Allowable deaths, Leave-no-one-behind and the value of human life in Zimbabwe. What actions to accelerate early progress on the implementation of SDGs

Lead Research Organisation: University of Manchester
Department Name: Environment, Education and Development

Abstract

countries in Southern Africa account for over 50% of HIV infections worldwide, with 9 of the region's 14 countries registering an adult HIV prevalence rate of over 10%. Although advances in HIV treatment have kept people well and stemmed infections, 2 million get infected yearly, 38 million live with HIV, and over 20 million don't access antiretroviral therapy (ART) (UNAIDS 2016). Research tracking the latest data on donor government funding to address the HIV epidemic in low and middle-income countries shows a decrease in donor funding from US$8.6 billion in 2014 to US$7.5 billion in 2015 (Kates et al 2016). UNAIDS (2016) estimates that resources to address the epidemic need to rise from US$19 billion in 2015 to US$26.2 billion in 2020 to reach global SDG targets by 2030. The Zimbabwean situation is severe. With more than 75% of its population experiencing poverty, 15% of its adult population living with HIV (ZimSTAT 2015), it accounts for 5% of all new infections in Africa. Zimbabwe's total years of life lost due to premature mortality increased by over 150% between 1990 and 2010 because of HIV/AIDS, yet domestic funding for HIV remains insignificant(IHME 2014). The uncertainty of donor government funding, the largest ART contributor in Zimbabwe and other low-income countries, aggravates HIV challenges.

But, it is not all PLHIV who struggle to access ART, it is the poorest, sexual minorities, female sex workers, prisoners, women and children who have it the hard way (Machingura 2016). Unless inequality in ART access is tackled, these vulnerable social groups will continue to constitute an ever-growing marginalized group of those left behind. Such inequalities will undermine progress on AIDS eradication and poverty reduction, creating the kind of social tensions and political dynamics that can derail the SDG agenda, and drive countries away from positive engagement in international processes.

Building on my doctoral research, the proposed work confronts these challenges in two ways. Firstly, the work sets out to engage political, academic, media and policy audiences to further conversation on leaving no one behind using my doctoral research findings as a starting point. Specifically, the work will engage with the MoH, NAC; and UZ in Zimbabwe; UKZN-South Africa; SADC-Botswana; ECSA-HC Tanzania and civil society working with PLHIV. It will also involve the University of Manchester, and global think tanks. This international network will assist to leverage and build impact opportunities to bring back political and policy attention on HIV allowable deaths.

Secondly, the work aims to pin down the priorities of the marginalized groups of PLHIV by digitizing and weighting their priorities through community level data traces. These will be linked with big data through wellbeing weighting economic techniques and transformed into a community HIV outcome measure (CHOM) to strengthen understating on what matters for the most vulnerable and how data uptake by those most vulnerable could improve patient choice. This approach is significant especially when data traces are the condition to access free health care and a pathway to addressing inequality at the community level where the need is greatest.
This work, unique in its approach, combines high-quality research with communications work, high-level political and academic networking, strategic convening and policy advice, dissemination and public engagement on what it means to confront allowable deaths and to 'leave-no-one-behind.' This work will maintain the momentum for action needed to continue dialogue on HIV and also demonstrate relevance in the implementation of SDGs and tracking progress for marginalized social groups. The work aims to put the lives of the poorest at the center and to show how their views and values can be better incorporated into policy making.
 
Description The project "Allowable deaths, Leave-no-one-behind and the value of human life in Zimbabwe: What actions to accelerate early progress on the implementation of SDGs," established a network that continues to provide value and extra opportunities beyond a single discipline. The network brought together novel combinations of perspectives and collaboration activities have had a high impact and led to long-term partnerships beyond the tenure of the GCRF award. Specifically, I have now joined the Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, where I have become part of a larger academic and interdisciplinary team, working on health research. CeSHHAR Zimbabwe houses several HIV prevention and sexual health research projects bringing together novel combinations of perspectives to identify critical areas for future research to address the global challenges.

Working with directly with Professor Frances Cowan as a Co-Principal Investigator on a large trial: Differentiated Prevention and Care to Support the Virtual Elimination of risk of acquisition and or transmission of HIV Among Sex Workers in Southern Africa. The consortium includes the Liverpool School of Tropical Medicine, The London School of Hygiene and Tropical Medicine, University College London and the University of york along with Malawi Wellcome Trust, Africa Health Research Institute. The research aims to understand the individual and sex work characteristics that predict active engagement in HIV prevention and care among Zimbabwean female sex workers (FSW) and how these vary as women transition into and out of sex work. We will determine what is needed, in terms of ART, PrEP and condom uptake to achieve virtual elimination of transmission through sex work and explore the predicted impact on HIV epidemics and cost-effectiveness in Malawi and Kwa Zulu-Natal.

Drawing on Professor Frances Cowan's more extensive network, I am also local lead and co-investigator of a pilot study to assess the feasibility and utility of recent infection testing for HIV within an outreach programme for female sex workers in Zimbabwe. The study explores the utility of evaluating recency of HIV infection among FSW to guide their management and to target HIV prevention more effectively. We will compare HIV incidence estimates, develop a risk score, explore the use of tests for recent HIV infection among newly diagnosed HIV infected women attending the clinic.

Additionally, I am a co-principal investigator in multiple secondary analyses of anonymised programme data collected through the Zimbabwe National Sex work programme on behalf of the Ministry of Health and the National AIDS Council. The study is undertaking secondary analyses of the national sex work programme data for purposes of scientific research. The national Sex work programme is a human rights-based programme for sex workers established in Zimbabwe in 2009 to foster an empowered and resilient sex work community fully engaged in HIV prevention and care cascades.

The GCRF award aimed at strengthening networks and collaborations through the dissemination of PhD research findings. My engagement work in Zimbabwe engaged partners, communities of practice both academic and non-academic communities - leading to more extended and more valuable collaborations and important work in Southern Africa.
Exploitation Route The work will substantially input into the national level planning processes including through engagement with the Ministry of Health and the National AIDS Council
Sectors Communities and Social Services/Policy,Digital/Communication/Information Technologies (including Software),Healthcare

 
Description The Ministry of Health and Child Care (MoHCC) in Zimbabwe took up the recommendation to implement community-level SDG meetings (symposiums). These symposia put together the local government, health officials, representatives of other sectors, communities and the MoHCC to engage on the notion of "leaving no one behind" in the health sector through a practice of collaborative rationality. Our findings from the extant work on the contextualisation of the SDGs in Zimbabwe make a case for some key factors of collaborative rationality. This entails bringing together disparate parties and interests through shared platforms and developing consciousness between the central and the local state, local business, NGOs, and communities. Such a process highlights what matters most to communities and streamline efforts for the 2030 Agenda while also assisting senior decision-makers to support the SDG contextualisation agenda by listening to communities and clarifying efforts - collaborative rationality. The collaborative practice tends to lead to a joint prioritisation process, which can build the energy needed to sustain pockets of effort in constrained contexts. If given a chance, these symposiums can function as the first step towards the SDG contextualisation process. The MOHCC in Zimbabwe has collaborated with the UNFPA to continue these SDG community symposiums in communities in Zimbabwe. This uptake of findings in practice came after the realisation that: 1. Contextualising the SDGs based on the input of the community can streamline and focus efforts for the 2030 Agenda. 2. When senior decision-makers are interested in supporting the contextualisation agenda and listen to communities, priorities can be clarified. 3. Prioritisation can build the energy needed to sustain pockets of effort in constrained contexts. (see Machingura et al. 2018)
First Year Of Impact 2017
Sector Healthcare
Impact Types Policy & public services

 
Description Health Minister's Meeting and Advisory Committee, Harare, Zimbabwe
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
URL https://www.pressreader.com/zimbabwe/the-sunday-mail-zimbabwe/20170423/281586650481030
 
Description Global Challenges Research Fund (GCRF) to tackle global health challenges and health inequality (I contributed in the proposal development process as part of a team at the Overseas Development Institute collaborating with the University of York)
Amount £6,600,000 (GBP)
Funding ID MR/P028004/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 10/2017 
End 12/2021
 
Description Ministry of Health and Child Care (Harare, Zimbabwe) - Leave no-one behind in the health sector 
Organisation Ministry of Health and Child Welfare of the Republic of Zimbabwe
Country Zimbabwe 
Sector Public 
PI Contribution The partnership forged between the Government of Zimbabwe's Ministry of Health and I helped to establish the conceptual basis for defining new institutional patterns in the context of partnership approaches to local SDG implementation. Drawing examples from three SDG symposiums held in Zimbabwe's rural areas in a paper on "collaborative rationality," (Machingura, et al. 2018), the nature of the partnership suggests that the SDG collaboration process involves a broader range of organisational types that jointly plan, implement, monitor and evaluate progress. Thus, the partnership not allowed me to investigate a participatory process that spurs authentic dialogue and interdisciplinary connections in local SDG implementation to understand what matters most to communities, but also enabled the engagement with local government structures much more accessible. The collaboration used the concept of a "collaborative rationality" to argue that a partnership approach adopted as a core methodology for engaging demands of the poor can facilitate the achievement of the fundamental principle of leaving no one behind. It also resulted in 6 joint publications facilitating use of the recommendations in policy decision making. Specifically: " Working paper - Collaborative Rationality to leave no one behind: Early Experiences on contextualising the health-related Sustainable Development Goals in Zimbabwe " Briefing paper - Leave No One Behind; Sentenced and locked away: HIV/AIDS in Zimbabwean Prisons " Briefing paper - Leave No One Behind; HIV/AIDS among people aged 50 and older in Zimbabwe " Briefing Paper - Leave No One Behind; HIV/AIDS: Women and Girls in Zimbabwe " Journal article under review - Journal for Health Sciences, USA (eMPDNS for reducing maternal and perinatal mortality in Zimbabwe) " Conference Paper - Implementation of a Laboratory Information System; Florida. USA " Conference Paper - The Electronic Maternal and Perinatal Deaths Notification System (eMPDNS) to reduce maternal mortality, Kilimanjaro, Tanzania
Collaborator Contribution The collaboration with the MOH was not a linear, one-way process. The MOH provided channels to communicate recommendations from my PhD research and offered ways of communicating effectively with other policymakers. The MOH increased in the number of cross-sector co-authorships (articles with authorship affiliations in more than one sector: academia, Government, NGOs, and local government). Specifically Community meetings 3 Rural Community symposiums - collaboration to implement SDGs at the community level in Zimbabwe working with multi sectors, local government, NGOs and local leadership. Community symposiums brought together over 500 ordinary men and women in the following rural districts of Zimbabwe " Seke " Goromonzi, " Dema, Publications Contributed to the writing and dissemination of 3 jointly published policy briefs on leaving no one behind i.e. " HIV/AIDS among women and girls " HIV/AIDS among people aged 50 and older " HIV/AIDS in Prisons Contributed to the writing and dissemination of a working paper on Collaborative Rationality to leave no one behind International Conferences Contributed to the writing, presentation and dissemination of two Conference Papers " Implementation of a Laboratory Information System in Zimbabwe, USA " The eMPDNS to reduce maternal mortality, Tanzania
Impact Publications Working paper - Collaborative Rationality to leave no one behind: Early Experiences on contextualising the health-related Sustainable Development Goals in Zimbabwe Briefing paper - Leave No One Behind; Sentenced and locked away: HIV/AIDS in Zimbabwean Prisons Briefing paper - Leave No One Behind; HIV/AIDS among people aged 50 and older in Zimbabwe Briefing Paper - Leave No One Behind; HIV/AIDS: Women and Girls in Zimbabwe Journal article under review - Journal for Health Sciences, USA (eMPDNS for reducing maternal and perinatal mortality in Zimbabwe) International Conferences Conference Paper - Implementation of a Laboratory Information System; Florida. USA Conference Paper - The Electronic Maternal and Perinatal Deaths Notification System (eMPDNS) to reduce maternal mortality, Kilimanjaro, Tanzania Community meetings 3 Rural Community symposiums - collaboration to implement SDGs at the community level in Zimbabwe working with multi sectors, local government, NGOs and local leadership. Community symposiums brought together over 500 ordinary men and women in the following rural districts of Zimbabwe " Seke " Goromonzi, " Dema,
Start Year 2017
 
Description Overseas Development Institute (London, United Kingdom) - Leave no one behind. 
Organisation Overseas Development Institute (ODI)
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution The collaboration between ODI and I was a significant catalyst for positive advancement in my project. It allowed access not only to an increased budgetary contribution but also a wider scholarly network looking into similar impact outcomes. This approach facilitated more disciplines into my research fostering the integration of ideas and prestige, success of joint publications and enhancing research publications quality and impact outreach Specifically, - Technical Report - SDGs and their Trade-offs - Journal article under review - BMC sustainable earth - Future Work - Joint Proposal with ODI and University of York Centre for Health Economics. RCUK awarded funding to tackle global health challenges in Malawi and Uganda. My contribution stemmed from the ESRC funded work. - Briefing policy paper - Contextualising SDGs in Health
Collaborator Contribution ODI ontributed by providing technical insights in reviewing publications for peer review input, providing a space for networking widely, creating space to meet new people interested in my research area and opportunities for presentations. " ODI - One journal article jointly submitted to the BMC sustainable earth and under review " ODI - joint Policy Briefing paper on localising SDGs in health " ODI - joint Case study report on SDGs and their trade-offs " ODI - One internal brown bag seminar organised in London via a multidisciplinary expert working group at ODI " ODI - Contributed a small grant to facilitate the research and collaboration " ODI - Provided peer review insight to my publications " ODI- Provided a London based venue for meetings related to my project - ODI hosted some of the publications on its website including my blog articles
Impact " Published Paper - Sustainable Development Goals and their Tradeoffs " Published Paper - Contextualising SDGs in Health -Experiences in Zimbabwe " Seminar - Brown bag seminar, London, ODI " Future Work - While working with the ODI, I contributed towards a joint Project Proposal with the University of York's Centre for Health Economics (CHE). RCUK awarded the proposal with significant (6.6million) funding to tackle global health challenges working closely with policy-makers in Malawi and Uganda to support them in using data to inform national health care budgets and resource allocation. I contributed to the writing of the proposal, and the contribution was in tandem with my ESRC funded research work. - Two blog posts on Zimbabwe and health
Start Year 2017
 
Description Sheffield Institute for International Development (SIID) - Digital Development in health to leave no one behind 
Organisation Sheffield Institute for International Development (SIID)
Country United Kingdom 
Sector Academic/University 
PI Contribution The partnership with SIID was forged via the ESRC Digital Development Network which is bringing together leading researchers and practitioners from information and communication technologies for development (ICT4D), Data Science and participatory practice. The network helped to develop an ambitious and innovative research agenda to support progress towards the Sustainable Development Goals. The network is made up of participants from different institutions, disciplines, and stakeholder groups, facilitating mutual peer-mentoring. * Conference presentation - ICT for Health in Africa, University of Pretoria - South Africa
Collaborator Contribution In April 2017, the ESRC Digital Development Network kicked off the network with an all-hands Symposium in South Africa, in April 2017 where I presented on ICT in health, the case of Zimbabwe. The network paid for my travel and attendance costs contributing to my research impact as it allowed me to present my work to new expert audiences. This platform also enabled me to meet, partake in workshops and meet researchers working on similar research interests. The network provided an opportunity to continue engaging with researchers through online meetings and webinars. * Conference attendance and conference costs - ESRC Digital Development Strategic Network - conference held in South Africa
Impact Conference plenary presentation - ICT for Health in Africa at the ESRC Digital Development Strategic Network - conference held in South Africa University of Pretoria
Start Year 2017
 
Description Communication as a Strategy on leaving no one behind by 2030 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact The University of Manchester-wide inequality paper was compiled to speak to the "real world," and in particular, to help communicate my work (PhD findings) to the wider public in simple communicative language. The approach was to partly inform the world about the translation of research to practice while also deluging the world with my ideas and vision. Following this major communications publication, I maintained professional contact with new and past colleagues in the following ways:
1. Periodic group e-mails: I established a mailing list of my new and past colleagues and sent out a quarterly report on what I'd been up to.
2. Facebook page: my professional Facebook page kept me in touch with colleagues whenever I shared a new publication or blog post or advertised a date on when I scheduled a scientific meeting.
Year(s) Of Engagement Activity 2017
URL https://issuu.com/universitymanchester/docs/m1889-global-inequalities_issuu/4
 
Description Improving climate information services in the countries that need them most 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact I have been asked to join the editorial team of the Sustainable Earth journal - a community-focused, open access journal where researchers, policy makers and citizens can read, discuss and promote ideas around sustainability and innovation.
Year(s) Of Engagement Activity 2018
URL https://blogs.biomedcentral.com/on-biology/2018/10/25/improving-climate-information-services-in-the-...
 
Description Local community symposium on "leaving no one behind" 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact The broadcast shows one of the SDG community symposiums held in Goromonzi districtm, rural Zimbabwe. The symposium was highly participatory and brought together various actors from government and non-governmental actors to kick-start a process of to deliberate on what health needs matter most to communities and what solutions to address these. This multi-stakeholder approach aimed to facilitate ownership and co-responsibility among actors. The panoply of stakeholders allowed for candid conversations on SDG 3 along the continuum of care at the local level regarding both the health services supply chain and system, making for nuanced discussions on the quality of care between providers and recipients of health services. This collaborative approach was trialled in Goromonzi, Mbire and Seke. Although these rural districts were randomly selected, their average poverty prevalence rates for 2015 were all above 50% i.e. Seke (56%), Goromonzi (62.4%) and Mbire (81%) (see Machingura and Nicolai, 2018). The symposium was an exercise to contextualise SDG Goal 3, with an eye to scale such an approach in other districts across Zimbabwe. It aimed to:
1. identify lessons that point to what works, how and why in the contextualisation of SDGs for communities.
2. explore how SDG contextualisation could be institutionalised at the lowest tier of the health system by mobilising and building partnerships with different local stakeholders.
The symposium attracted over 500 participants across gender, age, occupational, and political spectrums (Machingura et al. 2018).
Year(s) Of Engagement Activity 2017
URL https://www.youtube.com/watch?v=-bhcQenKMR0
 
Description London School of Economics - The Africa , Firoz Lalji Centre for Africa 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The London School of Economics Africa centre newsletter websites distributes newsletters and other documents to the constituents that they serve across the world. The "Africa" at LSE blog is part of the Firoz Lalji Centre for Africa which was launched in 2016. The Centre is the culmination of a long relationship between LSE and the African continent that stretches back over a century. The Africa at LSE blog provides expert analysis and debate on African issues and Africa's place in the world. The "Africa" re-blogged my blog post from the Overseas Development Institute catapulting my reach and impact to a broader audience.
Year(s) Of Engagement Activity 2017
URL http://blogs.lse.ac.uk/africaatlse/2017/11/22/zimbabwe-after-mugabe-three-reasons-for-hope/
 
Description Press conference 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact A special press conference event was organised by the Ministry of health and child care Zimbabwe and I, before the SDG community symposiums that were held in rural Zimbabwe to talk about my work in the MOH and planned activities. The 20-minute conference event brought together media and journalists to field questions about the series of symposiums before implementation and to share my PhD findings and future work.
Year(s) Of Engagement Activity 2017
URL https://www.pressreader.com/zimbabwe/the-sunday-mail-zimbabwe/20170423/281586650481030
 
Description The ConversationUK - Now Mugabe is gone there is a chance to get HIV/AIDS under controL 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact The Blog post was shared through the ConversationUK targeted over 400,000 fellow academic authors and researchers writing for the Conversation's websites. The blog post was published at an opportune time when significant events were happening in Zimbabwe. In essence, at a time when former president Robert Mugabe resigned from power. I combined the prevailing media discourse on what was happening in Zimbabwe with my PhD findings to increase the numbers of people who read the article as a way of growing impact to my postdoctoral fellowship.
Year(s) Of Engagement Activity 2017
URL https://theconversation.com/now-mugabe-is-gone-there-is-a-chance-to-get-hiv-aids-under-control-88274