THE PROBLEM

Zimbabwe is a lower-middle income country with an unstable economy characterized by high inflation, unemployment, and political uncertainty following the deposition of the former president in 2017. At 13%, Zimbabwe’s HIV prevalence is among the highest in the world and the government is spending hundreds of millions of dollars annually to reduce new infections and provide treatment to the approximately 1.3 million Zimbabweans are currently living with HIV. The country is developing key strategies to guide its large-scale HIV response, including annual implementation plans and budgets, which are essential inputs for international partners such as PEPFAR and the Global Fund (GF) as well. Zimbabwe faces an extremely constrained fiscal space for health and predicts additional stressors due to the global Covid-19 pandemic, therefore efforts to maximize efficiency of HIV financing are necessary.

THE PHAROS SOLUTION

The Bill and Melinda Gates Foundation (BMGF) has engaged the Harvard School of Public Health (HSPH) and Pharos to conduct an analysis of the costing infrastructure for Zimbabwe’s national AIDS programs in order to enhance efficiency and sustainability. The review includes interviews with key stakeholders such as UNAIDs and the Ministry of Health and Child Care (MoHCC), documentation of the national costing process, and identification of best practices, with the goal of helping to build a stronger system and institutional capacity to conduct HIV costing in the future.

Review and feedback of National Strategic Documents (January-May 2020) The Pharos team initiated the project with a rapid “just in time” review of the draft Zimbabwean National AIDS Strategic Plan IV (ZNASP IV) and the Global Fund Funding Request, providing consolidated feedback prior to the official submission of these documents.

Zimbabwe HIV Costing Case Study (May-October 2020) The Pharos team began a review of Zimbabwe’s existing costing tools, data, processes, and capacity in May. The team created a data extraction tool based on the Global Health Cost Consortium (GHCC) reference case, in order to evaluate the quality and completeness of previous costing work against an established metric. Using findings from interviews with key stakeholders and an analysis of documents, the team is writing a case study making recommendations for further improvements on HIV costing infrastructure and institutionalization. Additionally, the team will create a slide deck summarizing the case study results and delivering clear recommendations and policy messages.

LOOKING AHEAD

Pharos will disseminate the findings from the Zimbabwe HIV Costing case study and present to the government and partners. This will feed into a regional project led by HSPH including case studies from countries such as Mozambique, South Africa, and Kenya. This work will enhance HIV financing efficiency and improve sustainability of domestic resource mobilisation, which is of increased importance due to global economic contraction caused by the Covid-19 pandemic.

Status: Completed, December 2020

Team Members Involved: Robert Hecht, Steven Resch, Lindsey Hiebert, Claire Young

For more information, contact us at [email protected].