,578 or 29.7% in 2006 to 35,314 or 39.1% in 2007. One hundred percent of
transfused blood units are routinely screened for HIV.




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4.1.1   BLOOD SAFETY
UNGASS Indicator 3: Percentage of donated blood units screened for HIV in a quality
assured manner.

Table 4.1.1.1: Values for blood units screened for HIV in a quality assured manner
Disaggregation                       Year 2006                                 Year 2007
                      Numerator      Denominator        Value      Numerator   Denominator   Value
                All     54,783          54,783          100%         68,265      68,265      100%
Comment(s): All blood units collected during this reporting period were screened for HIV.
Data source: Zambia National Blood Transfusion Annual Report, Ministry of Health. Indicator
completed

The total number of blood units donated and screened for HIV in a quality assured manner nation-
wide in 2006 was 54,783 units, while in 2007 it was 68,265 units.

Variations were recorded in the blood collections by year between 2004 and 2007 by the Zambia
National Blood Transfusion Services under the Ministry of Health. In 2004, a total of 38,477 blood
units were collected which increased to 61,568 units in 2005 but dropped to 54,783 in 2006. This
drop in blood collection was due to less Kwacha available due to exchange losses from the same
dollars allocated for the programme. In 2007 however, the blood units collected increased to all
time high of 68,265. This situation is also illustrated in Figure 4.1.1.1 below.
Figure 4.1.1.1: Blood Collection by Year (Jan-Dec) for Period 2004 to 2007




Data Source: Zambia National Blood Transfusion Services, Ministry of Health




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All blood units collected were screened for HIV. Zambia has nine screening centres country-wide of
international standards, subjected regularly to internal and external quality assurance inspections11
in order to ensure safe blood transmission. It is estimated that transmission of HIV through blood
transfusion is less than one percent12. One hundred percent of the units of blood collected were
subjected to mandatory laboratory screening for HIV, Hepatitis B Virus (HBV) and Hepatitis C
Virus (HCV) (Zambia National Blood Transfusion Service, 2006).
Figure 4.1.1.2: Percentage of discarded blood by year for period 2005-2007




Source: Zambia National Blood Transfusion Services, Ministry of Health




11
   The external quality assurance team is from the Royal college of Pathologists of Australia who have
endorsed the screening procedures and results.
12
   Zambia Blood Transfusion Annual Report, 2006

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4.1.2   HIV TREATMENT: ANTIRETROVIRAL THERAPY
UNGASS Indicator 4: Percentage of adults and children with advanced HIV infection
receiving antiretroviral therapy in 2006 and 2007

Table: 4.1.2.1: Adults and children with advanced HIV infection receiving ART in 2006
                and 2007
Disaggregation                          Year 2006                                      Year 2007
                       Numerator         Denominator       Value      Numerator        Denominator   Value
   All Adults &             80,030             243,542      32.9%         149,199          295,540   50.5%
       Children
            Males           34,445             111,797      30.8%          65,648          136,031   48.3%
         Females            46,585             132,745      35.1%          83,551          159,509   52.4%
        <15 years            4,001              29,100      13.7%          10,096           29,260   34.5%
        15+ years           76,029             214,442      35.5%         139,103          266,000   52.3%
Data source: Epidemiology Projection Package (EPP) Spectrum Projections, Ministry of Health,
February 2008
The treatment uptake for the reporting period of 2006 was 80,030 (32.9%) based on a total
estimated need of 243,542. For 2007, the uptake was 147,697 or 50.5% out of an estimated total
need of 295,540. The programme implementation performance according to set targets of 90,000
for 2006 was 88.9% while for 2007, the 149,199 number attained surpassed the set target of
130,000 resulting in a 115% attainment. Figure 4.1.2.1 below shows the annual trend in treatment
uptake from 2005 to 2007 by gender.
Figure 4.1.2.1: Number of persons with advanced HIV on ART by reporting period (2005-2007)




                                     Source: Adapted from Ministry of Health Reports

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Figure 4.1.2.1 above shows that since 2005, the number of people on put ART has increased 30,103
(baseline figure September 2005) to 81,030 in 2006. This number further increased to 149,199 at
the end of 2007. An assessment of Table 4.1.2.1 above revealed that more women at 56% were on
ART as compared to men at 44.0%. Further of the 149,199 adults and children on ART in 2007, the
adults accounted for an overwhelming majority at 93.2% while children under 15 years of age
accounted for only 6.8%.
The scaling-up of free ART was continued in 2006, prompting a significant increase in the numbers
of centres nationwide,13 from 107 in 2005 to 156 in 2006 and 322 as of September 2007.
Additionally, all the 322 facilities providing ART also provide PMTCT services and paediatric
ART.
By the end of 2006, ART services were being provided in 71 of the 72 districts in the nine
provinces. With the scaling-up of free ART, treatment up-take has more than doubled for both male
and females between 2005 and 2006. A relatively higher increase also attained from 2006 to 2007
with the females being the majority for all the years. The gender distribution of number of persons
reached and on ART is illustrated in Figure 4.1.2.2 below.
Figure 4.1.2.2: Trend of Number of Persons by Gender with Advanced HIV Infection on ART 2005- 2007




Source: Adapted from Ministry of Health ART Quarterly Reports




13
     Ministry of Health Quarterly Report 2007

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4.1.3   PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
UNGASS Indicator 5: Percentage of HIV-positive pregnant women who received anti-
retroviral to reduce the risk of mother-to-child transmission in 2006 and 2007
The percentage of HIV infected pregnant women who received antiretrovirals to reduce mother to
child transmission in 2006 was 29.7% or 25,578 based on an estimated need of 86,232. In 2007, the
number of pregnant women on ART increased to 35,314. With an estimated number of HIV
pregnant women of 90,252 for 2007 this showed an increased percentage of HIV positive pregnant
women who received antiretrovirals to reduce the risk of mother to child transmission from the
29.7% in 2006 to 39.1% in 2007.

Table 4.1.3.1: HIV-positive pregnant women who received antiretroviral in 2006 and 2007
Disaggregation                        Year 2006                                  Year 2007
                       Numerator       Denominator         Value     Numerator   Denominator   Value
                All       25,578           86,232         29.7%       35,314       90,252      39.1%
Data source: Ministry of Health Facility Registers

Overall, PMTCT services have been rolled out to all the 72 districts of Zambia, representing an
increase from 67 in 2005, 307 in 2006 and 678 as of September 2007. This scaling up of PMTCT
services resulted in an increase in pregnant women who completed prophylaxis from 14,071 in 2005
to 25,578 in 2006, and by September 2007 this figure had reached 35,314. Figure 4.1.3.1 below
shows the number of pregnant women who completed prophylaxis, providing a trend from 2005 to
2007.
Figure 4.1.3.1: Scale up of PMTCT between 2005 and 2007




Source: Adapted from Ministry of Health Facility Register Reports.


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4.1.4   CO-MANAGEMENT OF TUBERCULOSIS AND HIV TREATMENT
UNGASS Indicator 6: Percentage of estimated HIV-positive incident TB cases that received
treatment for TB and HIV
Table 4.1.4.1: Percentage of estimated HIV-positive incident TB cases that received
treatment for TB and HIV
        Disaggregation                                          Year 2007

                                       Numerator                 Denominator             Value
                       All Cases
                                     5,017                12,835                          39%
Data Source: Ministry of Health TB Routine Programme Monitoring

In Zambia, TB is a major public health problem that has an intricate relationship with HIV and
AIDS. Approximately 70 percent of people with TB are co-infected with HIV, with variations
between regions ranging from approximately 60 percent to as high as 80 percent. The TB burden is
highest in the provinces with the highest HIV prevalence levels, with notifications in some areas
such as Lusaka and the Copperbelt as high as 800 per 100,000 population. To further complicate
matters, multi-drug resistant TB has been reported in almost every part of the country, with
approximately 50 cases recorded as of 2005.

The overall TB cure rate at national level for the 2005 cohort was 76 percent, with a treatment
success rate of 82 percent. The default rate for the same cohort was 4 percent, indicating a
remarkable decrease in the recent past.

The cure rates have apparently been stable, with slight but significant improvements as achievement
of the Global target nears completion; similarly, the decrease in default rates has also stabilized.

Implementation of TB/HIV collaborative activities was begun in 2006. Nation-wide and routine
testing of TB patients for HIV is being done on an “opt out” basis (i.e. provider initiated counselling
and testing). Out of a total of 48,417 TB patients that were counselled and tested for HIV infection,
the total TB notifications from the third quarter of 2006 to the second quarter of 2007 was 19,424,
or 40.1 percent. Of these 12, 835 (66 percent) tested positive and a total of 5, 017 (39 percent)
individuals were started on ART.




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4.1.5    HIV TESTING IN THE GENERAL POPULATION
UNGASS Indicator 7: Percentage of women and men aged 15-49 who received an HIV test in
the last 12 months and who know their results

Table 4.1.5.1: Percentage of young women and men who received an HIV test in last 12
               months and know their results
        Disaggregation                                          Year 2007
                                      Numerator               Denominator             Value
                      All 15-49          2,028                   13,141              15.4%
                          Males           703                        5,995           11.7%
                       Females           1,325                       7,146           18.5%
                   15-19 years            304                        2,990           10.2%
                   20-24 years            450                        2,436           18.5%
                   25-49 years           1,274                       7,715           16.5%
Data source: 2007 Zambia Demographic Health Survey Preliminary Data

The proportion of young people aged 15-49 who received an HIV test in the last 12 months and
knew their results in 2007 remained almost the same as the 2005 results at 15.4% and 15.6%
respectively. The males however were reported to have increased slightly from 10.3% in 2005 to
11.7% in 2007.
Overall, the pattern of results obtained across all categories remained the same with females and the
20-24 years age group scoring highest for both years although with slight decreases. Females
reduced from 20.0% in the 2005 survey to 18.5% in 2007 while the 20-24 years aged group moved
from 20.1% to 18.5% for 2005 and 2007 respectively. Again it was the 15-19 years aged group
which scored the least but with an increase from 8.2% in 2005 to 10.2% in 2007.
The percentage of young people who go for HIV testing and know their HIV status can be
influenced by many factors, including access to testing sites, knowledge about the need for HIV
testing, attitude towards HIV and AIDS and the level of stigma in society.
Based on programme implementation, a total of 234,430 women and men tested and received their
test result in 2006. However, as of September 2007, the number men and women had been tested
and received their results had increased to 254,585. In 2006, out of a total of 234,430 people tested
for HIV, 93,441 were males and 122,478 were females, while in 2007 data collected indicated that
112,845 were males with women scoring higher at 141,740. Overall, although the data collected for
2007 was only as of September, there was an observed increase in the total number of clients who
accessed the VCT services and obtained their results. A similar trend was observed across gender
lines, with increases observed for both women and men. Further, more women were reported to
have been tested and obtained their results relative to males for both 2006 and 2007. Figure 4.1.5.1
below further illustrates the national distribution of the general population who were tested for HIV
at the VCT centres and received their results. In VCT centres, counselling is done when individuals
are given their test results.


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Figure 4.1.5.1: Clients tested for HIV at VCT centres who also received their results, 2006 and
2007




Source: Adapted from National AID/HIV/STI/TB Council Annual Activity Reporting Form Annual Report, 2007

The percentage of men exposed to VCT remains low, but has increased slightly from 5.0 percent in
2000 to 6.0 percent in 2005. Among women in the total population, the percentage reporting
exposure to VCT was 9.3 percent, which is higher than in 2000 (4.3 percent). See Table 4.1.5.2
below.
Table 4.1.5.2: Voluntary Counselling and Testing Trend 2000-2005
                                       2000 ZSBS                   2003 ZSBS                   2005 ZSBS
         Indicator 
                               Males    Females    Total   Males    Females    Total   Males    Females     Total
 Voluntary Counselling &
 Testing Indicator:              5        4.3       4.6     5.1       5.2       5.1     6         9.3        7.8
 Percentage of people aged
 15-49 surveyed who have
 ever voluntarily requested    1,525     1,394             1,998     2,324             1,900     2,172
 an HIV test, received the
 test and their results.

As with the ANC-based VCT indicator, the overall percentage of respondents completing VCT is
higher in urban areas compared to rural areas. Respondents in urban areas are almost three times as
likely to score positively on this indicator, as are those in rural areas. Rural areas have shown a
double annual increase in service uptake from 2004 to 2005.




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From the total number of clients counselled, 10 percent came with their partners. Whereas
considerable improvements in exposure to voluntary testing and counselling are evident for
pregnant females, comparable improvements are not yet achieved in the general population.
Sustained and intensified efforts are needed to inform all Zambians (urban and rural) of the
importance of being tested and knowing the result.
Routine programme delivery data showed in 2006 that the drop out rate for CT clients decreased to
less than 10 percent as illustrated in figure 4.1.5.3 below. The number of clients opting to be tested
after counselling increased, indicating that counselling is effective in motivating clients to go for
testing. This increase has also been greatly attributed to the introduction of free ARVs, as most
clients feel that once they test positive there is a means to assist them.
    Figure 4.1.5.3: Comparison of Client’s Drop Rate in CT Service Delivery Points – 2006




    Source: 2006 JAPR Report




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A total of 883 facilities were providing counselling and testing services countrywide in 2006,
including Voluntary Counselling and Testing, Diagnostic Counselling and Testing and Provider
Initiated Counselling and Testing. By September 2007, the number of these centres had increased
to 1,028.
In 2006 alone, 2,969 providers were trained in the provision of VCT/ CT services and by September
2007, this number had more than doubled to 6,201 men and women. Of the 6,201 persons trained,
63 percent or 3,904 were professional health care providers while the remaining 37 percent or 2,297
were lay or community providers.
Figure 4.1.5.4: Persons trained in provision of VCT 2006 and 2007




Source: Adapted from National AID/HIV/STI/TB Council Annual Activity Reporting Form Annual Report, 2006


Post Test Services

Post Test Services are offered after the clients have undergone testing. It is imperative that once
clients are tested they go through post-test services, which include collecting results, attending post-
test counselling and receiving appropriate referrals.
A total of 195,815 clients were tested during the year under review from both VCT and PMTCT. Of
these 135,729 (70 percent) collected their results with 130,480 (67 percent) reported to have
received their results on the same day.




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4.1.6    HIV TESTING IN MOST-AT-RISK POPULATION
UNGASS Indicator 8: Percentage of most at risk population who have received an HIV test in
the last 12 months and who know their results

Table 4.1.6.1: Percentage of sex workers who received an HIV test in last 12 months and
               know their results
        Disaggregation                                          Year 2007
                                      Numerator               Denominator               Value
             All Sex Workers              445                        2,573              17.3%
                          Males           236                        1,675              14.1%
                       Females            209                        898                23.3%
                     <25 years            254                        1,416              17.9%
                     25+ years            191                        1,157              16.5%
Data source: 2007 Zambia Demographic Health Survey Preliminary Data

The 2007 Zambia Demographic Health Survey included sex workers as respondents for the HIV
testing in most-at risk populations. Preliminary data indicated that like for the young people 15-49
years under the UNGASS indicator 7, the females scored highest at 23.3% while males scored mush
less at 14.1% for receiving an HIV test and knowing the results in the last 12 months.

Overall, the percentage of sex workers who received an HIV and knew their results was 17.3. Data
disaggregation by age showed very marginal difference with the under 25 years scoring higher at
17.9% against the 16.5% for the 25 years and over category.

In 2006, Corridors of Hope undertook and produced two reports on i) Female Sex Workers in
Border and Transportation Routes with Trend Analysis and ii) Long Distance Truck Drivers
(LDTDs) in Transportation Routes with Trend Analysis. Results obtained revealed that 115 out of
133 female sex workers were tested for HIV and obtained their results accounting for 86.5%. An
even higher score was reported for the LDTDs who out of the 181 respondents, 178 received an
HIV test and got their results in the last twelve months accounting for 98.3%. Overall, 93.3% of the
most-at risk populations comprising female sex workers and LDTDs received an HIV test and got to
know their status based on a sample size of 314.
Female sex workers were targeted as the female most at-risk populations during the 2006 BSS. The
proportion of female sex workers respondents who reported ever taking an HIV test increased from
13.9 percent in 2000 to 49.8 percent in 2006. Of these, 52.7 percent took the test voluntarily in 2000
and 89.5 percent did so in 2006. No significant trend was observed in the proportion of the
respondents who received the HIV results (p=0.07). In Chirundu there was a significant increase in
those who had been tested, from 16.2 percent in round one to 49.6 percent in round three (p<
0.001). Similarly, there was an increase in those that that took the test voluntarily, from 56.5 percent
to 87.2 percent (p< 0.001) between rounds one and three. The trend was similar with regard to
collecting results, with an increase from 56.5 percent to 86.5 percent (P<0.001) between rounds one
and three.



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During the 2006 Behavioural Surveillance Survey, Corridors of Hope, Long Distance Truck Drivers
(LDTDs) were targeted as the most at-risk male population due to a lack of tracking of male sex
workers in Zambia. Many LDTD respondents (88.7 percent, N: 869, D: 979) reported having access
to confidential counseling and testing, though statistically this varied significantly (p=0.001)
between survey sites. Approximately 93.3 percent in Chirundu and 89.4 percent of respondents in
Livingstone reported having access to confidential HIV testing, while only 55.1 percent of those in
Kapiri Mposhi reported access to such services. Approximately 22 percent of the respondents (23.3
percent in Chirundu, 23.5 percent in Kapiri Mposhi and 17.1 percent in Livingstone) had ever been
tested for HIV, and 83.4 percent of those did so voluntarily. Among males tested voluntarily (from
any testing centre), the majority (98.3 percent) received the results of their HIV test. The proportion
of respondents who had ever been tested for HIV declined from 33.5 percent to 22 percent.
However, the number that found out their HIV test result among those tested increased from 90
percent to 96 percent in Livingstone and from 91 percent to 98 percent in Chirundu.
The programme implementation focusing on most at-risk populations has been undertaken by
Corridors of Hope. A survey targeting FSW and LDTD as MARPs was conducted in the following
MARP corridor sites in 2006: Livingstone, Chirundu and Kapiri Mposhi.
4.1.7   MOST-AT-RISK POPULATION: PREVENTION PROGRAMMES
UNGASS Indicator 9: Percentage of most at risk populations reached with HIV prevention
programmes.

Table 4.1.7.1: Percentage of female sex workers reached with HIV prevention programmes

        Disaggregation                                          Year 2006
                                       Numerator               Denominator              Value
                        Females           623                        994                62.7%
Data source: Behavioural and Biological Surveillance Survey, 2005 in the City of Ndola, Zambia
(Among Female Sex Workers). Indicator partially filled - data on male sex workers and age
disaggregation not available.
For the purpose of the 2006 Behaviour Sexual Survey, female sex workers were targeted as females
among most at-risk populations. Respondents for this indicator were prompted with questions on
where they would go if they wished to receive an HIV test. Further the survey respondents were
asked if they had been given condoms within the last twelve months through an outreach service or
drop-in-centre. Out the 994 interviewed, 623 or 62.7 percent had been reached by HIV prevention
services and were registered by the Corridors of Hope project.
The study did not capture male sex workers or any category of the most at-risk male populations,
neither was the data disaggregated by age.




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4.1.8      SUPPORT FOR CHILDREN AFFECTED BY HIV AND AIDS
UNGASS Indicator 10: Percentage of orphaned and vulnerable children aged 0–17 whose
households received free basic external support in caring for the child
Table 4.1.8.1: Percentage of orphans and vulnerable children whose households received
               free basic external support.
         Disaggregation                                         Year 2007
                                               Numerator      Denominator              Value
                    All Orphans                  578                 3,671            15.7%
Data Source: 2007 Zambia Demographic Health Survey Preliminary Data; Indicator completed
Zambia has an estimated number of 1.2 million orphaned and vulnerable children, of which 75
percent are orphaned from HIV14. The percentage of children who received support and care in
2007 was 15.7 or 578 based on a study sample of 3,671. This service was delivered through a
number of interventions with Home Based Care (HBC) programme taking the lead. The concept of
HBC was adopted by the Zambian Government to reduce the socio-economic impact of HIV and
AIDS in the workplace, in homes and society in general. Partners involved in providing OVC
support include GRZ, CHAZ, CRAIDS, ZNAN, RAPIDS, SUCCESS and ZPCT, bilateral and
Multi-lateral institutions.
As part of the government commitment to mitigate the socio-economic impact of HIV and AIDS,
the Public Welfare Assistance Scheme was mandated to provide social protection to orphans,
among others.
One of the goals of the 2006-2010 NASF is to provide social support services for those made
vulnerable by the HIV and AIDS epidemic, such as orphans, vulnerable children, PLHA and their
caregivers. The main strategies to achieve this goal in the NASF are to:
1.    Protect and provide support to orphans and vulnerable children;
2.    Provide social protection for people made vulnerable by HIV/AIDS;
3.    Promote programmes of food security and income/livelihood generation for PHLA and their
      caregivers and families.
The National Action Plan for children in Zambia (2008-2015) launched towards the end of 2007
reported that trends in access to health and education facilities still show that the percentage of
households having access to the nearest health care facility or to the nearest basic school is low. A
quick review of immediate output indicators suggests that since the launch of the first National
Action Plan, concerted efforts are being made in both the education and health sectors. With regard
to input indicators, both the health and education sectors show–despite an increase in absolute
terms–an increase in the provision of material inputs. These inputs have not been adequate to cater
for the higher levels of demand in the social sectors. Consequently, the availability of the resources
on a per capita basis has reduced markedly.




14
     Central Statistics Office, Zambia, 2005

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4.1.9   LIFE SKILLS-BASED HIV EDUCATION IN SCHOOLS
UNGASS Indicator 11: Percentage of schools that provided life skills-based HIV education in
the last academic year
Table 4.1.9.1: Percentage of schools that provided life skills-based HIV education in the last
               academic years
        Disaggregation                                          Year 2006
                                      Numerator               Denominator               Value
                    All Schools          4,567                       7,611              60%
                 Basic Schools           4,354                       7,256              60%
                  High Schools            213                        355                60%
Data source: Zambia Education Survey, 2006; Indicator completed
Zambia has 7,566 basic schools and 355 high schools with a combined total teacher population of
59, 384. Out of this total teacher population, 51,001 are in basic schools with the balance of 7,383 in
high schools. The 60 percent target for life skills-based education in the last academic year was
achieved at all levels of the Zambian education system, from basic to high school.

Service delivery data in 2006 showed that for the age group 15 to 24 year olds, a total of 454,069
received life skills-based HIV/AIDS education out of which 234,058 were males while 220,010
were females (Zambia, National HIV/AIDS/STI/TB Council, 2007).




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4.2       Outcome Programme Indicators – Knowledge and Behaviour

4.2.1     ORPHANS: SCHOOL ATTENDANCE
UNGASS Indicator 12 (A): Current school attendance rate of dual orphans aged 10-14
According to the Zambia Annual School Census conducted through the Education Management
Information System, a total of 1,566,416 children aged 10 to14 were in school in 2006, out of which
95,689 (or 6.1 percent) were orphans who had lost both parents and were able to attend school.
Gender disaggregation revealed that out of this total number of dual orphans in schools 49,333 were
males with the females accounting for the remaining 46,365. The system does not, however, collect
data on the number of dual orphans in the country and therefore cannot detect the rate of school
attendance of dual orphans in this age group. The Zambia Annual School Census for 2006 further
revealed that the total number of orphans (dual or single) in school was 349,818, accounting for
22.3 percent for the same age group. This indicator was incomplete because denominator values for
dual orphans in this age group have not been estimated for 2006 and 2007.
Trends on orphan rate of school attendance for the 10 to14 years for the period 2002 to 2005 and
based on the ZSBS, 2005 are presented in the Table 4.2.1.2 below.
Table 4.2.1.2: School attendance rate of orphans aged 10-14 trend analysis 2000-2005, ZSBS 2005
           Year                 Numerator                Denominator               Percentage
           2000                      53                         72                    73.6%
           2003                     118                        154                    76.5%
           2005                      91                         99                    91.9%

The 2005 ZSBS reported that the school attendance rate of dual orphans aged 10 to 14 years was
91.9 percent. Table 4.2.1.4 below illustrates that in 2000, the rate of dual orphans school attendance
for the same age was 73.6 percent, which increased steadily to 76.5 percent. However, in 2005 there
was a marked increase in orphan school attendance rate to 91.9 percent15.
Orphanhood is usually accompanied by prejudice and increased poverty, factors that can further
jeopardise children’s chances of completing school education and may lead to survival strategies
that increase vulnerability to HIV. It is therefore important to monitor the extent to which AIDS
support programmes succeed in securing education opportunities for orphaned children.




15
     Zambia Sexual Behaviour Survey 2000, 2003 and 2005

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UNGASS Indicator 12 (B): Current school attendance rate of children aged 10-14 both of
whose parents are alive and who live with at least one parent
The table below shows the trends for 2000-2005 of school attendance rate of non-orphaned children
aged 10 to14 and who live with at least one of the parents.
Table 4.2.1.3: School attendance rate of non orphaned children aged 10-14
         Year                   Numerator                 Denominator                 Percentage
         2000                       723                        966                       74.8%
         2003                      1,209                      1,459                      82.9%
         2005                      1,102                      1,223                      90.1%
The school attendance rate of non-orphaned children aged 10 to 14 in 2005 was 90.1 percent.
Further assessment revealed that the rate of school attendance of children aged 10 to 14 years both
of whose parents were alive increased steadily from 74.8 percent in 2000 to 82.9 percent in 2003
and then to 90.1 percent in 2005.
Table 4.2.1.4: Schooling of children 10-14, by orphanhood and residence status, ZSBS 2000-ZSBS 2005
                    Not an Orphan         Maternal          Paternal        Dual Orphan     Total Orphan
                                           Orphan           Orphan                           (Any Type)
Urban                   Number              Number           Number             Number         Number
 2000                    263                28               54               24              106
 2003                    456                36              125               62              223
 2005                    358                20               74               36              130
Percent in School         %                 %                %                %                %
 2000                   89.4               78.6             81.5             83.3             81.1
 2003                   88.6               86.1             90.4             77.5             86.1
 2005                   93.6               95.0             87.8             88.9             89.2
Rural                  Number             Number           Number           Number           Number
 2000                    703                44               97               48              189
 2003                   1,003               73              202               56              331
 2005                    865                52              181               63              296
Percent in School         %                 %                %                %                %
 2000                   69.4               72.7             62.9             68.8             66.7
 2003                   80.3               84.9             70.8             75.7             74.7
 2005                   88.9               80.9             91.2             93.7             89.9
Total                  Number             Number           Number           Number           Number
 2000                    966                72              151               72              295
 2003                   1,459              109              327              154              590
 2005                   1,223               72              255               99              426
Percent in School         %                 %                %                %                %
 2000                   74.8               75.0             69.5             73.6             71.8
 2003                   82.9               85.3             78.3             76.5             79.1
 2005                   90.1               84.7             90.2             91.9             89.7




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Table 4.2.1.3 above further shows that the attendance rate for all types of orphans for 2005 was 89.7
percent. Attendance rate for the rural dual orphans was marginally higher (93.1 percent) than the
urban ones (88.9 percent)
Figure 4.2.1.1 below compares the rate of school attendance between non-orphans and dual
orphans. Dual orphans aged 10 to 14 were slightly less likely to be attending school (73.6 percent
and 76.5 percent) than children of the same age group who were non orphans (74.3 percent and 82.9
percent) for the years 2000 and 2003 respectively. However, the results for 2005 which showed
slightly more dual orphans (91.9 percent) attending school than non-orphans (90.1 percent) for the
age group 10 to 14. These results are not what would be expected, because the implication is that
double orphans for the age group 10 to 14 are slightly more likely to attend school than children of
the same age group who are living with both parents.
        Figure 4.2.1.1: Rate of orphans aged 10-14 school attendance for the years 2000, 2003 and
                                                 2005




 Source: Zambia Sexual Behaviour Surveys, 2000, 2003 and 2005
The impact of HIV/AIDS is far-reaching and cuts across all aspects of society, including the health,
social and economic sectors. Management of the HIV/AIDS pandemic demands more resources and
skills than can be provided by any one sector alone. A multi-sectoral approach is needed and has
been adopted in Zambia.




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4.2.2   YOUNG PEOPLE: KNOWLEDGE ABOUT HIV PREVENTION
UNGASS Indicator 13: Percentage of young women and men aged 15–24 who both correctly
identify ways of preventing the sexual transmission of HIV and who reject major
misconceptions about HIV transmission
Table 4.2.2.1: Percentage of young persons 15-24 years who both correctly identified ways of
               preventing the sexual transmission of HIV and who reject major
               misconceptions about HIV transmission
        Disaggregation                                          Year 2007
                                      Numerator               Denominator            Value
                    All 15-24            1,917                       5,426           35.3%
                        Males                916                     2,482           36.9%
                     Females             1,001                       2,944           34.0%
                   15-19 yeas            1,004                       2,990           33.6%
                 20-24 years                 914                     2,436           37.5%
Data Source: 2007 Zambia Demographic Health Survey Preliminary Data. Indicator completed

This indicator assessed the percentage of young women and men age 15-49 who in response to
prompted questions say that people can reduce the risk of getting the AIDS virus by using condoms
every time they have sexual intercourse, by having one sex partner who is not infected and has no
other partners and by abstaining from sexual intercourse by category. The indicator further assessed
the percentage of the young people in the 15-49 age groups who say that healthy looking persons
can have the AIDS virus and who in response to prompted questions correctly reject local
misconceptions about HIV transmission or prevention and the percentage with a comprehensive
knowledge about AIDS background characteristics.
The 2007 ZDHS preliminary data revealed that 35.3% had a comprehensive knowledge about AIDS
by answering correctly to all the five questions. The spread of knowledge and awareness of issues
across the disaggregated categories did not show much difference with the 20-24 years scoring
highest at 37.5% while the 15-19 years age group scored the least at 33.6%.
However, based on individual questions, the respondents scored high for questions on reducing HIV
transmission by having sex with one uninfected sex partner who has no other partners; a health
looking person can have HIV and a person getting HIV by sharing food with someone who is
infected. For these questions the respondents scored between 80.5% and 89.6% across or
categories.
The least scores were reported for the question on a person getting HIV from a mosquito bite were
positive responses ranged between 65.4% and 67.3%.
Overall however, a significant drop was observed in the percentages of young people aged 15-24
who both correctly identified ways of preventing the sexual transmission of HIV and who rejected
major misconceptions about HIV transmission since the last reporting period for those who
responded correctly to all the five prompted questions from 47.8% in 2005 to 35.3% in 2007.


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4.2.3   MOST-AT-RISK POPULATIONS: KNOWLEDGE ABOUT HIV
UNGASS Indicator 14: Percentage of most-at-risk population who both correctly identify
ways of preventing the sexual transmission of HIV and who reject major misconceptions
about HIV transmission

Table 4.2.3.1: Percentage of higher risk sex persons 15-49 years who both correctly
               identified ways of preventing the sexual transmission of HIV and who reject
               major misconceptions about HIV transmission
        Disaggregation                                          Year 2007
                                      Numerator               Denominator           Value
                    All 15-49            1,066                       2,573          41.4%
                        Males                691                     1,675          41.3%
                     Females                 375                     898            41.8%
                    <25 year                 571                     1,416          40.3%
                   +25 years                 495                     1,157          42.8%
Data Source: 2007 Zambia Demographic Health Survey Preliminary Data. Indicator completed

For this indicator, Zambia targeted young women and men 15-49 years engaging in higher risk
sex16 who in response to prompted questions say that a healthy looking person can have the AIDS
virus, AIDS cannot be transmitted by mosquito bite, a person cannot become infected by sharing
food with a person who has AIDS and who correctly reject local misconceptions about AIDS
transmission or prevention and the percentage with a comprehensive knowledge about AIDS by
background characteristics.
Out of the 2,573 respondents in the survey, 41.4% or 1,066 gave correct answers to the five
questions correctly and therefore considered to have a comprehensive knowledge about HIV.
However the 25 years and above age category scored highest when data was disaggregated with 495
or 42.8% responding correctly out of the 1,157 participants. No substantial difference was reported
between females and males who scored 41.8% and 41.3% respective on comprehensive knowledge.
The least scored were observed for the question on a person getting HIV from a mosquito bite to
which the respondents score 68.2% for a correct response. The less than 25 years group scored
67.1% while the 25 years and above respondents scored 69.4%. Gender results were almost equal
at 68.0% for males and 68.5% for females.
An analysis of another most-at risk population, the female sex workers revealed much higher
knowledge and awareness on HIV overall.




16
  Higher risk sex is defined as sexual intercourse with a partner who neither was a spouse nor
who lived with the respondent

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Table 4.2.3.2: Percentage of female sex workers who both correctly identified ways of
preventing the sexual transmission of HIV and who reject major misconceptions about HIV
transmission
      Disaggregation                                        Year 2006 - 2007
                                      Numerator               Denominator         Value
     Females Sex Workers                     270                     719          71.6%
Comment: Data source: FSW in Border and Transportation Routes With Trend Analysis 200-
2006;
In the 2006 BSS, respondents comprising female sex workers were asked to identify ways of
preventing HIV in order to assess whether respondents had comprehensive knowledge of disease
transmission. Comprehensive was defined as knowing the ABCs of abstinence, being faithful and
condom use as methods of preventing HIV while rejecting any misconceptions such as HIV
transmission from a mosquito bite, by sharing a meal with somebody infected with HIV or greeting
somebody. Out of 719 respondents, 270 or 37.6 percent correctly answered questions relating to
methods of preventing HIV and denied misconceptions.

4.2.4 SEX BEFORE THE AGE OF 15
UNGASS Indicator 15: Percentage of young women and men aged 15–24 who have had
sexual intercourse before the age of 15

Table 4.2.4.1: Percentage of young people 15-24 years who have had sexual intercourse before
              the age of 15 years.
       Disaggregation                                            Year 2005
                                       Numerator                Denominator         Value
                     All 15-24               793                     5,426          14.6%
                        Males                396                     2,482          16.0%
                      Females                397                     2,944          13.5%
                  15-19 years                423                     2,990          14.1%
                  20-24 years                370                     2,436          15.2%
Data source: 2007 Zambia Demographic Health Survey Preliminary Data. Indicator completely
filled
The 2007 ZDHS indicated that of the 5,426 respondents in the survey aged 15-24 years, 14.6%
reported having had sexual intercourse before the age of 15 years. Females showed that they were
delaying at 13.5% as compared to men as 16.0%.
A comparison between the 2005 survey and the 2007 study revealed that overall a higher percentage
of young women and men had sexual intercourse before 15 years of age in 2007 when compared to
the 2005 across all categories.


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Early sexual debut is often a risk factor for HIV infection since early timing of first sex, often
before marriage, increases the chances of having many sexual partners during a lifetime. The
promotion of abstinence and delay of sexual debut among the adolescents has received strong
emphasis in HIV prevention efforts in Zambia. Figure 4.2.4.1 below provides a comparison
between the 2005 results and the 2007 results.

The most significant difference was observed in the 20-24 year age categories where respondents in
2005 revealed that 9.7% had sexual intercourse before 15 years against the while in 2007, slightly
more or 15.7% reported to have had sexual intercourse by 15 years of age.
Figure 4.2.4.1: Comparison between the 2005 and 2007 for 15-24 year old having sexual intercourse before
age of 15 years




Source: Adapted from the 2005 ZDHS and the 2007 ZDHS

The above results indicate a need to intensify targeting of young people with abstinence messages to
ensure that this pattern is reversed. Early sexual debut is often a risk factor for HIV infection, since
early timing of first sex, often before marriage, may increase the chance of having many sexual
partners during a lifetime.




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4.2.5    HIGHER-RISK SEX
UNGASS Indicator 16: Percentage of women and men aged 15–49 who have had sexual
intercourse with more than one partner in the last 12 months
Table 4.2.5.1:Percentage of young women and men 15-49 years of age who had sexual
              intercourse with more than one partner in the last twelve months
        Disaggregation                                        Year 2007
                                     Numerator               Denominator         Value
                   All 15-49             951                    13,141            7.2%
                       Males             865                     5,995           14.4%
                    Females                  86                  7,146            1.2%
                 15-19 years                 94                  2,990            3.1%
                 20-24 years             167                     2,436            6.9%
                 25-49 years             688                     7,715            8.9%
Data Source: 2007 Zambia Demographic Health Survey Preliminary Data. Indicator completed
The percentage of young people aged 15-49 years who have had sexual intercourse with more than
one partner in the last 12 months was 7.2%. When the data was disaggregated by gender, the males
showed that out of 5,995 respondents, 865 indicated that they had had more than one sexual partner
while for females scored only 1.2% or 78 out of the 3,649 respondents. The 25-49 year olds scored
higher among the three age groups (15-19, 20-24 and 25-49) at 8.9% while the least was scored by
the 15-19 years group who scored 3.1%. Figure 4.2.5.1 below compares the percentages of young
persons who had more than one sexual partner in the last twelve months.
Figure 4.2.5.1: Comparison between 2005 and 2007 for percentage of young people 15-49 years
who had sexual intercourse with more than one partner in the last 12 months




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4.2.6    CONDOM USE DURING HIGHER SEX
UNGASS Indicator 17: Percentage of women and men aged 15–49 who had more than one
sexual partner in the past 12 months reporting the use of a condom during their last sexual
intercourse*
Table 4.2.6.1: Percentage of young women and men 15-49 years of age who had more than
               one sexual partner in the past 12 month reporting the use of a condom during
               their last sexual intercourse
        Disaggregation                                     Year 2005 - 2007
                                      Numerator               Denominator           Value
                    All 15-49            1,173                       2,573         45.6%
                       Males                 837                     1,675         50.0%
                     Females                 336                     898           37.4%
                 15-19 years                 282                     717           39.4%
                 20-24 years                 341                     699           48.7%
                 25-49 years                 550                     1,157         47.5%
Data source: 2007 ZDHS Preliminary Data. Indicator completed
Based on the 2007 ZDHS preliminary data, out of a total sample of 2,573 women and men 15-46
years who had more than one sexual partner in the last twelve months, 45.6% of 1,173 reported that
they used a condom during their last sexual intercourse. More men at 50% or 837 out of 1,675
reported using a condom as compared to women at 37.4% or 336 out of the 898 sampled. Further
assessment revealed that the age groups 20-24 and 25-49 scored much higher at 48.7% or 341 of the
699 and 47.5% or 550 out of the 1,157 respectively than the 15-19 years who score 39.4% or 282 of
the 717.
Significant increased where also observed in the use of condoms at the last sexual intercourse
encounter for young persons who had more than one sexual partner in the last twelve months for all
categories when the 2007 results were compared to the 2005 findings. Composite (All 15-49) years
results showed an increase from 5.3% or 23 out of 430 in 2006 to 45.6% out of 2,573 in 2007.
Further, data disaggregated by age showed that the age group 20-24 scored the least at 2.7% against
7.7% and 5.4% for the 15-19 years and 25-49 years respective in 2005. However, a reverse
situation was observed in 2007 with results indicating that the 20-24 years scored highest at 48.7%
while the 15-19 years scored the least at 39.4% with the 25-49 years scoring 47.5%.
More females reported using condoms at their last sexual intercourse during the last reporting
period in 2005 at 6.4% as compared to males at 5.1% while in 2007 a reversal situation was also
observed as for the age disaggregated data; Males scored higher for condom use at 50.0% compared
to females at 37.4%. Figure 4.2.6.1 below provides a graphical presentation of changes between the
2005 results and the 2007 situation on usage of condoms during the last sexual intercourse for
young persons who had more than one sexual partner in the last twelve months.




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Figure 4.2.6.1: Comparison between 2005 and 2007 of percentage of young women and men 15-49
years who had engaged in sexual intercourse with more than one partner in the last twelve months
and reported using a condom during their last sexual intercourse.




Adapted from the 2005 ZSBS and 2007 ZDHS


4.2.7 SEX WORKERS/ LONG DISTANCE TRUCK DRIVERS: CONDOM USE
UNGASS Indicator 18: Percentage of female and male sex workers reporting the use of a
condom with their most recent client

 4.2.7.1:Percentage of female and male sex workers reporting the use of a condom with their
         most recent client
       Disaggregation                                          Year 2006
                                      Numerator               Denominator        Value
            All Most at Risk            933                      1,152           81%
              LDTDs-Males                    41                      57          71.9%
                  Females           892                   1,095                  81.5%
 Comment: Study did not capture male sex worker but targeted long distance truck drivers.
 Data Source: 1) BSS Zambia 2006 – Long Distance Truck drivers in Transportation Routes
 With Trend Analysis; 2) BSS Zambia 2006 – FSW in Border and Transportation Routes With
 Trend Analysis 2000-2006
According to the 2006 Behaviour Surveillance Survey, 1,095 female sex workers were asked (i)
when was the last time you had sex with a client? (ii) did you and your client use a condom?

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Approximately 81.5 percent of the female sex workers reported use of condoms at last sexual act
with a paying client and 61.3 percent with a non-paying client. However, consistent use of condoms
over the past 30 days with a paying client was 38.6 percent and 25.3 percent with a non-paying
client.
Data was also collected on Long Distance Truck Drivers (LDTD), considered to be among the
most-at-risk populations in Zambia and the region. The LDTD were assessed for last sex with a
female sex worker (FSW) and also with a non-regular (NR)/non FSW. Figure 4.2.17.1 below
illustrated the results of the survey.
Figure 4.2.7.1: Condom use at last Sex with FSWs and Non Regular/Non FSWs BY LDTD




Source: Behaviour Surveillance Survey Zambia, 2006

A trend analysis of condom use by the LDTDs showed that condom use with female sex workers
remained above 92 percent for each of the surveys of 2000 (93.3 percent), 2003 (92.7 percent) and
2006 (93.7 percent). Much lower levels of condom use were reported by the LDTDs at last sex with
a non regular/ non female sex worker for the same period. However, increasing use of condoms was
observed during this period from 50.7 percent in 2000 to 70 percent in 2003 and finally 71.9 percent
in 2006.




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4.3      Impact Indicators of National Programmes

4.3.1    REDUCTION IN HIV PREVALENCE
UNGASS Indicator 22: Percentage of young people aged 15-24 years who are HIV infected

4.3.1.1: Percentage of young people aged 15-24 years who are HIV infected
        Disaggregation                                     (Year 2005 - 2007)
                                           Numerator          Denominator              Value
                      All 15-24              1,284                   5,539            15.57%
                   15-19 years               289                     2,397            11.6%
                   20-24 years               834                     4,293            17.8%
Comment: Indicator completed
Data Source: Antenatal Surveillance Report 1994-2004. Data still valid
The HIV prevalence among antenatal attendees (aged 15 to 24) was 15.57 percent while for those
aged 15 to 19 years was 11.64 percent for all women. Urban sites had much higher prevalence for
the 15 to 24 age group (20.35 percent) compared to the rural sites with 10.36 percent. HIV
prevalence among women 15 to 19 years old may be used as a proxy for HIV incidence.
Among young people, the Zambia Demographic and Health Survey (ZDHS, 2003) reports that 7.7
percent in the 15 to 24 year age group are HIV infected. Table 4.3.1.2 below highlights the gender
differences in the prevalence between young men and young women, with women exhibiting higher
infections than men across all age groups. It splits the age groups as 15 to 19 and 20 to 24 years old
and also shows the aggregate (15 to 24 years old) differences.

Table 4.3.1.2     HIV Infection among 15-24 age group
           Age                     Women %                     Men %                 Total %
          15-19                       6.6                       1.9                    4.6
          20-24                      16.3                       4.4                   11.4
          15-24                      12.5                       3.0                   7.7%

The analysis based on sentinel surveillance indicates that the national situation contains many
smaller epidemics with their own dynamics in different geographical, sectoral, and other population
groups. Programming must take these into account, with sound analysis and understanding of the
driving forces for the epidemic in different population groups, between genders and in different age
cohorts.




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4.3.2    MOST-AT-RISK POPULATION: REDUCTION OF HIV PREVALENCE
UNGASS Indicator 23: Percentage of most-at-risk population who are HIV-infected

        Disaggregation                                      Year 2005 - 2007
                                           Numerator          Denominator             Value
                      Females                176                     284              65.4%
Data Source: Behavioural and Biologic Surveillance Survey In City of Ndola, Zambia (Among
Female Sex Workers), 2005. Indicators partially filled – Study did not target any male sex
workers and data was not disaggregated by age.
According to the Biological Behaviour Surveillance Survey 2005, the rate of HIV among female
sex workers was high, representing 65.4 percent or about two of every three female sex workers.
This survey was conducted in Ndola, one of the sites for the Corridors of Hope Project. The survey
neither disaggregated nor reported data by age or gender. No male sex workers were targeted during
this survey.
4.3.1    HIV TREATMENT: SURVIVAL AFTER 12 MONTHS ON ANTIRETROVIRAL THERAPY
UNGASS Indicator 24: Percentage of adults and children with HIV known to be on
treatment 12 months after initiation of treatment

Table 4.3.1.1 Adults and children survival after 12 months on ART Treatment
Disaggregation                 Year 2006                           Year 2007
                  Numerator Denominator         Value   Numerator Denominator               Value

 All Adults and
                  9,011        10,061        89.6%        7,919        9,040        87.6%
       Children
         Males    3,403         3,878        87.8%        3,507        4,029        87.0%
       Females    5,608         6,183        90.7%        5,312        5,911        89.9%
      <15 years    821           898         91.4%         729          792         92.0%
      +15 years   8,190         9,163        89.4%        8,090        9,148        88.4%
Data Source: Commonwealth Infectious Diseases Research in Zambia, 2008; Indicator completed

The percentage of adults and children with HIV known to be on treatment twelve months after its
initiation was above 87 percent for all categories. Overall, survival for both adults and children was
89.6 percent in 2006, which dropped to 87.6 percent in 2007. Disaggregated data revealed that
children (<15 years) scored the highest (91.4 percent in 2006 and 92 percent in 2007) and was the
only category that recorded an increase in survival.

Survival by gender was highest among females who scored 90.7 percent, while males were at 87.8
percent for 2006. Although there was a slight drop for both cases from 2006 to 2007, the females
again posted higher (89.9 percent) than the males (87 percent).

Figure 4.3.1.1 below further illustrates the percentage of adults (+15 years) who were on treatment
twelve months after initiation of the antiretroviral therapy was 89.4 percent in 2006 while in 2007 it

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was 88.4 percent. Thus for both years, the cohort revealed that survival among children remained
higher.

The indicator values provided in the above table are from CIDRZ Facility-based HIV Care/ART
Annual Reporting Forms involving 52 sites drawn from four provinces namely Lusaka, Southern,
Western and Eastern. The reporting period was from third quarter in 2005 to second quarter 2006
for the 2006 reporting period while for 2007, programme monitoring was from third quarter 2006 to
the second quarter 2007.

Figure 4.3.1.1: General population survival after 12 month on ART (2006 and 2007)




Chart produced based on data from: CIDRZ




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4.3.2   REDUCTION IN MOTHER-TO-CHILD TRANSMISSION
UNGASS Indicator 25: Percentage of infants born to HIV-infected mothers who are infected

According to a cohort study of 1999, 39 percent of infants born to HIV-positive mothers were
infected. No new information has been collected; even though the PMTCT programme has been in
existence since 1999, effecting protocols for testing babies to monitor the transmission rate was a
problem. New protocols have recently been developed which will track exposed children and their
mothers and effect early testing of children using PCR.

The development of the Paediatric and Family HIV Care Centre of Excellence (COE) at UTH has
led to a new partnership for the Paediatric Diagnostic and Research laboratory. It is providing
laboratory support for the Paediatric HIV program at the institution and helping in scaling infant
diagnosis to cover the entire nation.

The role of the laboratory is to implement the HIV infant diagnosis using PCR and to provide
diagnostic services for the comprehensive care of HIV-positive children attending the Paediatric
and Family HIV Care COE at UTH. The laboratory will also provide HIV infant diagnosis services
to two affiliated Lusaka Urban District Health clinics (Bauleni and Chilenje clinics) offering
PMTCT services.

The HIV infant diagnosis program will employ the Real-Time PCR and the Roche Amplicor HIV-1
DNA PCR version 1.5 methods to detect HIV infection in paediatric subjects using Dried Blood
Spot (DBS) specimens. This is being done with the help of the Centers for Disease Control and
Prevention NCHSTP, Global AIDS Program International Laboratory Branch, which is providing
the technical support to build capacity to roll out the program. The laboratory will also provide
training to other laboratories that will use DBS specimens for diagnosis of HIV-1 infection in
infants in programs to be implemented in other parts of the nation. The sites to offer this service will
be Ndola Arthur Davison Children’s hospital and Livingstone General hospital.

The laboratory anticipates receiving between 1500 and 2000 specimens for testing from UTH
during the first year of HIV-1 Infant diagnosis. With the two affiliated health centres sending
additional specimens this will bring the anticipated annual specimen load to approximately 4000.
An average of 80 DBS specimens will be processed weekly (KS HHV8 Treatment and Diagnostic
Laboratory Paediatric COE Laboratory Report, September 2005).

According to the Ministry of Health reports, a total of 15,631 infants born to HIV-infected women
and receiving any ARVs for PMTCT in 2007. During the same period 52,846 pregnant women
tested HIV positive in 2007 with 35,314 receiving antiretrovirals to reduce the risk of mother to
child transmission.




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                                             CHAPTER V.  
                                 BEST PRACTICES IN ZAMBIA 
                                BEST PRACTICE I:
                    THE MBOOLE RURAL DEVELOPMENT INITIATIVE

A detailed reflection on Mboole Rural Development Initiative (MRDI) reveals its fulfillment of various
criteria needed for a best practice. In this section the project is validated using SADC HIV & AIDS
best practice criteria.

Effectiveness
The MRDI is effective because it has defined, since its inception, clear, specific and measurable
objectives that are being met through various project activities. These objectives are in line with
Zambian National HIV and AIDS Strategic Frame 2006 – 2010. According to the national policy, as
well as the District HIV and AIDS Strategic Plan 2006 – 2010, community based projects targeting the
OVCs and other maginalised groups in communities are recognised as partners in the fight against the
epidemic. MRDI is one of the unique initiatives in the country and it is complementing government
efforts in responding to HIV and AIDS. It is also evident that the project objectives are clear to both
project implementers as well as to beneficiaries and community members in general.
 There is clear evidence that the community owns this project and that there is an outstanding depth of
community participation that gives the project health and a vibrancy that is tangible. There was, and
continues to be, wide and systematic consultation between project implementers and community
members as the project evolves and expands. Project objectives are shaped based on community needs
that are identified by these frequent consultations with traditional leaders and key community group
representatives.




Figure 9: Village headmen as part of FGDs




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“…..We are where we are, because all community leaders and other members of the community positively support the
project. They feel part of the project” Jonsen Habachimba; Chairman (Director)

The project takes into congnisance gender dynamics. The team composition of the project
implementers exhibits a balance between male and female. Similarly in services delivery issues, gender
needs are prioritized. Consequently women within the community are well informed about HIV and
AIDS, and it was clear that the MRDI has given women a voice in responding to the epidemic.
Previously it was considered taboo for a woman to speak out in public about AIDS, but with
information they receive from the project, women now fully participate in HIV/AIDS issues at
community level, equal to their male peers.
MRDI is undoubtedly effective in meeting its objectives. It has improved school attendance for
orphans and vulnerable children by providing them with school requisites such as uniforms, school
shoes, and books. Nutritional support to people living with HIV and AIDS is provided in a timely
manner. This has enhanced the quality of life in households affected by the epidemic. Access to
treatment for people living with HIV and AIDS has also improved as transport is provided using a
bicycle purchased from funds generated by the MRDI. Before this, patients had problems in accessing
treatment, as they did not have money to pay for transport to take them to the clinic. Almost every
member of the community has been reached by the project volunteers and the entire community is
now involved in establishing strategies on how they can reduce the spread of HIV and in taking care of
the infected and affected.

Ethical Soundness
For an HIV and AIDS initiative to succeed in Zambia and elsewhere, it needs to adopt a human rights
approach which requires that the rights of people, equality before the law and freedom from
discrimination are respected and protected. This entails that the project should be people centered and
should be cultural sensitive. The MRDI has taken cognisance and employed all these requirements and
thus succeeded in its activities.
The Mboole Initiative has gained the confidence of various vulnerable groups, including: people living
with HIV and AIDS, the orphans and vulnerable children and the aged. It has meaningfully involved
these groups at all levels of operation and execution of project activities. PLHA are frequently
consulted and their views are taken care of. Issues of confidentiality and informed consent are adhered
to by all project staff. Attesting to this, PLHA feel very respected by the project staff and not in any
way discriminated against in accessing the project services. This is clear indication of its ethical
soundness, and its employment of meaningful involvement of people infected with or affected by HIV
(MIPA).

Cost Effective
MRDI illustrates a notable example of cost effective projects. Before 2006, the MRDI had received no
external funding and its only resort for survival was to be locally funded. The project has thrived and
survived on voluntary work by the members and other community members as well as small financial
incentives from the income-generating activities mentioned earlier. Despite limited financial resources
the project has continued to have an impact on the community.
The project staffs are locally tapped and thus have a feel for the need of the community. Project
personnel are all dedicated volunteers who have given their time to serve the needs of the community
at no pay at all. The degree of volunteerism among the staff is amazingly touching but essential to the

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progress of the project. Although the project implementers do not have higher formal education
attainment, they have received some short term trainings through the DACA in the following areas:
Project management, HIV and AIDS, Volunteerism, Community mobilization and Self help initiative.
MDRI has support for its work both from the community and beyond. This is evidenced in the range
of contributions it receives from the local community in cash and in kind. Community members are
readily available to contribute to the project. For instance three of sewing machines were donated to the
project by community members. Community members have physically been involved in project
activities such as brick molding for the expansion of the project building. This demonstrates a deep
sense project ownership by community members.
MDRI has effectively used income generating activities to locally raise some money to scale up on the
project activities. In 2006 MRDI was awarded US$20,000 for being an outstanding project in the area
of OVC. In the same year the project received a boost of US$12,000 donation from the World Bank
through the Community Response to HIV /AIDS (CRAIDS) project. This money is being used to
extend the project to reach more beneficiaries. To ensure financial discipline, the project has two
accounts with the bank; one for discretionally funds and the other for non-discretionally funds.
The project has also multiplier effects in that, while the core business of the project is to look into
issues affecting OVCs, project staff do from time-to-time organize community members and offer
them VCT knowledge. It does not only refer people for VCT but physically transports those who are
interested to VCT centers and back. The project has also acted as a link between the Ministry of
Agriculture and the community. The Ministry of agriculture through MDRI identifies the agricultural
needs of the community and responds to these needs through the project staff. For instance some
women groups in the community have been trained in agriculture management by the ministry of
agriculture using the MRDI staff.

Relevance
The initiative has received overwhelming support and acceptance from political leadership (NAC,
District commissioner, area councilor), and traditional leadership (Chief and Village Headmen). The
project is also accepted by religious leadership although a certain degree of resistance is unavoidable.
For instance the catholic stance on condoms poses a challenge to the project which promotes condoms
as a prevention measure. However, generally the project sits well within the traditional and cultural
norms of the community. The relevancy of this initiative cannot be over emphasized.
What makes MRDI very relevant to the local community is the fact that it attempts to address the
critical problem of HIV and AIDS facing Zambia as a whole and rural communities in particular. It is
clear and unfortunate that Zambia one of the countries that has worst hit by the HIV and AIDS
epidemic. The ZDHS (2002), estimates that Zambia, a country of about 10.6 million people has about
16% of this population who are infected with the deadly virus. As a country, Zambia has experienced
the ill effects of the epidemic socially and economically. The epidemic has left millions of families
disintegrated and devastated. Breadwinners have been lost and old grandparents have been left to take
care of the orphans left by their children who have succumbed to the pandemic. Most of these
grandparents are too old to care for young children and usually do not even have the means to support
them. The children end up not going to school as they have no one to pay for their school requisites.
Some of them end up on the streets, where they turn to vices like theft and prostitution for survival. It
is estimated that over 70% of the orphans are as a result of deaths of their parents or principle
guardians.


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“…..When my mother died, I dropped out of school because I did not have a uniform and books…thanks to MRDI
I‘m now back at school ” A story of an 11 year old girl who once dropped out of school.

The relevance of MRDI is apparent in addressing the needs of the affected youths, PLHA, women and
the aged. These groups are vulnerable and need a ray of hope to live on in society. The Initiative has
helped send many children back to school by providing them with school requisites. It has improved
the quality of life through provision of nutritional support, transport to the local health centre as well as
ploughing for the sick and the aged.

Replicability
MRDI uses simple but effective processes that can easily be copied or replicated in similar context and
even at broader level. The project has used traditional leadership as an entry point to the community. It
has utilized the local and available resources in a meaning manner and its impact has been greatly felt.
Contrary to the wide held misconception that HIV and AIDS initiative need a lot of resources to be set
up, MRDI sets a unique example that you can make use what is in your means to produce positive
results in response to the epidemic.
The social and economic conditions prevailing in Mboole is typical of many rural set ups in Zambia as
well as in the whole Southern African region. Many SADC countries face the same challenges as the
Mboole community, this kind of intervention, if replicated, would help them address some of these
challenges. The resources needed to start up such an initiative are not beyond the reach of many
communities. If a community were to start an initiative like this one, they would need commitment
from local leaders, youth and other members of the community. Once this commitment is assured,
communities can pool their resources and start up Income Generating Activities (IGA) such as the
ones undertaken by the MRDI, or indeed any other economic ventures best suited to a particular area.
The community can then identify the beneficiaries of the project. This initiative also does not have to
be limited to the care and support thematic area, but can be focused on any other thematic areas such
as prevention, stigma reduction and discrimination or mitigation. Through documentation of this
Initiative and working through local leadership, other communities can be encouraged to start similar
initiatives.
Evidently village headmen and youths from villages outside the project sites have frequented MRDI to
grasp ideas on how to go about replicating this successful initiative within their village settings. At a
smaller level, women groups have replicated the project and running income generating activities to
help alleviate poverty among the women.

Innovativeness
It is true that MRDI is among a few initiatives, if not the only one in the country that has succeeded by
using minimal resources to score greater outcomes. The project is very unique in its operation. The
Initiative has properly been managed by the youths who have a passion for community work. The
youths running the initiative are spirited and visionary, and this has gained them the confidence and
respect of diverse community members. Unreserved confidence and support is expressed from the
level of the district commissioner to the traditional and religious leaders. To the community members “
MRDI is the best that has ever happened in the community.”
“It is amazing how these youths dedicate their lives to serving the needs of the community. We always pray for them that
they should live longer. At first we thought they were just like these come-and-go organizations, but we were wrong. Today
I can even tell men to be using condoms because I have learnt this from these youths”. – an elderly woman showering
praises for MRDI

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One other unique facet of MDRI is level of community participation in the project activities. Using
traditional leadership as an entry point to community participation has been a key point worth
borrowing from the initiative.
MRDI, innovation is exhibited through the use of local resources. For instance the material used for
furniture production is locally sourced, but realizing the danger of deforestation, it is a policy of MRDI
to plant more trees as they continue to use some. Timber reserves have also been established as
measure of conserving materials for future use. Similarly, it is innovative that while some uniforms are
sold at low cost to raise income for the project, some uniforms are provided for free to OVCs who
could not afford buying them.
The degree of volunteerism is a noticeable unique aspect of MRDI. The youths running the project
spend eight hours each day dedicated to helping PLHA, the aged and OVCs. The initiative does not
currently have adequate means of transport to take the project staff to do community senstisation in
distant villages, however this does not deter the youth from walking long distances and ensure that HIV
and AIDS information is well received by everyone within their reach. They also use these door-to-
door campaigns to identify various needs of the community. All these valuable activities re conducted
with no payment.

Sustainability
Prior to 2006, MRDI has been sustained through small financial incentives from the Income
Generating Activities (IGAs). From the inception, the initiative has been locally funded through use
IGAs and the good will of community members, which shows that the initiative is sustainable.
There is a deep sense of community involvement in the project simply because community members
have constantly been involved from project conceptualization to implementation. MRDI has full and
broad backing of the community. There is no doubt that the project can still run even in the absence of
the external donors. However to scale up the good works of MRDI, it is required that more funds be
sourced both internally and externally.
From the beginning of the project activities community members have been involved in all the project
activities. Evidently, community members were part of the team that designed the HIV/AIDS
Prevention and OVC Support Project proposal submitted to CRAIDS. This proposal which has since
been funded carried with it all the needs of the locals. Community members participated in bringing out
their concerns on HIV and AIDS for inclusion in the project proposal.
“The future of the project remains bright”, observed from the community members. They have pledged
to continue supporting the Initiative. Future plans for the project include:
•   expanding the initiative to surrounding areas,
•   expansion of the three income generating activities to;
•   create employment for youths, increase the number of OVC receiving support from the initiative,
    and
•   support the already registered OVCs with other school requisites




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                          BEST PRACTICE II:
     ZAMBIA INTERFAITH NETWORKING GROUP ON HIV/AIDS (ZINGO) BEST
                             PRACTICES

The Zambia Interfaith Networking Group on HIV/AIDS (ZINGO) was established in 1997 as a collective
religious force to respond to the challenges of HIV and AIDS and consequently promote and preserve life.
ZINGO consists of the seven major faith bodies in Zambia namely the Bahá’í faith, the Council of Churches
in Zambia, Evangelical Fellowship of Zambia, Hindu Association of Zambia, Independent Churches of
Zambia, the Islamic Council of Zambia and the Zambia Episcopal Conference (ZEC).
ZINGO is one of the few religious networks in Africa that have managed to bring together a diversity of faith
groupings for the purpose of responding to the HIV and AIDS pandemic both at the national and local levels.
ZINGO is represented at the local levels through the District Programmes Execution Committees, a
consortium of different faith institutions responding to HIV and AIDS at the district level.
Previously and before the creation of ZINGO, HIV and AIDS were seen to reflect badly on any religious
institution that acknowledged its presence among its faithful. Consequently HIV and AIDS were seen as a
problem for ‘them’ (‘Christians’ or ‘Muslims’ or ‘Hindus’) and not ‘us’. However since the creation of
ZINGO, members of different faith communities have realized that HIV and AIDS is not a problem for
‘them’ without ‘us’ but it is indeed a universal problem that affects everybody and which all people of all
faiths need to collectively address. Today all the major seven faith mother bodies in Zambia regard HIV and
AIDS as a problem arising from the inability to address the socio-economic challenges facing humans
holistically and not one associated with immoral behaviour.
ZINGO has also been successful in erasing barriers that normally exist between different umbrella faith
mother bodies with regard to most key national issues. For instance, three of the four main Christian faith
mother bodies in Zambia namely CCZ, EFZ and ZEC have for so long held divergent views over the
constitution making process with other faith bodies. In such matters, these faith bodies including the Islamic
Council of Zambia have at times been in opposing camps. However when it comes to HIV and AIDS,
ZINGO has managed to group these normally opposing camps into one camp. In fact the current chair of
ZINGO is held by the Council of Churches in Zambia while the vice chairmanship is held by the
Independent Churches of Zambia.
Aside from the ability to engage what would be normally opposing groups, ZINGO has also managed to
encourage greater participation of the minority religious groups into the HIV and AIDS response. Before
ZINGO came into existence, none of the faith mother bodies had a dedicated response to HIV and AIDS.
However with the creation of ZINGO, a process was initiated that contributed greatly to the strengthening of
existing weak HIV and AIDS responses of the faith mother bodies into fully fledged HIV and AIDS
programmes with fulltime HIV and AIDS Programme Coordinators. Today, it can be said that almost all the
seven faith mother bodies have up and running HIV and AIDS programmes with staff that are fully dedicated
to developing the programmes. Against that strength, ZINGO is now engaging all faith mother bodies to
come up with a written and documented policy that will guide their response to HIV and AIDS which aligns
with GRZ priorities and plans as outlined in the 5th National Development Plan.
Programmatically, perhaps the best practice has been ZINGO’s ability, despite the faith mother bodies’
divergent views on sex and sexuality within the context of HIV/AIDS, to develop guidelines that can be used
by all faith leaders and groups addressing adolescent sexual and reproductive health. The guidelines were
developed with support from the FHI/YouthNet Project using funds from the US Government.

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                          BEST PRACTICE III:
       NETWORK OF ZAMBIAN PEOPLE LIVING WITH HIV AND AIDS (NZP+)

NZP+ is a membership based organization that was formed in 1996 by a group of 28 people living
with HIV and AIDS. It promotes support to people living with HIV and AIDS, represents and
advocates for their interests, facilitates the access to information and vital services and encourages
their own livelihood development. NZP+ is an institutional member of NAC as provided for in the
National HIV/AIDS/STI/TB Act of 2002. As such, NZP+ was also part of the formation of NAC in
2002. It is also represented on the Zambia Country Coordinating Mechanism (CCM) of the Global
Fund to fight HIV/AIDS, Tuberculosis and Malaria, Partnership Forum, ZNAN as well as thematic
technical groups from complimentary organizations.
Support groups are the building block of NZP+ as well as the level where action takes place. Its
primary function is to provide a safe meeting point for PLHA who help one another. In addition to
this internal primary function, PLHA are encouraged to link up with their environment in order that
they contribute to the HIV/AIDS awareness and information in their communities. NZP+ has
developed and applied a package of ToTs which cover the essentials of the formation and
functioning of support groups and this includes a Support Group Manual which has been taken up
by the Southern Africa Regional network (of NZP+ is a member) and the Continental Network as a
best practice and also recognized by the Lesotho, Botswana, Zimbabwean and Swaziland country
networks.
As part of its decentralization which has been catalytic to the fast growth of the organization,
NZP+’s district chapters have been trained in a package of practical ToTs in order for the chapters
to be able to contribute better to the multi sectoral response at district level as well as facilitate
coordination of the support groups. Included in the trainings are community capacity enhancement,
support group management, Financial and administrative management, Project design and Anti
Stigma. The NZP+ District Chapter Manual has also been developed and this is another best
practice that has been taken up not only by the sub regional network, but also the Continental
network for further publication and roll out. The District Coordinators who represent NZP+ on the
DATFs have been able to enhance their advocacy and in some instances influenced provision of
HIV related services as well as accessed better services for their members.
The National Secretariat has been instrumental in the trainings of the District Chapters and all
activities have been tailored around the needs of the support groups. Even the formulation of the
manuals was a participatory process so that the support groups and district chapters have ownership.
NZP+ has the civil society mandate to seek and enter into dialogue on behalf of PLHA in order to
jointly identify issues and find solutions. Some of the key mechanisms and modalities that NZP+ is
applying in advocacy are policy dialogue (bilateral or using multilateral platforms and networks),
research for evidence based advocacy.
Through its decentralization, NZP+ has grown from a group of 28 Lusaka based PLHA to over 35,
000 people in over 3, 200 support groups in all the 73 districts in the country.
As a result of this growth and recognition of its good governance, NZP+ is the current Vice Chair of
the Southern Africa Regional network (NAP+SAR) as well as the Vice President of the Network of
African People living with HIV/AIDS (NAP+).



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                            BEST PRACTICE IV:
      THE ZAMBIAN PRIVATE SECTOR’S RESPONSE TO HIV&AIDS: PROGRESS,
                       CHALLENGES, & PROSPECTS

Background
The Zambia Business Coalition on HIV and AIDS (ZBCA) is a coalition of public and private companies
and NGOs in Zambia, which have come together to respond to HIV/AIDS and mitigate its impact. The
coalition is currently made up of 71 member-companies from various business sectors all over the country.
Private sector plays an important role in the multi-sectoral response to HIV and AIDS, as defined in the
Zambia HIV and AIDS Strategic Framework 2006-10. ZBCA thus closely works with the government, the
donor community, and other entities involved in the response to HIV/AIDS in Zambia.
Progress
With the formulation of a strategic plan, ZBCA has more or less identified key priorities in improving not
only the Secretariat’s performance in coordinating the response, but also the members’ capacity to coordinate
their in-house response to HIV&AIDS.
Among the progress made so far by the private sector are the following:
1.    Increase in member-companies’ awareness of the UNGASS minimum requirements in formulating
      workplace policies and programmes, through foras, workshops, and company visits;
2.    Increase in member-companies’ awareness of the rights and responsibilities of employers and
      employees under the ILO Code of Practice on HIV&AIDS;
3.    Increase in member-companies’ awareness of the Ten(10) Key Principles under the ILO Code of
      Practice on HIV&AIDS and the world of work;
4.    Increase in number of member-companies with HIV&AIDS Workplace Policies, and in the number of
      those conforming to the minimum UNGASS requirements;
5.    Increase in the formation of HIV&AIDS Committees coordinating the response at workplaces;
6.    Increase in the number of trained peer educators serving co-employees;
7.    Increase in the capacity of companies in the private sector to link up and network with government
      and international organizations to facilitate their own workplace response;
8.    Increase in private sector availability of sub-granting facility from the Global Funds, to finance
      HIV&AIDS workplace activities;
9.    Increase in number of business establishments contributing company funds to finance HIV&AIDS
      workplace activities;
10.   Increase in the capacity of the ZBCA to monitor the response at the Secretariat, and at the workplace
      levels.


In 2007, the ZBCA was able to install an electronic database which contains data relevant to its members’
HIV&AIDS response at their respective workplaces. A baseline survey tool was developed.
As of this writing, 52 out of the 71 member-companies have been surveyed. The data base at this stage
contains five (5) initial datasets which can be expanded to include more details, and the expansion will
emanate from the initial five (5) data groups.



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The envisioned scenario is that, when resources are available, each of the 71 member-companies will have a
database program in their workplaces, compatible with the ZBCA database. Then, the 71 members can
update information from their own end, and data can be sent to the ZBCA server. The ZBCA server will be
connected with the NAC Office, which will capture data and feed them into the national monitoring system.
Challenges
Specifically, the challenges which confront ZBCA as a private sector coordinating agency are:
1.    Organizational inadequacies in terms of technically-equipped manpower and long-term logistical
      support;
2.    Image-building gaps which hinder good coordinative functioning within the coalition and erode
      member-company confidence;
3.    Constitutional and administrative gaps which leave issues open and subject to misinterpretations.
At the company level, the challenges include the following:
1.    Minimal involvement of top-level company executives and decision makers;
2.    Inadequacy of monitoring and evaluation mechanisms to measure effectiveness and costs of
      programmes;
3.    Inadequacy of personnel to coordinate activities within the company and to represent the company in
      foras, conferences, etc.
4.    Capacity building gaps in HIV&AIDS programme management, mainstreaming, and in M&E.
Prospects
With a strong membership base, composed of private, parastatal, quasi-government corporations in the
banking, mining, energy, and service sectors, ZBCA has a great potential to bring private sector participation
in the response to its fullest. Once the challenges confronting ZBCA have been fully addressed and
eliminated, the road will be clear for it to take the lead in coordinating private sector response to
HIV&AIDS.
Specifically, the following areas will need to be prioritized:
1. Launching of an intensive image-building campaign and a series of activities involving role internalizing
   on the part of the Secretariat, the Board, and the member-companies to clarify the ZBCA mandate and
   core business;
2. Addressing gaps in the constitution, administrative policies and rules governing internal and external
   relations;
3. Developing a long-term programme for the entire coalition detailing manpower enhancement plans and
   logistical support;
4. Launching a massive campaign to advocate for greater management executives’ involvement in the
   response;
5. Installing a coalition-wide M&E system linked to the National AIDS Council;
6. Enhancing capacity of member-company personnel in the management, monitoring & evaluation of
   programmes and implementation of policies;
7. Beefing up the number of company personnel involved in the response, such as peer educators,
   counsellors, nutritionists, nurses, doctors, etc.


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                                         BEST PRACTICE V:
                     Churches Health Association of Zambia (CHAZ)
The Churches Health Association of Zambia (CHAZ) was established in 1970 as an umbrella
organization of church health institutions and church administered Community Based Organizations
(CBOs). There are 135 member units affiliated to CHAZ. Altogether these account for 50 percent
of health care coverage in rural areas and 30 percent of the overall health care in Zambia. However,
government has been providing the faith based health facilities through the provision of operational
grants, drugs and medical supplies. Additionally, over 90% of health professionals working in these
institutions are employed and paid by government. Due to CHAZ’s extensive infrastructure and
local experience, the Zambia Country Coordinating Mechanism (CCM) for the Global Fund to fight
HIV/AIDS in March 2003 chose CHAZ as one of the four principal recipients (PR) for HIV/AIDS,
one of the three PRs for TB and one of the two PRs for Malaria. CHAZ is mandated to disburse
funds to Faith Based Organizations (FBOs) for HIV and AIDS, tuberculosis, and malaria grants
from The Global Fund.
CHAZ Response to HIV/AIDS
CHAZ with the support of a number of cooperating partners that include The Global Fund,
DanChurchAid/DANIDA, DanChurchAid/European Union, The Royal Netherlands Embassy, Irish
Aid, Catholic Relief Service(CRS)/AIDS Relief Programme and Center for Disease Control (CDC)
has intensified its prevention, care and treatment programme. The Global Fund and CHAZ signed
HIV/AIDS, TB and Malaria grants totaling US$50,905,608 up to 2008 for Round One phase two. In
addition under Round 4 phase two additional grants for HIV/AIDS (US$64million) ART scale-up
and Malaria (US$6.6million) were approved in 2007. In October 2007, the Joint Financial
Agreement (JFA) to support the CHAZ HIV/AIDS Strategic Plan 2006-2010 was approved. These
programs, with CHAZ overseeing implementation are making significant inroads into the burden of
HIV/AIDS in Zambia. Through comprehensive prevention, care and treatment efforts, the
HIV/AIDS and TB program plans to contribute to the National HIV/AIDS and TB strategic Plans
for Zambia. CHAZ is significantly contributing to the rapid scale-up of Insecticide Treated Bed-
Nets (ITNs) and case management of malaria in line with the National Malaria Strategic Plan and
Roll Back Malaria initiative.
Results
CHAZ has used the resources from The Global Fund and other partners to scale-up life saving
interventions in the most remote areas of Zambia. The funds have enabled FBOs to rapidly expand
their capacity to respond to HIV/AIDS, TB and Malaria in their local communities. CHAZ is a
model in terms of working closely with government, The Global Fund and other cooperating
partners
CHAZ has continued to rapidly channel funding to its sub-recipients and recipients. A total of 411
FBOs for HIV/AIDS, 73 FBOs for TB and 75 FBOs for Malaria were funded between January 2005
and June 2007. The number of FBOs funded for HIV/AIDS is more because it does not include the
FBOs funded by the Sub-recipients. Generally, disbursements continue to be roughly “on track,”
The provision of Anti-Retroviral Therapy (ART) is being scaled up to 30 church health institutions
with the support of The Global Fund. By the end of 2008, it is expected that over 17,000 patients
will be on ART in mostly the rural areas of Zambia. Through the CRS/AIDS Relief Programme
supported by PEPFAR 14 additional church health facilities have been facilitated to be on the ART

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programme. By end of October 2007, 18,720 PLHA are on ART under this programme. Drugs for
opportunistic infections such as Diflucan have continued to be provided to church health institutions
By the end of June 2007, over 50,000 Orphans and Vulnerable Children were assisted with school
and medical requirements. Collectively 284,298 PLHA have been assisted through the Home-based
care programme. CHAZ has facilitated the establishment or refurbishment of 37 new counseling
and testing sites in rural Zambia. 70,344 people have been tested for HIV since 2004. 110 church
health facilities have been strengthened to implement DOTS. Efforts to intensify the integration
between HIV/AIDS and TB at central, district and community levels have been intensified
Over a million Insecticide Treated Bed-Nets (ITNs) have been distributed to rural areas of Zambia.
Skills for health workers and community volunteers have been enhanced in the management of
malaria. The Malaria interventions are showing some impact as the all cause mortality particularly
for under fives has reduced significantly.
Part of the funding from all the three grants have contributed to strengthening the health systems.
This includes training of health and non-health workers, provision of laboratory equipment and
support for human resources for health (doctors, nurses, clinical officers, and other health workers)
CHAZ Experiences with Multiple PR Arrangement
CHAZ has been a PR since March 2003. The following are the experiences with the Multiple PR
arrangement
Strengths:
1. Speed in the disbursement of funds
    Multiple PR arrangement removes bureaucracy particularly with the flow of funds to civil
    society organizations. The country has an opportunity to receive funds even though one PR
    could have a problem.
2.   Opportunity for Capacity building of the PR and Sub-recipients
     All the PRs in Zambia have been local organisations. This model has increased the technical
     and organisational capacity of local organisations. This has included areas such as grant
     making, monitoring and evaluation. In addition the programmatic and financial capacities of
     the sub-recipients have also been enhanced.
3.   Good Model for rapid-scale of programmes
     This model as demonstrated from the results so far provides a model for rapid scale up of
     programmes. Resources are shared based on the comparative advantage of the PR.
4.   Multiple PRs provide opportunity to share lessons
     The multiple PR model for Zambia has provided lessons not only for the country but also other
     countries.
What has made the Model Work for Zambia?
The following factors have contributed to the model working in Zambia
•    Government Commitment to Partnership. The government of Zambia is willing to share
     responsibilities for decision making and resources at highest level.
•    Long history of Civil Society involvement especially in HIV/AIDS.
•    The Zambian CCM has been instrumental in providing leadership in ensuring that this model
     works. The CCM has promoted a participatory process in decision


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                                   Best Practice VI
 COLLABORATIVE APPROACH TO SCALING UP COMPREHENSIVE HIV AND AIDS
INTERVENTION PROGRAMMES BETWEEN THE CIVIL SOCIETY ORGANISATION
                            AND THE PRIVATE SECTOR
  (A Case Of Zambia National Aids Network (ZNAN) And Konkola Copper Mines (KCM))
Background
The Zambia National AIDS Network (ZNAN) was established in June 1994 with the primary
mandate of promoting liaison, collaboration and co-ordination among non-governmental
organisations (NGOs) and community based organisations (CBOs) involved in the fight against
HIV and AIDS. ZNAN’s role has since diversified to include sub-granting of funds to NGO, CBOs,
private sector companies and health facilities undertaking HIV and AIDS prevention, human rights,
mitigation and treatment programmes in line with the Zambian National AIDS Strategic Framework
(NASF) 2006-2010.
Konkola Copper Mines (KCM) is the largest Copper and Cobalt mining company in Zambia with a
workforce of 10,000 permanent employees and an additional 4,000 contract workers. It also
provides direct and indirect employment to a large sector of the community in its various locations
spanning a radius of more than 80km on the Copperbelt. KCM provides both clinical and preventive
health care services through its two main hospitals (Nchanga South and Konkola Mine), with a total
bed capacity of 222, and eight primary health care clinics in the townships in Chingola,
Chililabombwe and Nampundwe

Effectiveness of the Programme
ZNAN is collaborating and financially supporting Konkola Copper Mines (KCM) to expand its HIV
and AIDS and ART programmes to offer comprehensive services to mine employees, their families
and surrounding communities. The financing is through grants from the Global Fund to fight AIDS,
TB and Malaria. ZNAN is supporting KCM in the following areas:
1.   Developing human resource capacity to deliver ART
2.   Strengthening the role of the community in the provision of ART services
3.   Provision of ARV drugs, commodities and other medical supplies for ART and
4.   Monitoring and evaluation of programme activities.
KCM’s comprehensive HIV and AIDS strategy has been successful due to the collaboration with
ZNAN and other partners (Ministry of Health, Comprehensive HIV AIDS Management Programme
and United States International Development Agency).
The HIV and AIDS workplace and community programmes have been established based on the
following interventions:
•    Prevention through Peer Education in the workplace and the community, focused AIDS
     education (central training, schools and churches); departmental condom distribution,
     management of sexually transmitted infections; sensitization through HIV and AIDS health
     education messages such as community film Shows, drama, electronic billboards, pay slips, e-
     mail, internet HIV and AIDS site and IEC materials (leaflets, pamphlets, posters and banners).

•    Prevention of Mother to Child Transmission (PMTCT) of HIV which also encourages couple
     counseling. PMTCT clients are provided with more effective drug treatment regimen while their

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    babies are provided with all necessary tests including PCR, free infant formula and nutritional
    supplements. In addition, eligible HIV positive babies are supported with free ART.
•   Home Based Care is being provided at the homes of all terminally ill AIDS and TB patients by
    teams of community volunteers and nurses. Nutritional and Psychosocial support is also
    provided to them.
Since 2001 the programme has had a number of successes to reach out to both the community and
its employees.
1    Increased Voluntary and Counselling Uptake
     Intensified sensitization and increased availability of HIV counselling and testing services has
     seen a gradual increase in the number of individuals accessing these services and the
     willingness to know their HIV status. Current 2007 uptake shows that over 6000 people have
     accessed this service this year alone. The above success is as a result of both workplace and
     community based counselling and testing services. Figure 5.4.1 below illustrates the trend of
     VCT uptake and results from 2001 to 2007.
     Figure 5.4.1: KCM – VCT Uptake and Number of Positive Results (2001-2007)




2    Increased uptake of individual accessing Anti-Retroviral Therapy
     Prior to 2005, less than 250 individuals had access to antiretroviral therapy. Currently, over
     1,200 people now have access to free ARVs which have been made available by the ZNAN
     partnership. This has allowed more employees to access this service, live longer productive
     lives and to also have an improved quality of life.


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3    Decline in Stigma and discrimination in the Workplace
     Through intensified workplace sensitization by employees who are peer educators there has
     been a decline in the levels of stigma within the workplace. Employees are more receptive to
     HIV health talks and also to the subject of going for HIV counselling and testing.

Ethical Consideration
KCM’s HIV and AIDS policy does not encourage pre-employment HIV counselling and testing. It
promotes confidentiality of HIV test results and ones status. The HIV policy also does not promote
discrimination of an employee within the workplace based on their HIV status.
KCM HIV clinical care is also provided for free to employees and their dependants.

Cost Effectiveness
KCM’s health policy is to provide comprehensive and quality health services to its employees and
their dependants free of charge. In addition, these services are also available to members of the
general public at a minimal cost recovery basis.
KCM initiated its HIV and AIDS programme in 2001 after it recognized the threat posed by HIV
through findings of an HIV anonymous prevalence survey amongst its employees which revealed
that 20% of its employees were positive. Findings of a KAP survey and an economic audit of the
possible impact of HIV and AIDS would have on business and production also prompted the
company and management to establish measures that are aimed at mitigating and minimizing the
impact of HIV. These measures included:
•   Establishment of HIV and AIDS steering committee – headed by the CEO and senior
    management to review the programme and also to ensure that resources are mobilized to
    strengthen or enhance the impact of activities.
• Appointment of an HIV and AIDS coordinator to run the programme
• Development and Implementation of an HIV and AIDS Workplace Policy
• Development and implementation of strategies that address the key areas of the programme
    which are; Prevention of New HIV infections; timely identification of HIV infection and
    comprehensive treatment care and support for HIV clients.
KCM runs a cost effective HIV and AIDS programme. Due to various partnerships with
government and non-governmental organisations like ZNAN, KCM has been able to save on costs
related to HIV related pharmaceutical products and reagents and hence reducing some of the
clinical care costs. Other benefits have seen some reduction in HIV related absenteeism and deaths
due to the programme but a detailed study on the cost effectiveness of the programme will be
required.
Relevance
The HIV and AIDS programme is extremely relevant to the success of the company in ensuring
sustained productivity and keeping employees’ health and productive as evidenced by the initial
2001 survey that demonstrated that the lack of such a programme would have a significant impact
to company production.




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Replicability
KCM has worked in collaboration with other companies and through sharing of its experiences, a
number of companies have adopted the KCM response and approach to the HIV and AIDS
epidemic. Based on a proven spread of the KCM approach, the programme can be easily replicated
and adapted by various workplace settings.
The impact of HIV and AIDS on those infected and affected by HIV in a workplace is very similar
considering that workers operate and interact not only with their fellow workers but within the
communities in which they leave. KCM has worked with various companies and institutions in
sharing exchanging experiences with a number of companies adapting the KCM response with
success.

Innovation
The success of the programme has been in employing innovation strategies to address the changing
environment in which KCM operates. These strategies include:
a) Mobile Counseling & Testing Services: The company ensures that VCT services are taken close
   to the target groups as close as possible through mobile counseling and testing which is carried
   out not only at the workplace but also within the communities taking advantage of public
   activities or events and any high human traffic places.
b) Door to Door Health Campaign: This is a service being provided to KCM employees and their
   dependants where HIV sensitization and the promotion of HIV counselling & testing is provided
   right in the home. This is aimed at promoting a family based approach in dealing with HIV to
   allow them make appropriate but informed decision regarding their health.
c) Partnerships and Resource Mobilisation: In order to address the increasing demands for HIV
   and AIDS intervention programmes, the project team is encourage to think “outside the box”
   and develop relationships and partnerships that enhance the level of performance in the various
   activities .e.g. ZNAN, CHAMP, government, community.
Sustainability
Continued management support and community participation include some of the measures to
ensure that the programme continues to be sustainable. Development of partnerships and innovative
plans by management to develop a sustainability plan are also constantly reviewed to provide a
comprehensive and quality service.




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                                        BEST PRACTICE VII
                EXPANDED CHURCH RESPONSE (ECR) TO HIV/AIDS TRUST
                Responding to HIV/AIDS through the Churches in Zambia



Background
The Expanded Church Response (ECR) to HIV and AIDS was established in August 2000 by a
gathering of 220 Christian church leaders and transformed into a non-denominational Christian HIV
and AIDS Trust with a focused mission of coordinating congregational and other faith based
national response to HIV and AIDS. However, the church involvement and contribution to the fight
against HIV and AIDS is evident as early as 1990s. The formation of the ECR was also inspired by
the need for documentation of the proven community based model of prevention, treatment, care
and compassion. The model involves a close collaboration between the community through home
based care and the church health institutions.
Effectiveness
Since its inception, ECR has initiated numerous projects and studies with support from local donors,
volunteer staff and substantial support and resources from member organizations and local FBOs.
ECR is led by a highly qualified team with extensive management experience and a history of
successful grant management in HIV and AIDS programming.
The ECR provides information and skills building to strengthen the considerable human capacity
and social infrastructure of Zambia’s Christian community, which encompasses a network of more
than 14,000 individual churches and the potential to mobilize millions of volunteers to care for
people affected by HIV / AIDS and their families.
ECR has built the capacity of over 94 FBOs and health facilities, which has resulted in the delivery
of high quality care, support and treatment to 28,270 beneficiaries in six of Zambia’s 9 provinces
with a focus upon rural communities.
The Expanded Church Response (ECR) has responded to HIV and AIDS in various ways including
the implementation of HIV and AIDS intervention programme in collaboration with other partners
such as the District AIDS Task Forces, Family Health International and Churches Health
Association of Zambia. In the past, ECR has partnered with Children AIDS Fund (CAF),
AIDSRelief, Vision Ledd and the Zambia Prevention, Care and Treatment (ZPCT) programme.
ECR is currently managing an annual budget in excess of $1.5 million.
ECR’s strategic plan is in now fully in line with National HIV and AIDS Strategic Framework 2006
– 2010 and continues to spread its activities to far flung provincial locations of Zambia.
Ethical Soundness
The ECR’s volunteers are equipped with knowledge on confidentiality, national guidelines on HIV
testing, confidentiality of information about Client and provision of basic HIV/AIDS prevention
services, as outlined by the World Health Organization’s Global Programme on AIDS (WHO/GPA)
and UNAIDS.
ECR also encourages full participation of people infected with HIV in the implementation of its
programmes. PLHA are frequently consulted and their views are taken care of. Issues of

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confidentiality and informed consent are adhered to by all project staff. Attesting to this PLWH feel
very respected by the project staff and not in any way discriminated against in accessing the project
services.
Cost Effective
Home Based Care, be it for orphans and other Vulnerable Children or the chronically ill helps those
most in need of assistance in their own areas. However, providing practical care alone only meets
physical needs. There are also very real emotional needs as people face orphan hood, prejudice and
rejection, and spiritual needs as they are facing death. Care must therefore encompass counseling of
the individual by appropriately trained Volunteer caregivers.
Once these caregivers are trained they provide care and support to both the infected and affected in
households at no cost. All community based interventions are by low-cost, yet trained and caring
volunteer home visitors, who are themselves, motivated by the calling of God to serve others.
Relevance
ECR recognises that HIV interventions (whether focusing on prevention, treatment, care or
mitigation) should take into consideration the pivotal role of food insecurity and livelihoods
vulnerability.
Further, traditional coping strategies and social safety nets are becoming increasingly challenged in
the face of stress and shocks. Community members that are left responsible for large numbers of
orphans are poor themselves, making care for these children a heavy burden. Coping strategies
where the food variety and frequency of meals are reduced has increased nutrition and hunger-
related vulnerabilities in PLHA. It is also true that orphans are more food insecure and less healthy
than non-orphans and that food insecurity progressively increases with the number of orphans in a
household.
Replicability
The ECR to HIV and AIDS has over the years been employed by various churches members,
church health institutions and the communities in which they are located and operate. The spread of
this model and resulting impact of programme implementation is evident among the beneficiaries,
the ever increasing community volunteerism, involvement and participation.            Further ECR
promotes unity in diversity by working with different churches. This model is unique and its
success will provide for replication in other countries in Africa.
Innovativeness
ECR implements HIV and AIDS programmes that are complimentary and integrated. This has
resulted in the strengthened of the organizations’ capacity to scale up its programmes and activities
easily.
ECR embraces Community Faith-based organisations participation in HIV/AIDS programmes who
are identified through the DATFs. ECR through different partnerships with CETZAM is assisting
its Caregivers both primary and secondary to access small loans so that they can sustain their
household through small businesses. It has also partnered with HABITAT for Humanity Zambia to
assist HIV/AIDS affected and infected households with building or renovating some houses in some
districts.
ECR also facilitates IGAs (income generating activities) initiatives of Community faith based
organisations. All these are done in order to help communities undertake additional activities.

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Sustainability
ECR’s approach will primarily focus on mobilising churches and their members as a primary
mechanism for providing care, support and protection to OVC, PLHA, and vulnerable youth. The
figure above illustrates ECR’s community led response and household focus.
In its approach, ECR recognizes the need to develop corresponding structures at all levels of
implementation that comprise of representatives of church mother bodies. At national, provincial
and district levels, ECR will facilitate the formation of representative HIV/AIDS steering
committees that will comprise members of church mother bodies. At community level, ECR will
also facilitate the formation of community HIV/AIDS steering committees that will comprise of
representatives of congregational and FBO HIV/AIDS steering committees. In each church and
FBO, these HIV/AIDS steering committees will coordinate ECR supported activities. ECR will also
build the capacity of these committees in conducting situational analyses, identification of viable
IGAs to sustain prevention and youth services and provision of care, support, protection and
treatment services to OVC and PLHA. It will also build the capacity of congregations and FBOs in
the provision of the above services to people affected by HIV/AIDS.
In its approach, ECR will provide sub-grants to congregations and FBOs to allow them respond to
HIV/AIDS. The composition and structure of FBOs allow for accountability and transparency
where members are held together by horizontal coordination mechanisms The structures are also
designed to remain sustainable by being association driven and not individual. In the provision of
grants, ECR will focus on funding grant proposals that intend to support people affected by
HIV/AIDS through sustainable IGAs.
At community level, ECR will provide support to people affected by HIV/AIDS through the
frontline service providers who will include caregivers, trainers and peer educators.
ECR will also focus its interventions at household level; develop a sustainable church/FBO led
response to HIV/AIDS; facilitate and support existing community networks that collaborate with
government support structures, strengthen the multi-sectoral response to HIV/AIDS by working
with an increasing number of organizations and institutions in a coordinated manner, and
implementing activities with the goal of informing national policy reforms and global entities.
This brings about ownership of projects at all level from community level in terms of identifying
intended beneficiaries and execution of project activities to the national where resource
mobilization and overall programme coordination and supervision is undertaken.




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                                             CHAPTER VI.  
                  MAJOR CHALLENGES AND REMEDIAL ACTIONS 
6.1.    Progress made on key challenges reported in the 2005 UNGASS report for
        Zambia.

6.1.1 Coordination (NAC) 
Issues
In 2005, the HIV and AIDS response was characterised by numerous local and international actors,
including donors, UN agencies, international financial institutions, universities and research
institutions, DPO, NGOs, FBOs, CBOs, etc. Much of the coordination efforts and coordination
capacities of NAC were absorbed by managing numerous individual coordination processes
associated with such a diverse group.
Stronger coordination mechanisms from national to the province and district were required to
ensure that stakeholders at various levels were regularly communicating and therefore able to
address specific, operational problems as they arose.
Remedial Action
Since the last UNGASS report, the government has developed a new strategic framework with
emphasis on more effective coordination. At the national level partners involved in the response are
organised using self-coordinating groups, theme groups, sector advisory groups, partnership forums,
cooperating partners, and the UN Joint Team. At sub-national level partnerships are organised
through the United Nations Volunteers (UNVs), District AIDS Task Forces (DATFs) and the
Community AIDS Task Forces (CATFs). (See details in section on partnerships).

6.1.2  Effective Leadership 
During the last UNGASS reporting period, NAC was faced with the following challenges;
Issues
1. National level strategic planning and visioning;
2. Monitoring the course of the epidemic and implementation programmes;
3. Resource mobilization;
4. Consistency in consultation process.
Remedial Action
National level strategic planning and visioning: Zambia has made remarkable progress in strategic
planning and visioning in the adoption and effective implementation of the “Three Ones” approach.
The capacity of NAC has been further strengthened to support development of multi-sectoral annual
work plans, programmes and publication of annual key priorities for partners.
Efforts have been made to strengthen the institutional capacity of the NAC Secretariat and
partnership mechanisms so as to enable it to effectively coordinate national, provincial, district and
community efforts targeted at the prevention and control of HIV and AIDS, STIs and TB. NAC has

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made great strides in filling the organisational structure (complement of staff), and it is nearly at full
staff. In addition, many partners engaged in institutional strengthening, including the placement of
advisors or seconded staff at NAC, to the point where there is nearly one advisor/seconded staff for
every two NAC staff. This has better enabled NAC to fulfil its role in coordination oversight and
technical leadership.
Deployment of human resources trough the DACAs and the PACAs to support NAC’s mandate at
the sub-national level: Provincial and District AIDS Taskforces (PATFs and DATFs) have been
further strengthened for effective coordination of the multi-sectoral response at provincial and
district levels. They are better integrated into the national structures with a clarification of roles and
responsibilities and further capacity building of the staff at the decentralised levels. Further
development is required for the community levels in the formal structures, although some districts
have embraced this more fully than others, especially those with a vibrant community grants
scheme in their district (e.g. CRAIDS or ZNAN mechanisms, which are linked to and through the
DATF).

Monitoring the course of the epidemic and implementation programmes: NAC, in collaboration
with its partners, has improved its tools in monitoring the epidemic through the JAPR process. This
includes the NARFs, HMIS, SMARTCARE and the EMIS. In addition, a Joint Supervision Process
has been put in place for all partners.
    The objective of the Joint Supervisory Mission is to interact with district authorities and
    implementing partners in the communities in order to assess the level of achievements and
    existing challenges that require action by NAC and development partners in order to
    strengthen the decentralized AIDS response.
    The Joint Supervisory Mission always includes representatives from NAC, civil society and
    UN agencies. Members of the mission meet with traditional and political leaders at the
    various levels, the PAFT and the DAFT.
    The first port of call is the courtesy call on the political leadership following due protocol.
    The mission’s objective is outlined by the head of the mission after which the delegated
    political leader then gives a profile of the province/district. According to this presentation, the
    team then probes further on key issues and challenges outlined in the presentation.
    In meeting with the DAFT, the same process is followed although the meeting with the
    District AIDS Task Force is always more lengthy as a lot of questions are asked about the
    activities in the district, accessibility to HIV related services by the public, the provision of
    services, funding that has been accessed by the CBOs as well as the challenges faced by the
    district.
    Site visits during the mission provide further triangulation of information. A range of CBOs
    as well as workplaces are visited under the different thematic areas of the National Strategic
    Framework. It is at this level (as well as in the meeting with the DATFs) that the checklist is
    used, dealing with the various aspects of the multi-sectoral response viz accessibility to and
    numbers of the counseling and testing sites; the numbers of ART sites; how many of these
    provide PMTCT services; community home care sites; community support groups affiliated
    to the National Network of Zambian People living with HIV and AIDS (NZP+); monitoring
    and evaluation systems; the funding that has been accessed in the district and under which



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    funding mechanism         (e.g.     GFATM,    CRAIDS);       challenges   around   funding     and
    implementation.
    A summary of the key findings are then consolidated into a report that is presented to the
    Council and Cooperating Partners in order to inform future activities. Previous mission
    findings have informed the recruitment of the District AIDS Coordination Advisors;
    allocation of coordination resources for the DATF and the provision of motor vehicles for the
    operations of the 72 district offices of the DACAs.
Technical and logistical support to an array of stakeholders:
NAC has mobilised several technical advisors and specialists to support other sectors specifically on
main streaming, M&E, civil society support and public-private partnership. Seventy-five vehicles
have been procured and distributed for provincial and district task forces to improve the HIV and
AIDS response. Quarterly allocations operational funds have been provided for the PATFs and the
DATFs since the last reporting year.
Resource mobilization
As part of the resource mobilization effort, government has established a Joint Assistance Strategy.
As part of this strategy a Joint Financial Arrangement has been initiated by NAC. NAC is further
pursing the implementation of the AIDS Trust Fund already contained in the act that established
NAC.
Several other mobilization efforts have been made through the Global Funds and PEPFAR.
Issues
Low skills capacities and insufficient human resources was a major barrier in rapidly scaling up the
response to AIDS at the district and community levels.
Remedial action
The following remedial actions have been implemented since the last reporting period:
•   Establishment of posts at the MOH and NAC;
•   Introduction of staff retention schemes in the public and private and civil society sectors;
•   Implementation of continuous staff training in local institutions;
•   Deliberate efforts to distribute available human resources to under-served areas, especially rural
    communities, as a national policy.

6.1.3 Scaling up action at local level 
Issues
Recent trend analysis of Antenatal Sentinel Surveillance data for the period 1994 to 2004 indicates a
stabilisation of HIV prevalence at 16 percent in 2004, with a return to the 1994 baseline after steady
increases up to 2002. However, the analysis based on sentinel surveillance and population surveys
indicate that the national situation contains many smaller epidemics with their own dynamics in
different geographical, sectoral, and other population groups. Programming must take these into
account with sound analysis and understanding of the driving forces of the epidemic in different
population groups, between genders and in different age cohorts. In addition, there is need for
tailor-made programmes to address specific issues.



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Remedial Actions
Since the last reporting period, partners have increased:
    1.   VCT/ CT sites from 450 to 1,023 in 2007;
    2.   PMTCT sites from 2 sites to 678;
    3.   ART sites from 8 to 322;
    4.   Resource envelope from US$104 million in 2004 to US$223 million in 2007.




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                      6.2.     Challenges Experienced in 2006 and 2007
The following challenges were experienced during this reporting year:
HIV Prevention
Major challenges in the prevention of HIV transmission were the high concentration of VCT and
PMTCT services in the urban areas with rural areas having limited access to these services;
inadequate availability and limited accessibility of both male and female condoms, particularly in
rural areas; inadequate incentives for VCT counsellors resulting in high drop out rates of
counsellors; an absence of trained child counsellors; and lack of quality translation of IEC material
from English into key local languages.
Expanding Treatment, Care and Support
The major challenges experienced were the limited accessibility to treatment and care guidelines,
operational manuals, tools and plans for provision of ART services; inadequate human resources
and infrastructure to support scale up of ART services and TB-HIV co-infection service provision.
The M&E systems to support ART, PMTCT and VCT service delivery require strengthening. Other
challenges included limited facilities for providing follow-up tests; a lack of specific drugs and
commodities for pediatrics; and difficulties accessing the remotest area. Stigma still remains a
barrier to access.
Mitigating the Socio-economic Impact of HIV and AIDS
The major challenge experienced in mitigating the socio-economic impact of HIV and AIDS was
inadequate resources (financial, human and material) for the MSYCD and other organisations and
NGOs providing support to OVCs, PLHA and other vulnerable groups, with the burden usually
ending up with women and grandmothers. Therefore, increasing funding and technical skills
training for these organisations and NGOs is strongly recommended. Food security remains a
challenge.
Decentralised Response & Mainstreaming of HIV and AIDS
Identified challenges were a lack of understanding of the concept of decentralisation and the
devolution of power, resources, authority and functions to elected local authorities; and low
responsiveness of the private sector to the NARF reporting requirements.
Monitoring and Evaluation
Key challenges included a lack of strong mechanisms for vertical interaction between district and
provincial levels; limited collaboration between public structures and private structures; and weak
M&E capacity at the community levels.
Advocacy, Coordination and Leadership of the Multi-sectoral Response
Challenges included difficulties in linking the development of “tools” to sustainable, well-resourced
integrated programmes, hampering the coordination and harmonisation of CSO activities; high
turnover of staff which negatively affected workplace programming; and difficulties accessing
pledged funds from development partners.




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     Box 6.2.1 Submission by Civil Society
     Although it is acknowledged that NAC’s initiative to convene civil society platforms and fora
     have led to improved inter and intra-sectoral dialogue, civil society groups suggest that the
     following issues need to be addressed:
     • There is little evidence that discussions that take place in NAC civil society fora are a)
         informed by decentralized consultation or information exchange and b) influence higher
         level decision making.
     • There is a need to establish a system of representation to a) ensure civil society
         representatives are transparently elected and have clearly defined mandates; b) ensure civil
         society representation supports participation through inclusive processes of consultation; c)
         ensure that the above process extend to decentralized and grassroots levels.
     • Civil society needs to strengthen its self-coordination in order to participate in platforms
         and fora more effectively. Indeed, civil society in Zambia has called for the “Three Ones”
         to be expanded to support a “Fourth One”, namely one united, informed and effective civil
         society voice. 17
     • There are minimal resources (financial or technical) available for strengthening civil
         society’s self coordination activities –and there are even less for civil society’s policy
         dialogue, monitoring and “watchdog” roles (despite a prevailing rhetoric that the latter are
         critical for good governance and an effective multi-sectoral response (see also Civil
         Society’s submission to Chapter VII).
     • In Zambia there is inadequate collaboration between structures/systems for civil society
         coordination, grant disbursement and M&E. The potential synergy between these structures
         and systems needs to be enhanced as a matter of priority.
NAC Zambia acknowledges the concerns of civil society raised in Box 6.2.1. above and is
attempting to address them through a systematic capacity development approach that focuses on
strategic support for a) key individuals (including civil society representatives); b) key organisations
(including civil society self-coordinating structures) and c) the enabling environment (including the
resource and policy environment).
Conclusions and recommendation
On the whole, the national response to HIV and AIDS made significant progress in 2006. Many
milestones were achieved, but there are many more to reach:
1.     Reporting on programme implementation should focus on targets that the country has set in
       relation to Universal Access to HIV Prevention, AIDS Treatment Care and Support for
       PLHA.
2.     The intensification of prevention using an evidenced based approach should be supported;
       there is a need to understand the epidemic better in order to support programming.
3.     Support for quality assurance and the building of institutional capacity to provide services,
       especially at the decentralised and rural level, should be increased.
 4.       Access to resources (human, financial and material) for a sub-national response should be
          increased.

17
  World AIDS Campaign. 2007. Challenges and Opportunities in Campaigning for Universal Access in Zambia. Cape
Town: World AIDS Campaign. Source: http://www.worldaidscampaign.org


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                                              CHAPTER VII.
             SUPPORT FROM COUNTRY’s COOPERATING PARTNERS 
The Zambian government recognises the role of cooperating partners in the search for an effective
response to the HIV/AIDS epidemic. This multi-sectoral approach will involve government
ministries at the national and sub-national levels, local and international NGOs, community based
organisations, religious organisations, international donors, the private sector, the United Nations
and other multilateral agencies. This involves working together to harmonize individual and group
efforts into an effective coordinated response. Each partner is therefore encouraged to bring into
play their individual comparative advantages into the process, but with the overall coordination,
monitoring and evaluation of NAC. This set-up fosters the harmonization of processes and
programmes against HIV and AIDS, thus upholding the Three Ones principles.

In the National AIDS Council structure, ZNAN, civil society, ministries, cooperating partners (i.e.
donor support and technical assistance partners) and international organisations are represented. In
addition, these groups are part of Thematic Working Groups of the National AIDS Council.
International or developmental organisations are working with government through the cooperating
partners group on HIV and AIDS. Both bilateral and multilateral organisations provide technical
assistance and other resources required to implement the National Strategic Plan. At the highest
level of representation, a national Partnership Forum on HIV Chaired by the Minister of Health,
who is also chairperson of the Cabinet Committee of Ministers on HIV and AIDS, was convened in
2006 and 2007.

It is hoped that Zambia’s development partners will continue supporting HIV/AIDS efforts through
different sectors. Apart from these channels, areas requiring immediate support include
strengthening of the National AIDS Council and its secretariat to ensure that the Council and its
secretariat are fully functional; and strengthening of the umbrella body for civil society. Ensuring
development of an effective and functional monitoring system is also a key area requiring both
financial and technical support.
    Box 7.1: Submission by Civil Society
     There is a general perception that HIV and AIDS civil society organisations (CSOs) are
     adequately resourced in Zambia. This perception belies an alarming reality (see also Siamwiza
     200718 for a more comprehensive analysis):

     •   Although Zambia has received grants from the Global Fund under Rounds 1 and 4 and has
         two highly effective civil society principal recipients (namely CHAZ and ZNAN), monies
         received under Round 1 will cease in 2008 and monies received under Round 4 are largely
         focused on treatment support. This means that grants available through the Global Fund for a
         comprehensive civil society response will rapidly diminish after 2008.

     •   Although the significant support for the national HIV and AIDS response received though
         PEPFAR are applauded 19 this initiative has not been effective in supporting a strong national


18
  Siamwiza R 2007. Analysis of Financing for the National HIV and AIDS Response: Civil Society Component.
Lusaka: NAC Zambia.


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          civil society response because a) the majority of civil society funding is channeled through
          international (US) recipient organisations b) there has been relatively little skills transfer to
          local recipient organisations (Oomman et al 2007)20; c) PEPFAR funding focuses largely on
          service delivery rather than the “good governance” role of civil society .

      •   World Bank funding for the ‘Community Response to HIV/AIDS’ (CRAIDS) is scheduled
          to end in February 2008. Despite the undisputed success of this project, it appears that
          funding will not be renewed.

      •   Responding to international agreements on harmonization and alignment (including the 2005
          Paris Declaration on Aid Effectiveness), a number of “like minded” donors are moving to
          direct budget support (DBS). It is increasingly recognized that such approaches place
          primary emphasis on donor-government partnerships and contribute to a funding
          environment for civil society that is both unpredictable and restricted, especially for CSOs
          engaged in advocacy and watchdog roles (Lönnqvist 2006; Siamwiza 2007)21.

      •   In Zambia, some cooperating partners have attempted to mitigate the effects of DBS by
          entering into Joint Financing Arrangements (JFAs) with civil society principal recipients.
          Although there may be some advantages to these arrangements, recent reviews have
          suggested that they can result in “skewed” funding arrangements for civil society with
          reduced resources available for innovation and the longer term programme approaches of
          NGOs and stretched organisational capacity for coordination and networking activities
          (Birdsall and Kelly 2007).22
      The cumulative effect of the above amounts to a potential funding crisis for HIV and AIDS
      CSOs in Zambia. Consequently, civil society recommends that the following URGENT
      measures be taken by Cooperating Partners:

      •   Cooperating partners should collaborate to develop (through consultation with government)
          a comprehensive plan for supporting civil society’s contribution to the national HIV and
          AIDS response in Zambia. This needs to be based on recognition of the invaluable role of
          civil society in the national response and key areas of comparative advantage (such as
          prevention, community mobilization and impact mitigation initiatives). Provision needs to be
          made in the plan for supporting civil society organisations with different strengths and
          capacities and at different stages of their development.

19
   By 2006, PEPFAR money constituted 62 percent of HIV/AIDS resources in Zambia out of a total of some $240
millions.
20
   Oomman N et al 2007. Following the Funding for HIV/AIDS A Comparative Analysis of the Funding Practices of
PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia. Center for Global
Development.
21
   Lönnqvist L 2006. The Paris Declaration on Aid Effectiveness: An Overview. INTRAC. Source:
http://www.intrac.org/resources; Siamwiza R 2007. Analysis of Financing for the National HIV and AIDS Response:
Civil Society Component. Lusaka: NAC Zambia.
22
   Birdsall K & Kelly K (Principal Researchers) 2007. Pioneers, Partners, Providers: The Dynamics of Civil Society
and AIDS Funding in Southern Africa (a research report for Open Society Initiative for Southern Africa).
Johannesburg: Centre for AIDS Development Research and Evaluation (CADRE).
23
   UNAIDS 2006. Report on the Global AIDS Epidemic, 2006, Chapter 9, The Essential Role of Civil Society.
24
   see World AIDS Campaign. 2007. Challenges and Opportunities in Campaigning for Universal Access in Zambia.
Cape Town: World AIDS Campaign. Source: http://www.worldaidscampaign.org


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   •   Cooperating partners need to recognise that the expected role of civil society in the national
       response has moved beyond service delivery (although in Zambia this remains vital) to
       include roles in policy dialogue and monitoring of programme roll-out (see for example,
       UNAIDS 2006)23. Funding for civil society organisations in Zambia needs to be ring-fenced
       to support these activities, as well as the coordination activities that enable it to speak with
       “one united, informed and effective voice”.24 It may also be necessary to assist national civil
       society organisations by facilitating linkages to relevant regional and international structures.

   •   Debates on aid effectiveness, harmonisation and alignment need to move beyond a narrow
       focus on improved donor-government partnerships, streamlined financing mechanisms and
       reduction of transaction costs to place more emphasis on donor – “governance” partnerships
       and development effectiveness (in other words what actually works in terms of development
       outcomes). This modified approach would require “development partners” to seek an
       optimal mix of financing mechanisms within a portfolio of risk; it would also create a
       platform for civil society, and indeed the private sector, to be mobilised as equal partners in
       the national multisectoral response to HIV and AIDS, as well as in the broader development
       agenda.




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                                         CHAPTER VIII.
               NATIONAL MONITORING AND EVALUATION SYSTEMS 
Since the last reporting period for Zambia in 2005, national commitment and funding dedicated to
fighting the HIV/AIDS epidemic have increased steadily. Strong M&E is a prerequisite for
programme oversight and accountability. Governments, donor organisations, and programme
managers are making conscientious efforts to ensure that active and interactive monitoring
processes are in place at every level of the national response. M&E in Zambia is part of the “Three
Ones” Principles:
“One agreed country-level Monitoring and Evaluation System”

Through NAC, government has finalized development of the 2006-2010 National HIV/AIDS M&E
operational plan to allow the country to track its progress towards the goals and objectives as stated
in the National HIV/AIDS Strategic Framework (NSF). Participatory and qualitative methods were
used in developing this M&E plan.
NAC has developed the National HIV/AIDS/STI/TB Monitoring and Evaluation Plan in line with
the following strategic objectives of the NASF.
   Table 8.1: Strategic Objectives and Activities Included in Theme V – Improving the Monitoring of
                                      the Multisectoral Response

   Objective: Strengthen mechanism and systems for M&E of the multisectoral response
   Activities:
       Institutionalise the HIV and AIDS M&E system to draw data from all sectors and at all
       levels on a routine and consistent basis
       Strengthen the system of data collection, management, and flow of information
       Align with the Joint Annual Programme Review (JAPR) and planning and budgeting
       cycles so that continuous programme redesign and improvement become standard
       operating procedure
       Improve national biological, behavioural, and social surveillance of HIV/AIDS/STI/TB
       Support essential prevalence, incidence, and evaluation research to complement national
       surveillance
       Ensure national financial management monitoring is integrated with programme
       monitoring for all HIV and AIDS programmes
       Complete and operationalise the operations manual
   Objective: Improve capacity of Implementing Partners for M&E of the situation and the
              national response
   Activity:
       Strengthen capacity to ensure that all stakeholders are able to provide the necessary
       information for the national M&E system
   Objective: Strengthen operational and behavioural research and access to information on
              best practice and cost effective interventions
   Activities:
       Develop a national HIV/AIDS research strategy that will contain a clear research agenda
       Establish links with research institutions that will promote cooperation between research

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         agencies to maximise utilisation of research findings
         Implement appropriate ethical review prior to research being undertaken
         Encourage, support, and strengthen research related to HIV/AIDS/STI/TB by both local
         and international researchers
         Support identified priority health research and application of research findings
         Promote research in traditional/alternative remedies
         Provide appropriate infrastructure and funding for HIV/AIDS/STI/TB research
         programmes
         Encourage collaboration and coordination between and among local and international
         health researchers
         Ensure Zambia’s participation in vaccine development in partnership with international
         health research institutions
         Invest in appropriate infrastructure and human resources that are requisite for vaccine
         development and clinical trials
         Negotiate for preferential access to outcomes of vaccine research.
         Organise HIV/AIDS research dissemination seminars where all new biomedical and
         social research relating to HIV/AIDS will be disseminated

Achievements in 2006 and 2007
•     Regular Monitoring and Evaluation meetings of the theme group;
•     Conduct of Joint Annual Programme Review (JAPR) for 2002-2005 - End of Term Evaluation;
•     Conduct of Joint Annual Programme Review (JAPR) for 2006;
•     Increased recruitment and retention of M&E human resources within the response;
•     The report has this time around been more widely consulted;
•     Finalization and implementation of the Monitoring and Evaluation Capacity Building Plan;
•     Roll-Out of the NAC Activity Report Form (NARF). Strengthening of the Public-Private
      Partnership in Data Collection.

    Box 8.:       Case Study - National Capacity-Building for NAC M&E,
    The Challenge
    In December 2006, NAC was charged with rolling out the new revised M&E National Activity
    Reporting Forms (NARFs) to support the 2006-2010 National HIV/AIDS Strategic Framework
    to all provinces and districts country-wide. It was an opportunity to reinvigorate the legitimacy
    and the need for data collection, reporting, and use at all levels. In addition, NAC aimed to
    improve basic M&E skills of all Provincial AIDS Coordinating Advisors (PACAs), District
    AIDS Coordinating Advisors (DACAs) and their key members of District AIDS Task Forces
    (DATFs).
    Approach
    NAC and Cooperating Partners (CPs) endorsed a performance-based philosophy for the training
    effort. This is, no “training for the sake of training” but rather to ensure that training material
    and support was relevant to the broad job-related tasks of PACAs and DACAs.


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  In the spirit of “The Three Ones,” a wide array of partners were involved including: MOH,
  CSO, MOFNP, University of Zambia, UNAIDS, CDC, USAID, SHARe Project, NASTAD,
  ZANARA, and CHAZ. All partners co-developed one agreed set of training and technical
  support materials which will be available in a reference guide later in 2008. The national
  training was opened by the NAC Director General, the UNAIDS Director of Evidence,
  Monitoring and Policy, and the Deputy Chief of Mission from the U.S. Embassy representing
  PEPFAR.
  Using a “cascade” model, implementation included a training of trainers (TOT) for PACAs and
  select DACAs at the national level; with the following week the PACAs and DACAs leading
  training in provincial capitals for all remaining DACAs, planning officers, and key DATF
  members. Each provincial team had 2 members of technical resource team from CPs to assist
  where needed. In all cases, PACAs and DACAs lead these trainings.
  Training Outcomes
  1.     27 persons were trained at the national training and then 195 at province wide trainings.
  2.     ‘Burning questions’ were reviewed at the end of each day by lead facilitators and then
         clarified the following day.
  3.     The cascaded training program ensured that the district trainings were modeled after
         experiences from the national level training.
  4.     The interactive design of the program encouraged a high level of participation from
         training participants who added more practical experience value to the trainings.
  5.     Esprit de corps was created between lead facilitators and TOTs as part of preparation to
         work as training teams in the district training.
  Emerging Challenges and Lessons
  1.     Some indicator clarifications could not be made within the trainings as this required
         outside processing through M&E Technical Working Group at NAC.
  2.     Organizing a country-wide training at national and cascading it to provincial centers
         presented logistical challenges to a relatively small national level unit.
         a)       Preparation and team coordination helped overcome these.
         b)       Having a district structure, albeit small, helped.
  3.     Resources could not allow more time than was allocated for training. Three-day training
         meant most sessions had to stick to the basics.
  4.     How to ensure feedback mechanisms from national to lower levels.
  5.     Databases and tools for collating data are required at different lower levels (districts and
         communities).




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Challenges

•     Slower pace of harmonization of M&E systems across stakeholders (eg. between NAC and
      MoH);
•     Reporting challenges at some sub-national levels;
•     Data quality challenges at some sub-national levels;
•     Inadequate use of data for decision-making, especially at sub-national levels;
•     Inadequate M&E capacity at the community, district and provincial levels.
Remedial Actions Planned

1.      Stronger mechanisms to improve harmonization and quality of data for routine monitoring
        systems need to be put in place.
2.      Information sharing and dissemination mechanisms at all levels need to be improved.
3.      The process of integrating the different Information Management Systems on AIDS needs to
        be improved.
4.      The M&E capacity-building plan needs to be scaled up at the national level.
5.      NAC data collection and reporting cycles need to be aligned with the already established MoH
        reporting cycles.




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Monitoring and Evaluation Technical Assistance and capacity building Needs

  NASF Strategic        Technical support and
                                                                                  Level of technical skills    Responsible
  objectives            Capacity Development         Human Resource needs
                                                                                  required                     partners
                        needs
                                                                                  Technical and
                                                     Capacity development in      professional expertise in
                                                                                                               NAC, UN,
                        Technical support to         data capture, aggregation,   national database
                                                                                                               USG
                        develop a NAC                reporting systems            development and M&E
                        comprehensive data base                                   Information Systems
                        linked to the Central
                        Statistical Office and       M&E Capacity                 Technical and
                        HMIS.                        development within the       professional expertise in    NAC, UN,
                                                     PATF and DATF to M&E         M&E Information              CDC
                        Technical Support to         at sub-national levels       Systems
                        improve record keeping at                                 Technical and
  Strengthen            the district level.          Capacity development         professional expertise in
                                                                                                               NAC, UN
  mechanisms and                                     among PATF and DATF          database development
  systems for                                        to report using CRIS         M&E Information
  monitoring and                                                                  Systems, and CRIS
  evaluation of the                                                               Technical and
                                                     Capacity development at
  multi-sectoral                                                                  professional expertise in
                                                     the National level to                                     NAC, UN
  response              Technical Support to                                      national spending
                                                     implement NASA
                        implement the National                                    assessments
                        AIDS Spending                                             Technical and
                        Assessment (NASA)            Strengthen institutional
                                                                                  professional expertise in
                                                     financial management                                      NAC, UN
                                                                                  national spending
                                                     systems
                                                                                  assessments
                        Set 2007 national and
                                                                                  Technical expertise target
                        provincial targets           Short term consultants                                    NAC, UN
                                                                                  setting
                        Technical Support in                                      Technical and
                                                     Development /review of
                        building      surveillance                                professional expertise in
                                                     surveillance systems/                                     NAC, UN,
                        system     to     monitor                                 assessing and developing
                                                     prioritizing research                                     USG
                        treatment outcomes                                        national surveillance and
                                                     activities
                                                                                  monitoring systems
                                                     Capacity building within
                                                                                  Institutions and
                                                     Civil Society
                                                                                  organisations with
                        Technical Support in Civil   Organisations to M&E                                      NAC, UN
                                                                                  training functionality in
                        Society M&E systems          programs (equipment and
                                                                                  M&E
                        development                  training)
  Improve capacity
  of implementing                                                                 Civil Society M&E
                                                     Build capacity within
  partners for                                                                    Consultant with expertise
                                                     Civil Society and private
  monitoring and                                                                  in developing partnerships   NAC, UN
                                                     partners to report using
  evaluation of the                                                               within Civil Society
                                                     NARF
  situation and the                                                               Organisations
  response              Provide M&E staff to                                      Expertise in M&E theory
                        improve reporting on         M&E staff for NZP+,          and practice, database
                        M&E in civil society         CHAZ, ZNAN and MOH           development, computer
                                                                                                               NAC, UN
                        organisations                to improve reporting on      skills in MS-Access,
                                                     Global Fund                  SPSS, MS-Excel, MS-
                                                                                  Word

  Strengthen            Developing operational                                    Technical and
                                                     Build Capacity within
  operational and       and research                                              professional expertise in
                                                     research institutions to                                  NAC, UN,
  behavioural           methodologies at the                                      development of national
                                                     develop and implement an                                  USG
  research and access   central level                                             and institutional research
                                                     AIDS research agenda
  to information on                                                               strategies and processes




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  NASF Strategic        Technical support and
                                                                              Level of technical skills   Responsible
  objectives            Capacity Development        Human Resource needs
                                                                              required                    partners
                        needs
  best practice and     Establish a coordinating                              Technical and
  cost effective        mechanism for research at   Research Specialist for
                                                                              professional expertise in   NAC, JFA
  interventions.        central level.              NAC
                                                                              research methodology




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                                       ANNEXES




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ANNEX 1. Consultation/preparation process for the Country Progress Report on Monitoring
         the Follow-up to the Declaration of Commitment on HIV/AIDS
Country: Zambia                                                                                  .
Date of Data Entry: 29-01-2008                                                                   .
1)   Which institutions/ entities were responsible for filling out the indicator forms?
     a) NAC or equivalent                                                           Yes   No
     b) NAP                                                                         Yes   No
     c) Others                                                                      Yes   No
     (please specify):         Central Statistics Office
2)   With inputs from:
     Ministries:
                   Education                                                        Yes   No
                   Ministry of Health                                               Yes   No
                   Labour                                                           Yes   No
                   Foreign Affairs                                                  Yes   No
     Others:                                                                        Yes   No
     (specify)        Community Development and Social Services
                      Sport, Youth and Child Development
                      Finance and National Development
                      Defense
                      Transport and Communication
                      Agriculture and Cooperatives
     Civil Society Organisations                                                    Yes   No
     People Living with HIV                                                         Yes   No
     Private Sector                                                                 Yes   No
     United Nations Organisations                                                   Yes   No
     Bilateral Organisations                                                        Yes   No
     International Organisations                                                    Yes   No
     Others:
3)   Was the report discussed in a large forum                                      Yes   No
4)   Are the survey results stored centrally                                        Yes   No
5)   Are data available for public consultation                                     Yes   No
6)   Who is the person responsible for submission of the report and the follow-up if there are
     questions on the Country Response Report?
     Name/ title:           Dr. Ben Chirwa, Director General
     Address:               National HIV/AIDS/STI/TB Council P O Box 38718, LUSAKA, Zambia
     E-mail:                bchirwa@nacsec.org.zm
     Telephone:             +260 211 255044




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ANNEX 2.       Check list for National Progress Report
                           Description of Activity                        Status

1. Identify data needs, data sources, stakeholders, funds

2. Plan for data collection, analysis and report writing

3. Secure funds, collect/ collate and analyse data, complete data forms

4. Draft Country Progress Report, share draft with stakeholders

5. Incorporate stakeholder views and reactions to the draft

6. Enter data in CRIS

7. Validate the narrative report against the data in CRIS

8. Reach consensus with stakeholders on final report

9. Send report to Cabinet for approval and security clearance

10. Submit the report timely




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ANNEX 3.        Report of Civil Society Consultation and Participation in the process
Introduction
Civil Society has been one of the leading forces of the National HIV/AIDS Response. It was in the vanguard
of setting up the National HIV/AIDS response as it is known in Zambia and has continued to play an active
role ever since. Within the context of the NAC operational framework, civil society is considered to consist
of a number of structures and interest groups including non-governmental organisations (NGOs),
community-based organisations (CBOs), faith-based organisations (FBOs), the media, trade unions,
professional associations, traditional healers, as well as PLHAs, people living with disabilities, gender groups
and youth structures.
In Zambia, civil society is considered to play a significant role in strengthening the multi-sectoral response to
HIV/AIDS, TB and STIs, and civil society organisations (CSOs) are frequently key role-players in
developing and implementing innovative, culturally-sensitive approaches that include elements of
mainstreaming, decentralisation, outreach and community participation. They also serve on various
structures of NAC including the technical thematic groups.
The positive contribution of civil society in the fight against the pandemic is attested by the large number and
quality of prevention and mitigation programmes that are being implemented by these organisations. These
contributions have grown over the years to include ART and palliative care.
The great contributions of the civil society have not been without challenges. Despite the financial and
material resource inputs by major cooperating partners such as the Global Fund to Fight AIDS, Tuberculosis
and Malaria (GFATM), the President’s Emergency Plan for AIDS Relief (PEPFAR), the European Union
(EU) and other bilateral donors, gaps still remain between the optimal and available resources.
Most of the civil society organisations are also faced with inadequate capacities to competently deal with
technical aspects of their programmatic work. These aspects include human resource issues, financial and
programme monitoring and evaluation, use of ICT to help strengthen the HIV/AIDS response and indeed
advocacy and effective outreach. Due to these inadequacies, a significant number of civil society
organisations report that they have been unable to interpret and implement key national strategic documents
(such as the 2005 National HIV/AIDS/STI/TB Policy, the NASF 2006-10 and the National
HIV/AIDS/STI/TB Monitoring and Evaluation Plan 2006-10) within the context of their projects and
programmes.
Other challenges reported by particular sections of civil society include: lack of financial and technical
support for the youth sector (despite the fact that young people are frequently heralded as the “window of
hope”); lack of a comprehensive HIV and AIDS programme for people with disabilities; inadequate human
rights legislation and policies relating to HIV and AIDS; poor coordination of OVC programmes; lack of
interventions for MSM and IDUs; and, finally, lack of agreement by FBOs on key prevention measures such
as abstinence and use of condoms.
Given the key role of civil society in the national response and its first hand experience of the challenges
faced in implementing comprehensive HIV and AIDS programmes in a range of settings, the participation of
civil society in Zambia’s UNGASS reporting process has been regarded as critical. The following section
documents how civil society organisations have been mobilised and consulted to ensure their active
participation in the process.


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       Consultation with and Participation of Civil Society in the 2008 UNGASS Reporting Process
The National HIV/AIDS Response in Zambia strives to report regularly on the AIDS Declaration adopted at
the UN General Assembly Special Session on AIDS (UNGASS) and submitted a report in the last round.
Zambia views the UNGASS report as part of the normative national monitoring and evaluation (M&E) report
for Zambia. The National AIDS Council in collaboration with stakeholders from civil society organisations,
cooperating partners, private and public sectors worked together to compile the 2008 UNGASS Report for
Zambia. This report which serves as the biennial response report for the country will be presented by the
President of the Republic of Zambia, H.E Dr Levy Patrick Mwanawasa SC, at the next United Nations
General Assembly Special Session (UNGASS) in June 2008. The participation of civil society in UNGASS
reporting process and national M&E is always considered as vital25.
The involvement of the civil society in the UNGASS reporting process proper started with the distribution of
materials pertaining to the process in early August 2007. This came to a meeting dubbed “Working Session
on Civil Society involvement in the UNGASS AIDS Declaration and the Universal Access National Targets”
which was held at the NAC Boardroom on Thursday 30th August 2007. The meeting was called to help civil
society improve their knowledge of and involvement in issues related to the UNGASS AIDS Declarations.
This meant providing civil society with information on the UNGASS declaration and increasing civil society
involvement in the 2008 UNGASS declaration reporting process. By the end of that meeting, civil society
coordination was noted as an essential component of the response. It was agreed that the NAC, as a
government body, cannot be mandated to coordinate civil society, but can support this process. Whereas it
was desirable for CSOs to elect representatives to participate in national processes it was also agreed that
these representatives must ensure they continue to relay information between their constituencies and the
national level fora and vice-versa26.
It was further agreed that active involvement of civil society in the UNGASS reporting process and the
national M&E structures was vital. Therefore, all efforts were to be made to ensure that both civil society and
government views of the national response are reconciled and that the various views are reflected in the 2008
UNGASS Report. In addition, it was further agreed that shadow reports were not to be encouraged as these
were against the 3 Ones Principle.
It was concluded that civil society involvement in the UNGASS must at a minimum include participation in
the small UNGASS Taskforce, civil society members’ sharing of key national documents and tools relevant
to the UNGASS process with their constituencies, participation in the larger consultations, and participation
in the implementation of the UNGASS Report recommendations as part of ongoing civil society work27.
Concrete civil society involvement in the UNGASS reporting was discussed and it was decided that a total of
6 civil society representatives will be members of UNGASS Taskforce team. The following constituencies
were asked to elect one member each to serve on the UNGASS Taskforce team:
         Persons with disabilities
         Youth
         People living with HIV/AIDS
         Treatment Advocacy


25
     Report for UNGASS and CSO Meeting held at NAC on 30th August 2007
26
     Report for UNGASS and CSO Meeting held at NAC on 30th August 2007
27
     Report for UNGASS and CSO Meeting held at NAC on 30th August 2007

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         Faith-based organisations & large NGOs, including international ones
         Policy/legal framework and private sector
The selected representatives of the civil society were to be selected by their constituencies based on the
following set of criteria:
         Having active communication link with their constituencies to ensure they relay information between
         their constituencies and the UNGASS reporting group
         Having access to data available with and about their constituencies
         Having basic technical competency to ensure meaningful participation in the UNGASS reporting
         group
         Committing to active participation in the UNGASS reporting group, including attendance at all
         meetings
Following this meeting, various constituencies within the civil society nominated their representatives and
sent the names to NAC and UNAIDS who were the two co-drivers of the 2008 UNGASS reporting process.
On 11th of October 2007, a stakeholders’ workshop was held at Chrismar Hotel in Lusaka. This was the first
meeting that looked at the 2008 UNGASS reporting process in context and it also looked at sharing of
responsibilities among all players. It was during this meeting that the Taskforce was selected from the larger
stakeholders meeting and this included the 6 representatives earlier chosen by the civil society.
The taskforce held more than 10 meetings in which it set the course for the writing of the 2008 UNGASS
Report and coordinated the process of writing the report until it was finished. Civil society representative
took part in all of the UNGASS Taskforce meetings beginning with the first meeting held at NAC on 17th
October 2007.
Through the series of these meetings, civil society took part and was consulted in the drafting of the
roadmap of the UNGASS reporting process28, the hiring of the consultants to undertake technical work that
needed outside competencies in the reporting process29, coming up with agendas of meetings, undertaking
field trips to data sources such as the Tropical Diseases Research Centre in Ndola, populating the UNGASS
indicators for the CRIS and Narrative reports30 and the collection, collation and analysis of HIV/AIDS data
from sources31. The details of the meetings can be found in Annex 1 which has all the minutes of the
meetings.
Finally, civil society took part in the process of conducting research into the NCPI. It was also consulted by
way of helping design the NCPI survey process and filling in questionnaires that gave the civil society
perspective on various components of the NCPI32.
It is now planned that civil society participation shall continue in the UNGASS reporting process with more
time dedicated to the process to avoid rushing the work towards the deadline for submitting the report. Civil
society agreed to do awareness work within its ranks to ensure better participation in subsequent reporting
processes33.


28
     Ash Lodge Taskforce meeting of 12th December 2007
29
     Taskforce meeting minutes
30
     Taskforce meeting minutes
31
     Taskforce meeting minutes
32
     Taskforce meeting minutes
33
     Consultative Meeting report

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ANNEX 4.       National Composite Index Policy Report




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ANNEX 5.          Country Response Information System (CRIS)




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ANNEX 6.          List of Participants interviewed during the NCPI
Part A - Administered to Government Officials
                 Organisation                      Name of Respondent               Position of Respondent                   Respondents to Part A
                                                                                                                       A.I   A.II   A.III   A.IV     A.V
1.   Centre for Disease Control                   Mr. Ian Membe            Associate Monitoring & Evaluation Advisor                                  √
2.   MCDSS                                                                 Director HRA                                                               √
3.   Ministry of Agriculture                                                                                                                          √
4.   Ministry of Health                           Dr. Dean Phiri            Monitoring & Evaluation Specialist                       √                √
5.   Ministry of Health                           Dr. Albert Mwango        National ARV Programme Coordinator                                √
6.   Ministry of Transport & Communication                                                                                                            √
7.   Ministry of Defence                          Major. Remmy Mulenga      Monitoring & Evaluation Manger                                            √
8.   Ministry of Sport, Youth and Child           Ms. Spaita               MRHO                                                                       √
     Development
9.   National AIDS Council                        Mr. Paul Chitengi         Monitoring & Evaluation Specialist                                        √
10. National AIDS Council                         Mr. Brian Nakaanda       PACA Mongu                                  √      √      √       √        √
11. National AIDS Council                         Mr. Harold C. Witola     PACA Kasama                                 √      √      √       √        √
12. National AIDS Council                         Mr. Oswald Mulenga       Acting Director General                     √      √
13. National AIDS Council                         Mr. Bwalya Mubanga       PACA Central Province                       √      √      √       √        √
14. NGO to be identified                                                                                                                              √
15. PACA                                          Mr. Emmanuel Chama       PACA Lusaka                                 √      √
16. UNAIDS                                        Dr. Catherine Sozi       Country Coordinator                         √      √
17. UNAIDS                                        Dr. Michael Gboun        Monitoring & Evaluation Advisor                                            √
18. Zambia Business Coalition on AIDS             Ms. Julie Baratita       Monitoring & Evaluation Coordinator                                        √
19. Zambia Disability HIV/AIDS Human              Mr. Harvey Ngwale        Programme Officer                                                          √
    Rights Programme (ZAMDHARP)
20. ZANARA                                                                                                                                            √




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PART B – Administered to Non Governmental Organisations, Bilateral Agencies and Multilateral Organisations
                        Organisation                      Name of Respondents                 Name/Position               Respondents to part B
                                                                                                                        B.I B.II B.III       B.IV
1.   Zambia Interfaith Networking Group (ZINGO)          Mr. Jeff Ayami           Executive Director                    √      √      √       √
2.   Treatment Advocacy & Literacy Campaign (TALC)       Mr. Chris Mumba          Information Officer                   √      √      √       √
3.   To be identified                                                                                                   √             √       √
4.   Southern African AIDS Trust (SAT)                   Mr. Mwiya Mundia         Country Programme Officer                    √
5.   Zambia Disability HIV/AIDS Human Rights             Mr. Harvey Ngwale        Programme Officer                     √      √
     Programme (ZAMDHARP)
6.   Zambia Business Coalition on AIDS (ZBCA)            Ms. Julie Baratita       Monitoring & Evaluation Coordinator          √
7.   International HIV/AIDS Alliance                     Ms. Lillian Byers        Acting Programmes Director                          √       √
8.   Legal Resources Foundation (LRF)                    Ms. Triza Phiri                                                √      √
9.   Women for Change                                    Ms. Lumba Siyanga                                              √      √
10. Forum for Youth Organisations                        Mr. Beck Banda           President                                    √      √       √
11. ZANARA                                                                                                              √             √       √
12. DFID                                                 Dyness Kasumngami        HIV and AIDS Advisor                  √
13. Envision Zambia                                      Mr. Scott Robertson      Director                              √      √
14. Centre for Disease Control (CDC)                     Mr. Ian Membe            Monitoring & Evaluation Associate                   √       √
                                                                                  Adviser
15. Save the Children Sweden                             Ms. Petronella Mayeya    Country Manager                              √
16. Zambia AIDSLaw Research & Advocacy Network           Mr. Paul Sichalwe        Programmes Coordinator                √      √
17. Youth Vision                                         Mr. Amos Mwale           Director Programmes                          √
18. National Youth Network on Population &               Mr. Katuta Chilambe                                                   √
    Development
19. Network of Zambian People Living with HIV/AIDS       Ms. Kunyima Banda        Programme Officer                     √      √      √       √
20. SNV, HCP, Concern World wide, UNHCR, NZP+            Mr. Brian N. Nakaanda    PACA Mongu                            √      √      √       √
    (PACA Mongu)
21. Human Rights Commission                              Ms. Hope Chanda          Chief Research & Planning (HIV FPP)   √      √




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ANNEX 7.      List of Contributors to the Report


                Consultants
Kaimfa P. Chandang’oma - Lead Consultant
Malala Mwondela - NCPI Consultant
Oscar Daka - NASA Consultant
            Technical Advisors
Osward Mulenga – National AIDS Council
Dr. Alex Simwanza – National AIDS Council
Dr. Michael Gboun – UNAIDS




              CRIS Data Entry
Charles Nkunta - NAC


                                   Data Disaggregation Consultants
Beyant Kabwe – Corridors of Hope
Jeff Stringer – CIDRZ
Paul Chitengi – National AIDS Council
Grace Tembo Mumba – Ministry of Health
Dr. Dean Phiri – Ministry of Health
William C Mayaka – Central Statistics Office
Chola Nakazwe-Daka – Central Statistics Office




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UNGASS Taskforce Members
No             Name                                Organisation                        Designation
 1. Augustine Mukuka               Media Institute of Southern Africa            Information Officer

     2.   Barbara Banguna            National AIDS Council                       Data Entry

     3.   Beyant Kabwe               Corridors of Hope                           M&E Advisor

     4.   Catherine Muyawala         NAC (Secretary)                             Resource Centre Manager

     5.   Charles Nkunta             NAC                                         MIS Specialist
     6.   Chazanga Tembo             Support to the HIV/AIDS Response in         Strategic Information
                                     Zambia (SHARe)                              Specialist
7.        Chibwe Lwamba              United States Agency for International      HIV/AIDS Multi-sector
                                     Development                                 Senior Advisor
     8.   Christopher Mumba          Treatment Advocacy & Literacy Campaign      Communications Officer

 9.       Dean Phiri                 Ministry of Health                          M&E Specialist
11.       Edgar Chani                Zambia National AIDS Network                M&E Officer

12.       Elijah Ngwale              ZAMDHARP                                    Program Director

13.       Emelda Mweemba             Zambia Voluntary Counseling Trust           M&E Officer

14.       Gershom Kapalaula          Network for People Living with HIV in       Program Officer
                                     Zambia (NZP+)
15.       Grace Tembo Mumba          Ministry of Health                          HIV/AIDS & STIs Officer
16.       Harvey Ngwale              ZAMDHARP                                    Program Officer
17.       Ian Membe                  Centre for Disease Control (CDC)            M&E Associate Advisor
18.       Julie Baratita             Zambia Business Coalition on HIV/AIDS       M&E Coordinator
19.       Kaimfa Chandang’oma        Petrich Projects                            Consultant
20.       Kennedy Tembo              OVC Media Network                           OVC Representative
21.       Lillian Byers              International HIV/AIDS Alliance             Ass. Program Director
22.       Lizzy Chanda               Zambia Business Coalition on HIV/AIDS       Program Coordinator
23.       Lois Mulube                Ministry of Justice                         Focal Point Person
24.       Malala Mwondela            Zambia AIDS Law Research & Advocacy         Executive Director
                                     Network
10.       Michael Gboun              Joint United Nations Program on             M&E Advisor
                                     HIV/AIDS
25.       Moses Zeggetti             Ministry of Education                       OVC Desk Specialist
26.       Osward Mulenga             National AIDS Council (Chairperson)         Director - Research M&E
27.       Patrick Banda              National AIDS Council                       Consultant
28.       Paul Chitengi              National AIDS Council                       M E Specialist
29.       Paul Kalinda               European Union                              Health Advisor
30.       Remmy Mulenga              Defence Force Medical Services              M & E Officer
31.       Ruth Nkandu                Ministry of Community Development &         HRMO
                                     Social Services
32.       Shadreck Kaonga            Centre for Infectious Disease Research in   HIV/AIDS Coordinator
                                     Zambia



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33. Shalala O. Sepiso              Forum for Youth Organizations in Zambia   M&E Representative
34.   William. C. Mayaka             Central Statistics Office               Deputy Director
35.   Wendy Kateka                   ZAMHARP                                 Women’s Officer




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Attendance Sheet for the First National Stakeholders’ Consensus Meeting

 #            NAME                         DESIGNATION                         ORGANISATION                   EMAIL

1.    Augustine Mutelekesha      M&E Specialist                            ZANARA                    amutelekesha@yahoo.com
2.    Anna Mpundu                HBC - Coordinator                                                   muyondi@yahoo.co.uk
3.    Augustine Mukuka           Program Officer                           MISA                      oogoga@gmail.com
4.    Beatrice Kaimbo            UNV                                       MSYD                      kaimbobeatrice@yahoo.com
5.    Bernard Munkombwe          Mainstreaming Specialist                  NAC                       bmunkombwe2004@yahoo.com
6.    Catherine Muyawala         Resource Centre Manager                   NAC                       cmuyawala@nacsec.org
7.    Charles Mbewe              HIV Specialist                            AA                        kentembo@yahoo.com
8.    Charles Nkunta             Information System Manager                NAC                       cnkunta@nacsec.org
9.    Christine Kalalwe          Director                                  GIDD                      gender@gov.zm
10.   Christine Kaimba           UNV                                       MTENR                     christinee@yahoo.com
11.   Christopher Busiku         UNV HIV/AIDS                              MIB                       cbusiku@yahoo.com
12.   Claude Kasonka             M&E Officer                               RAPIDS                    claudekasonka@yahoo.com
13.   Clement Mwambila           Driver                                    Global Fund / NAC         cmwambila@nacsec.org
14.   Confucius Mweene           Civil Society Specialist                  NAC                       cmweene@nacsec.org
15.   Deirdre Allison            Private Sector Adviser                    NAC                       deirdrea@zamnet.zm
16.   David Mwanza               Volunteer                                 GIDD                      davidmwanza@gender.gov.zm
17.   Dr. Dean Phiri             M & E Specialist                          MOH                       deanphiri@yahoo.co.uk
18.   Diana Bulanda              Capacity Building Director                Rescue Mission Zambia     dianabulanda@yahoo.com
19.   Dr. Mabvuto Kango          HIV Specialist                            Ministry of Health        kangom@gmail.com
20.   Dr. N Kapata               TB Specialist                             MOH                       nkapata@gmail.com
21.   Dr.Terri Collins           Civil Society Advisor                     NAC                       tcollins@nacsec.org.zm
22.   Dr. Alex Simwanza          Director Multi-sectoral Response          NAC                       asimwanza@nacsec.org.zm
23.   Dr. GC Chishimba           DIMC&S                                    NAC                       gshishimba@nacsec.org.zm
24.   Dr. Kaonga Wezi            PAED HIV Coordinator                      MOH                       wkaonga@yahoo.com
25.   Evans Zulu                 Office Assistant                          NAC                       ezulu@nacsec.org.zm
26.   Edgar Chani                M&E Officer                               ZNAN                      edgarchani@gmail.com
27.   Elijah Ngwale              Programme Director                        ZAMDHARP                  zamdharp@yahoo.com
28.   Elisabeth Serlemitsos      Chief Advisor                             NAC                       eserlemitsos@nacsec.org.zm
29.   Emmanuel Chama             PACA Lusaka                               NAC                       chamaemmanuel@yahoo.com
30.   Dr. Eric Sattin            ART Advisor                               NAC                       esattin@nacsec.org.zm

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                       Zambia Country Report - National M&E Report to UN General Assembly
31.    Felix Mwanza                     Programme Manager                         TALC                    felixmwa@yahoo.com
32.    Friday Kasisi                    UNV HIV/AIDS                              MOWS                    kasisif@yahoo.com
33.    Friday Nkoma                     Youth Coordinator                         UNFPA                   fnkhoma1@yahoo.com
34.    Godfrida Kamanga                 Receptionist                              NAC                     fkamanga@nacsez.org
35.    Grace Mumba Tembo                                                          MoH                     gracetembomuka@yahoo.co.uk
36.    Gershom Kapalalula               Programme Officer                         NZP+                    wounfount@yahoo.com
37.    Getrude Musonda                  Programme Officer                         SCN-Z                   getrudemusonda@scizam.org
38.    Gibson G Nkole                   Coordinator HIV Aids                      Ministry of Mines       gibsongnkole@yahoo.com
39.    Gladys Ngoma                     Private and Public Sector Specialist      NAC                     gngoma@nacsec.org.zm
40.    Gladys Ngoma                     Private Sector Specialist                 NAC                     gngoma@nacsec.com
41.    Harvey Ngwale                    Programme Officer                         ZAMDHARP                harveyngwale@yahoo.com
42.    Ian Membe                        M & E Associate Advisor                   CDC                     membei@cdczm.org
43.    Joan Nkama                       NAC                                       NAC                     jnkama@yahoo.com
44.    Jonathan Mtonga                  Focal Point Person                        National Assembly       Jcmtonga@yahoo.co.uk
45.    Joseph Ngulube                   HOD                                       NAC                     jngulube@nacsec.org.zm
46.    Justine Mwiinga                  PRM/Donor Coordinator                     NAC                     jmwiinga@nacsec.org.zm
47.    Kaimfa P. Chandang’oma           Consultant                                Petrich Projects        kaimfapc@yahoo.com
48.    Kalaluka Akalala                 Info and Publicity Director               Rescue Mission Zambia   kalalukaaka@yahoo.com
49.    Kanyanta Sunkutu                 HIV Advisor                               WHO                     sunkutuk@zm.afro
50.    Kelvin Kings Mulembe             UNV-HIV/AIDS Specialist                   Ministry of Mines       kelvinkings@yahoo.com
51.    Kennedy Tembo                    Programme Officer                         OVC Coordinator         kentembo@yahoo.com
52.    Maggie N. Sinkamba               CIRDRZ Comm.                              CIRDZ                   Maggie.sinkamba.cirdz.com
53.    Maha Aon                         Partnership Advisor                       UNAIDS                  aonm@unaids.org
54.    Malala Mwondela                  Executive Director                        ZARAN                   mwandela@zaran.org
55.    Mary Wendy Kateka                Women Officer                             ZAMDHARP                zamdharp@yahoo.com
56.    Maureen Daura                    HCF                                       HSSP                    kaina-maureen@yahoo.com
57.    Maureen Mwanza                   Condom Programme Officer                  UNFPA                   manmwanza@yahoo.com
58.    Mirriam Banda                    Chairperson                               NZP+                    milliebcee@yahoo.com
59.    Mirriam Simunika                 Admin Officer                             ZWAP                    Zwap2006@yahoo.com
60.    Moses Zeggetti                   OVC Education Specialist                  OVC desk                mozeovc@yahoo.com
61.    Motoko Seko                      HIV/TB Programme Coordinator              NAC/JICA                mseko@nacsec.org.zm
62.    Mwenda Silumesi                  Projects Coordinator                      HURID                   mwenda@zambia.com
63.    Alwyn Mwinga                     Associate Director                        CDC                     mwiinga@cdczm.org
64.    Nachilima Felishio               Administrative Officer                    NAC                     cmfelisio@nacsec.org

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65.    Namwayi Membe                    Programme Manager                         Kara Counselling             Nmembe@kara.org
66.    O.S. Shalala                     M&E Representative                        RMZ                          ssepiso@gmail.com
67.    Oswald Mulenga                   Acting Director General                   NAC                          omulenga@nacsec.org
68.    Partick Kachusha                 Ass. Assistant                            NAC                          pkachusha@nacsec.org
69.    Patrick Banda                    Consultant                                NAC                          patrickbnd@yahoo.co.uk
70.    Paul Chitengu                    M&E Specialist                            NAC                          pchitengu@nac.com
71.    Paul Kalundu                     Health Advisor                            EU                           Paul.kalundu@ec.europa.eu
72.    R. Sunkutu                       Senior PHN Specialist                     WB                           rsunkutu@wb.org
73.    Remmy Mulenga                    M&E Officer                               Defense
74.    Robert Haloba                    Technical Support Specialist - M&E        International HIV/AIDS       roberth@alliancezambia.org
                                                                                  Alliance
75.    S. Ulimbi                        Coordinator                               RIF                          sedrickko@yahoo.com
76.    Scott Robertson                  Director                                  Envision                     envisionza@yahoo.com
77.    Solomon Kayulula                 Principal Planner                         MOH                          skayulula@yahoo.com
78.    Stephen Chisenga                 Desk Officer - NAC                        NSJ
79.    Susan Mwape                      Assistant Coordinator                     CSO-APRM Secretariat         jiggasue@gmail.com
80.    T. Musonda                       Procurement                               NAC                          tmusonda@nacsec.org
81.    William C. Mayaka                Deputy Director                           Central Statistical Office   wcmayaka@zamnet.zm
82.    Yusuf Ayami                      Executive Secretary                       ZINGO                        jeffyussuf@gmail.org




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Attendance Sheet for the Final National Stakeholders’ Consensus Meeting

#                  NAME                           DESIGNATION                        ORGANISATION                  EMAIL

1.    A. Mumba                           Information Officer                     NCA
2.    Anne C. Kabayi                     Social Worker                           CHD                     anniekabayi@yahoo.com
3.    Augustine Mukuka                   Information Officer                     MISA                    oogaoga@gmail.com
4.    Bernard Munkombwe                  Mainstreaming Specialist                NAC                     bmunkombwe2004@yahoo.com
5.    Bishop Joshua H.K. Banda           Board Chairperson                       NAC                     jhkbanda@zamnet.zm
6.    Catherine Muyawala                 Resource Centre Manager                 NAC                     cmuyawala@nacsec.org.zm
7.    Charles Chabala                    UNV                                     MEWD                    Chachabala2000@yahoo.co.uk
8.    Charles Nkunta                     Information System Manager              NAC                     cnkunta@nacsec.org.zm
9.    Chazanga Tembo                     Strategic Information Specialist        SHARe                   chazanga.tembo@share.org.zm
10.   Chimbwete Bibian                   Office Assistant                        NAC                     bchimbwete@nacsec.org.zm
11.   Christopher Busiku                 UNV                                     MIB                     cbusiku0@yahoo.com
12.   Confucius Mweene                   Civil Society Specialist                NAC                     cmweene@nacsec.org
13.   Diana Bulanda                      Capacity Building Director              Rescue Mission Zambia   dianabulanda@yahoo.com
14.   DR G. Biemba                       CDS                                     Ministry of Health      godfreybiemba@yahoo.com
15.   Dr Rosemary Kumwenda               Assistant Resident Representative       UNDP                    mwenda@zambia.co.zm
16.   Dr Terri. Collins                  Civil Society Advisor                   NAC                     tcollins@nacsec.org.zm
17.   Dr. A Simwanza                     Director Multisector                    NAC                     asimwanza@nacsec.org.zm
18.   Dr. Catherine Sozi                 Country Director                        UNAIDS                  sozic@unaids.org
19.   Dr. G.C. Chishimba                 DIMC&S                                  NAC                     gshishimba@nacsec.org.zm
20.   Dr. Michael Gboun                  UNAIDS                                  M&E Advisor             gbounm@unaids.org
21.   Elijah Ngwale                      Programme Director                      ZAMDHARP                zamdihp@yahoo.com
22.   Eric Saltin                        Advisor                                 NAC                     esaltin@nacsec.org.zm
23.   Francis Phiri                      Information Officer                     ACC                     Grajoe2010@yahoo.co.uk
24.   Friday Kasisi                      UNV                                     Ministry of Works and   kasisif@yahoo.com
                                                                                 Supply
25. Gladys Ngoma                         Private & Public Sector Specialist                              gngoma@nacsec.org.zm
26. Godfridah Kamanga                    Receptionist                            NAC                     fkamanga@nacsez.org
27. Harvey Ngwale                        Program me Officer                      ZAMDHARP                harvetngwale@yahoo.com

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28.   Ian Meembe                                                        CDC
29.   Jama Raphael                       Driver                         NAC                           jama@nacsec.org.zm
30.   Jennifer Savidge                   Intern                         UNAIDS                        savidgej@zm.afro.who.int
31.   Kabwe Beyant                       M&E Advisor                    COHII                         beyantkabwe@yahoo.com
32.   Kaimfa P. Chandang’oma             Consultant                     Petrich Projects              kaimfapc@yahoo.com
33.   Kalaluka Akalala                   Info and Publicity Director    Rescue Mission Zambia         kalalukaaka@yahoo.com
34.   Kennedy Tembo                      Programme Officer              OVC Media Network             kentembo@yahoo.com
35.   Maggie N. Sinkamba                 CIRDRZ Comm.                   CIRDZ                         Maggie.sinkamba.cirdz.com
36.   Malala Mwondela                    Executive Director             ZARAN                         mwandela@zaran.org
37.   Max Musunse                        DACA/UNV                       NAC                           musunsem@yahoo.co.uk
38.   Michelle Kanene                    DACA/UNV                       NAC                           michelle_nyam2003@yahoo.com
39.   Mirriam Banda                      Chairperson                    NZP+                          milliebcee@yahoo.com
40.   Moses Zaggetti                     OVC Education Specialist       OVC desk                      mozeovc@yahoo.com
41.   Mubanga C                          UNV                            Ministry of Labour            mubangack@yahoo.com
42.   Mumba Christopher                  Communication Officer          TALC                          mumbamumba64@yahoo.co.uk
43.   Mwenda Silumesi                    Projects Coordinator           HURID                         mwenda@zambia.com
44.   Namwayi Membe                      Programme Manager              Kara Counselling              nmembe@kara.org
45.   Osborn Kabingu Mutapa              Youth Worker                   NYDC                          kabingu@gmail.com
46.   Oswald Mulenga                     Director – M&E and Research    NAC                           omulenga@nacsec.org
47.   Phiri Joan                         CEO                            GNP                           gnp@zamnet.zm
48.   Prof K. S. Baboo                   Chair – HIV/AIDS Prevention    UNZA Community                Sridutt2001@yahoo.com
                                         Theme Group                    Medicine
49. Robert Haloba                        Technical Support Specialist - International HIV/AIDS        roberth@alliancezambia.org
                                         M&E                            Alliance
50. Rose Musumali Lungu                  HIV/AIDS Workplace Coordinator SHARe                         rose.lungu@share.org.zm
51. Samuel Banda                         UNV                            Ministry of Foreign Affairs   samuelebanda@yahoo.com
52. Shalala Lufwendo Louis               Professional Assistant for     National Assembly of          louishalala@yahoo.com
                                         Nangoma Constituency           Zambia
53. Shalala Oliver Sepiso                M&E Representative             FYOZ                          ssepiso@gmail.com
54. Shambulo Kabangu                     M&E Specialist                 Kara Counselling &            skabangu@kara.org.zm
                                                                        Training Trust
55. Wendy Kateka Mudzingwa               Women’s Officer                ZAMDHARP                      Simudzi1@yahoo.com


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