Peer-reviewed article
Understanding stakeholder perspectives on integrating and sustaining a vertical HIV prevention programme into routine health services in Zimbabwe: a qualitative study.
Amanda Marr Chung, Joseph Murungu, Peter Case, Precious Chitapi, Rudo Chikodzore et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study examines stakeholder perspectives on integrating Zimbabwe's donor-funded voluntary medical male circumcision (VMMC) HIV prevention programme into routine government health services. Researchers conducted 54 interviews with national and subnational leaders, managers, healthcare providers, and community members to identify barriers and facilitators to this transition. Key barriers included financing constraints, staff shortages, resistance to operational changes, and concerns about job security, while successful integration requires addressing both psychological and structural obstacles and increasing government autonomy from donors.
Key points
- Financing and staffing were major barriers, including lack of domestic resources and staff attrition during the transition from fee-for-service to facility-based performance models
- Psychological barriers such as loss of power and job security among providers created resistance to programme changes
- Donors and implementing partners retained control of VMMC funding, limiting government autonomy and ownership
- Healthcare providers had valid concerns about financial security and increased responsibilities without adequate compensation
- Decentralisation of governance at subnational level presented opportunities for increased local ownership and responsibility
Limitations
This qualitative study captures stakeholder perspectives but does not measure actual implementation outcomes or programme effectiveness. The findings reflect views at a specific point in the transition process and may not generalise to other contexts or health programmes.
Abstract
INTRODUCTION: The transition of voluntary medical male circumcision (VMMC), an HIV prevention service, in Zimbabwe from a donor-funded to a government-owned programme involves the collective efforts and alignment of national and subnational government leaders, managers, healthcare providers, village health workers, community members, donors and implementing partners. We sought to understand stakeholders' perspectives on barriers, facilitators and recommendations as a vertical HIV prevention programme transitioned to an integrated, government-led model. METHODS: We conducted 54 semistructured stakeholder interviews at the national and subnational levels. Interviews were audio recorded, transcribed and thematically analysed. RESULTS: Participants highlighted a range of psychological and structural barriers and facilitators to integrating and sustaining the VMMC programme. Respondents mentioned financing and staffing barriers to integration, particularly a lack of domestic resources, the transition from a fee-for-service to a facility-based performance model and staff attrition. Notably, resistance to changing the VMMC programme's operations was a significant barrier that may be tied to individual psychological barriers such as loss of power and job security. Donors and partners continued to control the funding for VMMC. Ideally, the Ministry of Health and Child Care should have more autonomy over these decisions. At the subnational level, there is an opportunity for increased responsibility and a greater sense of ownership through the decentralisation of governance. CONCLUSIONS: To ensure successful integration and local ownership of VMMC as an HIV prevention programme, stakeholders must address both psychological and structural barriers while aligning their perspectives on the transition. Individual providers have valid concerns about their financial security and the burden of additional responsibilities without adequate compensation. It is crucial for donors and partners to reduce their involvement and oversight. Additionally, resolving the financial barriers that prevent the government from having complete control of the programme will require empowering local government stakeholders to fully take ownership.