THE Zimbabwe National Family Planning Council (ZNFPC) is a parastatal under the Ministry of Health and Child Welfare, mandated to co-ordinate the provision of family planning (FP) services in Zimbabwe.
This includes the provision of technical assistance/support and quality control for all public and private FP service providers; training, marketing and communications for FP and other reproductive health (RH) issues; youth reproductive health; RH research; and the procurement and distribution of contraceptives for the whole country including the private sector.
ZNFPC operates in nine provinces and has a total of 13 clinics in all the provinces.
Community Based Distribution programme
One of ZNFPC’s key programmes is the Community Based Distribution which is the principal means of outreach work for the FP programme at community level, the adolescents sexual and reproductive health programmes, and the integration programme, which has seen ZNFPC offering both RH/FP and HIV and Aids services simultaneously.
Through the integrated FP and HIV and Aids services programme, the CBD’s responsibility is educating the community and counselling clients on FP/RH, initiating contraceptives and instructing clients on how to use contraceptives correctly.
Clients are referred to health centres for physical examination, management of problems, HIV testing and counselling, prevention of mother to child transmission of
HIV and sexually transmitted infections treatment services.
The programme has contributed tremendously to the acceptance of family planning and the adoption of small family norms and child spacing in Zimbabwe. In line with global trends of service provision the programme managed to adopt the concept of integration through the expansion of CBD roles to include other HIV and Aids services at community level.
The CBD service delivery model is commendable as it ensures that clients are provided with extensive information material to aid informed and educated decision-making.
According to ZDHS 2010/11, the percentage of women who were informed about the side-effects or problems of the contraceptive methods used by the CBD programme was 64 percent, which is a favourable percentage compared to clients who obtain their methods from other sources.
Despite the fact that the CBD programme is the principal means of outreach work for the FP programme, currently ZNFPC has a 56 percent CBD staff shortfall.
This has been attributed to reduced sources of funding. Matabeleland North province has the biggest short fall of 94, followed by Masvingo with 67, Mashonaland East with 58 and Manicaland with 51.
However, despite its successes, the programme has been seriously affected by the macroeconomic environment that prevailed in Zimbabwe; the number of CBDs has reduced through high attrition, deaths and resignation without replacement.
Thus there is now a low coverage of services. The problem of low coverage is further compounded by the emergence of new areas that require service provision (new and resettled areas).
The CBDs also do not have enough essential job aids, such as a lack of uniforms, and a shortfall of motorcycles for group leaders and bicycles for CBDs.
Adolescent and Sexual Reproductive Health (ASRH) Programme
ASRH is a youth services programme that came from the need to offer reproductive health services specifically to young people.
The World Health Organisation defines young people/youth as those aged between 10 and 24 years.
According to the Inter-Censal Demographic Survey 2008 report, Zimbabwe’s population is relatively young with over 62 percent below 25 years.
This makes the ASRH programme an imperative component of FP in the country.
The major components of the ASRH model being implemented include youth friendly clinical services; advocacy and community leadership; peer education activities; life skills training; recreational activities; survival skills training; information education and communication activities; and monitoring and evaluation.
ASRH has adopted three approaches to address the adolescent and youth needs which are; (i) Youth Centre Based Approach, (ii) Health Facility Based Approach (youth centres at health institutions) and the (iii) School Based Approach (through HIV clubs, guidance and counselling and peer education).
With the three approaches, ZNFPC is able to to reach the youth that are both in and out of school.
The activities are supported by National Aids Council (Zimbabwe), United Nations Population Fund, International Planned Parenthood Federation, the United Nations Children’s Fund (Unicef), among other players.
Global Fund (GF) and the European Commission (EC) were the main funders towards the ASRH Youth Centre programme.
The EC funded 16 districts while GF funded 24 districts. ZNFPC runs 25 stand alone youth centres in eight provinces.
Manicaland and Mashonaland West provinces have the most youth centres, each having five. Matabeleland South has four, Mashonaland Central with three while Matabeleland North, Mashonaland East, Masvingo and Midlands have two in each.
It also runs 43 youth corners in the eight provinces which are strategically housed in district hospitals under the Ministry of Health and Child Welfare.
ZNFPC has now incorporated clinical services in some of its youth centres, these being Magunje, Mutare, Nyakuchena in Mudzi, Kasanze in Zvimba and Mt Darwin.
Clinical services are to be expanded to three more youth centres this year with the aim of eventually establishing them throughout all the centres.
The programme has been able to reach in and out of school youth through the Community Based model, Health Facility model and the School Based Approach.
ZNFPC in partnership with Ministry of Health and Child Welfare have developed the standard guidelines of training youth friendly service providers; at least 450 nurses have been trained across the country in the provision of youth friendly services since the inception of the programme; and some youth centres are implementing self-help projects that help local youths in gaining life skills to start their own income generating ventures.
An end of programme evaluation conducted by UNFPA in 2009 , it was noted that ZNFPC had a comparative advantage in the implementation of ASRH programmes in Zimbabwe through its vast experience of implementing such programmes.
It was also reported to have the best curriculum for the training of peer educators and nurses on the provision of ASRH services.
The programme has contributed to youths being able to access sexual and reproductive health information whilst at the same time enabling them to use safe and reliable RH services.
This is important given the early sexual debut that is being reported in youths thereby exposing adolescents to a range of RH problems such as a high risk of contracting HIV, STIs and unplanned pregnancies.
The HIV prevalence among young women aged 15-24 decreased from 11 percent (ZDHS 2005/6) to 7 percent (ZHDS 2010/11), while for males in the same age bracket it has remained stable at 4 percent.
Whilst this signifies progress the prevalence rate, is still high and needs to be reduced.
There is need for increased investment in adolescents’ sexual and reproductive health through the provision of gender-sensitive youth friendly SRH services including STI treatment, counselling, VCT referral and condom distribution.
The programme is currently running under limited funds which are reflected in the limited operational capacity.
Only eight districts out of 61 districts have youth centres and a mere 16 percent of health facilities have youth friendly corners.
This lack of funding means there is limited capacity to setup clinical services at all youth centres as only five out of the 26 standalone centres have such services.
The funding for youth friendly corners for 215 identified sites expired in 2009, only 43 youth friendly corners (including new sites) are currently operational with the limited funding being provided by UNFPA, thus the other sites are neglected, reducing the potential coverage of the programme.
There is also a high attrition rate of peer educators partly due to low allowances which is de-motivating.
There is a need for modern facilities such as computers and internet connection at the youth centres, which would have the effect of attracting young people to utilise the centre s and expose them to the FP services available.
Also service providers need transport such as motorcycles and bicycles so they can conduct outreach activities.
Current programme vehicles require replacing as the organisation is currently operating with old vehicles which are unreliable.
Today, Zimbabwe’s knowledge of contraceptives is virtually universal and the level of use of modern methods is among the highest in sub-Saharan Africa.
According to the 2010/11 Zimbabwe Demographic Health Survey, knowledge levels on contraception were 98 percent in women and 99 percent in men.