Factors that impact on the capacity of district aids task forces to coordinate sustainable decentralized hiv/aids services in Zambia: the case of Lusaka daft

Abstract

Introduction According (UNAIDS/WHO, 2011a) globally, 34.0 million [31.4 million–35.9 million] people were living with HIV at the end of 2011 out of which 80% live in Sub Saharan Africa. In absolute terms, the burden of HIV increased by 354% between 1990 and 2006 (Ortblad et al, 2010). The prevalence of HIV in Zambia stands at 14.3% in the age group 15 to 49 years. Having realized that HIV/AIDS is no longer a health issue alone Zambia embarked on the multisectoral response initiative which allows many stakeholders to play their role. In order to coordinate this multiplicity of stakeholders the government of Zambia created the National HIV/AIDS/STI/TB Council (NAC) with the core mandate to coordinate the national HIV/AIDS response agenda. In turn, the NAC created the Provincial (PATF) and District AIDS Task Forces (DATF) as decentralized structures through which to coordinate the response at provincial and district levels respectively. However, DAFT is not coordinating the response to HIV/AIDS epidemic effectively but the reason for the ineffective coordination has not yet been described. Aim The aim of the study is to explore factors which impact on the capacity of Lusaka DATF to coordinate an effective and sustainable local HIV/AIDS response. Methods A descriptive qualitative research was undertaken using purposive sampling methods. Data collection methods included a Document Review, Key Informant Interviews using semi structured interview guides, Focus Group Discussions and Field Notes. Results The study has found that the following factors promote effective coordination of DATF stakeholders and their activities at local level: recognition of the DATF by stakeholders as a formal structure which is enshrined within the institutional framework of the government; joint planning and resource mobilisation for activities by stakeholders particularly around national commemoration days such as World AIDS Day and the National VCT day and holding of stakeholder forum meetings to share experiences and lessons learnt. The study has also established that the following factors are responsible for preventing the DATF from coordinating effectively include: DATF does not exist as a legal entity enshrined in any Act of Parliament No. 10 of 2002 which created the NAC; there are multiple reporting channels for local stakeholders instead of having only one reporting framework through the DFATF; inadequate stakeholder forums; lack of memoranda of understanding between the DATF and stakeholders; weak technical capacity of the DACA due to factors such as lack of a training programme; inadequate joint planning and resource mobilisation plans and efforts; poor understanding and different interpretations of the of the concept of coordination by different stakeholders; weak feedback mechanisms from the DATF secretariat to stakeholders; and multiplicity of DATF guidelines by different partners which have at times contradicted each other. Poor political, civic and technical leadership engagement has been identified as key inhibiting factors.