NAC Zambia nac.org.zm
Zambia has line up key intervention areas over the next few years in order to reduce new infections and ensure equitable access to treatment amongst all its population, irrespective of age, gender, income level or geographical location. However, the environment within which these interventions are implemented must be conducive and for the success of a comprehensive HIV programme. These critical enablers are activities that are essential for the effective and efficient implementation of basic programme activities and whose sole or primary objective is an HIV-specific outcome.
The social, political and cultural environment can either negatively or positively affect different members of the communities’ access to and use of HIV related services. Gender inequality and stigma are still significant barriers affecting both men and women, particularly youth and key population groups such as sex workers. Critical enablers can help ensure equitable access to HIV related services, ensuring full involvement of communities to encourage a more locally led and owned and, therefore, more sustainable response that is based on local priorities. Such a system needs good governance at both national and sub-national levels that takes advantage of all local opportunities, including financial.
Gender Equality & Empowerment
Gender inequality and Gender-based violence are both important human rights and development themes beyond HIV responses. However, they are significant barriers to the overall goal of reducing new infections and ensuring all Zambians have access to appropriate treatment.
In Zambia, HIV prevalence rates are consistently higher in women than in men demonstrates the importance of taking a strong stance to address gender inequality and gender-based violence. More women are living with HIV (16.1%) in Zambia than men (12.3%) in the general population but the gender disparity amongst adolescents is even greater with girls in the 15 – 24 age group twice as likely to be HIV-positive than boys of the same age The higher number of girls and women living with HIV is a direct result of cultural barriers which expose them to risk. Girls and women are not expected to take a lead on issues of sexual negotiations or question men’s sexual behavior outside marriage, making it difficult for them to demand condom use.
In some communities intergenerational sex places girls at significant risk of exposure to the virus. One of the most common reasons for girls dropping out of school is unwanted pregnancy or early marriage, both demonstrating unsafe sexual practices exposing young girls to the HIV virus. Men and boys are less likely to use health services including HTC meaning they are less likely than women to know their HIV status but due to unequal power relations a woman may not wish to share her sero-status with her husband for fear of being blamed.
Gender-based violence has been identified as a significant factor in gender inequality in Zambia, affecting all aspects of women and men’s life including their access to and use of HIV services. Whilst most violence is perpetrated by men against women, it is also clear from the report that child abuse of boys as well as girls was high. Alcohol abuse is a significant co-factor in GBV and is perceived as a serious problem by communities throughout the country.
Resource Mobilization/ Sustainable Financing
At the core of any national response is the mobilization of financial resources. Zambia has been advocating increased allocation of domestic resources to fund the NASF and encourage development partners to maintain their support for implementation of this strategic framework. The Health Fund is a sustainability measure the Government is putting in place to increase available resources for health, including for HIV.
Funds from the United States Government (USG), a major partner, flow through multiple channels including PEPFAR, CDC and USAID and are managed through a Partnership Framework signed between the Government of Zambia and the USG. Additional resources are also mobilized from other partners including the Global Fund. However, more effort has been put into identifying local funding opportunities at sub-national level from the private sector or from within communities themselves.
Mainstreaming HIV within other key social and development sectors such as health, social protection, education, infrastructure and transport is expected to share the cost of funding more evenly.
International financial assistance has declined steadily over the past several years and this situation is expected to continue, requiring the Government of Zambia to take more and more responsibility for financing the major portion of HIV interventions. A viable sustainable funding strategy, therefore, requires development and implementation. Accordingly, for the next three years, in addition to regular annual audits, value for money audits will be conducted in randomly selected institutions at each level of the national response. The information obtained from these audits will be used to strengthen the financial accountability system at all levels of the response.
Leadership and Good Governance
Sustained political, civic, traditional, community and corporate leadership commitment at all levels, national, provincial, district and community, is essential to ensuring an effective and focused multi-sectoral response. Zambia has successfully demonstrated its political commitment to tackling HIV in a holistic manner through the development of appropriate policies, establishing a coordination structure, which reaches from district to national levels, and working collaboratively between state and non-state actors. However, more can be done, particularly with regards to the implementation of prioritised policies and strategies. Besides, HIV needs to be more assertively mainstreamed into planning and policy development processes. In line with the NASF 2014 -2016 Zambia seeks to strengthen community led initiatives and improve political accountability and good governance of the response.