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Articles by Zambia

Illustration woman and nurse
22 July 2021

Rolling out self-managed contraceptive care to women and young people in Zambia

The COVID-19 pandemic has caused huge disruption and restrictions for individuals globally, and has been felt acutely with challenges to accessing sexual and reproductive healthcare. Yet, with challenges often come opportunities, and the pandemic has enabled a transformation in how we deliver health and contraceptive care – especially to women and girls who are among the most affected in times of crisis.   Adapting in a crisis to meet need  Like many of our Member Associations, Planned Parenthood Association of Zambia (PPAZ) acted swiftly in March 2020 to develop a new and efficient strategic approach to healthcare delivery for its clients. PPAZ introduced an initiative that, for the first time, offered self-managed contraceptive care to women and young people across the four districts of Choma, Livingstone, Lusaka, and Kitwe.   The PPAZ healthcare team identified eligible women to participate in the initiative through group counselling sessions on contraceptive methods (both hormonal and non-hormonal) via healthcare clinics and community outreach. The provision of accurate and easy-to-understand information on the types of contraceptive methods available gives women the knowledge and autonomy to make decisions about what method is right for them and their lifestyle.    Personal and convenient contraceptive care    Women who opted for oral contraceptives were provided with a six-month supply of Combined Oral Contraceptives (Microgynon, Zinnia-F), free-of-charge. Other women chose Sayana Press, which is the only self-administering contraception available in Zambia. They were trained on the correct technique for administering the dose (an injection in either the anterior thigh or abdomen), correct storage, and safe needle disposal. Effective for 12 weeks, the women were given a two-dose supply free-of-charge.    PPAZ healthcare teams trained 1,535 women on the Sayana Press method, and 3,070 doses of the contraceptive were provided. They also provided follow-up appointments with their clients over several months to ensure correct use and address any concerns.   Impressed with PPAZ’s presentation and discussion about how Sayana Press works and its benefits, 21-year-old Eunice Chikoti, chose the injectable because of its convenience. “They took time to explain how to self-inject and were very patient while doing so. They answered all my questions until I was satisfied,” she says. Despite her initial apprehension, Eunice was trained in how to self-inject safely and easily, “I thought it would be very difficult to self-inject, but once I followed the instructions of the nurse, I did so without any challenge,” she says. Eunice has a nine-month-old baby and hopes to have more children in the future.   Commitment to self-managed care   Due to the success of this strategy, which is not solely reliant on a healthcare provider, PPAZ plans to roll out the initiative to other districts across Zambia. This approach will ensure the most marginalized and low-resource settings are reached where access to healthcare and trained professionals is limited.  PPAZ’s initiative has gone a long way in advancing the rights of women and young girls to sexual and reproductive healthcare. Through self-management of their contraceptive needs, women and young girls are exercising their right to bodily autonomy and personal choice with confidence.  

チピリ・ムレムフウェさん。資金が途絶えるまで、IPPFザンビア(PPAZ)が実施するUSAIDオープンドア・プロジェクトのサービスデリバリー・マネージャーを務めていた

“We are losing precious time"

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. “When I lost my job as service delivery manager [at PPAZ USAID's Open Doors project], I felt like a part of me had died, I’m very passionate about this. I look forward to seeing a day where everybody will be free to access health services without stigma and discrimination, especially public health facilities. That’s what I’d like to see, [I] want to see integrated services, being provided to key populations, without stigma and discrimination, and fear of being arrested." The Global Gag Rule The reinstatement of the ‘Global Gag Rule’ resulted in the termination of Planned Parenthood Association of Zambia grant for the USAID Open Doors being terminated.  Chipili says “We didn’t expect its implementation to come with the termination of the grants suddenly. We thought that we were going to be given time, a year, one year to work and complete the project and hand over to the partner that was going to take over the responsibilities that Planned Parenthood Association of Zambia handled.” The termination of the project means progress that has been made, especially the work done to help reduce the number of HIV and STIs cases among the key populations will be undone. Progress, that is desperately needed to meet Zambia’s targets on HIV reduction. “We are losing precious time. We have got targets to meet as a nation, we need to ensure that by 2020 we reach the 90/90 goals, set by UNAIDS, and also the country has a broader vision of eliminating the threat of HIV, HIV as a public threat by 2030. So if we have such stumbling blocks, then the targets might not be met.  And then these key populations are also linked with the general population, we have men who sex with men, they also have partners, some of them are married, and if we don’t get into their networks, HIV and STIs will end up in the general population, therefore putting everybody at risk." Other impacts have been the increased vulnerability and the lost investment of peer promoters from the key populations and loss of safety and security that was provided by the organization.  Loss of safety and security “For safety and security, key populations cannot freely go to facilities they don’t know very well. The clinic setup was the most ideal set up for them. No one would question them, because this is open to everybody. But now what the project is doing, they are renting houses, the USAID is renting houses where they are providing services, so a house is very different from a clinic, that also affects the element of sustainability. The element of sustainability has also been lost because PPAZ has been here for a long time, since 1972, so we were hoping that the project was going to build the capacity for PPAZ to continue providing services to key populations that are free from stigma and discrimination. That has been lost. To me it’s a lost opportunity.” The Zambia National AIDS/HIV Strategic Framework for 2017 to 2021, bears a strong emphasis on leaving no one behind when it comes to stopping the HIV/AIDS epidemic. “No one should be left behind, if we are to reduce HIV infections to zero, if this is not done, the dream, the vision will not be achieved, we cannot afford to start pointing fingers, we have to use the public health approach and eliminate the risk of HIV infection amidst our people”.

Thomas, 34 years old, former PPAZ peer educator and counsellor

"The community really appreciated the services we were offering"

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. "My name is Thomas, I’m 34 years old. At PPAZ I worked as a peer educator and counsellor, I used to work on the outreach programmes in the community to offer access to health services like voluntary counselling and testing, we also used to sensitize women on the importance of family planning. We also used to refer women we would find had different problems, to the facilities so they can access health services. We also used to help by giving information on things like HIV prevention and signs and symptoms to look out for.  At other times, since the places were very far, we would take the services from the facilities to where the people were, so PPAZ used to help us do that.  I was at the clinic when they came to tell us that PPAZ would no longer be involved in the project because the funding had been stopped. It was a challenge for us because the services that people had become accustomed to in the communities, HIV counselling and testing services levels reduced because we couldn’t manage to go and take these services to them in the places where they live.  When we worked with PPAZ we used to put condoms in these places for them, in the bars and taverns, and even pool tables. Now that PPAZ is gone, the government cannot meet the supply of condoms needed in these places, even the services can’t be offered on the same scale. Unable to meet needs in rural areas Like you can see here, I look after my grandmother and other family members and that money [peer educators' allowance] used to go a long way in helping us look after our children and buy food, and other things. At the moment it is very difficult. Nyangwena is a very big place, it also includes 14 villages, so there are many people in this area. With the money that we were given through PPAZ, my friend and I would manage to get tyres for a bicycle and go to these places, we’d cycle distances as far as 14Km away. It was very helpful; the community really appreciated the services we were offering because we used to take them to the people. We would be very happy if PPAZ were to start them again because we would really help our communities a great deal with these services. Even school children would go and access them, at the youth-friendly corner twice a week. Information is really needed amongst these school children."

Joyce, HIV positive and PPAZ client

"If I hadn’t come at that time to get help I would have been seriously ill"

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. “My name is Joyce. I live in Sopoloyi with my grandmother. I tested positive for HIV, around November, but was doubtful about starting treatment. I stayed away for three months and came back in January, to retest, when they asked if I wanted to start treatment right away, I refused, because I wasn’t ready.  I told my sister what happened and explained that I had tested positive for HIV, so she advised me to go back and start treatment as soon as possible, because the longer I waited the more I was wasting away.   I returned to the clinic and I was given medication for two weeks. I was changed and put on another course for a month. I would go back every two weeks to get medication, then gradually I was given a course for two months. From the time I commenced treatment till now, there’s a clear difference, my body is slowly coming back to normal. I felt very safe, I was happy that they protected me, if I hadn’t come at that time to get help I would have been seriously ill, the medication wouldn’t have helped me at all, but now I have been on medication I feel much better and my body is also getting better. They are still giving me medication. They need to continue giving us the medicines and the information, because at least they tell us that once we start we are not supposed to skip any dose, even when you feel fit, you can’t stop because the virus multiplies everyday by a thousand, so the more you take your medication it keeps the virus levels low, so I would say they need to continue. All I am asking is that they don’t stop giving us this treatment because a lot of people will suffer or even die without these medicines.”

Image 1
06 August 2018

Decades of progress in sexual health care under threat in Zambia

For 50 years, the Planned Parenthood Association of Zambia (PPAZ) has provided sexual and reproductive health care, including contraception, safe abortion, HIV treatment.  Through their Open Doors and Zambia Community HIV Prevention Project (Z-CHPP), PPAZ has become a safe-haven to access integrated health care; particularly to the many who would not normally be able to seek health care without fear of discrimination, like men who have sex with men and sex workers. These services are critical in a country like Zambia where being LGBTI and sex work is against the law.  Yet, since the Global Gag Rule was reintroduced in January 2017, this vital care and support for local communities can no longer continue due to loss of funding. Since November many of PPAZ's services have already closed leaving communities with limited or no access to healthcare, and staff with no jobs. The Global Gag Rule impact Executive Director Joan N. Kamwale, based at the Lusaka clinic, was faced with breaking the news to her team that they would no longer have jobs, and to the many people they supported that they would no longer have access to PPAZ's safe space and quality of health care. “The 'stop order' came on the 17th of November 2017 and we closed on the 31st of December 2017. During the festive season, we were busy handing over everything. It was so depressing and very hectic not knowing where the next funds would come from and how to manage the situation with our clients. They already knew the clinic, so it was a very difficult time and moment for PPAZ to try and ensure our clients we would continue to provide the service”, explains Joan. “Now, in a week, we might see about maybe, 30 or less than 50 people, depending on those who come to the facility. Since now it is mandatory to test [for HIV], so we just rely on those who come to the facility. But before in a month we’d go to over 100, like 150 – 200 people, it was that high”, said Viness Kamulenge a physiotherapist and team leader at the Nyagwena clinic in Rufunsa.  Young people in Rufunsa that were part of the sexual health and adolescence programmes fear that there will be a rise in teenage pregnancies as they have already seen a reduction in attendance and engagement. “Now there is a gap in the information flow and I am seeing a lot of my friends falling back into risky behaviour. The gap needs to be addressed. I have learned a lot about teenage pregnancy and but now that there is no information it will be a problem”, says 18-year-old student, Precious.  Losing a safe place  Many communities actively sought out PPAZ's clinics because of their reputation as a safe place but now those that visit can’t even take a seat in the waiting area. The social network that promotes PPAZ's health care relies on a trusted chain of communication that ensures those wanting to access information, will be protected and most importantly not judged, especially among the LGBTI and sex work communities. With a lack of available healthcare there is already evidence of people 'hiding away'; afraid to go to the government-run institutions where they feel discriminated against. “I am a former sex worker and this project helped me bring some of my friends who need the services. It was important for me to let them know how important it is to know their status and keep them healthy. This place was a key population friendly clinic. Now they will have to go to places where they might not get the right attention”, said Maczoline, a former peer promotor on the Open Doors project.  Lovemore ‘Moses’ Lungu identifies as transgender, he joined the programme as a peer promoter after a friend told him about a place where he could get medical treatment without being judged. Inspired by his experience, he became a PPAZ peer promoter, encouraging other friends to seek health care.  “At other places, we are unable to talk about the conditions that we find ourselves in. It is embarrassing, and people judge you. At PPAZ I could explain my condition without anyone judging me. They just helped me get the medication. A lot of my friends who need help now have nowhere to go and they are staying away”, said Lungu.  Accessing treatment and care is vital for people living with HIV. Joyce has been living with HIV for two years and after initially struggling to accept her status received a treatment plan and support through PPAZ. “I felt very safe, I was happy that they protected me, if I hadn’t come at that time to get help I would have been seriously ill. From the time I commenced treatment till now, there’s a clear difference, my body is slowly coming back to normal. All I am asking is that they don’t stop giving us this treatment because a lot of people will suffer or even die without these medicines”, says Joyce.  A threat to progress PPAZ is now operating at less than half capacity. Having lost 46% of its funding, PPAZ is looking to source funding from elsewhere. Partnering with the government has brought some relief with assistance being given for medical resources. The effects are evident and real and if not addressed immediately threaten to reverse decades of progress made in combating and mitigating some of the country’s vital sexual health care provision.  “We were told of the Gag Rule but we didn’t expect for it to be done immediately. It came abruptly. There is usually a period for notice but there was no notice. We had 26 staff on site and at the head office, almost everyone was let go. The sad part is the increase in the disease burden. If they [key populations] are not accessing services that are stigma-free and discrimination-free, the disease burden, among the key population will increase", says former PPAZ Service Delivery Manager, Chipili Mulemfwe. 

Photo of ACT!2030 young activists
07 February 2017

ACT!2030

IPPF collaborates with UNAIDS and The PACT to implement ACT!2030 (formerly ACT!2015), a youth-led social action initiative which engages young people in 12 countries with advocacy and accountability around the Sustainable Development Goals (SDGs) and other SRHR agreements/frameworks. ACT!2030 was initiated in 2013 as a way to increase youth participation in the negotiations leading up to the adoption of the post-2015 development agenda, and for two years focused on establishing alliances of youth-led and youth-serving organisations in 12 countries across the world. The project is currently in Phase 4, which runs until the end of 2017, and aims to establish youth-led, data-driven accountability mechanisms to ensure youth engagement with the implementation of the SDGs and build an evidence base for advocacy. Ultimately, Phase 4 of ACT!2030 seeks to identify, assess and address key policy barriers to young people’s sexual and reproductive data by using existing data, supplemented by youth-collected data, to advocate and lobby for policy change. This phase involves four main activities: indicator advocacy (persuading decision makers to adopt youth-friendly SRHR and HIV indicators, including on things like comprehensive sexuality education (CSE) and access to youth-friendly services, into national/global reporting mechanisms); evidence gathering (creating national databases on quality of and access to youth-friendly services and CSE); communications (transforming this data and evidence into communications pieces that can be used to advocacy and lobby at national and international level); and global exchange (facilitating global visibility to share advocacy and engagement learnings and increase youth-led accountability in global and regional processes). ACT!2030 is implemented by national alliances of youth organisations in 12 countries: Algeria, Bulgaria, India, Jamaica, Kenya, Mexico, Nigeria, Philippines, South Africa, Uganda, Zambia and Zimbabwe.  

 Edford Mutuma, former Executive Director of the Planned Parenthood Association of Zambia

Tribute to former Zambian Executive Director

The IPPF family mourns the passing of Edford Mutuma, the former Executive Director of the Planned Parenthood Association of Zambia (PPAZ). Edford was recognised as an advocate and leader in the field of sexual and reproductive health (SRH) both at national and international level. Edford started his engagement as a young volunteer for PPAZ and grew to become the first president of the Africa Youth and Adolescent Network on Population and Development (AfriYAN). At the same time he served as the Executive Director of Youth Vision Zambia and then joined PPAZ as Director of Programmes and Executive Director. Edford often represented IPPF in high-level meetings and for several years he represented his country at the Commission of Population and Development. After almost eight years with PPAZ, Edford had recently become the Country Director of Ipas Zambia. Edford had been recognised as one of 25 emerging or mature global leaders in the field of HIV and AIDS prevention by UNAIDS, UNDP, WHO et al, through the St. George’s House Windsor Castle Leadership Initiative on HIV/AIDS. The IPPF family will deeply miss Edford and his energy, commitment and dedication to support the sexual and reproductive health and rights of young people in Zambia and around the world.

Planned Parenthood Association of Zambia

The Planned Parenthood Association of Zambia (PPAZ) was created in 1972. Then, it was dedicated to the promotion of family planning services. Over the years, it has evolved into a major service provider and advocacy body, with significant input into government policy on sexual and reproductive health (SRH) issues.

Services offered include family planning, voluntary counselling and testing (VCT) for HIV, the treatment of sexually transmitted infections (STIs), antenatal and post-natal care, emergency contraceptive provision, laboratory tests, and screening. PPAZ refers clients on for additional services including prevention of mother-to-child transmission (PMTCT), antiretroviral treatment and home-based care.

The organization operates 3 static clinics, 11 mobile units and 10 community-based services (CBSs). It has a full-time staff of 34, backed by 1,300 volunteers which include over 200 community-based distributors (CBDs) and 398 peer educators. In total, PPAZ runs 229 service points.

PPAZ places a strong emphasis on HIV and AIDS prevention and treatment: as the statistics show, HIV prevalence rates are exceptionally high in Zambia. PPAZ has worked intensively on integrating gender and empowerment perspectives into HIV prevention. It has undertaken behaviour change communication projects directed at young people, both in and out of school settings, and it’s taken similar projects out to rural communities. 

PPAZ partners extensively with non-governmental organizations (NGOs), particularly those involved in youth and HIV and AIDS work. It receives financial support from Care international, UNICEF, the Japanese Organisation for Cooperation in Family Planning (JOICEP), Forum RFSU and IPPF’s Japan Trust Fund

 

Illustration woman and nurse
22 July 2021

Rolling out self-managed contraceptive care to women and young people in Zambia

The COVID-19 pandemic has caused huge disruption and restrictions for individuals globally, and has been felt acutely with challenges to accessing sexual and reproductive healthcare. Yet, with challenges often come opportunities, and the pandemic has enabled a transformation in how we deliver health and contraceptive care – especially to women and girls who are among the most affected in times of crisis.   Adapting in a crisis to meet need  Like many of our Member Associations, Planned Parenthood Association of Zambia (PPAZ) acted swiftly in March 2020 to develop a new and efficient strategic approach to healthcare delivery for its clients. PPAZ introduced an initiative that, for the first time, offered self-managed contraceptive care to women and young people across the four districts of Choma, Livingstone, Lusaka, and Kitwe.   The PPAZ healthcare team identified eligible women to participate in the initiative through group counselling sessions on contraceptive methods (both hormonal and non-hormonal) via healthcare clinics and community outreach. The provision of accurate and easy-to-understand information on the types of contraceptive methods available gives women the knowledge and autonomy to make decisions about what method is right for them and their lifestyle.    Personal and convenient contraceptive care    Women who opted for oral contraceptives were provided with a six-month supply of Combined Oral Contraceptives (Microgynon, Zinnia-F), free-of-charge. Other women chose Sayana Press, which is the only self-administering contraception available in Zambia. They were trained on the correct technique for administering the dose (an injection in either the anterior thigh or abdomen), correct storage, and safe needle disposal. Effective for 12 weeks, the women were given a two-dose supply free-of-charge.    PPAZ healthcare teams trained 1,535 women on the Sayana Press method, and 3,070 doses of the contraceptive were provided. They also provided follow-up appointments with their clients over several months to ensure correct use and address any concerns.   Impressed with PPAZ’s presentation and discussion about how Sayana Press works and its benefits, 21-year-old Eunice Chikoti, chose the injectable because of its convenience. “They took time to explain how to self-inject and were very patient while doing so. They answered all my questions until I was satisfied,” she says. Despite her initial apprehension, Eunice was trained in how to self-inject safely and easily, “I thought it would be very difficult to self-inject, but once I followed the instructions of the nurse, I did so without any challenge,” she says. Eunice has a nine-month-old baby and hopes to have more children in the future.   Commitment to self-managed care   Due to the success of this strategy, which is not solely reliant on a healthcare provider, PPAZ plans to roll out the initiative to other districts across Zambia. This approach will ensure the most marginalized and low-resource settings are reached where access to healthcare and trained professionals is limited.  PPAZ’s initiative has gone a long way in advancing the rights of women and young girls to sexual and reproductive healthcare. Through self-management of their contraceptive needs, women and young girls are exercising their right to bodily autonomy and personal choice with confidence.  

チピリ・ムレムフウェさん。資金が途絶えるまで、IPPFザンビア(PPAZ)が実施するUSAIDオープンドア・プロジェクトのサービスデリバリー・マネージャーを務めていた

“We are losing precious time"

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. “When I lost my job as service delivery manager [at PPAZ USAID's Open Doors project], I felt like a part of me had died, I’m very passionate about this. I look forward to seeing a day where everybody will be free to access health services without stigma and discrimination, especially public health facilities. That’s what I’d like to see, [I] want to see integrated services, being provided to key populations, without stigma and discrimination, and fear of being arrested." The Global Gag Rule The reinstatement of the ‘Global Gag Rule’ resulted in the termination of Planned Parenthood Association of Zambia grant for the USAID Open Doors being terminated.  Chipili says “We didn’t expect its implementation to come with the termination of the grants suddenly. We thought that we were going to be given time, a year, one year to work and complete the project and hand over to the partner that was going to take over the responsibilities that Planned Parenthood Association of Zambia handled.” The termination of the project means progress that has been made, especially the work done to help reduce the number of HIV and STIs cases among the key populations will be undone. Progress, that is desperately needed to meet Zambia’s targets on HIV reduction. “We are losing precious time. We have got targets to meet as a nation, we need to ensure that by 2020 we reach the 90/90 goals, set by UNAIDS, and also the country has a broader vision of eliminating the threat of HIV, HIV as a public threat by 2030. So if we have such stumbling blocks, then the targets might not be met.  And then these key populations are also linked with the general population, we have men who sex with men, they also have partners, some of them are married, and if we don’t get into their networks, HIV and STIs will end up in the general population, therefore putting everybody at risk." Other impacts have been the increased vulnerability and the lost investment of peer promoters from the key populations and loss of safety and security that was provided by the organization.  Loss of safety and security “For safety and security, key populations cannot freely go to facilities they don’t know very well. The clinic setup was the most ideal set up for them. No one would question them, because this is open to everybody. But now what the project is doing, they are renting houses, the USAID is renting houses where they are providing services, so a house is very different from a clinic, that also affects the element of sustainability. The element of sustainability has also been lost because PPAZ has been here for a long time, since 1972, so we were hoping that the project was going to build the capacity for PPAZ to continue providing services to key populations that are free from stigma and discrimination. That has been lost. To me it’s a lost opportunity.” The Zambia National AIDS/HIV Strategic Framework for 2017 to 2021, bears a strong emphasis on leaving no one behind when it comes to stopping the HIV/AIDS epidemic. “No one should be left behind, if we are to reduce HIV infections to zero, if this is not done, the dream, the vision will not be achieved, we cannot afford to start pointing fingers, we have to use the public health approach and eliminate the risk of HIV infection amidst our people”.

Thomas, 34 years old, former PPAZ peer educator and counsellor

"The community really appreciated the services we were offering"

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. "My name is Thomas, I’m 34 years old. At PPAZ I worked as a peer educator and counsellor, I used to work on the outreach programmes in the community to offer access to health services like voluntary counselling and testing, we also used to sensitize women on the importance of family planning. We also used to refer women we would find had different problems, to the facilities so they can access health services. We also used to help by giving information on things like HIV prevention and signs and symptoms to look out for.  At other times, since the places were very far, we would take the services from the facilities to where the people were, so PPAZ used to help us do that.  I was at the clinic when they came to tell us that PPAZ would no longer be involved in the project because the funding had been stopped. It was a challenge for us because the services that people had become accustomed to in the communities, HIV counselling and testing services levels reduced because we couldn’t manage to go and take these services to them in the places where they live.  When we worked with PPAZ we used to put condoms in these places for them, in the bars and taverns, and even pool tables. Now that PPAZ is gone, the government cannot meet the supply of condoms needed in these places, even the services can’t be offered on the same scale. Unable to meet needs in rural areas Like you can see here, I look after my grandmother and other family members and that money [peer educators' allowance] used to go a long way in helping us look after our children and buy food, and other things. At the moment it is very difficult. Nyangwena is a very big place, it also includes 14 villages, so there are many people in this area. With the money that we were given through PPAZ, my friend and I would manage to get tyres for a bicycle and go to these places, we’d cycle distances as far as 14Km away. It was very helpful; the community really appreciated the services we were offering because we used to take them to the people. We would be very happy if PPAZ were to start them again because we would really help our communities a great deal with these services. Even school children would go and access them, at the youth-friendly corner twice a week. Information is really needed amongst these school children."

Joyce, HIV positive and PPAZ client

"If I hadn’t come at that time to get help I would have been seriously ill"

In November 2017,  Planned Parenthood Association of Zambia (PPAZ) received the news that they must cease all USAID funded programmes. The stop order was a result of the 'Global Gag Rule' (GGR), also referred to as the Mexico City Policy. The reinstatement of the policy has resulted in Planned Parenthood Association of Zambia losing 46% of its funding. You can learn more about the Global Gag Rule here. “My name is Joyce. I live in Sopoloyi with my grandmother. I tested positive for HIV, around November, but was doubtful about starting treatment. I stayed away for three months and came back in January, to retest, when they asked if I wanted to start treatment right away, I refused, because I wasn’t ready.  I told my sister what happened and explained that I had tested positive for HIV, so she advised me to go back and start treatment as soon as possible, because the longer I waited the more I was wasting away.   I returned to the clinic and I was given medication for two weeks. I was changed and put on another course for a month. I would go back every two weeks to get medication, then gradually I was given a course for two months. From the time I commenced treatment till now, there’s a clear difference, my body is slowly coming back to normal. I felt very safe, I was happy that they protected me, if I hadn’t come at that time to get help I would have been seriously ill, the medication wouldn’t have helped me at all, but now I have been on medication I feel much better and my body is also getting better. They are still giving me medication. They need to continue giving us the medicines and the information, because at least they tell us that once we start we are not supposed to skip any dose, even when you feel fit, you can’t stop because the virus multiplies everyday by a thousand, so the more you take your medication it keeps the virus levels low, so I would say they need to continue. All I am asking is that they don’t stop giving us this treatment because a lot of people will suffer or even die without these medicines.”

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06 August 2018

Decades of progress in sexual health care under threat in Zambia

For 50 years, the Planned Parenthood Association of Zambia (PPAZ) has provided sexual and reproductive health care, including contraception, safe abortion, HIV treatment.  Through their Open Doors and Zambia Community HIV Prevention Project (Z-CHPP), PPAZ has become a safe-haven to access integrated health care; particularly to the many who would not normally be able to seek health care without fear of discrimination, like men who have sex with men and sex workers. These services are critical in a country like Zambia where being LGBTI and sex work is against the law.  Yet, since the Global Gag Rule was reintroduced in January 2017, this vital care and support for local communities can no longer continue due to loss of funding. Since November many of PPAZ's services have already closed leaving communities with limited or no access to healthcare, and staff with no jobs. The Global Gag Rule impact Executive Director Joan N. Kamwale, based at the Lusaka clinic, was faced with breaking the news to her team that they would no longer have jobs, and to the many people they supported that they would no longer have access to PPAZ's safe space and quality of health care. “The 'stop order' came on the 17th of November 2017 and we closed on the 31st of December 2017. During the festive season, we were busy handing over everything. It was so depressing and very hectic not knowing where the next funds would come from and how to manage the situation with our clients. They already knew the clinic, so it was a very difficult time and moment for PPAZ to try and ensure our clients we would continue to provide the service”, explains Joan. “Now, in a week, we might see about maybe, 30 or less than 50 people, depending on those who come to the facility. Since now it is mandatory to test [for HIV], so we just rely on those who come to the facility. But before in a month we’d go to over 100, like 150 – 200 people, it was that high”, said Viness Kamulenge a physiotherapist and team leader at the Nyagwena clinic in Rufunsa.  Young people in Rufunsa that were part of the sexual health and adolescence programmes fear that there will be a rise in teenage pregnancies as they have already seen a reduction in attendance and engagement. “Now there is a gap in the information flow and I am seeing a lot of my friends falling back into risky behaviour. The gap needs to be addressed. I have learned a lot about teenage pregnancy and but now that there is no information it will be a problem”, says 18-year-old student, Precious.  Losing a safe place  Many communities actively sought out PPAZ's clinics because of their reputation as a safe place but now those that visit can’t even take a seat in the waiting area. The social network that promotes PPAZ's health care relies on a trusted chain of communication that ensures those wanting to access information, will be protected and most importantly not judged, especially among the LGBTI and sex work communities. With a lack of available healthcare there is already evidence of people 'hiding away'; afraid to go to the government-run institutions where they feel discriminated against. “I am a former sex worker and this project helped me bring some of my friends who need the services. It was important for me to let them know how important it is to know their status and keep them healthy. This place was a key population friendly clinic. Now they will have to go to places where they might not get the right attention”, said Maczoline, a former peer promotor on the Open Doors project.  Lovemore ‘Moses’ Lungu identifies as transgender, he joined the programme as a peer promoter after a friend told him about a place where he could get medical treatment without being judged. Inspired by his experience, he became a PPAZ peer promoter, encouraging other friends to seek health care.  “At other places, we are unable to talk about the conditions that we find ourselves in. It is embarrassing, and people judge you. At PPAZ I could explain my condition without anyone judging me. They just helped me get the medication. A lot of my friends who need help now have nowhere to go and they are staying away”, said Lungu.  Accessing treatment and care is vital for people living with HIV. Joyce has been living with HIV for two years and after initially struggling to accept her status received a treatment plan and support through PPAZ. “I felt very safe, I was happy that they protected me, if I hadn’t come at that time to get help I would have been seriously ill. From the time I commenced treatment till now, there’s a clear difference, my body is slowly coming back to normal. All I am asking is that they don’t stop giving us this treatment because a lot of people will suffer or even die without these medicines”, says Joyce.  A threat to progress PPAZ is now operating at less than half capacity. Having lost 46% of its funding, PPAZ is looking to source funding from elsewhere. Partnering with the government has brought some relief with assistance being given for medical resources. The effects are evident and real and if not addressed immediately threaten to reverse decades of progress made in combating and mitigating some of the country’s vital sexual health care provision.  “We were told of the Gag Rule but we didn’t expect for it to be done immediately. It came abruptly. There is usually a period for notice but there was no notice. We had 26 staff on site and at the head office, almost everyone was let go. The sad part is the increase in the disease burden. If they [key populations] are not accessing services that are stigma-free and discrimination-free, the disease burden, among the key population will increase", says former PPAZ Service Delivery Manager, Chipili Mulemfwe. 

Photo of ACT!2030 young activists
07 February 2017

ACT!2030

IPPF collaborates with UNAIDS and The PACT to implement ACT!2030 (formerly ACT!2015), a youth-led social action initiative which engages young people in 12 countries with advocacy and accountability around the Sustainable Development Goals (SDGs) and other SRHR agreements/frameworks. ACT!2030 was initiated in 2013 as a way to increase youth participation in the negotiations leading up to the adoption of the post-2015 development agenda, and for two years focused on establishing alliances of youth-led and youth-serving organisations in 12 countries across the world. The project is currently in Phase 4, which runs until the end of 2017, and aims to establish youth-led, data-driven accountability mechanisms to ensure youth engagement with the implementation of the SDGs and build an evidence base for advocacy. Ultimately, Phase 4 of ACT!2030 seeks to identify, assess and address key policy barriers to young people’s sexual and reproductive data by using existing data, supplemented by youth-collected data, to advocate and lobby for policy change. This phase involves four main activities: indicator advocacy (persuading decision makers to adopt youth-friendly SRHR and HIV indicators, including on things like comprehensive sexuality education (CSE) and access to youth-friendly services, into national/global reporting mechanisms); evidence gathering (creating national databases on quality of and access to youth-friendly services and CSE); communications (transforming this data and evidence into communications pieces that can be used to advocacy and lobby at national and international level); and global exchange (facilitating global visibility to share advocacy and engagement learnings and increase youth-led accountability in global and regional processes). ACT!2030 is implemented by national alliances of youth organisations in 12 countries: Algeria, Bulgaria, India, Jamaica, Kenya, Mexico, Nigeria, Philippines, South Africa, Uganda, Zambia and Zimbabwe.  

 Edford Mutuma, former Executive Director of the Planned Parenthood Association of Zambia

Tribute to former Zambian Executive Director

The IPPF family mourns the passing of Edford Mutuma, the former Executive Director of the Planned Parenthood Association of Zambia (PPAZ). Edford was recognised as an advocate and leader in the field of sexual and reproductive health (SRH) both at national and international level. Edford started his engagement as a young volunteer for PPAZ and grew to become the first president of the Africa Youth and Adolescent Network on Population and Development (AfriYAN). At the same time he served as the Executive Director of Youth Vision Zambia and then joined PPAZ as Director of Programmes and Executive Director. Edford often represented IPPF in high-level meetings and for several years he represented his country at the Commission of Population and Development. After almost eight years with PPAZ, Edford had recently become the Country Director of Ipas Zambia. Edford had been recognised as one of 25 emerging or mature global leaders in the field of HIV and AIDS prevention by UNAIDS, UNDP, WHO et al, through the St. George’s House Windsor Castle Leadership Initiative on HIV/AIDS. The IPPF family will deeply miss Edford and his energy, commitment and dedication to support the sexual and reproductive health and rights of young people in Zambia and around the world.

Planned Parenthood Association of Zambia

The Planned Parenthood Association of Zambia (PPAZ) was created in 1972. Then, it was dedicated to the promotion of family planning services. Over the years, it has evolved into a major service provider and advocacy body, with significant input into government policy on sexual and reproductive health (SRH) issues.

Services offered include family planning, voluntary counselling and testing (VCT) for HIV, the treatment of sexually transmitted infections (STIs), antenatal and post-natal care, emergency contraceptive provision, laboratory tests, and screening. PPAZ refers clients on for additional services including prevention of mother-to-child transmission (PMTCT), antiretroviral treatment and home-based care.

The organization operates 3 static clinics, 11 mobile units and 10 community-based services (CBSs). It has a full-time staff of 34, backed by 1,300 volunteers which include over 200 community-based distributors (CBDs) and 398 peer educators. In total, PPAZ runs 229 service points.

PPAZ places a strong emphasis on HIV and AIDS prevention and treatment: as the statistics show, HIV prevalence rates are exceptionally high in Zambia. PPAZ has worked intensively on integrating gender and empowerment perspectives into HIV prevention. It has undertaken behaviour change communication projects directed at young people, both in and out of school settings, and it’s taken similar projects out to rural communities. 

PPAZ partners extensively with non-governmental organizations (NGOs), particularly those involved in youth and HIV and AIDS work. It receives financial support from Care international, UNICEF, the Japanese Organisation for Cooperation in Family Planning (JOICEP), Forum RFSU and IPPF’s Japan Trust Fund