Hospice and Palliative Care Association of Zimbabwe (HOSPAZ) is a national membership body, registered in Zimbabwe in 1999 as a private voluntary organisation (PVO 13/99). It has over 120 members who provide a wide range of comprehensive services throughout the country. The members comprise of palliative care service providers (hospices, home-based care & OVC care organisations, support groups of PLHIV and hospitals), with at least one member in each of the 62 districts. The organisation’s mission is to promote palliative care and support palliative care service providers, through capacity development, advocacy and membership coordination.
HOSPAZ has highly qualified program staff, most of whom are health professionals, trained and extensively experienced in various areas of programming. The staff complement includes qualified and experienced finance and monitoring and evaluation officers. The organisation has recently gone through an Organizational Capacity Assessment whose purpose was to assess the organizations; Governance, Administration, Human resources management, Financial Management, Organizational Management, Program Management and Compliance and Program Performance Management. The overall assessment score on all areas revealed that HOSPAZ is a sound organisation.
HOSPAZ uses advocacy, capacity development and membership coordination to promote palliative care and support palliative care providers in Zimbabwe. The principal approaches of the organization over the years have focused mainly on partnership and strategic alliances and standardisation of care processes and methods to ensure that the association remain relevant and in line with global, regional and national trends and expectations whilst enhancing the effectiveness of its interventions. HOSPAZ recognizes the need for continued engagement of policy makers, government and other key stakeholders in ensuring that palliative care is clearly understood and integrated in the national health system. In the past ten years, HOSPAZ has complemented government in the training of health professionals in palliative care and development of frameworks, policies and other materials that enhance the implementation of palliative care in Zimbabwe.
HOSPAZ’s primary target group are children (OVC, living with disability, living with illness) and adults with life threatening illnesses and their families. The other target groupinclude policy makers, Community Based Organisations (CBOs), Faith Based Organisations (FBOs) and Non-governmental Organisations (NGOs) implementing comprehensive prevention, treatment, care and support interventions in Zimbabwe. In the next five years the focus of HOSPAZ’s work will remain in Zimbabwe with regional and international consultations. Although the organization has presence in all the country’s 62 districts, actual coverage in each district is still very low with members having programming in a few wards per district. This means there is scope for the organization to expand its work in the country. In the next five years HOSPAZ will seek to scale-up its intervention to reach as many people in need for palliative care as possible.
The strategic direction of HOSPAZ for 2014-2018 is crafted taking into consideration the contextual background, gaps, competencies and results of the SWOT analysis.
“Palliative Care for all”
Palliative Care Reflects Comprehensive Care
In order to achieve its vision, HOSPAZ’s mission is to:
Promote palliative care and to support palliative care providers in Zimbabwe through capacity development, coordination and advocacy.
Promotion of a comprehensive health systems approach to quality care for all in order to relieve pain and suffering of individuals, families and communities affected by life threatening and chronic illness
All decisions and activities undertaken by HOSPAZ are guided by the following values;
Strategic drivers are leadership choices to change institutional direction, scope, visibility of the organization and organisational cultural. These are the critical elements that help determine the success or failure of an organization's strategy.
Capacity development encompasses training, mentorship and materials development. The main aim is to develop both the technical and organizational capacity of members and partners. Building organisational capacity will include training and mentorship on financial management and governance among others. Capacity development will also focus on building the technical capacity on the actual provision of palliative care, compliance to national standards among others. This therefore implies that training has to be tailor-made to suit the needs of members and partners. The needs have to be determined through regular assessments. Knowledge on palliative care and how it is provided is still low among service providers and it is anticipated that once the palliative care training curriculum that was developed by HOSPAZ is implemented, then knowledge levels among service providers will improve. Another key component is the development of training materials for use by HOSPAZ and its members and partners. This has been one of the areas where HOSPAZ has excelled in the past. HOSPAZ is expected to build on such competencies and review existing training material in order to ensure that it is still relevant. New materials should also be developed especially focusing on training in newly identified areas e.g. working with special populations.
Strategic objective:To build technical and organisational capacity of members and partners through assessments, training, mentorship and materials development
This strategic driver is directly derived from HOSPAZ’s mandate. A database of palliative care service providers was developed during the last strategic plan in order to facilitate coordination of members. This needs to be constantly updated during the next five years. It was noted that whilst the question of “who is providing palliative care in Zimbabwe” can be easily answered, the question on “what other services are provided by the palliative care providers” cannot be answered with the same ease. The information is important for further referrals of clients, planning and implementation of complementary activities. This gap will be covered by conducting an assessment of all members and partners. Closely linked to coordination is networking. Networking by member organisations is essential as it facilitates information sharing, formation of consortiums and exploitation of synergies. Networking at regional and international levels is expected to be done mostly by the secretariat. At such levels, HOSPAZ is expected to identify groupings that they can relate or attach themselves to. Existing relationship e.g. with APCA should continue and be strengthened.
Strategic objective:To coordinate HOSPAZ membership and network with key local, national, regional and international partners
HOSPAZ has been involved in a lot of advocacy work in the past. It is expected that the organization will continue with such activities in the next five years. Lobbying and advocacy has been identified as one of the strategic drivers for the next five years in recognition of the work that still has to be done especially in terms of provision of palliative care to the rest of the population, implementation of policies and availing of resources for palliative care. One key area for advocacy is the integration of palliative care into the health system in Zimbabwe. This has been lacking in Zimbabwe and working towards this is in line with the current drive in the sub-Saharan region. Allocation of resources for palliative care in the national budget has to be advocated for so that there are resources from the fiscus specifically devoted to enhancing knowledge and the provision of palliative care country-wide. Adequate resourcing of palliative care activities coupled with the integration of palliative care in the health delivery system is expected to contribute significantly towards the attainment of the vision.
Strategic objective: To advocate for palliative care and represent member organizations nationally, regionally and internationally
Empirical evidence on palliative care to inform decision making and programming has been lacking throughout sub-Saharan Africa including in Zimbabwe. This has restricted both the provision and uptake of palliative care. Of importance is the translation of research findings to inform programming and decision making. It is envisaged that through the creation of a body of knowledge on palliative care and its impact, the importance of palliative care will be more pronounced. This will ultimately form a basis for advocating for more resources to fund palliative care activities. HOSPAZ will therefore be expected to build capacity of members and palliative care providers to carry out research on palliative care and share findings. HOSPAZ will also undertake research to complement such efforts. Focus will also be on packaging the research findings and disseminating through various means e.g. newsletters and posting on the website. The availability of information on palliative care, especially case studies highlighting impact, will ultimately contribute towards the stimulation of demand for palliative care services.
Strategic objective: To conduct research, document and share best practices to inform decision making
HOSPAZ has the mandate of ensuring compliance to set national palliative care standards. Although standards were set by HOSPAZ in the past, it is imperative that HOSPAZ continues to review these in line with national, regional and international standards and expectations. HOSPAZ has to monitor compliance by members through conducting monitoring visits. The results of monitoring visits are also to inform the revision of standards and decision making especially on the provision of palliative care.
Strategic objective: To determine, recommend and monitor standards of care for quality assurance
An analysis of the core competencies of HOSPAZ was done considering its past achievements and mandate. The focus of the analysis was to identify what HOSPAZ is good in and not what HOSPAZ should be doing. The identified competencies were prioritized as follows:
HOSPAZ has immense experience in OVC programming built over the years of implementing projects with funding and technical support from partners such as World Education Incorporated (WEI), UNICEF, Regional Psychosocial Support Initiative (REPSSI), and Egmont Trust. With support from UNICEF, HOSPAZ implemented, NAP for OVC a four-year programme on integrating children’s needs into home based care through 60 CBOs reaching 108,000 OVC and 4,000 community leaders in 9 provinces. Under this project HOSPAZ developed a training manual on palliative care for children; piloted community based psychosocial interventions such as support groups and camps for children, which are now widely used now in Zimbabwe because of their tried and tested effectiveness. Through support from WEI’s Children First Project, HOSPAZ has also advocated for increasing children’s access to ART and palliative care. This project which commenced in 2008 was inspired by the low uptake of ART by children and has seen the scale up of integrated management of AIDS care and treatment among children. This was achieved through enhanced community and policymaker involvement and strengthening of existing linkages between communities and the health institutions. The pilot project in four districts benefitted 700 children commenced on ART within one year of implementation. The second phase of the project which HOSPAZ is and its partners are currently implementing provides a holistic package of services, including comprehensive health, education, child protection and economic strengthening activities. Reaching 56,000 with these services in 7 districts. In response to emerging gaps in programming, support to children has also been expanded to focus on a group previously marginalised, adolescents and youths aged 15 - 24 years facing life-threatening illnesses in a pilot project in five districts. In 2011, HOSPAZ received an international award for best implementing partner for this project from Egmont Trust.
HOSPAZ brings with it a wealth of experience in Chronic Care programming including HIV for both adults and children and capacity development of member organisations to improve the quality of comprehensive care services offered at community, district and national level using home-based care as an entry point. Programming experience gained as SSR during implementation of the on-going Global Fund for AIDS, TB & Malaria (GFATM) Round 8, whose focus is on Care and Support for the Chronically Ill at Home, strengthened HOSPAZ and its partners’ skills in HIV prevention, treatment, care and support. The scope of activities of the programme includes, identifying and referring clients for TB screening, HIV Testing and Counselling (HTC), Prevention of Mother-to-Child Transmission of HIV (PMTCT), and Medical Male Circumcision (MC); Treatment literacy and Adherence support for individuals infected with either HIV or TB on ART and DOTS respectively including those with co-infection.
Capacity development to improve the quality of services by care providers in Zimbabwe is a core business for HOSPAZ. The organisation has managed to build the capacity of member organisations to provide basic home based care, palliative care, and psychosocial support (PSS) to children, adolescents, youth and adults. To support the provision of quality care within affected households, training has been provided on improving food security and livelihoods. Meanwhile, communities through their leadership have been empowered to support HIV prevention, treatment, and care services in their various geographic areas nationwide. HOSPAZ capacity development approach focuses on training both health professionals and civil society staff at district level, as well as mentoring and supporting them to cascade the training to respective community target groups to narrow the information gaps, foster programme ownership, and strengthen collaboration and the referral system within the continuum of care. HOSPAZ has provided training for health and other professionals at national and regional level.
In addition to developing IEC materials for use by communities, HOSPAZ spearheaded the development of various care standards and training manuals that have since been adopted by the Government of Zimbabwe as national guidelines. HOSPAZ has also influenced national health policies through the inclusion of palliative care into the National Health Strategy, National Cancer Strategy, National Palliative Care Policy and the National Palliative Care Curriculum for Zimbabwe. The organization has contributed articles and chapters in international journals, books and manuals and participated at international conferences.
In line with its strategic thrusts HOSPAZ values and achieves its objectives through partnerships and strategic alliances. Through working and collaborating with national partners and member organisations, HOSPAZ has been at the forefront of addressing community health and welfare needs through supporting community efforts and strengthening existing linkages between communities and government institutions to other service providers. HOSPAZ has successfully worked with government through line ministries such as Ministry of Health & Child Care Ministry of Education and Sport, Arts and Culture and Ministry of Labour’s Department of Social Services, Ministry of Agriculture, National AIDS Council as well as local Hospices and other palliative care service providers. Regionally and internationally it has enjoyed the support of organisations such as African Palliative Care Association; Help the Hospices, UNICEF, UNDP, WHO, JSI UK, WEI and REPSSI in terms of both technical and funding support.
Monitoring and evaluation of programs and projects is an integral function of HOSPAZ activities. M&E is implemented at project partner and community level according to established M&E systems, plans and project strategies. Guidelines on reporting and data collection, collation and analysis, are provided for programme level M&E and are complimented by training workshops for program and M&E staff. Data quality checks including verification of data at programme implementation level are conducted routinely and are integrated into the mentoring checklist. Mechanisms for data use and feedback are also included in the approach for decision making to improve programming. These are all housed under the performance monitoring plan (PMP). This function is designed to provide information on best practices, for sharing experiences among the stakeholders, beneficiaries and project implementers.
HOSPAZ has a strong financial background which has been built over the past 14 years through investments from DFID, JSI (UK), UNICEF, Egmont Trust, Global Fund and USAID through Futures International and World Education Incorporated. Through the above funding investments HOSPAZ has built a strong financial system that has been constantly evaluated by funding partners and annually audited by Deloitte & Touché. The organization has received clean audit reports since inception.