Thanks to strong political and financial support from the city – including a 50% increase in the city budget allocation for HIV and gender-related activities – Lusaka is making significant improvements to its HIV response. A Fast-Track Action plan, with a dedicated monitoring and evaluation unit and robust coordination mechanisms – that include affected communities – have contributed to a better understanding of the city’s epidemic and needs, and to better programming and services.
The city’s model for success is being expanded to others in the country, particularly in the Copperbelt, Eastern and Southern Provinces, which have similar epidemiological profiles. City representatives, as members of the National HIV/AIDS/Tuberculosis/STI Council Technical Working Group, are also using their experiences to engage in the development of HIV policies, guidelines and strategy. These include Zambia’s National AIDS Strategic Framework and applications for PEPFAR and Global Fund funding.
Leading and coordinating
Key to the success of Lusaka’s improved HIV response has been the establishment of the Fast-Track City Steering and Technical committees. These committees guide the implementation of the response using strategic information and specific expertise – including from affected communities – and ensure improved coordination and collaboration among implementing partners.
The Steering and Technical Committees are convened by Lusaka and the Alliance of Mayors and Municipal Leaders on HIV/AIDS in Africa (AMICAALL). Meetings have continued despite the constraints imposed by the COVID-19 pandemic, with WhatsApp groups and virtual meetings taking the place of physical meetings where necessary. The Steering Committee provides oversight for Fast-Track City activities in Lusaka. The Technical Committee meets regularly to develop annual Fast-Track City workplans and budgets, and to monitor their implementation. It also produces training materials for community and leadership development.
In 2020, a new Innovations Team was established under the Technical Committee. This multisectoral team includes representatives from key HIV organizations: networks of people living with HIV; sex workers’ organizations; faith-based organizations; and the LGBTQI consortium. It works to identify and promote cost-effective, efficient and sustainable community-led initiatives.
The Fast-Track City committees have had a significant impact on the city’s political leadership and management capacity. They have helped civic leaders to understand their own role in the HIV response – including through capacity-building workshops organized by the Technical Committee to build recognition of both the successes of the response and of major structural, social and legal response gaps and constraints. They also provided orientation training to the newly elected Mayor and 38 Ward Councillors, and provided support for the Mayor’s Fast-Track Champions campaign, with awards for councillors who contributed most to the city’s HIV response. As a result of these activities, the City Council has increased resources for HIV and gender mainstreaming in the city’s annual budget by 50%1.
The committees also campaigned for and developed Lusaka’s inclusive and participatory Fast-Track Action Plan for 2020-2023, launched by the Mayor in December 2020. This guides the city’s multisectoral HIV response over a longer period, enabling a broader strategic focus. The Action Plan addresses gaps and barriers in the HIV response, with specific emphasis on the city’s key and other vulnerable populations.
Community groups have been engaged as implementing partners in accelerating the provision and uptake of HIV-related services under the Action Plan. These partners, as well as city staff and other stakeholders, receive capacity-building and mentorship assistance from the Fast-Track Cities project to monitor the Action Plan. The District Medical Office also provides support for the ongoing mapping of all Action Plan implementers, which began with a desk review of registered service providers, their locations, their partners and their resources. When completed, the map will enable city residents to access the HIV and related services they need more easily.
Empowering and serving communities
Empowering the community organizations that implement Lusaka’s HIV projects helps them to engage more effectively with the communities they serve. Most recently, the city has identified 15 key organizations and networks of people living with HIV and members of key populations (including sex workers) in wards with particularly high HIV burdens in all seven of Lusaka’s constituencies. These organizations will be recruited for the social contracting of HIV services – and will receive training so they can better implement community-led, high-impact interventions that improve uptake of testing and prevention services and linkage to treatment and care. Through the Fast-Track Cities project, the International Association of Providers of AIDS Care (IAPAC) and the International Treatment Preparedness Coalition (ITPC) also deliver regular training sessions. These help to educate and empower community peer educators, and to improve the quality of services provided by health care workers (including by reducing stigma and discrimination). Through these activities, increasing numbers of people are being reached with HIV-related services.
Measuring and evaluating: Using data to fast-track action
Lusaka benefits from a solid – and improving – body of HIV-related strategic information. The Fast-Track Cities Technical Committee uses this information to advise city councillors and inform decision-making in terms of focus on geographic areas and populations of concern, including for the annual Fast-Track City workplans and the Fast-Track Action Plan 2020-2023. It has also been used to advocate with the City Council for HIV financing in the 2021 City budget.
The city’s strategic information comes both from partners and from its first-ever monitoring and evaluation (M&E) unit, established in 2019. Buoyed by committed resources and hard work from the city and partners, it now has the capacity to collect and analyse HIV data – producing strategic information for decision-making – and to track progress in the implementation of the city’s Fast-Track Action Plan. The unit also works to build partnerships with other organizations that collect key data.
Staff from the M&E Unit and Planning Department have received training in the use of programme, secondary and census data and estimation models, as well as the different sources of health and HIV data and HIV data analysis. The training was organized by AMICAALL, Zambia’s National AIDS Council (NAC) and the District Health Information Unit.
As a result, the M&E team can compile HIV situation reports at the city and ward levels, generate estimates for the 90-90-90 treatment targets for Lusaka city for 2018, 2019 and 2020, and build capacity to do so for the new 95-95-95 targets. The unit’s data contribute to Lusaka’s input to the NAC, which is responsible for UNAIDS Global AIDS Monitoring (GAM) reporting.
Thanks to an agreement with the city, the District Medical Office also shares sub-district-level geospatial data and strategic information on HIV with city leaders and management to inform decision-making. This includes relevant information from the District Health Information Management System (DHIS), and unit staff members have been given access to and training in the use of the system. Integrated Health Situation Room hardware and software have been installed in the Mayor’s Office to enable easy access to national level health-related information.
1 The city budget for HIV increased from ZMW 500,000 in 2020 to ZMW 750,000 in 2021.
