Project Overview

The Zimbabwe Accountability and Citizen Engagement Programme (ZIMACE) project, titled “Strengthening Voices, Ensuring Accountability, and Improving Access to Health Rights and Quality Services for Women and Girls,” aims to enhance access to health rights and services for women and girls in their diversity while strengthening their voice and agency. The Pangaea Zimbabwe ZIMACE project team will collaborate closely with Health Centre Committees at the local level, the District Health Executive, other health-focused NGOs and partners at the district level, and the Provincial Health Executive and other provincial partners involved in supporting health programs. The project addresses immediate health access and rights challenges while contributing to broader national, regional, and international health agendas aimed at achieving equitable access to healthcare and improving health outcomes for all.

Objectives

  1. Enhance community engagement, women’s rights awareness, and trust-building.
  2. Increase the voice and participation of women and girls in health delivery issues.
  3. Foster multi-stakeholder engagement on health service delivery and rights realization for women and girls in Masvingo.
  4. Increase accountability in service delivery for women and girls, including those with disabilities and key populations, to improve service quality and the range of services available locally.
  5. Increase local and national advocacy on health financing and resource allocation.

Scope of work

The project targets women and girls in Masvingo district, both urban and rural. It will work with four urban clinics and 13 rural clinics.

The proposed intervention will be implemented in Masvingo district covering the provincial level and district with linkages between local communities, district, and provincial levels. The will leverage on CLM and COMAPSS partners in Masvingo.

Community Led Monitoring:

Community-Led Monitoring (CLM) model is a participatory approach to monitoring and evaluating HIV/AIDS and health programs at the community level. It empowers communities to take ownership of their health programs by actively engaging in the monitoring process and providing feedback on the effectiveness and impact of interventions. The CLM model is designed to promote community ownership, participation, and accountability in HIV/AIDS programs, ultimately leading to more effective and sustainable interventions that address the needs of those affected by the epidemic. CLM initially focused on HIV/AIDS treatment but now has expanded to include broader health delivery issues.  CLM empower patients and communities to seek out treatment services, increase health literacy, expand engagement with health service delivery, support demand creation, and demand accountability from the health system to improve and deliver these services. Women and girls are important and integral part of CLM as they make the significant portion of patients through their observed health seeking behaviours

Expected Outcomes

  1. Enhanced participation, voice, and agency of women and girls, including those with disabilities and key populations, in health-related matters, leading to reduced waiting periods at project health facilities and improved client experiences.
  2. Collaborative and functional multi-level, multi-stakeholder platforms that bridge the gap between service providers and citizens (women and girls) to enhance responsiveness and accountability in health service delivery.
  3. Improved service quality at local health centers through increased social accountability.

Key Achievements

Key Highlights or Achievements:

The project achieved significant milestones. The project successfully lobbied for all 18 Community Health Rights Champions (CHRCs) to be incorporated and included as members of the respective HCCs at the facilities they are serving. The lobbying was difficult in rural clinics HCCs as thy were male dominated with most members being elderly people, making it difficult for them to easily accept middle aged women who were recruited as CHRCs to be easily accepted as HCC members but that was finally achieved. Now as full members of the HCCs, CHRCs are now influencing agenda items and discussions in HCCs by bringing and highlighting major issues affecting women and girls’ health rights and access and ensuring that these are discussed by the HCCs and addressed. The CHRCs utilize their engagements and interactions with women and girls to give feedback on issues raised and brought to the HCCs. In addition, CHRCs are being given a platform to speak at all HCC meetings where they have successfully brought health rights and access issues affecting women and girls including privacy and confidentiality, lack of friendly services for women and girls, prolonged waiting times and absence of health staff at night during emergencies and these have all been successfully addressed by various HCCs.

Additionally, other project related improvements include improvement in HCCs membership collectively for the 18 clinics from 156 (79%) averaging 9 members per HCC to 200 members averaging 11 members per clinic, improved gender balance and representation of women in HCCs from 44% before training and support for HCCs by PZ to 56% after. There is slight improvement in representation of women in HCC leadership (Chairperson and Vice Chairperson positions combined) which increased from 31% at baseline to 39%, now project, improvement in representation of youths and persons with disability in HCCs from 22% at baseline to 66% now and improvement in feedback mechanisms at health facilities from 78% at baseline to 100% now. Furthermore, 11 HCCs following training by PZ have initiated various local resource mobilisation initiatives, projects, programs and support initiatives to their respective clinics because of the information, knowledge and guidance from the HCC training. The clinics are Chisase, Guwa, Njajena, Mapanzure, Runyararo, Northwest, Nemamwa, Mushandike, Summerton, Bere and Nyikavanhu clinics, and the initiatives to support clinics vary from engaging village heads to fundraise and pay local guards to secure the clinic, buying electricity coupons, renovating mother waiting shelters and construction of toilets among others.  All these initiatives by HCCs to support the clinics have been confirmed and verified by the project team during support and supervision visits.

As part of “Know Your Health Rights” campaign, the project reached 24 716 women and girls in 14 rural and 4 urban communities through trained and empowered CHRCs and they sensitised women and girls on their health rights, health services and accountability mechanisms available that can be utilised to address any barriers they face in accessing health services.  Nurses in charge (NIC) of the facilities confirmed that communities are now utilising feedback and accountability mechanisms at the clinics, with notes now being found in the suggestion boxes and patients requesting to see the NIC when not satisfied with the service. CHRCs also offer an alternative feedback mechanism to the HCCs on emerging issues from the women and girls and the CHRCs give feedback to the community (women and girls). The health facilities have applauded CHRCs for bridging another gap in terms of health accountability together with the DNOs office. MoHCC through the DNO, engaged all facilities on the need for feedback mechanisms at the clinic in line with MoHCC guidelines and protocols. The feedback mechanism guidelines are now being implemented and followed by the facilities as confirmed during health scorecards in January 2025 and program monitoring support visits in February 2025 by both the facility and community including CHRCs. Client satisfaction surveys and health score cards these were done in February, and the results are average score for client satisfaction survey was 69.67% and health score cards was 91%. These results will now work as a baseline for comparison with next survey results and measure progress on the project.