Differentiated Service Delivery in Zimbabwe
Differentiated service delivery (DSD) policies in Zimbabwe are supported by the national government’s HIV and ART Guidelines. Zimbabwe was an early adopter of decentralization of care and task shifting, and has seen successes in retention in implementing DSD with adolescent and peer-led approaches.
Current guidelines include operational and service delivery procedures for stable patients, supply chain management and community, nurses, and systems for people living with HIV. Coordination resources at the national level include a technical working group, and a newly hired coordinator supported by CQUIN. Plans are underway to update measurement and evaluation systems and training services for mentors, nurses, and the community to incorporate DSD.
Challenges to scale up DSD include limited access to routine viral load testing, funding, and acceptance of community models in urban and peri-urban areas. As part of CQUIN, Zimbabwe will take part in demonstration and learning exchange visits. A key priority will be sensitization of all provinces on DSD standard operating protocols and the operational and service delivery manual, agreeing on core DSD indicators, and the roll out of comprehensive models to districts.
Research priorities include assessing the cost-effectiveness of DSD, client satisfaction, and male participation. Zimbabwe will prioritize tracking outcomes of the 600,000 patients currently captured in their electronic health database systems. There are also plans to incorporate DSD with tuberculosis programs and within the national HIV/TB partnership forum.