1. on behalf of Zimbabwean Local Authorities
From the Ground Up- Sexual and Reproductive Health Rights and Local Government in Zimbabwe
Daniel Chirundu
on behalf of Zimbabwean Local Authorities

2. Organisation of Local Authorities and Reproductive and Sexual Health Rights
Local Authorities in Zimbabwe- Urban 32 and Rural Councils 60 (92)
Mandated by Urban Council Act and Rural Districts Council Acts to provide services
Sexual and Reproductive Health Services
Maternity Services
STI Treatment and Prevention
HIV Services
Advocacy – Community Services Sections of Council
Scope of service vary depending on size of Council
Harare and Bulawayo- National Centres of Excellence STI treatment
Kadoma –Chinhoi- Kwekwe Mutare- Integrated HIV/TB Treatment
Other Council- Basic SRH Services and advocacy
Ministry of Health and Child Care
Ministry of Women Affairs and Gender
Partners Genderlinks, Ceshar

3. As local authorities we strive to……..
“….develop, implement and evaluate effective policies and strategies related to SRHR leading to the improvement of sexual and reproductive health outcomes for our residents”
UCAZ Health Officers Forum 2015

4. Problems that need address
Gender inequity- Cross Cutting all LA Depts
Poverty among women-Cross Cutting all LA Depts
Weak economic capacity- Economic Development Sections
Sexual and Gender based Violence- Health and Community Services
Issue of Gender and Sex make women and males experience different health risks; affects health seeking behavious Health outcomes and even responses from the health system. Women are likely to dies from communicable diseases, HIV, TB maternal and perinatal conditions well well as perinatal conditions

5. Issues and Challenges in Health Departments
Inadequate Information
Syndromic Approaches
Inadequate implementation of intervention
Counselling Behavioural Intervention
Sex Education
Condom Distribution
Inadequate access to services
Structural factors contribute to increased vulnerability and prevent equitable access to SRH Services
Limited Resources
Stigmatisation
Poor quality of Services
Little or no follow up of sexual partners

6. Limitation in Case management
Heavy reliance on syndromic management to guide treatment
No use of laboratory
Antibiotic resistances to gonorrhoea reducing treatment option
Inadequate resources
Materials (medicines)
Human Resources
Heavy reliance on partners
Limited Research on SRH
Centres of excellences among LA (Harare; Bulawayo and Kadoma)
Hampers understanding of epidemiology of SRH problem

7. Health Target in SRH…. Screening for HIV/ STI- 100% of all women
Women Receiving effective treatment- 95%
Syphilis sero-positive women receiving at least effective regime-100%
Key population having full range of services- at least 50%
LAs to provide SRH services and facilitate linkage to services not available at primary health care
HIV Services ( Post Exposure Prophalaxis)
Reproductive Health- VMMC and VIAC
Family Planning
Post Natal Care Services
Provision of HPV vaccines through immunisation programs

8. Guiding Principles in Provision of SRHS in LAs
Universal Health Coverage
Residents obtain services without suffering financial hardships
Evidences Based Intervention
Services based on latest available scientific Evidences
Protection and Promotion of Human Rights
Gender equity
Health Equity
So that no one is left behind
Partnerships and Integration with other relevant sectors
Community Engagement
To provide sustainable and locally appropriate solutions

9. Best Practises in SRHR In LAs
Specific Health Program for Special Groups
Commercial Sex Workers
Adolescents
Integration of HIV and TB Services
Integration of VMMC and VIAC Services
Evidence based interventions

10. Best Practises Shared at International Forum
Policy Implication
Evaluation of Emergency Obstetric and Neonatal Care in Kadoma City-2012
Primary health Care facility ca deliver 1st Pregnancies with good outcomes
Delayed Initiation of ART in TB?HIV Co Infected Patients Sanyati-2012
Decentralisation if ART Initiation to Primary care level
Trends in Maternity Delivery Outcomes at Kadoma General Hospital
Unbooked deliveries increase need to remove barriers
Cost Analysis of Setting Medical laboratory Services at Primary Care facility 2013
Feasible to provide lab services at Primary Care facilities
Evaluation of Infection Control Program at Primary Health care facilities-2013
Provision of Post Exposure Prophylaxis at Primary Health Care Facilities
Determinants of Late Presentation for Paediatric ART Services-2014
Decentralisation of Paediatric ART Services to reduce costs
Pre-cancerous Lesions of the Cervix Among Women –Secondary Data Analysis -2015
Integration of HIV Services and VIAC Services

11. Best Practises
Policy Implications
Determinants of Uncontrolled Hypertension among Clients on ART seeking Care in LA Health Centres
Integration of NCD care with HIV Services
Evaluation of PMTCT of HIV program focusing on option B
Improvements of tracking systems to reduce lose to follow up
Evaluation of Clinical care given to Sexual Assault Victims-2017
Need for guidelines on dealing with victims
Willingness to Pay for HIV Services-2017
Free Services to continue
Viral Load Suppression among Adolescents on ART in Harare-2017
Determinants of First Line ART failure among Clients attending LA Health Centres -2016
Cross boarder collaboration in Provision of ART.
Evaluation of the Sexual and Reproductive Health Program for Female Sex Workers, Kadoma City, 2017
Relook at sustainability of the Program and introduce VIAC and Wart Treatment

12. Best Practise
Policy Implication
Evaluation of the Maternal Death Surveillance and Response System, Sanyati, Zimbabwe 2017
Surveillance System need to include communities
Adherence to Antiretroviral therapy among Clients Utilising a Primary Health Care Facility Kadoma Zimbabwe (2016)
Need to reinforce adherence as it was below 95%.
Do Short Message Reminders Improve ART Adherence? Randomized Control Trial among HIV Clients - Kadoma (Zimbabwe) - KAMP Study Protocol.
Methodology to test efficacy of SMS on Adherence
Use of Technology to Improve Healthcare Outcomes is the Need of the Hour!
Clients on ART Willing to be reminded to adhere through SMS
A Parallel Group Randomised Control Study to Investigate the Efficacy of Weekly Motivational Text Messages on Adherence Among Clients on Anti-Retro viral Therapy- Kadoma Mobile Phone Study (KAMPS)
Good viral suppression and immunological outcomes due to receiving weekly motivational SMS
Condom Use among HIV infected clients seeking care at Rimuka Integrated HIV and Tuberculosis Site, Kadoma, Zimbabwe 2015.
Need for continued condom promotion

13. Thank You