TRAINING AND RESEARCH SUPPORT CENTRE annualreport

TRAINING AND RESEARCH SUPPORT CENTRE annualreport 2006

Produced by: TARSC Designer: Wayne Nel, Blue Apple Design

TRAINING AND RESEARCH SUPPORT CENTRE annualreport 2006 TARSC, Box CY2720 Causeway Harare Zimbabwe Phone: +263-4- 708 835 / 705 108 / 725 194 Fax: +263-4-737 220 Email: admin@tarsc.org Website: www.tarsc.org

T A B L E O F C O N T E N T S TARSC ANNUAL REPORT 2006 TABLE OF contents 1. ABOUT US 3 2. OUR WORK IN 2006 5 2.1: RESEARCH ACTIVITIES AND RESOURCES 5 2.1.1 Participatory and community based research 5 2.1.2 Community monitoring and sentinel surveillance 7 2.1.3 Other research 7 2.1.4 Research materials in 2006 8 2.2: CAPACITY BUILDING ACTIVITIES AND RESOURCES 10 2.2.1 Participatory materials and training 10 2.2.2 Participatory materials and training for adolescent health 12 2.2.3 Public health training 13 2.2.4 Web based training in social policy 14 2.2.5 Training materials produced in 2004 14 2.3: INFORMATION RESOURCES 15 2

1. ABOUT US TTraining and Research Support Centre (TARSC) Zimbabwe is a non profit company registered in 1994 in terms of Sub-Section 4 of Section 13 of Statutory Instrument 178 of 1984 by the Minister of Justice, Legal and Parliamentary Affairs in terms of Section 26 of the Companies Act (Chapter 24;03). The full objectives of the company may be examined at the office of the Registrar of Companies, Electra House, Samora Machel Avenue, Harare. The principal objective of the organisation is to provide training, research and support services to develop social and organisational capacities within organisations to interact with the state and private sector on areas of social policy and social development. TARSC works towards these goals through Research, particularly analytic and participatory research Capacity building and mentoring in research methods, particularly participatory action research and community based research methods, to inform social and economic policy debates Compilation, analysis and review of information on social and economic development Training, skills development and mentoring of organisations working in areas of social and economic development Technical advisory services and support to networking and engagement between civil society, private sector and state on specific areas of social and economic policy. TARSC is a small organisation that works with other organisations and areas of expertise to fulfill its goals. TARSC provides technical support, mentoring, cadreship building and organizational development to a range of membership based civil society organizations, to organizations in the state, in local government and in parliament at local, national and international level. The work focuses on various dimensions of health and social development. The organization has developed partnerships, materials and other resources towards this and has made its resources publicly available. TARSC is a learning and knowledge organization, with a particular focus on skills building and methods to support community-based work, and with a commitment to long-term national capacity building in the public sector and in civil society. Our work is documented in a range of research reports, training materials and other documents, further discussed in the final section on our information resources. Our organisational structure has remained the same since 2004 and is available in the 2004 annual report at www.tarsc.org. In 2006 the following personnel were involved in TARSC work for all or part of the year: Directors: Dr. Rene Loewenson, Dr. Nikki Jazdowska and Mr. I. Rusike General Manager (Administration) Mr. Zvikomborero Mlambo Programme personnel: Ms. Barbara Kaim, Mr. Thomas Chikumbirike, Ms Fortunate Machingura, Ms. Elizabeth Sithole, Mr. Godfrey Musuka Administrative personnel: Ms. Mevice Makandwa, Mr. Jacob Chakupwaza, Mr. Francis Chakupwaza TARSC staff have in 2006 continued to move from project specific roles to wider research and training roles. Towards this TARSC personnel co-operated as an institution in some areas of activity, such as in the Winter School. Fortunate Machingura was brought as an intern in 2006 and has built skills in areas of participatory training, health equity and programme management, with direct supervision from senior personnel, and will continue in the institution in 2007. The internship approach has proved to be very useful and TARSC will continue to use it to build capacities. All TARSC staff are email and computer literate and in house training was used in 2006 to strengthen skills in library management, bookkeeping, report and proposal development, participatory methods. Staff development continues to be a priority for the organization and 3

T A R S C : A B O U T U S TARSC ANNUAL REPORT 2006 personnel have pursued the following courses with TARSC support; Family Therapy (with Connect Institute of Zimbabwe), Personnel Management (with the Zimbabwe Institute of Personnel Management, ZIMPM), Masters in Population Studies (with the University of Zimbabwe, UZ), Advanced Accounting and Financial Management (with the Association of Chartered Certified Accountants, ACCA, UK), Bookkeeping and Accounting (with Southern Africa Association of Accounting Technicians, SAAT. TARSC staff were also included in regional skills building activities such as the regional training in participatory methods reported on later in the report. Any activity in the organization is an outcome of the combined inputs of the technical, administration and finance departments. The administration unit provides a conducive workplace, functional communications systems, supplies, copying, printing and other inputs. The administrative staff have supported the viability of the organisation under difficult economic conditions. There is mutual respect among the personnel in all departments for the role they each play. Our policy advisory committee continued to provide advice for TARSC general direction and comprised Y Tandon SEATINI / South Centre, G Woelk UZ Medical School, M Mushayabasa Zimbabwe Congress of Trade Unions, G Kanyenze Labour LEDRIZ, W Chikuvanyanga Civic Alliance for Social and Economic Progress. The advisory body met once in 2006 to review ongoing implementation of the areas of programme focus, while individual members were consulted on various issues through the year. TARSC continued its co-operation with various organisations in its areas of work and has built some new relationships in 2006. These include Community Working Group on Health (CWGH), Ministry of Health, National AIDS Council, Zimbabwe National Family Planning Council, Parliament of Zimbabwe committee on health, Zimbabwe Economic Policy Research Unit, LEDRIZ, University of Zimbabwe Department of Community Medicine, York University (Canada), Fahamu (UK), GTZ (Tanzania). We also work with, and mentor individuals within the public (state and civil society) institutions in various areas of work, and mention these in the various theme areas of this report. We continue to receive website support through Fahamu and publications support through Print Dynamix and Blue Apple Design. Mashet Ndhlovu has provided graphic art input to TARSC publications, including the graphics from the toolkit on participatory methods for people centred health systems, that we have also used in this report. The centre contracts legal services, auditing, computer servicing, editing and printing services. TARSC accounting uses ACCPAC, an internationally recognised accounting package and finances are governed by a finance procedures manual reviewed annually. The TARSC (Zimbabwe) financial year is July 1- June 30 and audit statements have been prepared for the financial year ending 30 June 2006 and independently audited by a firm of Chartered Accountants, Ziumbe & Co. The various policies and procedures of the organization (finance procedures, library procedures and publications policy) were reviewed and updated in 2006 and assist TARSC in its co-operation with partner organisations and the public. In the next section we outline our major areas of work in 2006, within the areas of: Research activities and resources Capacity building activities and resources Information resources We have in 2006 built a programme of work that supports the knowledge, analysis and capacity within communities and in the public sector in Zimbabwe and more widely in southern Africa to respond to challenges to human development at all levels, towards building a just and equitable society. We have sustained programmes that have been demanded or had a positive track record and added some new areas of work in 2006. As an institution we have increasingly broken the silo's of project work to build institution wide work and capacities. Within each theme we discuss the work, outcomes and publications. In 2006 we sought to achieve outcomes that would see the institution providing a spectrum of research and training to state and civil society partners in southern Africa, and particularly Zimbabwe, that is demand driven, backed by relevant materials that are recognized for their quality, reported in accessible publications through hardcopy and electronic means that reach key target groups, and supported by a competent technical and administrative base. As the next sections on our work suggest, we have made progress towards this and have some gaps to address. We will increasingly in 2007 monitor and review our institution wide objectives and outcomes so that we provide the quality of institutional support demanded by our partners and by the scale of human development challenges we seek to address. 4

2. OUR WORK IN 2006 This report outlines the major areas of TARSC work in 2006. More detailed reports of the work are available from TARSC and training and research resources are available from the TARSC website (www.tarsc.org) 2.1: Research activities and resources The work we do is organised within three main areas: Participatory and community based research Community monitoring and sentinel surveillance General research Our research programmes have involved technical inputs in TARSC from Thomas Chikumbirike, Barbara Kaim, Rene Loewenson, Fortunate Machingura, Godfrey Musuka, Itai Rusike, Elizabeth Sithole and Faith Chikomo. We have also worked on a number of research activities with other institutions, including National AIDS Council, Community Working Group on Health, Zimbabwe Economic Policy Research Unit, Parliament of Zimbabwe, Zimbabwe Peace Project, Ministry of Health Zimbabwe, UNICEF, CHESSORE Zambia, REACH Trust Malawi, Malawi Health Equity Network and civil society organisations in the Community Monitoring Programme. We have Graphics: M Ndhlovu from Loewenson et al 2006). worked in these programmes with consultant inputs and with a range of institutions and personnel from those institutions, noted in the reports. 2.1.1 Participatory and community based research TARSC has further developed skills and work in participatory research in 2006. This approach is motivated by the understanding that community level skills and experiences are critical evidence for policy and programme design, and that where the process for organizing this knowledge can involve community institutions it creates a stringer link between research and practice. The CWGH, TARSC and the Parliament of Zimbabwe parliamentary committee on health developed work in 2006 to support MPs, local government, health centre committees and primary and district level health staff to identify areas for and support equity oriented resource allocation within districts. This meant exploring within districts how the resources for health (money, drugs, people etc) that are collected or made available at district level are allocated through the different health providers (public, private and traditional) and how this matches the distribution of health needs in a district. This learning aimed to support planning within districts on the equitable allocation of health resources. This work was done with the communities, health workers, councilors, district officials and MPs in two districts as a pilot, working with the communities, local leaders and health authorities. It was supported by Health Systems Trust South Africa through the Global Equity Gauge Alliance. A study protocol was developed and reviewed by personnel from the Parliamentary committee on health, Ministry of Health and Child Welfare and PRA experts, and training inputs provided to the team through a 4-day regional training workshop in February 2006 on participatory methods for health in Tanzania run by TARSC and Ifakara through EQUINET. The protocol was piloted in March in a different district. Formal approval for the work was provided in writing from Parliament of 5

T A R S C : O U R W O R K I N 2 0 0 6 TARSC ANNUAL REPORT 2006 Zimbabwe and the directors of TARSC and CWGH, the MoHCW formally notified and the protocol submitted to MoHCW for input and comment. At a planning meeting, two pilot districts (Insiza and Goromonzi) were selected. Field trips were held of Parliament, CWGH and TARSC representatives and meetings held of stakeholders in each of the two districts to introduce the work, seek input from the local structures and also set up local meetings and key informant interviews with the field team. Organising and mobilization of people to the community meetings was done by members of the district stakeholder committees and no problems were encountered in this regard. The fieldwork was implemented through PRA work with the community and interview of key informants. The research involved the MPs, rural district council councilors, government ministries (health, education, agriculture, youth development), the Zimbabwe Republic Police (ZRP), National Aids Council (NAC), local NGOs, headmen, village community workers, CWGH structures and community members. Available health statistics were gathered and included in the final report. Preliminary reports of the findings were prepared for each district and provided to the community and authorities in each district. A follow up feedback meeting was held in each district in September 2006 to discuss options for enhancing equitable resource allocation in the districts, both in response to the specific priorities raised, and more generally in health planning. The final research report was submitted to the full team, parliamentary committee on health and Ministry of Health for peer review and input. The research raised a number of priorities for health in the two districts, the interventions to deal with these priorities and the ways in which resources can be better matched to priorities to enable these interventions. Districts are very different and making resource use match the profile and needs of the district demands flexibility at district level, in line with national norms and standards. The research identified similar and differing health priorities across social groups and suggested ways these can be accommodated in district plans. Generally, both districts observed that more equitable allocations within districts is only partly based on evidence and also calls for more active participation of communities, backed by stronger communication between communities and health and local government authorities. Proposals were made to support this. 6 Generally the team felt that the PRA approaches were useful to bring people together and reduce community divisions, build confidence and capacity in communities to proactively develop and take measures on health and increase the voice of women in the findings. The PRA methods created an in-depth two-way process of communication and built an enabling environment. They require patience, humbleness and respect for the traditions and beliefs of the community. The participants noted that the PRA methods used enabled people to be more collectively involved in the needs assessment in a systematic way, although it would be useful to widen the range of community members involved. Dai takaramba tichiita mameeting akadai even tiri toga, zvinobatsira chaizvo, zvinofanira kusvika kunedzimwe nzvimbo! [I wish we could have more of such meetings, even on our own, they are really helpful, this should extend to other areas as well!] Graphics: M Ndhlovu from Loewenson et al 2006).

2.1.2 Community monitoring and sentinel surveillance The Community Monitoring Programme has been described in earlier TARSC annual reports. The Programme aims to provide community based information to inform programmes aimed at household and local socio-economic development in Zimbabwe and to inform civil society- state interactions on social and economic development. The Community Monitoring Programme is implemented through civil society organisations based within districts and through community-based monitors. Quarterly monitoring is implemented every three months to examine in a more focussed way specific social and economic issues. The civil society reference group for this includes TARSC, Fosenet, Community Working Group on Health, Civic Alliance for Social and Economic Progress, Zimbabwe United Residents Association, Media Monitoring Project of Zimbabwe, Zimbabwe Peace Project and Women's Action Group, and technical peer review is provided by a range of national institutions. In 2006 financing constraints limited the CMP and quarterly monitoring was not implemented. In 2006 TARSC participated in an African regional meeting of the Poverty and Economic Policy (PEP) Network Meeting Ethiopia June 2006 to share with other monitoring programmes the work and methodology of the CMP. In October 2006, a repeat of the health basket monitoring carried out in 2004 and 2005 was implemented together with the CWGH supported by resources from CWGH and TARSC. To date three rounds of health basket research has been done. This community research work aims to measure the costs of maintaining health for an average household and to identify the changing costs of medical care for different care providers and communities to assess the main elements that are driving up the cost of medical care. Health basket items include Hygiene items (e.g. soap); Food items; Health care items and Public health inputs. They were compiled from background surveys of health inputs, from household survey items in Central Statistical Office surveys and from perceived items from CWGH district members. Between the June 2005 round and the October 2006 round ARVs were added to the health basket. The quantity of items making up a monthly basket were derived from the same sources, using an average family of 4.2. The costs of items in the health basket were collected by trained CWGH monitors for each indicator from households in the district and prices from outlets and institutions serving communities. The cost of medicines such as for hypertension, diabetes, was divided by an estimate of the prevalence of such conditions in the community from health statistics. It is noted that these are all estimates. The report highlighted items in the health basket that represented the largest cost to households, the nominal and real value of the health basket compared to previous years and the items that showed greatest inflation in real costs. The work has also been used to build research capacities within the CWGH at district and national level. 2.1.3 Other research TARSC has also been involved in research in various areas relating to health equity through its membership of the Regional network for Equity in Health in east and southern Africa. The EQUINET secretariat is based at TARSC and the centre provides support to the network in a number of areas of research and training (with training discussed in the next section). The EQUINET Steering committee has in 2006 worked on a regional equity analysis, and within this framework, country level equity analyses are being developed to draw evidence and discuss priorities, practice and experiences. Two countries have been covered in the first round, where health equity networking is already established i.e. Zambia and Malawi, and country equity analyses have been implemented through background literature and country level equity meetings, coordinated by CHESSORE in Zambia and REACH Trust and Malawi Health Equity network in Malawi. In end August 2006 a regional EQUINET steering committee meeting was held in Bagamoyo Tanzania involving also representatives from focal points for existing work and partners. The meeting reviewed and debated the work done on the regional equity analysis, and country equity analyses the key messages and proposals for action and follow up work. TARSC has used evidence from the research in the network to support and provide input to the Regional Health Secretariat for East Central and southern Africa, to SADC division for human resources and social development, to WHO AFRO, to parliamentary committees on health and to the Knowledge network work of the Commission on the Social Determinants of Health. For example, parliamentary briefs have been prepared on health financing and Ante-retroviral 7

T A R S C : O U R W O R K I N 2 0 0 6 TARSC ANNUAL REPORT 2006 treatment and health systems- two key areas of EQUINET work. These have been sent to the clerks of parliament in Zimbabwe, in the region and at SADC level. A budget audit was carried out in Zimbabwe 2000-2006 by Zimbabwe Economic Policy Analysis Research Unit and TARSC, to support the 2007 budget process, with support from IDRC (Canada). This fed into the parliamentary budget review process through ZEPARU, which also presented to the Ministry of Finance. There has been a significant improvement in the budget allocations to the Ministry of Health as a share of government budget from 10.8% in 2006 to 13.5% in 2007 and this can, in part, be attributed to the stakeholder inputs and consultations carried out by the Portfolio Committee on Health. Dialogue with the Ministry of Health finance department on the report has identified areas for follow up action and research that will be taken forward. TARSC provided technical support and peer review with CHESSORE to the development of two reports in EQUINET on barriers to participation at district level. These were used in the knowledge network on health systems for the WHO Commission on the social Determinants of Health. Both papers are on the EQUINET website. 2.1.4 Research materials produced in 2006 Banda HTR, Bongololo GT, Ng'ombe J and Makwiza I (2006) 'Country health equity analysis: Malawi,' EQUINET Country Equity Review. EQUINET: Harare. Batte A, Odoi-Adome R (2006) Patient involvement in treatment decision making among women with breast cancer: Creating personcentred and equitable health service systems, unpublished paper produced with the support of EQUINET: Harare. Chimwele P (2006) 'Willingness of women to test for HIV/AIDS: A case study of Zomba rural, Malawi, unpublished paper produced with the support of EQUINET: Harare. EQUINET (2006) EQUINET Steering Committee and Review Meeting, August 29-31 Bagamoyo Tanzania At regional level, EQUINET through REACH Trust with support from CHESSORE, TARSC and IDRC carried out a review of literature on equity and health systems strengthening in ART roll out in east and southern Africa, with case studies in South Africa, Zambia, Zimbabwe and Malawi (see www.equinetafrica.org). REACH Trust has liaised and coordinated with World Health Organisation (WHO) and CHESSORE Zambia and TARSC on the project promoting equity and health systems approach towards treatment access and responses to HIV and AIDS in southern Africa. The project aims to build working examples of equity and health systems monitoring and analysis at country level in southern Africa for country planning of health systems strengthening approaches to ART expansion. Research activities are underway in Malawi and Zambia and the draft reports of the quantitative components of the study are expected early February. TARSC has provided technical and peer review support to this work and has facilitated input of publications to the EQUINET searchable databases on the EQUINET website. TARSC has also co-authored with REACH Trust presentations for regional and international meetings on AIDS and health equity. TARSC provided in the year analysis, research and technical support and presentation of evidence to a number of other research and policy activities in the region, including to UNICEF for the Situation analysis of women and Children in Zimbabwe 2006 update. 8 Graphics: M Ndhlovu from Loewenson et al 2006).

EQUINET; Medical Research Council; University of the Western Cape (2006) Report of a research workshop: The role of health systems in food sovereignty and nutrition, June 2006 Cape Town. EQUINET; TARSC; Health Systems Trust; University of Namibia (2006) Report of regional planning meeting: Retention and migration of health personnel in southern Africa, 3 April 2006, Lusaka Zambia, EQUINET meeting report. EQUINET: Harare. Industrial Health Research Group (IHRG) (2006) Raising our voice, breaking our silence: Health workers' experiences and needs around Occupational Health Services in Cape Town, South Africa, EQUINET A PRA project report, South Africa. Kamuzora, P; Rutagumirwa, SK (2006) Secondary school students' voice in HIV/AIDS prevention interventions in Tanzania: A case study of Mbeya region, unpublished paper. Lopez-Levers L, Magweva FI, Mpofu E (2006) 'Discussion paper 40: A literature review of district health systems in east and southern Africa: Facilitators and barriers to participation in health,' EQUINET Discussion Paper Series. EQUINET: Harare. Makwiza I, Bongololo G, Nyirenda L, Schouten E, Agabu A, Loewenson R, Theobald S (2006) 'Monitoring equity in ART scale up,' WEPE0966 (Abstract) XVI International AIDS Conference, Toronto, Canada, 13-18 August 2006. Matchaya, M; Muula, AS (2006) Perceptions of medical students, faculty and private GPs towards the utilisation of private GPs in the teaching of undergraduate medical students in Malawi, unpublished paper. South African Municipal Workers Union (SAMWU); School of Public Health, University of the Western Cape (2006) Discussion paper 36: Issues facing primary care health workers in delivering HIV and AIDS related treatment and care, EQUINET Discussion paper series. EQUINET: Harare. Students and Youths Working on Reproductive Health Action Team (SAYWHAT) (2006) Reproductive health challenges of students, lecturers, administration and college communities in the agricultural training institutions in Zimbabwe EQUINET PRA project report, Zimbabwe Ssemaluulu, R; Adome, R (2006) Patients' knowledge of medication use as an equity issue in health care: Do health workers pay attention to this? Unpublished paper. Panulo B, Muula AS, Maseko FC (2006) "The financial losses from the brain drain of health professionals from Malawi," unpublished paper produced with the support of EQUINET: Harare TARSC, CWGH, CMP (2006) The costs of health: a community research report, October 2006, Harare TARSC, CWGH, Parliament of Zimbabwe, Parliamentary Committee on Health (2006) Strengthening community participation in equitable resource allocation for health. REPORT Zimbabwe November 2006 with support from Health Systems Trust/ Global Equity Gauge Alliance. TARSC, CWGH, Parliament of Zimbabwe, Parliamentary Committee on Health and Goromonzi District Authorities and community (2006) Strengthening community participation in equitable resource allocation for health: summary report of research in Goromonzi, October. TARSC, CWGH, Parliament of Zimbabwe, Parliamentary Committee on Health and Insiza District Authorities and community (2006) Strengthening community participation in equitable resource allocation for health: summary report of research in Insiza, October TARSC, HEU, CHP, SEAPACOH (2006) Parliament briefing 2: Fair financing for health, Ideas studio, SA TARSC, HST, EQUINET (2006) Retention and migration of health personnel in Southern Africa: report of a regional planning meeting, Lusaka, Zambia, April 2006. TARSC, REACH, SEAPACOH (2006) Parliament briefing 1: Equity in access to AIDS treatment through stronger health systems, Ideas studio, SA. University of Namibia; Ontevrede Community (2006) A PRA project report: Creating nurse student awareness on community knowledge on health in Ontevrede (unsatisfied) informal settlement, Namibia, EQUINET PRA report, Namibia. ZEPARU (S Shamu), TARSC (R Loewenson) (2006) Zimbabwe national health sector budget analysis and equity issues 2000-2006, Mimeo, Harare. 9

T A R S C : O U R W O R K I N 2 0 0 6 2.2: Capacity building activities and resources 2.2.1 Participatory materials and training TARSC ANNUAL REPORT 2006 Our training programmes have involved technical and consultant inputs in TARSC from Thomas Chikumbirike, Barbara Kaim, Rene Loewenson, Fortunate Machingura, Faith Chikomo, Itai Rusike, Mel Davies and with art work by Mashet Ndhlovu. We have also worked on a number of training activities with other institutions, including National AIDS Council, the Ministry of Higher and Tertiary Education and the Zimbabwe Participatory HIV/AIDS Prevention and Awareness Teacher Training Programme (ZimPATH), Zimbabwe National Family Planning council, University of Zimbabwe Medical School, Community Working Group on Health, Southern Africa AIDS Information and Dissemination Service (SAfAIDS), Ifakara Health Research Development Institute Tanzania, SEATINI Zimbabwe, Centre for Health Policy South Africa, Malawi Health Equity Network, GTZ and TARSC Tanzania, Fahamu (UK) and York University Canada. We have worked in these programmes with a range of institutions and personnel from those institutions, noted in the reports. TARSC has since its inception been involved in the development of training materials and activities for health and social development using participatory methods. The work done to date is presented in prior annual reports. In 2006 TARSC and Ifakara Tanzania initiated a programme of work to develop materials for training on participatory training and research for community based mechanisms to strengthen their voice in planning and implementing primary health care and health services at primary care level. A toolkit has been published by TARSC/Ifakara and a workshop held in February 2006 in Tanzania to build regional skills on PRA methods, supported by the participating institutions and by SIDA and IDRC. The training work in 2006-2008 aims to use this material to strengthen capacities in researchers and health system/ civil society personnel working at community level to use participatory methodologies for research, training and programme support. Graphics: M Ndhlovu from Loewenson et al 2006). After the PRA training workshop TARSC implemented work to mentor the participants to apply participatory approaches for community health work in a selected area of work and to use this work to apply and further develop on useful areas of the toolkit. A pra4equity mailing list was set up by EQUINET and TARSC provided mentoring support in follow up work on changes in community and nurse student attitudes towards community knowledge and action in health in an informal settlement area of Windhoek, implemented by University of Namibia health worker perceptions on their occupational health services in Cape Town, implemented by Industrial Health Research Group SA health worker - community interaction in health planning in Lusaka and Chama district Zambia, implemented by the Lusaka District Health Board reproductive health training needs for youth in agricultural colleges in Zimbabwe, implemented by SAYWHAT Zimbabwe PRA methods for support of orphans and vulnerable children in Zimbabwe, implemented by NAC Zimbabwe 10

The toolkit was revised based on the feedback from the first training workshop, and the revised version has been published by TARSC/Ifakara. A further training workshop will be held in February 2007 in Tanzania. In 2006, TARSC and CWGH undertook an evaluation of the CWGH Civic Health Education Programme with the intention of improving and updating this programme in 2007 (see Evaluation Report, August 2005). The findings of the evaluation were reported and discussed with the CWGH the information committee, staff and presented to the CWGH annual general meeting in July 2006. The findings and recommendations from the evaluation have been taken forward through the health literacy programme in the region. In 2006, TARSC initiated a regional health literacy programme with CWGH, and later with Malawi Health Equity Network, with support from Kellogg Foundation and the institutional resources of the three institutions involved. The health literacy programme will support national health literacy material development and for skills building, starting in three countries in southern Africa to support the development and use of participatory health education materials for health civil society. It will be piloted in Zimbabwe, Malawi and in Mozambique/ Botswana / Lesotho for wider regional outreach. TARSC and CWGH organized a facilitators' review meeting in November 2006 that discussed the 1998-2006 civic education programme and the findings of the evaluation and identified the proposed scope, content and approaches for the future health literacy programme. Drawing from this TARSC developed a core curriculum and carried out work to gather materials already available in these areas. In late 2006 work commenced to write the core regional content for the health literacy materials, so that the areas identified in national level planning processes can be integrated within this core. The materials cover areas of health, health systems and organizational development relevant to the work of the health civil society organizations and the health priorities in the selected countries. A Health Literacy planning committee was set up with two project representatives each from TARSC, CWGH and MHEN to review and plan the regional work. In each country a local advisory group is being set up drawn from key stakeholders in health promotion, civil society, and health. In Zimbabwe this group was set up in 2006, and includes the Health Promotion Department Ministry of Health and Child Welfare, the University and local civil society organisations. The outcomes for the programme aimed at are to have by 2009 in three countries National organisations with capacities to run and sustain the programme Clear, relevant, user friendly materials locally adapted and in use National skills for health literacy facilitation using PRA approaches Regional networking and exchange on health literacy using PRA approaches Improved relationships with national and local authorities and leadership within communities. Expanded number of people at community level trained and using health literacy to advance health and health civil society The programme has commenced with needs and capacity assessments to identify the course content for the programme. In Zimbabwe this was done through the CWGH evaluation reported above and in Malawi it will be done through a needs and capacity assessment to be implemented in 2007. This pilot programme will be a learning experience for all institutions involved and each brings important capacities and experience to the process. TARSC has also provided several other training inputs on participatory methods. For example in 2006, TARSC responded to a request from National AIDS Council (NAC) to provide training to district level NAC officers, NGO cooperating partners in districts and district youth cocoordinators in 10 districts around the country. This 11

T A R S C : O U R W O R K I N 2 0 0 6 TARSC ANNUAL REPORT 2006 training aimed to build skills in using participatory methodologies for HIV and AIDS programming, particularly in relation to mobilizing and strengthening community support for care of orphans and vulnerable children and promoting adolescent reproductive health. The training covered the use of PRA approaches from the PRA toolkit produced by TARSC and Ifakara-Tanzania under the auspices of EQUINET, and use of the Auntie Stella toolkit. In 2007 there will be follow up through NAC structures on use of PRA methodologies for OVC planning and action, as well as use of the AS toolkit. 2.2.2 Participatory materials and training for adolescent health The Auntie Stella interactive youth reproductive health pack was launched in October 2005. Since then, TARSC has distributed over 2 500 copies of the English version of the pack to youth organisations in Zimbabwe and the East and Southern Africa (ESA) region. In early 2006 the Shona and Ndebele versions of the pack became available and they have also been distributed widely within Zimbabwe. The high demand for AS in such a short period of time demonstrates a growing interest in materials generated with and for young people that reflect their real experiences and concerns. The feedback from organisations working with young people and, importantly, from young people themselves, is that the letters to Auntie Stella provide an excellent tool for generating discussion among young people, and between young people and their wider community, on important and often sensitive issues. To support this process, in 2006, with support from SIDA, HIVOS and UNICEF, TARSC provided additional training and technical support to partners in use of the AS toolkit and in participatory methods to working with young people. In January, TARSC, the Ministry of Higher and Tertiary Education and the Zimbabwe Participatory HIV/AIDS Prevention and Awareness Teacher Training Programme (ZimPATH) launched an Auntie Stella training programme in 14 teacher training colleges in Zimbabwe. Since then, students have set up AS Clubs and are using AS in their school placements. TARSC also provided support to the CWGH Youth Programme in rolling out their youth peer education programme in 8 districts in Zimbabwe, to the Zimbabwe Parliamentary Portfolio Committee on Health who undertook a series of short two-hour trainings in use of AS at district level, to the Zimbabwe National AIDS Council and to a range of community-based organizations both in Zimbabwe and regionally. Technical support to all these partners will continue into 2007. TARSC is working with the Southern Africa AIDS Information and Dissemination Service (SAfAIDS) in distribution of Auntie Stella at a regional level. In October 2006, TARSC trained SAfAIDS Satellite Resource Centre officers and Distribution Hub focal persons in use and distribution of AS. A Kiswahili version of Auntie Stella, undertaken in cooperation with GTZ- Tanzania and TARSC Tanzania, is now ready to go to print and the Portuguese version should be ready by mid 2007. To support the training, in mid 2006, TARSC produced a 30-page Auntie Stella Trainer's Handbook to support organizations who will be training facilitators and peer educators on how to use the AS toolkit. This handbook is now available on the TARSC website at www.tarsc.org A participatory review was undertaken in late 2006 with support from UNICEF to assess the impact and use of the AS toolkit within the CWGH Youth Programme and other key institutions in Zimbabwe. The review aimed at assessing youth, peer educator and institutional experiences in training and use of the AS toolkit. Findings showed that the CWGH youth peer education programme has made good inroads in improving the knowledge and skills of peer educators in meeting the needs of youth, but that more intensive training and follow up is needed to increase their understanding and use of participatory facilitation techniques. However, there was an overwhelmingly positive response to Auntie Stella, with almost all organizations noting that the AS toolkit has had an important impact on youth programming. In 2007, the Auntie Stella programme in Zimbabwe will focus on consolidating relations with partners, especially with regard to strengthening the skills of peer educators through institutional capacity in participatory approaches to working with young people. Regionally, TARSC will with its partners finalise production of the Swahili version and move toward distribution and training. In addition, TARSC will be expanding to other countries in the ESA region, in particular to Zambia, Malawi and Mozambique. 12

2.2.3 Public health training The University of Zimbabwe, Department of Community Medicine (UZ-DCM) together with the Training and Research Support Centre (TARSC), held the second level 1 Public Health Winter School short course-training programme at UZ Health Sciences Building from the 10th-15th of July 2006, funded by the participants and the institutional resources of the two institutions. The structure and content of the course was based on the findings from a needs and capacity assessment carried out by the two institutions in 2005 and the feedback from the July 2005 Winter School course. The programme was aimed at building capacities for people working particularly at district level in healthrelated work, but who may not have had the benefit of formal training in health. The course included people from government education, social welfare, statistical services, from health related civil society, from researchers working at community level and from community leaders and parliament technical staff. The course aimed to build an understanding of public health and of health systems, particularly at district level. The course covered Principles of public health and epidemiology Major public health issues, including HIV and AIDS, TB, Malaria, nutrition Elements of health systems, health financing, essential drug supplies and human resources for health Zimbabwe's health services at national, district and primary healthy care level Community and non health sector roles in health An open invitation was made for applicants and of the pool of applicants a total of 26 participants attended the course, 16 women and 10 men. Participants included district level officers from various government ministries, non governmental organisations, civil society and research organisations working on HIV and AIDS programmes and reporters from the parliament of Zimbabwe. Participants came from or worked in various districts across the country. The resource persons and facilitators for the course came from the University of Zimbabwe, Training and Research Support Centre, Ministry of Health and Child Welfare, National AIDS Council of Zimbabwe, Food and Nutrition Council of Zimbabwe, Non governmental organisations (CWGH, WAG) Parliament of Zimbabwe and industry. Sessions were accompanied by handouts and course materials. Two assignments were done by the students in groups to test their public health and health systems knowledge. An end of course test was completed with all students passing. An end of course evaluation at the end of the training indicated that students found the course relevant to their work and very useful. Students rated trainers and materials as good. The majority of students understood the lectures, and found the handouts and assignments clear and appreciated the Zimbabwe relevant content. For future courses students proposed that a fieldwork period followed by a week's training be done. Various subjects were suggested for the follow up course. It was also proposed that the course conveners meet with organisations supporting health programmes to support the course costs and scholarships. In a follow up to the evaluation three months later students indicated that they had applied learning from the course, shared the materials with colleagues and maintained contact with either resource persons or classmates of the winter school programme. On the basis of the positive feedback it is planned to hold further winter school training in 2007. TARSC has also been involved in other capacity building activities in public health. With the Southern and East African Trade and Investment Negotiation Institute (SEATINI) and EQUINET and the Centre for Health Policy (CHP) TARSC has piloted a capacity building programme and training materials on trade and investment and health systems for countries in southern and East Africa. The training was implemented in Zimbabwe and Tanzania in 2005, and in Malawi in 2006 and was followed by a programme of national assessments of trade and investment policies for their impact on commercialisation of health systems in Malawi and Zimbabwe. The meeting and research reports are on the EQUINET website (www.equinetafrica.org). Under the EQUINET umbrella, TARSC has managed in 2006-7 a student grant scheme for small research grants for students at college or university in various programmes in east and southern Africa to carry out supervised work on health equity. The grants have been made through an open call, and responses peer reviewed and grants decided on by EQUINET steering committee members. The grants awarded in 2006 included A study of 'Career Plans of Parts III and IV Medical Students at the University of Zimbabwe College of Health Sciences' - Zimbabwe. (paper at www.equinetafrica.org) Willingness of women to test for HIV/AIDS: A Case 13

T A R S C : O U R W O R K I N 2 0 0 6 TARSC ANNUAL REPORT 2006 Study of Zomba Rural, Malawi (paper at www.equinetafrica.org) Patient involvement in treatment decision making among women with breast cancer, Uganda (paper at www.equinetafrica.org) Women's health in EPZs in Tanzania (in process) Costs of nurse migration in Malawi (paper published in BMC) Issues in the structure of healthcare financing in Uganda for the proposed social health insurance scheme (in process) Knowledge and attitudes of intern doctors at urban and rural hospitals regarding global migration (Uganda) (in process) Control of corporates: Case study of control of infant formula in Zimbabwe (in process). This work will be taken forward in 2007. 2.2.4 Web based training in social policy In 2006, TARSC provided technical support to York University Canada for a pilot web based course on civil society-state relations in sub-saharan Africa on social policy. TARSC and York University jointly designed this Internetbased course, with lectures contributed by scholars in east and southern Africa and Canada. It brought together students from York and cooperating research and scholarly institutions in South Africa and Zimbabwe. Student enrollment in the course at York was divided equally between York and Southern Africa, and four students were involved from Zimbabwe. TARSC, York University and University of Kwazulu Natal South Africa provided technical and academic mentoring for the students, and in Zimbabwe resources to support Internet access. Core instructional materials were made available online through the course website and compact disks, including original lecture texts, supplied background readings, links to e-resources at the York Library and elsewhere on the Internet, and other documents. Students were also expected to access traditional academic sources of research for their work in the course. Students completed two assignments. Following the course an evaluation was implemented with the students both in writing and through a follow up presentation and discussion during the TARSC policy advisory committee meeting in April 2006. The course was well rated by the students in all three countries, and while the Zimbabwe students reported difficulties with Internet access and time commitments, they were able to participate fully in the course and found the analytic approach and materials to have given them a deeper and more evidence based understanding of their work on civil society- state interactions. 2.2.5 Training materials produced in 2006 Kaim, B (2006) 'Auntie Stella: Teenagers talk about sex, life and relationships' - Trainer's Handbook. TARSC Harare Zimbabwe Kaim, B (2006) 'Auntie Stella: Teenagers talk about sex, life and relationships' - Shona and Ndebele versions. TARSC Harare Zimbabwe Loewenson R, Kaim B, Mbuyita S, Chikomo F, Makemba A, Ngulube TJ (2006) Participatory methods for people centred health systems A toolkit for PRA methods, TARSC, Ifakara, Ideas Studio, Harare Malawi Health Equity Network; Centre for Health Policy; SEATINI; EQUINET (2006) Report on a training workshop: Promoting health in trade agreements, 12 to 13 June 2006, Lilongwe, Malawi NAC and TARSC (2006) Participatory approaches for support of orphans and vulnerable children and for youth reproductive children and for youth reproductive health: training workshop report, 11-13 July 2006 O'Gorman Davies, M (2006) Participatory Review of the Auntie Stella programme TARSC Harare, Zimbabwe TARSC, CWGH (2006) Report on the Facilitator's workshop on the Health Literacy programme, 1-2 November 2006, Silveira House, Harare TARSC; EQUINET; IFAKARA (2006) Meeting report: Participatory methods for a people centred health system: Training workshop, Bagamoyo Tanzania, 28 February-4 March 2006, EQUINET meeting report. EQUINET: Harare TARSC and UZ Department of Community Medicine (2006) Report of the public health Winter School training, 10-15 July 2006 Mimeo, Harare Wadee H, Tayob R and Loewenson R (2006): Promoting Health in Trade Agreements: A training kit for East and Southern Africa, EQUINET training manual, Ideas Studio, Harare 14

2.3 Information Resources TARSC maintains an information resource centre that is widely used by its co-operating partners and other organisations. The information resource centre provides publications on major areas of social and economic policy complementary with TARSC activities sorted by category, captured in an electronic data base using ISIS and retrievable as hardcopy publications. The TARSC website is at www.tarsc.org and is regularly updated with information on activities and reports produced. Our information resources have involved technical inputs from Mevice Makandwa, Jacob Chakupwaza, Rene Loewenson, Zvikomborero Mlambo, Barbara Kaim and Francis Chakupwaza. Consultant inputs to web resources have been provided by Fahamu, Rebecca Pointer, Jane Nineham and Blue Apple, with the latter providing design work for hardcopy publications. The library has several thousand publications particularly from southern Africa held at TARSC on key areas of health and social policy, including: Occupational health, Public participation in health, AIDS and employment, Equity in health, Reproductive health Zimbabwe health, Zimbabwe social and economic policies, and Food security and nutrition The full list is available from TARSC. Selected TARSC publications are downloadable as pdf files (www.tarsc.org). Information on the full set of TARSC publications and on the library publications in specific areas can be obtained from admin@tarsc.org. Publications produced by TARSC are available for purchase at replacement printing costs. Please direct requests to the TARSC Information Resource Centre to obtain information email: admin@tarsc.org. TARSC provides its materials on an exchange basis with other major libraries and sends it publications as to the National Archives. TARSC maintains in co-operation with other partners three databases of publications to support research and training work: A web based searchable data base on civil society and health established with WHO (see www.tarsc.org/whocsi/ ) A web based searchable database of publications on equity in health under EQUINET (at www.equinetafrica.org) A web based searchable data base of publications by or about civil society in Zimbabwe (www. zimciv.org/search.php) In the last quarter of 2006, with support from Fahamu- UK, TARSC updated the web version of the Auntie Stella materials on the TARSC website (www.tarsc.org and www.auntiestella.org). This work will be completed in March 2007. The updated site will be more user friendly and will include new features. Apart from the databases that are Zimbabwe specific, all others include information from the Southern Africa region and other international sources. These databases are searchable by author, subject area and year and have been used by researchers, academic institutions, civic, state and international organisations and others in work on the areas covered. TARSC's own publications, numbering more than 800, are organised within the following categories: Occupational health and safety Economic and employment and HIV/AIDS Community and public health Health equity Child health and child welfare Gender and reproductive health Socio-economic policies Food Security and nutrition 15