Unesco Health Facility Assessment O3 Zimbabwe_Report_A4

Our Rights, Our
Lives, Our Future
(O3 )PLUS Project

Higher and Tertiary Education Institutions
Health Facility Assessment Report, Zimbabwe

APRIL 2021

UNESCO Regional Office for Southern Africa
8 Kenilworth Road, Newlands
PO Box HG 435 Highlands, Harare, Zimbabwe

© 2021 by UNESCO

This publication is available in Open Access under the Attribution-ShareAlike 3.0 IGO (CC-BY-SA 3.0 IGO) license (http://creativecommons.
org/licenses/by-sa/3.0/igo/). By using the content of this publication, the users accept to be bound by the terms of use of the UNESCO Open
Access Repository (http://www.unesco.org/open-access/terms-use-ccbysa-en). The present license applies exclusively to the text content of
the publication. For the use of any material not clearly identified as belonging to UNESCO, prior permission shall be requested.

Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect
the views of UNESCO.

Author: Muthengo Development Solutions

Design and layout: Marike Strydom, Jade Rose Graphic Design

Cover photo: © stock.adobe.com

Contents 03
05
Acronyms 06
12
Acknowledgements 15
16
Executive summary 16
16
1. Project description 18
19
2. Objectives and research questions 19
21
3. Methodology 24
3.1 Approach 34
3.2 Methodology 38
3.3 Limitations
42
4. Findings
4.1 Operating environment for health education and health service delivery in HTEIs 43
4.2 Health education interventions
4.3 Health services delivery 50

5. Conclusion and recommendations 52

Appendix 1: 54
Information, Education and Communication (IEC) & services and services availability
17
Appendix 2: 20
Health facilities characteristics 22
25
Appendix 3: 26
Terms of reference: Health Facility Assessments 29
30
Appendix 4: 31
2021 Student enrolments for the O3 PLUS project HTEIs
01
Appendix 5:
List of stakeholders consulted

Appendix 6:
Interview guides for key informant interviews, in-depth cases studies and focus group discussions

List of tables

Table 1: Distribution of respondents for the assessment
Table 2: Student health insurance schemes
Table 3: Health education interventions
Table 4: Availability of iec materials
Table 5: Availability of the required package of services
Table 6: Categories of staff available
Table 7: Health service provider competences
Table 8: Health facilities characteristics

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Acronyms

AIDS Acquired Immune Deficiency Syndrome
ASRH Adolescent Sexual and Reproductive Health
AYFHS Adolescent and Youth-friendly Services
CAPI Computer Assisted Personal Interview
CSE Comprehensive Sexuality Education
CSOs Civil Society Organizations
CUT Chinhoyi University of Technology
DAAC District AIDS Action Committees
DITC Danhiko Industrial Training Centre
ESA Eastern and Southern Africa
FGDs Focus Group Discussions
GZU Great Zimbabwe University
HEXCO Higher Education Examination Council
HIV Human Immune-deficiency Virus
HTEIs Higher and Tertiary Education Institutions
HTS HIV Testing Services
ICSs In-depth Case Studies
IEC Information, Education and Communication
KIIs Key Informant Interviews
LGBTQ Lesbian, Gay, Bisexual, Transgender and Queer
MITC Mupfure Industrial Training Centre
MoHCC Ministry of Health and Child Care
MoHTEISTD Ministry of Higher & Tertiary Education, Innovation, Science and Technology Development
MRCZ Medical Research Council of Zimbabwe
MSUAS Manicaland State University of Applied Sciences
NAC National AIDS Council
NUST National University of Science and Technology
PAAC Provincial AIDS Action Committees
PSC Public Service Commission
PSI Population Services International
PSMI Premier Services Medical Investments
SAYWHAT Students and Youth Working on Reproductive Health Action Team
SDC Swiss Agency for Development and Cooperation
SDGs Sustainable Development Goals
SGBV Sexual and Gender-based Violence
SRC Students Representative Council
SRHR Sexual and Reproductive Health and Rights
STIs Sexually Transmitted Infections
ToR Terms of Reference
VMMC Voluntary Medical Male Circumcision
WHO World Health Organization
WITC Westgate Industrial Training Centre
YFHS Youth-friendly Heath Services
YFSP Youth-friendly Service Provision
UNAIDS Joint United Nations Programme on HIV/AIDS
UNESCO United Nations Educational, Scientific and Cultural Organization
UZ University of Zimbabwe
ZNFPC Zimbabwe Family Planning Council

03

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Acknowledgements

The health facility assessment was
commissioned by the United Nations
Educational, Scientific and Cultural
Organization (UNESCO).

The assessment team would like to express gratitude to the
UNESCO staff for the technical guidance. The support from
the Ministry of Higher and Tertiary Education, Innovation,
Science and Technology Development, The Vice Chancellors
and Principals of the assessed Higher and Tertiary Education
Institutions (HTEIs) deserves special recognition. The team
would like to recognize and appreciate all those who
participated in the assessment: key informant interviews,
focus group discussions and in-depth interviews. We give a
special thanks to the youthful research assistants (Nyasha
Madzingira, Sandra Muzambe, Tinashe Mlambo and Leaveus
Tonderai Munamati) for dedicating their expertise and time
towards the assessment; community members that took
time out of their busy schedules to speak to us and provide
valuable information that has informed this report. We thank
Muthengo Development Solutions for taking and providing
photographs in this report. The views and opinions expressed
in this report are those of the independent consultants and do
not represent UNESCO’s position.

Assessment team

Aveneni Mangombe (National Consultant) and
Ashley Ngwenya (Lead Research Assistant)

05

Executive summary

Introduction Findings

Zimbabwe has continued to strengthen its Higher and Operating environment: This assessment established that
Tertiary Education (HTE) system since independence in Comprehensive Sexuality Education (CSE) and provision of
1980. This has been characterized by an expansion of the Youth-friendly Health Services (YFHS) in HTEIs is currently
system from 1 state university to 13 state universities, 7 being guided mainly by the National Adolescent & Youth
private universities, 13 polytechnics, 13 teachers’ colleges, Sexual and Reproductive Health Strategy II: 2016 – 2020 and
43 vocational training centres and 16 quasi-government the 2016 National Guidelines on Provision of Clinical Sexual and
and independent research institutions by 2018. As such, in Reproductive Health Services. These two strategic documents
recent years, student enrolments in public Higher and Tertiary provide the key intervention strategies and a minimum Sexual
Education Institutions (HTEIs) in Zimbabwe have also gradually and Reproductive Health (SRH) service package for the HTEI
increased. For example, the HTEIs enrolments increased from settings for students. Their development processes also drew
18809 (68% females) in 2013 to 31471 (68% females) in 20181. lessons from the 2015 global review of CSE and the Global
However, the 2021 enrolments in the 12 HTEIs being covered Standards on Provision of Quality Services for Adolescents
under this assessment show male dominated enrolments in and Young People. At national level, both documents define
most of the HTEIs except Great Zimbabwe University (GZU) key adolescent and young people’s groups, defining the
and Danhiko Industrial Training Centre (DITC). These students, four settings and approaches through which young people
especially young people (18 – 24 years) face a myriad of can be reached with information and integrated sexual
challenges and risks as they navigate new responsibilities, and reproductive health and HIV services. These provisions
relationships, and experiences on their own and in unfamiliar are in line with other key strategic documents such as the
settings. In Zimbabwe, UNESCO would like to implement the Zimbabwe National AIDS Strategic Plan III, the National
“Our Rights, Our Lives, Our Future” (O3 )PLUS project across 12 Youth Policy the National Health Strategy, and the National
HTEIs from January 2021 to December 2024. The O3 PLUS project Reproductive Health, Maternal, Newborn, Child & Adolescent
seeks to ensure that young people in HTEIs realize positive Health and Nutrition Strategy. All the assessed HTEIs need to
health, education, and gender equality outcomes through be commended for having institutional sexual harassment
sustained reductions in new HIV infections, unintended and HIV/AIDS policies which have been popularized fully
pregnancy and sexual and gender-based violence. A health to the students. The harmonization processes for the sexual
facility assessment was therefore commissioned by UNESCO harassment policies through the public service commission
to provide comprehensive information on the status of presents a good opportunity for standardizing sexual
health service delivery for young people in these HTEIs and harassment prevention and management responses across all
make recommendations for informed decision making and the HTEIs in Zimbabwe and the whole public sector.
investments.
The scope of services at each campus-based clinic is
Methodology determined and approved by the Health Professions Authority
of Zimbabwe in line with the available infrastructure, staff
A mixed methods assessment design including both competence, commodities, equipment, and supplies whilst
quantitative (primary and secondary data sources) and the Nurses Council of Zimbabwe regulates and approves the
qualitative (Key Informant Interviews (KIIs), Focus Group nurses’ practice. The delivery of the essential health services in
Discussions (FGDs), In-depth Case Studies (ICS) and document/ HTEIs is being facilitated largely by registered nurses, guided by
desk review approaches was used. An adolescent and youth various service delivery guidelines and protocols, e.g., Sexually
led approach (including using the students themselves) was Transmitted Infections (STIs) guidelines, family planning
used for data collection and analysis. An adapted observation guidelines, Voluntary Medical Male Circumcision (VMMC)
checklist was also used to assess the status of health facilities guidelines, HIV Testing Services (HTS) guidelines, antenatal
in addressing the information and service needs of young care protocols & guidelines, protocols on management of
people against the global standards on provision of quality obstetric complications, guidelines on management of Sexual
services for adolescents and young people. and Gender-based Violence (SGBV) and post abortion care
guidelines, among others. Most of the clinics except for Harare
1 Ministry of Higher and Tertiary Education, Innovation, Science and Polytechnic, Danhiko and Mupfure Industrial Training Centres,
Technology Development data. had the relevant guidelines to facilitate health service delivery.
Availability of updated guidelines/documents varied from
clinic to clinic, depending on the partnership arrangements
between clinic staff and relevant ministries, parastatals, and
civil society organizations (CSOs).

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Ownership and funding of health facilities: The registration, © stock.adobe.com
inspection, and renewal of operating licenses for HTEI clinics
is regulated by the Health Professions Authority of Zimbabwe,
as industrial health institutions, under the Health Professions
Act Chapter 27:19. Ten health facilities, except Premier Services
Medical Investments (PSMI) hospital in Bulawayo and Mupfure
Industrial Training Centre (owned by the Chegutu Rural District
Council), are fully owned and funded by their respective HTEI
councils. Almost all the assessed HTEIs, except DITC have
mandatory medical aid schemes for all students as the major
source of funding for health service delivery. However, the
provisions of these schemes vary in scope and administration,
with some HTEIs having one standard/universal scheme for all
students and whilst others HTEIs have an open system, which
accepts any medical aid of student or family’s choice.

Infrastructure and staffing: The assessment established
that HTEI clinics were not constructed or designed using a
standard plan. University campus-based clinics have more or
bigger infrastructure than polytechnics and industrial training
centres. Majority of the polytechnics and industrial training
centres have makeshift clinic infrastructure, e.g., improvised
hostel apartments and offices. The assessment established
that the health facility staff establishments in universities are
managed by the university councils, whilst the public service
commission, through the Ministry of Higher and Tertiary
Education, Innovation, Science and Technology Development
(MoHTEISTD) manages four polytechnics and almost all
industrial trainings centres, except Danhiko. As such, clinics
under this assessment, including PSMI Hospital have different
staff establishments, with university clinics having higher
staff establishments and filled posts than polytechnics and
industrial training centres.

Health education: CSE delivery approaches were largely
characterized by the health and life skills course & sessions,
distribution of information, education, and communication
(IEC) materials, peer education, quiz competitions and
orientation weeks for first year students in all the 12 HTEIs.
Student run resource centres, HTEI based radio stations, the
“Mugota” for males and “Web for Life” for females, SRH dialogues,
training of young people in leadership & advocacy and learning
visits were also noted in various HTEIs. All the HTEIs under
this assessment have various partnership arrangements with
relevant ministries, parastatals, and CSOs in providing CSE and
health services. The assessment established underutilization
of HTEIs websites and Facebook pages towards provision
of current and relevant health information to students. Use
of social media platforms (e.g., Facebook and WhatsApp)
and provision of mobile health services by CSOs beyond
the orientation weeks and health fairs/days for first year
students provide good opportunities for expanding CSE. The
assessment established that though the health and life skills
course present an opportunity for CSE, its delivery approaches
differ across all HTEIs due to the unavailability of a standard
CSE curriculum for HTEIs.

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© stock.adobe.com Health service delivery: The assessment established that
almost all the HTEIs, except Westgate Industrial Training Centre
(WITC) have campus-based clinics. All the WITC students are
supposed to access health services from the PSMI Hospital.
The scope of services being provided in all the assessed
clinics largely depend on the registration status (approved
services) by the Health Professions Authority and the existing
medical aid schemes for students. Though all the campus-
based clinics are run largely by nurses, special arrangements
for visiting/sessional doctors on specific days and times were
reported in majority of the campus-based clinics except
at Harare Polytechnic, Masvingo Polytechnic, Danhiko and
Mupfure Industrial Training Centres. However, the 2021
student enrolments (annex 4) demonstrates that these
arrangements are far below the World Health Organization’s
(WHO) recommended 1:1000 doctor-patient ratio.

The study established that university clinics are offering a
more comprehensive service package than polytechnics and
industrial training centres. The assessment identified that the
most services being taken by both sexes were counselling,
condoms (especially the male ones) and HIV testing. STI
screening and treatment services were the most common
among males whilst pregnancy testing, oral pills, headaches,
and menstrual pain management were common among
female students. Uptake of preventive services was reportedly
high during the health days/fairs and campaigns. The
assessment ascertained that there are clearly defined referral
pathways in almost all the HTEIs, for services not available at
their respective campus-based clinics, except at WITC, where
the services are already being accessed off campus, at PSMI
Hospital.

Youth-friendly Health Service (YFHS) Provision: Availability
of trained health facility staff in YFHS provision was only
mentioned at four universities, through partnerships with the
Ministry of Health & Child Care (MoHCC) and the Zimbabwe
National Family Planning Council (ZNFPC) provincial offices.
However, the trainings had only reached nurses, with no plans
and indications for on-the-job mentoring or training of other
staff members. As such, young people raised concern over
the attitudes of both nurses and staff when receiving care.
Similarly, trainings in family planning, STIs management and
HTS have also been provided to nurses in HTEIs through the
various collaborations and partnership arrangements. The
issue of female dominance in clinic nurses’ posts was noted as
a barrier by male students, towards giving them confidence to
discuss sensitive sexuality issues. The assessment established
that by the time of the assessment, none of the HTEIs had
been assessed and certified youth-friendly in line with the
adapted 8+1 standards on YFHS for Zimbabwe.

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CSE and service delivery in HTEIs has not been tailor made National level
to suit the diversities of young people, especially those with
disabilities and the Lesbians, Gays, Bi-sexual, Transgender i. The unavailability of a standard curriculum on
and Queer (LGBTQ). In most instances, the infrastructure comprehensive health education for HTEIs is a huge
is not friendly for wheelchair users whilst majority of HTEI gap towards effective structured delivery of health and
campus-based clinics have no capacity to communicate in life skills sessions by the lecturers. As such, the allocated
sign language. Service providers expressed comfort in serving time for health and life skills sessions is not being fully
LGBTQ students without discrimination. However, there was utilized for the purpose. There is the need for a high-
no HTEI which confirmed having essential commodities level policy commitment by both the MoHTEISTD
(e.g., lubricants) for LGBTQs in their stocks. Additionally, there and the Higher Education Examination Council
were mixed feelings among students during FGDs and ICSs (HEXCO) on strengthening health and life skills
regarding the LGBTQ community, with some expressing education, as the main entry point for CSE. The policy
negative and hard feelings over their existence in HTEIs. will need to be implemented or delivered through
a standard curriculum contextualized to all the
Campus based clinics’ characteristics: Only seven health different categories of HTEIs in Zimbabwe. This will
facilities open after hours whilst only four of them open during ensure standardized and quality delivery (including
weekends (mostly in universities), thus inconvenient especially documentation and monitoring) of health and life
for the majority of students who stay off campus. Low staffing skills course.
levels especially in polytechnics and industrial training centres
was raised as the major reason for not opening after lecture ii. The national YFHS standard guidelines were only
hours and during weekends. Majority of all the HTEI clinics’ available at Chinhoyi University of Technology (CUT),
rooms had doors and curtains to help ensure privacy when Great Zimbabwe University (GZU), National University of
providing care and services to young people. However, young Science and Technology (NUST), University of Zimbabwe
people especially in polytechnics and industrial training (UZ), Masvingo Polytechnic and Mutare Polytechnic
centres raised concern over the location and size of the clinic campus-based clinics. In addition to the unavailability
infrastructure in ensuring privacy (auditory) and confidentiality of these guidelines in some clinics, they are not yet fully
when receiving care. contextualized to the different categories of HTEIs. The
assessment also established that the minimum package
Stakeholder participation: Young people’s participation in of services provided by the guidelines is limited to SRH
CSE and service delivery was mostly noted through the student and HIV. There is the need to review and contextualize
representative councils, hostel committees, peer education the guidelines to the different categories of HTEIs,
and counselling, quiz competitions, Mugota and Web for including expanding the scope of services beyond
life platforms. Though majority of the HTEIs acknowledged SRH and HIV and the monitoring tools (observation
having committees that promote youth participation, checklist) for the certification processes by the MoHCC
documentation for this practice was poor to substantiate the on YFHS.
claims. Utilization of suggestion boxes and client satisfaction
surveys as opportunities for youth participation remains low, iii. The assessment established that students and young
mostly in polytechnics and industrial training centres. people’s participation in planning and monitoring is limited
to the student representative council and peer educators.
Recommendations There is the need to generate evidence about CSE
and health service delivery as experienced by young
The assessment established that the assessed HTEIs clinics are people through provision of feedback mechanisms to
at different capacity levels (human resources, infrastructure, duty bearers and service providers in HTEIs. There is
and commodities) in terms of provision of quality essential the need to develop youth led social accountability
services to young people. The assessment has identified CSE and YFHS score cards and develop the capacity
a number of opportunities, gaps, and challenges, which of young people to utilize them meaningfully. The
range from policy, strategy, and programming, through score cards can be adapted from the Youth 2030 score
which the following recommendations are premised on. The card and the 2019 International Planned Parenthood
recommendations therefore address the policy, infrastructure, Federation (IPPF) guidance.
human resources, service delivery, partnerships, young people
and service providers’ perspectives at national, provincial, iv. The assessment established that there are no standard
district and HTEI levels. designs or plans to guide the construction of clinics in the
various categories of HTEIs. The MoHTEISTD needs to
consider adapting the public sector clinics’ standard
design/plan from the MoHCC, to guide construction or
expansion of existing clinics for the various categories
of HTEIs (e.g., universities, polytechnics, industrial
training centres). This will help match the clinic
infrastructure to the ever-increasing student enrolments
and the current scope/package of health services as new
evidence and needs continue to emerge.

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v. Availability of youth-friendly nurses was only reported by This can also be strengthened through joint and
young people in clinics which had received YFHS training. multisector monitoring visits by MoHCC, key
However, even in these situations, YFHS was not facility- parastatals (e.g., ZNFPC and NAC) and civil society
wide (only limited to trained nurses). There is the need organizations to HTEIs within their respective
for capacity building of lecturers, nurses, and support catchment areas, to generate evidence and lessons
staff in CSE and YFHS through a training of trainers, as critical for decision making and improved quality
an entry point for on-the-job continuous mentoring service delivery.
and training of core staff. This training will also clarify
the different interpretation of the constitution, HTEI level
laws, and policies on sensitive SRH issues such as
termination of pregnancy, LGBTQ, post abortion care i. HTEIs need to expand the public – private sector
and SGBV, with HTEI management for consensus partnerships to construct and/or expand the size
building. of clinics to match the ever-increasing student
enrolments and the expanding scope/package of
vi. The assessment established that the student enrolments health services as new evidence emerges.
have been increasing in all HTEIs across the country yet
the staff establishments for polytechnic and industrial ii. The assessment established that the clinics were at
training centres’ clinics has not been expanding. There is different stock levels for essential medicines and supplies.
the need to advocate and support the review of the Most required medicines, supplies and equipment were
staff establishments of these HTEIs with the public available in majority of the clinics. However, examination
service commission, through MoHTEISTD, to align lights, haemoglobinometers, lactate strips, nasogastric
with the increasing scope or package of services, tubes, pap smear test kits, implants, atenolol, cotrimoxazole
demand for after hours and weekend opening hours suspension, glibenclamide, omeprazole, magnesium
by students and the long waiting periods by students sulphate, pre-exposure prophylaxis (PrEP), post exposure
in some campus clinics. prophylaxis (PEP) and antiretroviral drugs (ARVs) were not
available in majority of the clinics, especially polytechnics
vii. Majority of all the assessed HTEI clinics did not have and industrial training centres. There is the need for HTEIs
staff members able to communicate in sign language. to routinely conduct stock checks and replenishment
This is also worsened by unavailability of IEC materials in to sustain service provision. These stock checks need
braille in most HTEIs. There is the need for the Public to be integrated with the quarterly participatory
Service Commission, MoHTEISTD, MoHCC and HTEIs administration of the observation YFHS checklist.
to consider integrating sign language training in
both pre-and in-service training of service providers iii. Most HTEI clinics have unfriendly opening hours for
beyond health education and service delivery. young people as they remain closed during the weekends
(except PSMI Hillside Hospital, CUT, NUST and UZ), when
Provincial and district levels students expressed having less pressure with academic
work and motivation to seek both preventive and curative
i. Though reported in a few HTEIs, the coverage of YFHS and services. There is the need for polytechnics and
CSE trainings in HTEIs have remained largely on nurses industrial training centres to open health clinics after
and the health and life skills focal persons, excluding lecture hours and on weekends. However, awaiting
other academic, support and ancillary staff. There is the the review of staff establishments, HTEIs need to
need to develop and roll out capacity building plans consider rotating nursing staff to cover weekends,
of HTEI staff in CSE (including a training of trainers accommodate at least one of the nursing staff on
for lecturers) and YFHS delivery approaches for the campus for after lecture hours services and avail
essential health services, in collaboration with MoHCC selected non-clinical services (e.g., HIV self-testing)
and ZNFPC. through youth-led platforms such as peer educators
and resource centres.
ii. The assessment established various existing partnership
arrangements for HTEIs. However, visibility of issues
affecting students in HTEIs have remained low in provincial
CSE and YFHS related networking and coordination
platforms such as the provincial Adolescent, Sexual and
Reproductive Health (ASRH) coordination forums, the
Family Planning technical working groups, Provincial
AIDS Action Committees (PAAC) and District AIDS Action
Committees (DAAC) meetings. Adoption of a setting-
based approach, as defined by the national guidelines
on SRH services to young people to these meetings is
therefore critical to ensure equity in discussions.

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iv. Health education and service delivery approaches in HTEIs
have not fully mainstreamed disability and key populations.
Health education approaches targeted for young people
with disabilities were only noted at the Manicaland State
University of Applied Sciences (MSUAS), UZ and NUST.
There is the need to further explore disability friendly
health education approaches beyond development of
IEC materials in braille. Stigmatization and discrimination
of the LGBTQ is still a challenge in HTEIs, especially among
higher authorities and young people themselves. As such,
all the HTEIs commodity security systems lack recognition
of LGBTQ supplies such as lubricants. There are still mixed
feelings among young people regarding acceptability of
the LGBTQ community. HTEIs need to develop inclusive
policies which do not discriminate against the LGBTQ,
comprising inclusion of essential supplies. There
are lessons to be drawn from the New Start Centres
and MoHCC public health facilities implementing
the national key populations programme. One such
lesson is the deliberate adoption of youth-led human
rights-based approaches to health education and
counselling to address stigma and discrimination.

v. Opportunities for young people’s participation in planning
and monitoring quality of CSE and health service delivery
remain limited to the SRC and peer educators. There is
the need for HTEIs to popularize the use of suggestion
boxes, client exit satisfaction surveys and implement
youth-led social accountability score cards.

vi. Apart from the health and life skills education courses’
delivery approaches being perceived as unattractive and
boring by young people, the assessment also established
that CSE activities are largely centered on the orientation
weeks for the first-year students. Student-led approaches
to CSE and periodic mobile outreach services to HTEIs
need to be considered to complement the health and
life skills course and the static services.

vii. Theunavailabilityofadequateaccommodationforstudents
on campus is a huge gap for advancing health education
and service delivery, especially after hours and weekends
as majority of students stay off-campus. There is the need
for HTEIs to explore and establish public – private
sector partnerships for improving accommodation for
HTEIs to reduce the risks associated with staying off
campus. These partnerships will also enable disability
friendly infrastructural adjustments.

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1. Project Description

A third of Zimbabwe’s population It has been over a decade now since the international technical
are young people aged 10-24 years2. guidance on sexuality education was first released in 2009.
Of these, a significant proportion The 2030 Agenda for sustainable development also shows us
is in Higher and Tertiary Education that quality education, good health and well-being, gender
Institutions (HTEIs) in the country, with equality and human rights are intrinsically intertwined. In
some institutions recording increasing 2018, UNESCO published a revised edition of the International
numbers of women entering higher Technical Guidance on Sexuality Education. The guidance
and tertiary education3. benefits from a review of the current evidence and reaffirms
the position of sexuality education within a framework of
Female students’ enrolments at universities and teachers’ human rights and gender equality. It promotes structured
colleges is currently at 54% and 74% of the student population, learning about sex and relationships in a manner that is
respectively4. Additionally, an analysis of the 2021 student positive. It outlines the essential components of effective
enrolments among the 12 selected HTEIs for this assessment sexuality education programmes, as well as designing
shows that ten of them had a higher proportion of male comprehensive curricula.
students than females, except GZU and DITC.
What is CSE? The International Technical
Young people (mostly aged between 18 and 24 years) in these Guidance on Sexuality Education defines
HTEIs come from diverse backgrounds and face a myriad of comprehensive sexuality education (CSE) as
challenges that form key sexual and reproductive health (SRH) a curriculum-based process of teaching and
related concerns and risks as they navigate new responsibilities, learning about the cognitive, emotional, physical,
relationships, and experiences on their own and in unfamiliar and social aspects of sexuality, going beyond the
settings. Negative SRH outcomes, such as sexual violence/ narrower approaches focused on reproduction
assault, unintended pregnancies, and STIs, immediately and physiology that were more common in the
affect students’ well-being and often cause disruptions in past. As an active teaching and learning approach
educational attainment, career progression, and life goals. This centred on students, CSE helps develop skills such
ultimately limits the potential of this critical human capital as critical thinking, communication and decision-
to contribute towards personal, community and national making that empower young people to take
development. A 2018 situation analysis commissioned by responsibility for and control over their actions
UNESCO in selected institutions in Zimbabwe and Tanzania and help them become healthy, responsible, and
established that for many students, the age of sexual debut productive citizens.
coincides with entry into college. This sexual debut also
coincides with low condom use (66% of female students and The UNAIDS Strategy (2016-2021) therefore underscores the
47% of male students had not used a condom the first time importance of empowering young people, particularly young
they had sex) and lack of comprehensive knowledge on HIV women, to prevent HIV and end Sexual and Gender-Based
(only 63% of respondents in Zimbabwe correctly answered Violence (SGBV) while promoting positive gender norms.
questions on HIV)5. In line with the Sustainable Development Goals (SDGs), the
strategy calls for a world where young people, regardless of
2 Zimbabwe National Statistics Agency. Zimbabwe Population Census where they live or who they are, have the knowledge, skills,
2012, 2013, http://www.zimstat.co.zw/dmdocuments/Census/ services, rights, and power to protect themselves from HIV. This
CensusResults2012/National_Report.pdf reinforces the December 2013 Eastern and Southern Africa
Ministerial Commitment on CSE and sexual and reproductive
3 Situational analysis on the status of the sexual and reproductive health services for adolescents and young people in Eastern
health of students in tertiary institutions © michaeljung/Shutterstock. and Southern African (ESA), popularly referred to as the ESA
com February 2018 in the SADC region https://safrap.files.wordpress. Commitment6.
com/2018/12/situational-analysis-on-the-status-of-the-sexual-and-
reproductive-health-of-students-in-tertiary-institutions-in-the-sadc- 6 United Nations Educational, Scientific and Cultural Organization
region-february-2018.pdf (UNESCO), 2016, Fulfilling our promise to young people today 2013-
2015 progress review: The Eastern and Southern African Ministerial
4 https://www.chronicle.co.zw/females-surpass-males-in-tertiary- Commitment on comprehensive sexuality education and sexual and
enrolments/ reproductive health services for adolescents and young people.

5 United Nations Educational, Scientific and Cultural Organization
(UNESCO) (2018), Situational Analysis on the status of sexual and
reproductive health of students in Tertiary Institutions in the SADC region

12

The urgent task of delivering CSE to young people across To date, the standards-based guidelines10 have been fully
the globe, as an integral part of the delivery of good quality rolled out in 24 focus districts, with minimal efforts in four
education, is more relevant than ever. Governments reaffirmed tertiary colleges: Midlands State University, Hillside Teachers
this by including CSE in the Brussels Declaration at the Global College, Mutare Teachers College and Belvedere Technical
Education Meeting of December 2018.7 Evidence shows that Teachers College as part of the adaptation processes to higher
CSE improves sexual and reproductive health outcomes, such and tertiary education settings.
as reductions in HIV infection and adolescent pregnancy
rates, which in turn helps expand education opportunities. The revised National Youth Policy of Zimbabwe11 highlights
It transforms harmful gender norms and promotes gender the need for provision of health services, within the context
equality, which helps reduce or prevent gender-based of youth development. It recognizes youth participation in
violence. It also promotes safe, inclusive and gender-equitable issues affecting them as one of its guiding principles, whilst
learning environments and improves educational access and highlighting the rights and responsibilities of young people.
attainment. Among others, it provides for the establishment of youth-
friendly health services, including reproductive health and
As such, there is an increased global recognition of the role youth counselling services and life-skills teaching/education in
played by CSE as an essential part of a good quality education every district. The policy also calls for increased involvement of
that helps prepare young people to play a meaningful the private sector and civil society organizations in education
role and lead a fulfilling life in a changing world8. Despite on abstinence, deferment of sexual debut and provision of
Zimbabwe not having an explicit policy on youth health, the family planning and STI information and services, including life
national youth policy, and the national adolescent & youth skills education. It also calls for mobilization of communities,
health strategy: 2016 – 2020 recognizes the importance of policy and decision-makers and the participation of health
integrating health education with service delivery in four service providers toward removal of barriers to youth access
settings: school, HTEI, community and health facilities. Over to SRH information and services, integrating and expanding
the past decade, interventions on health education and HIV/AIDS programming in all youth activities and allocating
service delivery have been designed and implemented within adequate financial, human, and other resources to adolescent
the context of the following WHO description of “youth- and youth health.
friendly service provision”:
The 2013 – 2017 National Gender Policy, advocates for gender
“Services that are accessible and appropriate for adolescents. responsive mechanisms to ensure universal and affordable
They are at the right place, right price, (free where necessary) access to health services for all and support affirmative action
and delivered in the right style to be acceptable to young initiatives to address areas that have sharp gender disparities
people. They are effective, safe, and affordable. They meet including initiatives that directly address problems that are
individual needs of young people who return when they need specific to women such as sanitary facilities. The 1999 National
to and recommend these services to friends.” HIV/AIDS policy highlights that

The launch of the SDGs coincided with the launch of “…… young people are vulnerable to HIV infection. Their
the global standards on provision of quality adolescent visit to a health facility for advice and/care should present a
health services, against which the WHO’s description of special opportunity to health professionals to provide them
youth-friendly service provision can be measured against. with education information and counselling about HIV/AIDS/
Zimbabwe is one of the first ESA countries to adapt the STIs and the advantage of behaviour change (“secondary
global standards on provision of quality adolescent health virginity”) and deferment of further sexual adventures.”
services9, through a consultative and evidence-based process,
in 2016. The adaptation processes included pilot testing in all UNESCO, as one of the founding co-sponsors of the Joint UN
clinical settings, including tertiary colleges, family planning Programme on HIV/AIDS, would like to implement the O3 PLUS
clinics and community youth centres as well as adding an project with support from the Swiss Agency for Development
additional standard on strengthening the policy environment and Cooperation (SDC), across 22 Higher and Tertiary
and institutional commitments & frameworks for provision of Education Institutions (HTEIs) in Zambia and Zimbabwe from
adolescent and youth-friendly services. January 2021 to December 2024.

7 UNESCO (2018a) Global Education Meeting 2018: Brussels Declaration. 10 Ministry of Health and Child Care Zimbabwe. National Guidelines on
Available at: https://www.gcedclearinghouse.org/resources/global- Clinical Adolescent and Youth-friendly Sexual and Reproductive Health
education-meeting-2018-brussels-declaration Services Provision (YFSP). 2016.

8 UNESCO (2019) Facing the Facts: The case for CSE. UNESCO Policy Paper 11 National Youth Policy, Ministry of Youth Development, Indigenisation and
39. Available at: https://unesdoc.unesco.org/ark:/48223/pf0000368231 Empowerment

9 Global standards for quality health-care services for adolescents: a guide
to implement a standards-driven approach to improve the quality of
health care services for adolescents (2015) Volumes 1-4

13

This initiative aligns well with the review of the National
Adolescent & Youth Sexual and Reproductive Health Strategy
II: 2016 – 2020, which re-affirmed the need for innovative, life
skills oriented human rights and equity focused approaches
towards addressing the health needs of young people,
including in higher & tertiary institutions. This will be achieved
through contributing towards the three key youth health
outcomes:

• Outcome 1: Increased safe sexual and reproductive
health among adolescents and young people.

• Outcome 2: Increased uptake of quality youth-friendly
integrated SRH and HIV prevention services

• Outcome 3: Strengthened protective environment for
adolescents and young people.

The O3 PLUS project also fits well with the resolutions of the
October 2017 Nyanga, high level advocacy meeting that was
attended by Vice-Chancellors, Deans of Students, student
representatives, senior management of line ministries such
as Higher and Tertiary Education, Science and Technology
Development, Health and Child Care, the National AIDS
Council (NAC) and Development Partners. Among other issues,
the meeting’s communique, advocated for interrogation of
university policies, ordinances, and funding mechanisms in
support of the provision of CSE and SRH services for students
and strengthening the capacities of universities to deliver
these services in line with international standards.

The O3 PLUS project therefore seeks to ensure that young people
in HTEIs in Zambia and Zimbabwe realize positive health,
education, and gender equality outcomes through sustained
reductions in new HIV infections, unintended pregnancy and
sexual and gender-based violence. The project will thus enable
them to reach their full educational potential and contribute
more effectively to the development of their countries and
region as graduates, professionals, and young leaders. It seeks
to work closely with relevant regional structures, national
ministries, higher and tertiary education institutions, and key
partners to advance access to life skills based CSE and SRH
services for HTEI students. This shall be achieved through
advocacy and promoting innovation to make campuses safe
and inclusive learning environments for students and staff.
In doing so, the project will institutionalize health and well-
being programmes for students while engaging leadership
for long-term commitment and sustainability. The work will be
delivered through four complementary pillars or work streams
as follows: institutional strengthening for sustainability;
student health and well-being; safe and inclusive campus
environments; and evidence building and knowledge sharing
platform.

14

© stock.adobe.com 2. Objectives
and Research
Questions

The assessment collected
comprehensive information on health
service delivery for young people in
line with existing international youth-
friendly services (YFS) guidelines and
standards, to make recommendations
for investments required for the health
facilities to be fully functional and
deliver services effectively.

It covers infrastructural issues; institutional arrangements;
registration of health centres; service provision; and functionality
and human resource capacity. This helped towards identification
of opportunities and gaps in these areas to guide appropriate
recommendations. As such, the assessment answered the
following key questions:

1. What are the existing youth-friendly health services
guidelines, standards, and policies in Zimbabwe? How do the
guidelines, standards and policies align with international
guidelines i.e., WHO Global Standards for Quality Healthcare
Services for Adolescents and Youth? Is delivery of health care
services at health facilities in tertiary institutions in-line with
the guidelines, standards, and policies?

2. What types of services are offered at health facilities in HTEIs,
and what is the quality of these services as per the existing
standards and guidelines? Do the health facilities have the
necessary resources i.e., infrastructure, human capacity,
financial etc. to ensure effective service provision? Are there
any guidelines or minimum standards for infrastructure of
health facilities in tertiary institutions? Which ministry is
responsible for the administration of health facilities in HTEIs?
Is there clear ownership and linkages of the health facilities
in HTEIs with district, provincial and national level MoHCC?
What are the major sources of funding for the HTEIs?

3. What are the perspectives of health providers on health
service delivery for young people in HTEIs? What are the
perspectives of young people in HTEIs on the health services
provided at the health facilities? What factors enable or
hinder young people’s access to health services at the health
facilities in HTEIs?

4. How can the health facilities be improved/strengthened to
ensure effective health service provision to young people?
What resources or capacities are required i.e., infrastructure,
equipment, human resources, training etc.?

15

3. Methodology

3.1 Approach Key Informant Interviews (KIIs)

The assessment adopted a participatory quantitative and KIIs were held with the MoHCC and MoHTEISTD national levels,
qualitative approach. We used an adolescent & youth led to determine any policy and strategy, provisions for HTEIs
approach (including using the students themselves) for the on young people, among other issues. Additional KIIs in the
data collection and analysis. Based on our experience with MoHCC were conducted at district levels to explore issues of
conducting baselines for YFS delivery in Zimbabwean health integration and partnership arrangements between HTEIs and
facilities, we ensured the team of data collectors was made up the National Health Service delivery system. At the HTEIs, KIIs
of young people representative of gender and marginalized were held with institution administration and management
groups (including those living with HIV, disabilities, and (Vice Chancellors, Principals, Deans of Students and Health &
LGBTQ). This enhanced our ability to reach out to these special Life Skills focal persons) to determine the policy frameworks
groups due to shared understanding of their situations with for health (including insurance/medical aid schemes), funding
their peers in the research team. Given the current COVID-19 (source and levels of funding and gaps), and administration of
context in Zimbabwe and the restrictions on movement, the health facilities. At each health facility level, KIIs with either
which remain fluid, our approach remained flexible as well. In a clinical or non-clinical staff to determine their perspectives
cases where physical interactions were possible, face masking, regarding health service delivery for young people were
social distancing and sanitizing were enforced on the team. conducted. At GZU, the assessment was conducted at the
Safety of the team and respondents remained the primary Masvingo City Campus Clinic (one of the 3 university clinics).
issue of concern. Additional KIIs were also held with the NAC, ZNFPC, CSOs like
Students and Youth Working on Reproductive Health Action
3.2 Methodology Team (SAYWHAT), Population Services International (PSI) and
Female Students Network Trust, both at national and HTEI
This section provides details of the specific quantitative and levels.
qualitative methods that were used for the assessment.
Focus Group Discussions
Quantitative
FGDs were held with young people (18 – 24 years) in
Quantitative data was collected from both primary and homogenous groups of gender. Given 2020 entrants had
secondary data sources in eleven selected HTEIs, except limited physical interaction with their respective HTEIs,
for WITC, where there is no campus-based clinic. Primary participants for FGDs were mainly drawn from students in
quantitative data was collected from health facility records on their third and final years. Five FGDs were conducted with
infrastructure, staff establishment and commodity security. a homogenous group of young people (3 males and 2
Service uptake primary registers (e.g., T12) were also checked females). FGDs were used to collect information on young
for completeness. The observation sheet availed by UNESCO people’s perspectives on health services being provided at
was refined/adapted and utilized on AYFHS delivery, through health facilities (e.g., health insurance policies, competence
a participatory and consultative processes. and friendliness of health facility staff, quality, and adequacy
of service, including referral system) and the facilitators and
Qualitative barriers for accessing services at the respective HTEI health
facility as well as the friendliness of the infrastructure.
Qualitative data was collected mainly through document/
desk review, key informant interviews (KIIs), FGDs and ICS. In-depth Case Studies (ICSs)

Desk Review of Relevant Literature Nine (9) in-depth case studies (6 males and 3 females) were
held with young people, drawn from the HTEIs which were
We reviewed key documents and literature on provision not selected for FGDs. ICSs were also elicited from special
of CSE and youth-friendly health service provision in HTEIs. groups of young people, such as LGBTQ, living with HIV and
Documents reviewed include policies and guidelines (at all those with disabilities. These ICSs explored on performance
levels, e.g., national, and institutional), reports on research, of health workers, their own experiences with seeking health
evaluations, assessments, or reviews on youth-friendly health services at the HTEIs health facilities (including quality and
service delivery, reports on health facility assessments, as well adequacy of service) as well as barriers to accessing services.
as relevant project documents.

16

Data collection Covid-19 Responsive Approach

The national consultant and lead research assistant led data Most of the KIIs at national level were conducted virtually
collection with assistance from four young people: two through Zoom platform. The administration of the observation
males and two females. Our research assistants comprised checklist for commodities, infrastructure and registers was
young people in tertiary colleges and representatives of key conducted physically at the 11 eligible clinics. Similarly, all
populations. These were trained on the quantitative and the KIIs, FGDs and ICSs were conducted physically in all the
qualitative tools by the lead team over a period of three selected 12 HTEIs. Each team was comprised of a team lead
days, including a pre-testing exercise. The Computer Assisted and only two research assistants (in a vehicle), maintaining
Personal Interview (CAPI) software, Survey Solutions12 was COVID-19 regulations. The fieldwork data collection team
used to capture data gathered through the observation underwent COVID-19 screening (temperature and history
checklist in the 11 HTEIs which have static/on-site clinics. Use taking) prior to the fieldwork and were provided with face
of Survey Solutions Software enabled the national consultant masks and sanitizers for hands and vehicle spraying. Table 1
and lead research assistant to conduct real time data quality illustrates the distribution of respondents for the assessment.
assessment. It accommodated the use of topic guides to
collect qualitative data. All qualitative data was recorded and
transcribed for further analysis.

Table 1: Distribution of respondents for the assessment

National Level KIIs MoHCC, MoHTEISTD, NAC, ZNFPC, SAYWHAT, PSI and FSNT

Name of Institution HFA Key Informant Interviews (KIIs) ICS FGDs

District / City Vice Chancellor Deans of Students (DOS) / Health facility Male
(VC) / Principal Health and Life Skills focal staff * 1
person (HLS FP)
Male
Harare Institute of Technology DOS 1
1
Harare Polytechnic VC HLS FP
DOS, HLS FP & campus Female
Chinhoyi University of Technology ZNFPC Psychologist 2
ZNFPC DOS 1
Mupfure Industrial Training College
National University of Science and DOS Female
Technology 2
Westgate Industrial Training College DOS & HLS FP
Male
University of Zimbabwe DOS 1
95
Danhiko Industrial Training Centre Mutare City Principal HLS FP
Mutare City Principal DOS
Manicaland State University of DOS
Applied Sciences

Mutare Polytechnic

Masvingo Polytechnic MoHCC Principal DOS

Great Zimbabwe University ZNFPC HLS FP & Gender Lecturer

Total 11 6 4 16 10

12 Survey Solutions is free software developed in the Data group of World
Bank.

17

Data validation and quality assurance Ethical considerations

Quality assurance for both the processes and expected Considering that this assignment involved research with
deliverables was ensured through various mechanisms. human subjects in sensitive health issues, ethical clearance
For example, the development of tools was informed by by the Medical Research Council of Zimbabwe (MRCZ) was
the key assessment questions and the O3 PLUS project results granted (MRCZ/A/2720), as part of the baseline study, before
framework. We also conducted the following to ensure quality getting into the field. Entry and exit protocols were conducted
for our assignment: with all the concerned structures. Stakeholders which include
government departments, partner organizations, traditional
A three-day training of the research team on the protocol and local leadership were informed of the intentions of
and tools the assessment, methods to be used, duration of the study
and use of the information gathered therefrom. On exit
Ensured routine monitoring by the team leader and from each respective HTEI, the gatekeepers were alerted
periodic assessment against the protocol so that they knew that work had been completed. During
exit or debriefing meetings information around findings
Used two voice recorders for our FGDs was not shared. An outline of an informed consent process
Checked through each transcript for consistency against was administered before each interview. Our ethics training
focused on making the key principle tenets of informed
the facilitator’s guide consent become a natural process for our team of research
We also conducted daily briefings and assistants/enumerators. Consent for recording of KIIs, ICSs
A meeting to validate the results/findings was conducted and FGDs was sought before commencement, through use
of structured consent forms. Respondents’ identities were
with key stakeholders for a quality deliverable. protected. FGD participants were asked to use code names
which could not be traced back to them.
Samsung Galaxy Tablets were used for administering the
observation checklist due to their reliability and fastness. The 3.3 Limitations
large, responsive screen surface of these tablets ensured that
the enumerator made the right and intended selection always. Westgate Industrial Training Centre does not have a campus-
The use of CAPI software eliminated the need to digitize data, based clinic. The existing referral relationship between
while improving quality through a series of built-in checks. the centre and the Premier Services Medical Investment
CAPI has the ability to validate data in real time because (PSMI) Hillside Hospital could not allow us to administer the
the platform’s programming can allow for automated skip observation checklist and therefore limited us to conduct KIIs.
patterns, display error messages whenever unexpected values Although GZU has three clinics, only one clinic was assessed
are entered by the interviewer, and follow other validation due to time constraints. As such, the findings from the GZU
rules (e.g., ranges of values). assessed clinic cannot be generalized across all the 3 clinics.
The assessment relied heavily on non-probability sampling
Data analysis and reporting techniques. As such, the results cannot be generalized
across all the HTEIs in Zimbabwe. Use of virtual platforms
Descriptive statistical analysis was conducted for quantitative such as telephone and Zoom platforms for KIIs, limited full
data using SPSS (Version 26). Evidence tables were used engagement of participants due to poor network connection
to reinforce the validity of the findings in the analysis. sometimes. Participants who were grouped in one place,
On qualitative data analysis, the team utilized NVivo and away from the interviewers, may have provided biased data.
Excel software. NVivo and Excel allowed the team to find
connections and understand underlying themes and patterns
that informs and support decisions. Qualitative data was
entered into a Microsoft Excel template where responses were
organized by theme, question, and respondent to facilitate
discourse analysis. Discourse analysis (using sort functions in
Microsoft Excel and text search and word frequency queries in
NVivo) allowed the team to pick emerging conclusions across
respondents for each theme as well divergence in views and
perceptions.

18

4. Findings

4.1 Operating Environment for In 2019, the MoHTEISTD commenced a process of
Health Education and Health harmonization and standardization of the different sexual
Service Delivery in HTEIs harassment policies, a process which has since been embraced
and taken over by the Public Service Commission (PSC), since
The National Development Strategy I: 2021 – 2025 recognizes 2020. The PSC processes broadly and now seeks to address
health as a fundamental human right, enshrined in the 2013 sexual harassment in all government entities, beyond HTEIs.
constitution of Zimbabwe. The National Adolescent and Youth
Health Strategy (ASRH) II: 2016 – 2020 and the draft Zimbabwe The assessment also established that the government of
National AIDS Action Plan IV: 2021 – 2025 are the only key Zimbabwe, through the PSC is committed towards provision
strategic documents that provide for health education (largely of quality health services in HTEIs. This has been demonstrated
through comprehensive sexuality education) and provision largely through human resource support for polytechnics,
of quality and friendly health services for young people and teachers’ colleges, and industrial training centres, mostly
students in HTEIs. In terms of health service delivery, HTEIs are with campus-based clinics. The MoHTEISTD has a staff
governed by the policies, guidelines and protocols provided establishment for majority of the assessed polytechnics and
by the MoHCC, including the registration of the clinics and industrial training centres except for Danhiko (owned by
clinical staff. The health and life skills module/course is the the HTEI) and Mupfure (owned by Chegutu Rural District
main entry point for addressing CSE in HTEIs. However, the Council). The PSC human resource policies for these HTEIs,
assessment established that currently, there is no standard however accommodate for individual HTEI-private sector
national framework for CSE in HTEIs. partnerships for expansion of the establishments and
infrastructure for health service delivery. Universities, which
The assessment therefore established that all the assessed 12 are considered quasi-autonomous administer and manage
HTEIs have different structures and mechanisms for provision staff establishments for their campus-based clinics on their
of health education for students. As such, health education own. The assessment therefore established that HTEIs clinic
interventions in HTEIs under this assessment are not uniformly staff establishments are not standard hence polytechnic and
designed, named, implemented, documented, assessed, and industrial training centres from time to time can apply or
evaluated. The National ASRH Strategy II: 2016 – 2020 and submit a request for an expansion of the staff establishment
the National Guidelines on Clinical SRH services only provide through the MoHTEISTD to the PSC.
a list of essential topics, alongside the health services to be
delivered in HTEIs, without contextualizing or providing a The assessment established the clinics vary in terms of size
standard framework or models for implementation in the (infrastructure) from HTEI to the other, with universities largely
different categories of HTEIs. The UZ, Department of Teacher having better/bigger infrastructure than polytechnics and
Education’s guidance to all teacher training colleges’ health industrial training centres. Each respective HTEI executive is
and life skills course, provides a good learning point for a solely responsible for mobilizing resources for construction
structured, mandatory, and examinable approach to CSE. and maintenance of these clinics. The MoHTEISTD facilitates
The assessment established that there are processes, though registration of these clinics with the MoHCC and the Health
at infancy to develop a CSE, Gender, HIV and Human Rights Professions Authority as well as capacity building of clinic
curriculum framework for HTEIs in Zimbabwe, through the staff on new health issues. The assessment established that
NAC, as part of addressing the resolutions of the 2017 Nyanga these capacity building partnerships are more visible at local
higher level advocacy meeting on CSE and health service level (district or city level), with the MoHCC, ZNFPC, NAC,
delivery, highlighted earlier on. Population Services International and SAYWHAT.

The assessment noted a high level of commitment by the In Zimbabwe, health service delivery in HTEIs is governed
HTEIs towards prevention and management of sexual & by the policies, guidelines, procedures, and protocols
gender-based violence and HIV. Almost all the assessed HTEIs developed and updated by the MoHCC from time to time.
have their own sexual harassment policies, and HIV/AIDS The assessment established that most of the clinics except
policies except WITC, which is currently using the 2020 draft for Harare Polytechnic, PSMI Hospital, Danhiko and Mupfure
produced by the MoHTEISTD. Although the policies are at industrial training centres had the relevant guidelines to
different levels of implementation, they provide for education, facilitate health service delivery. Additionally, the assessment
service delivery (including prevention and management) and established that the guidelines on provision of friendly clinical
creation of structures for effective reporting and management services to young people, even in HTEIs center largely on SRH
of sexual harassment as well as care and support for staff and and HIV, leaving out other health issues affecting students and
students living with HIV. young people.

19

Similarly, by the time of the assessment, the 2020 guidelines on “We charge our students on health learning and all our
provision of essential reproductive, maternal, newborn, child, students are on CIMAS (Commercial and Industrial Medical
adolescent and youth health services in the humanitarian Aid Society), so they pay a certain amount on their fees for the
crisis and COVID-19 situations had not been contextualized to cover and our agreement they charge an administrative fee,
HTEI environments. so it accumulates over the years and the beauty of it is that it
has no shortfalls. We have a scheme with CBZ (Commercial
Funding for health service delivery is largely through Bank of Zimbabwe): it’s a life insurance cover which has a
HTEIs authorities. This includes revenue collected through component which takes care of the student when they get
established mandatory health insurance schemes for students’ sick, injured or even when they are on attachment they are
health. However, the amounts being paid by students, scope covered even if they die, currently the money which is given
of services being covered and partnership arrangements with to the student’s family is $47 000rtgs (US$547) be it accident
medical aid insurance companies vary from institution to or natural death except suicide, within 24 hours”. University
institution. Dean of Students

Table 2: Student health insurance schemes

HTEI Student Health Funding Schemes

Harare Institute of Technology The institution has a student development levy paid by each student towards
empowerment programmes for students. The CIMAS fund also provides access to
services at the college clinic whilst emergency services can be accessed through the
CIMAS clinics and Baines Emergency Centre, without any extra cost. The fund is also
accepted by the municipal clinics for basic services not available at HTEI’s clinic.

Harare Polytechnic Students have a mandatory medical aid that allows them to get services from the clinic
for free. However, the medical aid does not cover referred cases.

Chinhoyi University of Technology Allows family medical aid schemes, whilst it offers a university medical aid which
covers basic medical care, administered through the clinic. The life skills fee (Levy) is
also used for health education and life skills empowerment initiatives, including T-Shirts
and refreshments for life skills and peer education activities.

Mupfure Industrial Training College Similarly with other earlier mentioned HTEIs, MITC has a medical aid cover, paid by
students as part of tuition fees.

National University of Science and Technology The university has a student’s medical fund which covers for basic health care,
excluding maternity services.

Westgate Industrial Training College As part of the tuition fees, all students contribute towards PSMAS (Premier Service
Medical Aid Society) and students utilize Hillside PSMAS clinic, for medical care.

University of Zimbabwe All students are on CIMAS medical cover, paid as part of the fees. Also have a CBZ life
insurance cover which has a component which takes care of the students when they
get sick, injured or even when they are on attachment, they are covered in the event of
death, the money is given to the student’s family.

Danhiko Industrial Training Centre The institution does not have any medical insurance cover for students and young
people. As such, if the student requires further management beyond the scope of the
clinic, the institution engages parents and guardians to take over.

Manicaland State University of Applied Sciences Currently has an open system where students are required to bring a valid medical aid
as part of registration. The medical aid allows the students to access available health
care services from the HTEI’s clinic without any extra cost or charge.

Mutare Polytechnic Has a medical and clinical assistance fee charged on every student’s account. It covers
basic health services only at the clinic. Currently have a partnership arrangement with
EMRAS (Emergency Medical Rescue Ambulance Service) for transporting emergencies
to referral centres. The institution is considering establishing a medical aid insurance
scheme. Medical aid covers emergency transport services provided by EMRAS.

Masvingo Polytechnic The institution charges students, as part of tuition fees, for the CIMAS medical aid cover.

Great Zimbabwe University The university has a mandatory medical scheme for all students. However, the scheme
20 does not cover maternal bills and dental issues.

4.2 Health Education Interventions Young people identified and largely appreciated the
relevance of the various health education interventions being
This section profiles the health education initiatives being implemented within their institutions. They indicated that
implemented in the 12 selected HTEIs, the capacity of health apart from the health and life skills course, most of the other
facilities in addressing the health information needs of young initiatives such as dialogues, debates and campaigns were
people as well as the existing partnership arrangements for largely concentrated during the orientation weeks for first year
promoting health education for students and young people. students and externally driven by civil society organizations. As
such, CSE was very much aligned to students that are more
Scope of health education initiatives education and health oriented. However, young people during
FGDs and ICSs indicated that the health and life skills sessions
In all the assessed HTEIs, health education interventions are were not being fully prioritized since they were not examinable
mainly delivered by the student affairs division through the and additionally, the delivery approaches were also perceived
Dean of Students, with support from the health and life skills to be inappropriate for students and young people. As such,
focal persons and the clinic staff. Health education is largely getting attention of both the students and lecturers, who have
characterized by the health and life skills course or sessions, other competing assignments require more innovative and
peer education, orientation of first year students, health interactive approaches for delivering CSE initiatives.
fairs/days (e.g., at MSUAS), resource centres (e.g., at NUST,
GZU, MSUAS, Mutare Polytechnic, CUT, Harare Institute of ‘’So far, I am aware of orientation for new students at campus.
Technology and UZ), radio shows (e.g., at GZU and Harare The sister in charge is given a chance to express and explain all
Polytechnic), and provision of IEC materials. The student the services that they offer at the clinic. So, during orientation
affairs department, which houses the clinics also provides students are sensitized about health issues. There is also what
counselling and rehabilitation services, through the health and we call node spot but at the moment the activities are on hold.
life skills focal persons, nurses, psychologists, and counsellors. Last year these activities were elected and dedicated for health
education but at the moment, again it has since been put on
The health and life skills course or sessions are being delivered pause. I am not sure if it is for first students only or it was just
in all HTEIs that were assessed. However, the scope and stopped". Male ICS respondent
delivery approaches for this course or sessions differ from
HTEI to HTEI, ranging from being time-tabled at two hours “There is nothing like CSE at …… unless your course is aligned
per week per student to an examinable course for first year to the topic. We only have mentors who at times take their
students. All the universities covered under this assessment time to do CSE during core module time. Those mentors have
have also been participating in the SAYWHAT organized a lot on their plate and are as busy as we are….” FGD Male
annual quiz competitions. Below is table 3 that profiles health participant
education interventions by HTEI.
“We have a module that is called Comprehensive Sexuality
The assessment established that there are a number of Education, however at the moment it is taught at the school
partners such as the ZNFPC, NAC, Female Student Network of education…. course should be a university wide course
Trust (FSNT), Padare, SAYWHAT and PSI, through their because I think it’s important to be studied by every student”.
decentralized offices, who support HTEIs through: Health and Life Skills focal person

• CSE training for peer educators & lecturers ‘’Nurses do it at times, they go around the campus teaching
• film & video screening those willing to listen. They at times put up mobile clinics
• leadership trainings and around where those requiring services like HIV testing can
• IEC material distribution and life skills training. access them. They do the counselling as well from these
booths. Yes, there are some organizations that come through,
The assessment established that the Ministry of Women’s but they do so once in a blue moon.’’ Male ICS respondent
Affairs, Gender, Small and Medium Enterprises development,
Musasa Project, Zimbabwe Women Lawyers Association, “We do not have platforms such as these to discuss about
SAYWHAT, Adult Rape Clinic, FSNT and the Victim Friendly Unit such issues beyond peer education of which it is only a
are very active partners on prevention and management of process of providing condoms and nothing else”. FGD female
sexual and gender-based violence in these HTEIs. participant

“We work with SAYWHAT, we work with NAC, Victim Friendly “The approach is not appealing to male students. With time
Unit, Adult Rape Clinic, and The Ministry of Women affairs, these campaigns become less appealing and monotonous”.
we also work with human rights lawyers, Msasa for gender- FGD Male participant
based violence issues, we even invite them, and they talk to
our students…” Health and Life Skills Focal Person “We carry out orientation on life skills training for all our
students especially during the first years such that when the
students are new to the university, we set aside a day for life
skills where we invite other stakeholders who are into Sexual
and Reproductive Health” Health and Life Skills focal
person.

21

Table 3: Health education interventions

HTEI Summary of Health Education Interventions
Harare Institute of Technology
• The university has three modules on leadership, basic counselling, and health
Harare Polytechnic lifestyles for the first-year students. LASOF (Laying Sound Foundation) and
Chinhoyi University of Technology SAYWHAT provide leadership training.

Mupfure Industrial Training College • It also has a student resource centre, established with support from SAYWHAT and
National University of Science and Technology is being run by students and peer educators.
Westgate Industrial Training College
• The institution also runs church groups that also integrate sexuality issues among
other health issues.

• Orientation weeks for the first-year students are characterized by health education,
counselling, and service delivery through partnerships with CSOs like the Msasa
Project and SAYWHAT. Dialogues and discussions through the Mugota (for young
men) and Web for life (Munhanga for females) are some of the platforms that
continuously run across all academic years.

• Radio shows are also run through the radio poly local station, through which,
interviews, discussions, dialogues, and campaigns are also run through.

• The university has a two-hour time slot every week for every student across all the
academic years.

• Each department has trained peer educators who also help the lecturers during
the weekly two-hours as well as other dialogues.

• SAYWHAT train students in leadership, and works with DAAC, ZNFPC, Childline,
Msasa Project, during the orientation weeks.

• The university has a life skills levy charged to every student to help fund health
education activities.

• First year (1.1) students receive comprehensive orientation on SRH and other
related sexuality issues thoroughly. This is complemented by hostel talk shows,
health awareness days facilitated by stakeholders, counselling (both individual and
group), and off campus discussions as well.

• The university also has a student resource centre through which the peer
education programme is also administered throughout the campus.

• Conducts sensitization workshops for students ready for attachment, especially on
sexual harassment and role modelling.

• The training centre offers counselling to students and young people on issues
affecting their health.

• As part of the curriculum, it conducts health education sessions every three weeks
(time-tabled for all students) on various topics such as SRH, personal hygiene, STIs
and other related issues.

• First year students receive health education and counselling on university life
during the first week of orientation.

• Has service providers like SAYWHAT who interact with our students. During
orientation, other periods of time that we choose and wellness days.

• The university has a resource centre where young people access information,
education, and counselling on health issues largely through peer educators, as well
as IEC materials.

• The centre has a timetabled lesson weekly, in which students, in a classroom
setting are taught health and life skills for informed decision making across all the
academic years.

• At the first week of every term, the centre conducts discussions, and dialogues
with students on various health related topics. As part of the opening ceremony,
the principal also highlights on the centre’s interventions, procedures and policies
that relate to safeguarding the students.

22

HTEI Summary of Health Education Interventions

University of Zimbabwe • The university has a resource centre for students, which is integrated with the
peer education programme. Peer educators use drama and poetry, among other
innovative and engaging approaches for health education.

• Also has a clinical psychologist, department, and faculty counsellors.
• Also runs a friendship bench where student well-being issues are discussed

through peers. This complements the chaplaincy services, which also provides
counselling.

Danhiko Industrial Training Centre • Rides on the orientation week of first year students to orient them on health and
life skills for informed decision making, usually with support from NAC and PSI.

• Clinic staff usually make presentations and facilitate dialogues on common health
issues arising through their engagements with students when seeking services.

Manicaland State University of Applied Sciences • The university has a comprehensive orientation programme which also focuses on
health issues.

• Has a resource centre being run by peer educators with support from SAYWHAT,
clinical psychologists and the clinic staff. The resource centre also provides IEC
materials.

Mutare Polytechnic • The college runs a timetabled health education course (though not examinable by
HEXCO), every Friday for all the students. The course is administered by both nurses
and lecturers depending on the issues to be addressed.

• A resource centre is also being run, with support from SAYWHAT, through trained
peer educators.

Masvingo Polytechnic • Generated own syllabus outline as a college, borrowing from teacher training
colleges through the dean of students. Health and life skills course is taught for
two hours per week; however, it is not examinable. The course is administered by a
24-member committee comprising both academic and non- academic staff.

• Conducts orientation on health and life skills especially for first year/new students
usually during the four-day orientation period. Different partners provide relevant
and updated information on topical issues such as SRH, HIV and drug abuse.

• Runs a well-coordinated peer education programme through the HIV club and
the Peer educators club. Peer educators have led and implemented condomize
campaigns on campus.

• Conducts health talk shows, which are recorded for further reference and
utilization.

• Conducts dialogues periodically, usually on SRH during the evenings, in the
hostels.

Great Zimbabwe University • The university has an examinable module that is called Comprehensive Sexuality
Education, which is being taught at the school of education only for the first-year
student teachers.

• Conducts orientation sessions on life skills for first year students during their first
week at university.

• Conducts video screening and radio presentations through the university campus
radio station.

• Uses social media platforms like Instagram, Facebook, and WhatsApp to educate
and interact with students on health issues.

• Runs the Mugota and Web for life platforms.
• Gender studies department also cover sexuality issues as an examination module.

23

Health facilities’ status on health education Stakeholder participation

The assessment established that HTEI clinics, as part of the The assessment also established various platforms and
student affairs division also play a critical and active role systems for promoting stakeholder participation towards
towards ensuring that young people are knowledgeable provision of health services to young people in the HTEIs.
about their own health and rights, and they know where and Most of the HTEI’s clinics have well-represented committees,
when to obtain health services. As such, this section presents with young people’s representatives, which seeks to address
the status of all the HTEI clinics towards addressing young and advance young people's SRH, except HIT, NUST and
people’s health literacy. Mutare Polytechnic. Participation of young people in these
committees has largely been through the peer educators
Outside environments and the student representative council members. However,
minutes for the committee meetings were only available at
Ten of the assessed 11 clinics’ surroundings (including the the UZ and GZU.
PMSI Hillside Hospital) were found to be clean and welcoming,
except Mupfure Industrial Training Centre. This clinic is located 4.3 Health Services Delivery
outside the campus, and it is usually crowded with people
from the surrounding community. Only five university clinics This section presents on availability of essential health
had clear and visible signboards (CUT, GZU, Harare Institute services in the 11 selected HTEI clinics and PSMI Hillside
of Technology, UZ and NUST). However, the assessment Hospital (referral centre for WITC). The assessment established
established that the signboards were not showing the clinic’s various partnership arrangements between HTEIs and other
operating hours. This leads to the perpetuation of hearsay by stakeholders. The orientation weeks and health fairs/days were
young people that have not even gone to access services and identified as key towards health service demand generation.
have no signboards properly informing the students of the Partners like ZNFPC and MoHCC were noted as critical towards
correct times and services. capacity building of service providers in various health related
areas and provision of health commodities and supplies.
Information & educational materials PSI, Population Services Zimbabwe were also identified as
key partners in both demand generation and provision of
All the 11 clinics’ waiting areas were assessed on availability integrated SRH and HIV services for young people.
of up-to-date IEC materials (posters, brochures, leaflets) for
young people or that target young people on various topics. Availability of health information, counselling,
The assessment established that majority of the campus-based diagnostic, treatment, and care services
clinics had IEC materials outsourced from other stakeholders,
on most of the health issues at their waiting areas. Table 4 Only 11 HTEI clinics (excluding PSMI Hillside Hospital) were
illustrates the assessment of IEC materials. assessed on the availability of essential services on the day of
visit, using an observation sheet. A review of service primary
Other information dissemination channels in addition to registers was also conducted as part of observations and
the IEC material verifications. Most HTEIs, except DITC, Harare and Masvingo
polytechnics have relevant policies, guidelines and procedures
The assessment established that only DITC, Harare and that define the required package of health information,
Mutare polytechnics were not sharing any health information counselling, diagnostic, treatment, and care services. Table 5
through HTEI websites and social media platforms like describes the status of health service’s capacity to provide the
Facebook and WhatsApp. Though they were perceived required package of services.
during KIIs as complementary to the IEC materials, a review of
these websites and Facebook pages by the assessment team
showed that majority of the messages were too old and not
health oriented. Almost all HTEIs’clinics except DITC have peer
educators who facilitate dialogues, distribute IEC materials,
and share information through WhatsApp groups, to young
people. Videos with relevant health information for young
people were only being played in the waiting areas of HIT,
Mutare Polytechnic and NUST clinics.

24

Table 4: Availability of IEC materials

Topic Status (n=12)
Emergency contraception
Most of the clinics’ waiting areas except Harare Institute of Technology (HIT), Harare
Contraception Polytechnic, Premier Services Medical Investment (PSMI) Hillside Hospital and Mupfure
Industrial Training Centre (MITC), displayed IEC materials on emergency contraception.
Early pregnancy and consequences
Pre exposure prophylaxis (PrEP) Most of the clinics’ waiting areas except Danhiko Industrial Training Centre (DITC),
Post exposure prophylaxis (PEP) Harare Institute of Technology (HIT), Harare Polytechnic, PSMI Hillside Hospital and UZ,
Healthy and unhealthy relationships displayed IEC materials on contraception.
Drug and alcohol use
Male circumcision Majority of the clinics’ waiting areas, except DITC, PSMI Hillside Hospital and Harare
Mental health Polytechnic displayed IEC materials on early pregnancy and consequences.
Prevention, care, and treatment of HIV
including living with HIV IEC materials on PrEP were displayed in majority of the assessed waiting areas, except
Sexually transmitted infections (STIs) at DITC, (HIT), Harare Polytechnic and MSUAS.
Safer Sex and condom use
Sexuality, including sexual orientation, gender Similarly, IEC materials were not available only at DITC, Harare Polytechnic, HIT and
identity, and positive sexuality MSUAS’s clinic waiting areas.
Prevention of gender-based violence and
seeking services IEC materials on this topic were not available at DITC, Harare Polytechnic and MITC’s
Covid 19 prevention, management, and clinic waiting areas.
vaccinations
Abortion and Post-Abortion Care Most waiting areas had IEC materials on drug and alcohol use displayed except at DITC,
Healthy living (nutrition, exercise, etc.) Harare Polytechnic and MITC.
Rights of young people are displayed.
The IEC materials (posters, brochures, leaflets) HIT, MSUAS, PSMI Hillside Hospital and Harare Polytechnic Clinic waiting areas did not
are also available in braille have IEC materials on male circumcision displayed.

DITC, MITC and Harare Polytechnic Clinic waiting areas did not have IEC materials on
mental health displayed.

Almost all the waiting areas except at Harare Polytechnic had displayed IEC materials
on prevention, care, and treatment of HIV including living with HIV.

Only Harare Polytechnic clinic’s waiting area did not have IEC materials on STIs
displayed.

Similarly, IEC materials on safer sex and condom use were not displayed, only at Harare
Polytechnic’s waiting area.

DITC, MSUAS, Harare Polytechnic, and MITC did not have IEC materials on sexuality
displayed.

Majority of the clinic’s waiting areas had IEC materials on prevention and management
of GBV displayed except at Harare Polytechnic and MITC.

Almost all the waiting areas except at Harare polytechnic had IEC materials on
COVID-19 displayed.

CUT, GZU, HIT, UZ, PSMI Hillside Hospital, NUST and Masvingo Polytechnic Clinic
waiting areas had IEC materials on abortion and post abortion care.

Only Harare and Masvingo polytechnics did not have IEC materials on healthy living
displayed on their waiting areas.

Most waiting areas, except at CUT, HIT, MSUAS, UZ and NUST did not have IEC materials
on rights of young people displayed.

Only three university clinics’ waiting areas (MSUAS, UZ and NUST) had IEC materials in
braille displayed.

25

Table 5: Availability of the required package of services

Type of Service Status
Contraceptives
Contraceptive counselling Contraceptive counselling services were available in all the selected
Safe motherhood clinics, except PSMI Hillside Hospital.
HIV and other STIs
Emergency contraception Emergency contraceptives were not available only at HIT, Harare
Polytechnic, PSMI Hillside Hospital, MITC and UZ.

Oral contraception Oral contraceptives were available in almost all the selected clinics, except
at Harare Polytechnic, PSMI Hillside Hospital and HIT.

Condoms Condoms (both male and females) were available in all the 11 assessed
clinics. The most common condoms were the panther, FC2 and protector
plus, whilst some HTEIs had the ICON and Love brands.

Injectable Injectables were available in almost all the clinics except at HIT and Harare
Polytechnic.

Intra-uterine Devices (IUD) IUDs were available in most clinics except at Harare Polytechnic, PSMI
Hillside Hospital, HIT, Masvingo Polytechnic and MITC.

Implants Implants services (insertion and removal) were available in almost all the
clinics except at HIT, MITC, PSMI Hillside Hospital and Harare Polytechnic.

Pregnancy testing Pregnancy testing services were available in all the 11 assessed clinics and
PSMI Hillside Hospital.

Antenatal care (ANC) ANC services were only available at CUT, DITC, HIT, UZ and MITC.

Post-natal care (PNC) PNC services were only available at CUT, DITC, NUST, UZ and MITC.

Pre exposure prophylaxis (PrEP) PrEP counselling was available in most of the clinics, except at CUT, HIT,
Harare Polytechnic, MSUAS, and NUST clinics.

Post exposure prophylaxis (PEP) PEP counselling was available in most clinics except at HIT, Harare
Polytechnic and MSUAS.

Pre-/post HIV test counselling DITC, HIT and Harare Polytechnic are the only HTEIs whose clinics were not
offering pre-/post HIV test counselling.

HIV testing Similarly, DITC, HIT and Harare Polytechnic were not offering HIV testing
services.

STI screening and treatment All the 11 HTEI clinics were offering STI screening and treatment services
methods to students and young people.

TB screening TB screening was not available at Harare Polytechnic, Masvingo
Polytechnic, MUAS and Mutare Polytechnic clinics.

Medical male circumcision Only CUT, DITC, MITC, UZ and Mutare Polytechnic were providing
voluntary medical male circumcision.

ART and adherence to ART and adherence to treatment counselling services were available in
treatment counselling almost all the 11 clinics (including PSMI Hillside Hospital) except Harare
Polytechnic Clinic.

26

Type of Service Status
Cancer screening
Abortion & post Manual breast examination Manual breast examination services were available on most HTEI clinics
abortion care (including PSMI Hillside Hospital) except at DITC, NUST and Harare
Sexual Gender-based Polytechnic.
Violence (SGBV)
Mental health Pap smear or other cervical The pap smear and cervical cancer screening services was only available
cancer screening method at DITC.
Chronic health
conditions Induced medical abortion Induced medical abortion was only available at CUT, MITC and UZ clinics.
Alcohol, tobacco,
and drug use Treatment for incomplete Treatment for incomplete abortion services were available only at CUT,
abortion GZU, HIT, NUST, PSMI Hillside Hospital and MITC.
COVID-19.
Pre-/post-abortion counselling Pre-/post-abortion counselling was not available only at HIT and Harare
Polytechnic.

Screening for SGBV Screening services for SGBV were available in majority of the clinics except
at Harare Polytechnic, PSMI Hillside Hospital and Mutare Polytechnic.

SGBV management and referral HIT and Harare Polytechnic were the only clinics not able to provide SGBV
management and referral services.

Assessment of mental health Assessment of mental health problems, treatment, and referral services
problems, treatment, and were being provided in all the 11 selected clinics, including PSMI Hillside
referral Hospital.

Suicide risk screening Suicide risk screening services were not only available at DITC, Harare
Polytechnic, PSMI Hillside Hospital and MITC.

Therapy for suicide ideation Therapy for suicide ideation was available at most clinics except at DITC,
HIT, Harare Polytechnic, PSMI Hillside Hospital and MITC.

Stress counselling/therapy for Stress counselling/therapy for stress services were available in 10 of the 11

stress assessed clinics. PSMI Hillside Hospital was also not offering this service.

Screening for chronic health All the assessed clinics were screening for chronic health conditions,
conditions including PSMI Hillside Hospital.

Treatment of chronic health All the assessed clinics were providing treatment for chronic health
conditions conditions, including PSMI Hillside Hospital.

Alcohol, tobacco, and drug use Only UZ, CUT, NUST and MITC were providing alcohol, tobacco, and drug

screening use screening services.

Alcohol, tobacco and drug Except at DITC and PSMI Hillside Hospital, all the other clinics were
use prevention services or providing alcohol, tobacco and drug use prevention services or
programmes programmes.

Alcohol, tobacco and drug use Most of the clinics except DITC, Harare Polytechnic and HIT were providing

treatment and referral alcohol, tobacco and drug use treatment and referral services.

COVID-19 screening All the assessed clinics were conducting COVID-19 screening, including
PSMI Hillside Hospital.

COVID-19 testing COVID-19 testing was only being provided at MSUAS, NUST, UZ, PSMI
Hillside Hospital and MITC.

COVID-19 referral COVID-19 referral services were being provided in most clinics except at
MSUA, Harare Polytechnic, UZ, PSMI Hillside Hospital and MITC.

27

Type of Service Status

Other Sex and sexuality counselling Sex and sexuality counselling services were available in majority of the
assessed clinics except at PSMI Hillside Hospital, DITC and MITC.

Relationship counselling DITC, PSMI Hillside Hospital and Harare Polytechnic are the only clinics
which were not providing relationship counselling services.

Life skills counselling Life skills counselling services were available at all the assessed 11 clinics.
PSMI Hillside Hospital did not provide this service.

Nutritional needs and healthy DITC and Harare Polytechnic are the only clinics which were not providing

eating counselling nutritional needs and healthy eating counselling services.

Policies and procedures are Referral guidelines and forms Referral guidelines and forms were available in most clinics except
in place that describe the are in place Masvingo Polytechnic, PSMI Hillside Hospital and DITC.
referral system to services
within and outside the The facility keeps a register of All the 11 assessed clinics keep a register of all referrals for young people.
health sector, including all referrals for young people
provisions for transition Almost all the clinics except Harare Polytechnic have a system in place to
care for young people with The facility has a system in ensure safety, quality and follow up on referrals.
chronic conditions. place to ensure safety, quality
and follow up on referrals

The facility has a functional Legal services Legal services resource lists were only available at NUST and UZ clinics.
resource list for referral Psycho-social services (PSS)
services with updated Functional resource lists for PSS were available at CUT, HIT, UZ, NUST, MITC
contact details: and Mutare Polytechnic.

Drop-in centres for young Only HIT, MSUAS, NUST, UZ and Mutare Polytechnic had a resource list for
people drop-in centres for young people.

Rehabilitative services (i.e., for Functional resource lists for rehabilitative services were available in most
drug and alcohol use, physical clinics, except at DITC, GZU, Harare Polytechnic, Masvingo Polytechnic,
and mental disability) MITC.

Service uptake and referral pathway All the assessed HTEIs have adequate documentation and
Service uptake registers and engagements with young people referral tools for referring and receiving feedback on referred
through FGDs and ICSs showed that the most services being emergency cases. In almost all HTEIs except at DITC, the
taken by both sexes were counselling, condoms (especially clinic staff facilitates emergency referrals either through
the male ones) and HIV testing. STI screening & treatment ambulances or college vehicles. At DITC, emergency referral
services were the most common among males. Pregnancy cases are managed through parents and guardians mainly
testing, oral pills, headaches, and menstrual pain management due to unavailability of a student medical insurance scheme.
were common among female students. The assessment also In most instances, young people expressed satisfaction with
established that service uptake for preventive services like the referral pathways for the services not being offered on
condoms and HTS were reportedly high during health fairs/ static HTEI clinics.
days and the condom campaigns. The assessment established
that all the selected 11 clinics had clearly defined referral “When you are being referred, they write you a letter that is
pathway for services not available on-site. For example, HIT acceptable at most public facilities around here and you can
refers to CIMAS hospitals and Parirenyatwa group of hospitals; be attended to quickly”. Male FGD participant.
Harare Polytechnic refers to Parirenyatwa group of hospitals; “I prefer going through the clinic first even if the case isn’t
CUT refers to the Chinhoyi provincial hospital; MITC refers to manageable there so as to get their referral. It saves me from
Chegutu District Hospital; NUST refers to United Bulawayo queueing when l have to go to the facility, I have been referred
Hospital & PSI clinics; MSUAS and Mutare Polytechnic refers to”. Female ICS respondent
to the Mutare Provincial Hospital and PSI new Start centres,
whilst GZU and Masvingo Polytechnic also refers to Masvingo “We do not have a clinic here so we cannot comment on
Provincial Hospital. youth-friendly service provision if you have issues such as
these you sort them out yourself. Each man for himself’’. FGD
female participant

28

‘’Since I have not been able to visit the clinic, I am not sure Profile of health-care providers in place
if I will answer that correctly but what I know is we have
ambulance here and for services which are not available the The assessment established that HTEIs have different staff
students are usually referred to Parirenyatwa Hospital’’. Male establishments due to the different ownership and funding
ICS respondent arrangements. The assessment established that all the HTEIs
and authorities in both MoHCC and MoHTEISTD were clear
Provider competences that universities are quasi autonomous hence their clinics
and staff establishments are solely managed through their
The global standards on provision of quality services for councils. Clinics of polytechnics and industrial training centres
young people require health-care providers to demonstrate (except Mupfure clinic owned by Chegutu rural district
the technical competence and motivation required to provide council) are owned by the respective HTEIs whilst their staff
effective health services to young people. Both healthcare establishments is under the Public Service Commission
providers and support staff are required to respect, protect, through the MoHTEISTD. The assessment established that all
and fulfil young people's rights to information, privacy, the polytechnics under this study have an establishment of
confidentiality, non-discrimination, non-judgmental attitude, two nurses. However, of the three industrial training centres
and respect. This section presents on the status of health under this assessment, only WITC has an establishment of two
facilities, staff competence in this regard: nurses as well. Table 6 shows the distribution of staff available
in all the 12 clinics covered under this assessment.

Table 6: Categories of staff available Categories of Staff (number)

HTEI Doctors Nurses Counsellors Others

Harare Institute of Technology 12x1
Harare Polytechnic
Chinhoyi University of Technology x1x1
Mupfure Industrial Training College
National University of Science and Technology 131x
University of Zimbabwe
Danhiko Industrial Training Centre x3xx
Manicaland State University of Applied Sciences
Mutare Polytechnic 141x
Masvingo Polytechnic
Great Zimbabwe University 2211

x111

1221

12xx
x1x1

1411

Table 6 shows that all the universities had doctors whilst all However, some nurses expressed concern over the low staff
the two assessed industrial training centres did not have. establishments, to cope with the increasing scope of services
The assessment however established that available doctors and long waiting periods of young people.
were not full time or resident doctors but had special days for
visiting the clinics. HTEIs which did not have doctors in post “……yes, if more staff are hired, I won’t have to manage the
highlighted resource challenges to fund the doctors’ costs. waiting area, so we need staff for the outside area so that I can
Other staff members, indicated in Table 6 were mostly nurse concentrate on clinical issues”. Nurse
aides.

29

Provider competence in youth-friendly health service As such, the 2016 national guidelines on provision of clinical
(YFHS) delivery SRH services to adolescents and young people remain the
most key reference document or tool for delivering YFHS
Zimbabwe, through the MoHCC has standardized capacity through various service specific guidelines such as STI
building of health service providers, in both pre- and in-service guidelines, HTS guidelines, ART guidelines, VMMC guidelines,
settings. This has been achieved through development of ANC protocols, FP guidelines and protocols on management
a standard training manual and participant handbooks on of obstetric and neonatal care complications. The assessment
ASRH. The package, which includes the global standards on established that the trainings on YFHS have been rolled out
provision of quality services to adolescents and young people mainly to public health facilities in 24 districts since 2016.
has since been adapted to the pre-service settings for training The assessment established different HTEI partnership
of midwives and nurses on CSE and youth-friendly health arrangements for capacity building of clinic staff in essential
service delivery. health service delivery, including COVID-19. Table 7 shows the
status of HTEI clinic staff towards YFHS delivery.

Table 7: Health service provider competences

Competence Area Status (n=11)

Training register for providers showing youth-friendly health Only four universities, CUT, GZU, NUST and UZ, confirmed having at
service (YFHS) courses listed in 'training content' worksheet is least one of their health facility staff having undergone training in YFHS
available and having a training register in place.

Continuous Professional Development (CPD) plan for health CPD plans were only available at CUT, GZU, Masvingo Polytechnic,
care providers showing relevant YFHS courses is in place MITC, NUST and UZ.

Providers’ obligations to young people's rights are clearly Only three universities: CUT, NUST and UZ had the providers’
displayed in the health facility obligations to the young people’s rights displayed.

Service charter is displayed in the health facility The service charter was not displayed in majority of the clinics except
at MITC and NUST.

Evidence of when last a supervisor, if applicable, visited the CUT, UZ, NUST, MSUAS, MITC and Mutare Polytechnic had the evidence
facility: last 3 months ago, 6 months ago (visitors’ book) of supervision.

Guidelines /Standard Operating Procedures (SOPs) on These guidelines were only available at Mutare Polytechnic, CUT, UZ,
supportive supervision in young people's health care are in NUST and GZU.
place

National YFHS guideline/standards The national YFHS standard guidelines were only available at CUT, GZU,
NUST, UZ, Masvingo and Mutare Polytechnics.

Guidelines/SOPs on protecting the privacy and confidentiality These SOPs were available in most clinics except at HIT, Harare
of young people
Polytechnic and MITC.

Guidelines/SOPs on equitable service provision to all young These guidelines were only available at DITC, HIT, MSUAS, Harare
people irrespective of their ability to pay, age, sex, marital Polytechnic, and MITC.
status, disability, or other characteristics

Guidelines/SOPs for self-monitoring of the quality of care Only CUT, Masvingo Polytechnic, Mutare Polytechnic, NUST and UZ had
provided to young people the guidelines for self-monitoring of the quality of care provided to
young people.

Table 7 above shows that the 11 assessed clinics are at Health facility characteristics
different competence levels, varying from training in YFHS
and availability of essentials job aids for quality health service This section presents the status of the selected 11 health
delivery to young people. The assessment showed no co- facilities (assessed using the observation checklist), regarding
relationship between the level of HTEI, staffing levels and convenient operating hours, a welcoming and clean
providers’ competences. environment and maintains privacy and confidentiality. It also
shares the status of these clinics in terms of the equipment,
30 medicines, supplies and technology needed to ensure
effective health service delivery to young people.

Table 8: Health facilities characteristics

Characteristic Status (n=11)
Policy and / or standard operating procedures
Operating hours convenient to young people Most of the clinics, except Harare Polytechnic had policies and guidelines on service
Waiting area delivery.

Basic amenities Majority of the clinics, except HIT, Harare Polytechnic MITC, and GZU were opening
Visual and auditory privacy features even after lecture hours. However, only CUT, MITC, NUST and UZ were opening over
weekends.
Facility medicines, supplies and equipment
Most of the clinics had a clean and welcoming environment except MITC. MSUAS and
Overall MITC did not have adequate and comfortable furniture at the waiting area. Availability
of comfortable and adequate furniture in consultation rooms was identified in most
clinics except at GZU, MSUAS and MITC. All the clinics had hand and hygiene sanitizers
in their toilets except Masvingo Polytechnic.

Majority (10) of the clinics had functional and clean toilets. All the clinics had electricity
during working hours whilst at DITC, there were no storage & disposable bins for
sharps and hand hygiene materials.

Most of the clinics (10) had consultation rooms away from the public view and had
closed doors and curtains in consultation rooms. Most consultation rooms were
marked in a neutral way that avoids stigmatization except at Masvingo Polytechnic and
MITC.

Most required medicines, supplies and equipment were available in majority of the
clinics. However, examination lights, haemoglobinometers, lactate strips, nasogastric
tubes, pap smear test kits, implants, atenolol, cotrimoxazole suspension, glibenclamide,
omeprazole, magnesium sulphate, PrEP, PEP and ARVs were not available in majority of
the clinics, especially polytechnics and industrial training centres.

Universities have better environment, infrastructure, commodity stocks and
technology for provision of YFHS, than polytechnics and industrial training centres.

The assessment established that some institutions over the “I was treated in a welcoming way the first time I came here. If I
past recent years, have created very welcoming environment had been treated badly, I could not have returned here for HIV
and fostered good relations between clinical staff and young testing. I could have chosen to go either to …… or anywhere
people. else”. Male ICS Participant

“The infrastructure hasn't changed a lot from the time I first Young people’s confidence to visit HTEI clinics was also being
came here as a first-year student. However, the services have influenced by familiarity of students with the nurses, gender
improved remarkably …...the patient-nurse relationship of nurses and opening times. The assessment established
here is impressive. The relationship is more welcoming as through FGDs and ICSs that young people feel uncomfortable
compared to necessary public health institutions. Like I was sharing their issues with a familiar clinic staff, fearing that they
saying the relationships between nurses and their clients at would probably share their issues with other students and
this clinic are wonderful than those from public hospitals like staff members. This was noted in clinics which had only one
Mpilo are somewhat aggressive”. Male ICS participant nurse and a nurse aid.

“The nurses are friendly; I remember there was a time I went “……. No, I am shy to do so because I will be approaching the
to collect my condoms they were so supportive...”. Male FGD regular faces I see every day with a very sensitive problem. I
Participant am afraid they might share my health status with my peers or
even lecturers which I will not be comfortable with…. so, it’s
“The health facility at this college is accessible and the staff better to live with your problem than to go seek counselling or
at the clinic is so helpful and accommodative. Students living any other service at the clinic.” Male ICS respondent
with disabilities also regularly visit the clinic for their therapies”.
Female ICS Participant

31

Clinic operating times were also a challenge especially for During the assessment, young women also noted that some
students who live off campus as they felt it was only convenient men were not comfortable approaching female nurses for
for those that had an opportunity before and after lectures to condoms. The fear of reproach and judgement is yet another
access the clinic as they lived within the vicinity of the campus. hindrance resultant of the above. Many of the young men
This was also worsened by the fact that some HTEI clinics grimaced over the availability of female nurses only and felt
do not open during weekends. Some male students during that their access to services was compromised as they were
FGDs highlighted that the clinics were largely dominated by uncomfortable opening up to female nurses.
female staff thereby limiting their confidence to approach
them for sexuality discussions. The unavailability of resident “The other limitation is that she is female and at times male
doctors was raised as a huge concern by majority of students, students find it difficult opening up to her? At least if they add
especially during the weekends where their timetables are male staff to balance the services… the clinic is not a good
less demanding. Below are some of the extracted expressions dispensing point because some of the guys will be shy to
by young people during the assessment: collect them”. Female ICS participant

“.... The clinic is strategically located for those that live on “I have heard from my colleagues that there are only female
campus, however 80% of students are staying off campus nurses so for male students it’s difficult for us to communicate
thus there is the need for an off-campus establishment for sexually related problems with them”. Male ICS Participant
students living off campus”. Male FGD participant
The assessment established that condoms were being
“No, I checked in the female hostels and campus toilets, accessed through various points within the HTEIs: clinics,
only female condoms are made available and as an LGBTQ resource centres (NUST, GZU, MSUAS, HIT, CUT, UZ and Mutare
member I would love to see the same commodities we require Polytechnic), peer educators, dispensers (at UZ, GZU, and
being made available like any other service offered. At the Mutare Polytechnic), toilets and hostels’ passages. Young
moment LGBTQI services are being accessed nicodemously, so people (both in FGDs and ICSs) expressed great satisfaction
for me to say there is a system to promote CSE in the context of with condom dispensers despite being few in HTEIs where
LGBTQ, it would be a lie and because the clinic and university they were available. However, both young men and young
do not recognize our existence, our access to services is women raised concern over unavailability of the most
compromised”. LGBTQ ICS respondent preferred flavoured brands such as “Love”, Protector Plus and
ICON rather than the public sector panther condom popularly
Young people also indicated the perennial shortage of some known as “maDembare”. Below are some of the sentiments
services in their clinics, including for the key populations as that were shared by the students with regard to condoms:
a key demotivating factor in visiting campus clinics. These
services include HIV self-testing kits, post exposure prophylaxis “Condom brands on supply are not fancy hence at times
and flavoured condoms such as Love and ICON brands. This students don’t want to use them. The girls will feel cheapened
was also in some clinics worsened by unfriendly opening if you use a condom, they know is being disbursed for free
hours. Below are some of the voices of young people in terms everywhere on campus and outside campus in public halls”.
of service availability: Male FGD participant

“Hmm there is nothing motivating here, you go to the “On that issue of condoms, we need a variety and better
clinic seeking help, but you don’t get it. All they give you is condoms like the ones which are flavoured…”. Female FGD
paracetamol and amoxicillin and nothing more”. Female ICS participant
respondent
Target groups
During an FGD with young men they revealed that one of the
outstanding hindrances in service provision is the age and The national guidelines on provision of clinical services also
efficiency of personnel as some are unqualified and pose as seeks to ensure that health facilities provide quality services
parents more than service providers. to all young people irrespective of their ability to pay, age, sex,
marital status, education level, ethnic origin, sexual orientation,
“At times, the staff level of engagement is unprofessional since or other characteristics. All the assessed HTEIs expressed that
they tend to use a parent-child approach instead of a service their health education and service delivery approaches were
provider- client one”. Male FGD participant not being tailor made for any specific groups of young people
and students. CUT, GZU, Masvingo Polytechnic, MITC, NUST
“There are two nurses, one of them is friendly and the other and UZ were established to have made important strides and
one is very rough…”. Male FGD participant improvements specifically to ensure that the health facility
and its essential wards/units are accessible to young people
on wheelchairs.

32

The assessment however, established that only CUT, GZU, “No, we work, or we offer the services equally here without
NUST and UZ clinics had staff who were able to communicate checking the backgrounds of students. We believe that all
in sign language and there were no IEC materials in braille in students are equal”. Nurse Aid
all the HTEIs.
“...if we discover that you are homosexual, we will beat you up”.
Only five clinics (CUT, GZU, UZ, NUST and DITC) had their Male FGD participant
prices of the services clearly displayed for clients to see. DITC,
GZU, MSUAS, and UZ clinics are the ones which had clear “From my observations they are accepting existence of
policies on creating a safe environment for young people. different stakeholder like GALZ (Gays and Lesbians of
Despite acknowledging the existence of the LGBTQ students Zimbabwe). They are even accepting peer educators from our
in their HTEIs, all the KIIs expressed reservations regarding special group (LGBTQ). There are also members from CESHHAR
the targeting of the LGBTQ community, due to different (Centre for Sexual Health and HIV Research Zimbabwe) who
interpretations of the constitution regarding them. Young are also coming to educate people”. Key population ICS
people are therefore being treated through an individualistic respondent
approach that, however, does not discriminate them from
accessing counselling and health services. Unfortunately, “LGBTQ services are being accessed secretly so for me to say
there is no HTEI that confirmed procurement and distribution there is a system to promote CSE in the context of LGBTQ it
of materials such as condoms and lubricants specifically for would be a lie”. Key population ICS respondent
the LGBTQ community (both students and staff ). Interaction
with the beneficiaries of the services and CSE revealed that Data collection and quality improvement
the operating environment was intolerant of different sexual
orientations. As such, the assessment established existence of The study assessed HTEI clinics’ systems and practices on
mixed feelings regarding the LGBTQs between policy makers, collection, analysis, and utilization of data on service utilization
service providers and young people, as reflected below: for quality improvement. The assessment established that
health facilities rely heavily on the MoHCC T-series like the T-12
“We haven’t had such per see, and we have never given and T-5 which are not yet adolescent and youth-friendly. As
provision to accommodate them since the principal has such, only CUT, NUST and UZ clinics had improvised registers
never mentioned anything along those lines, so we do not which were disaggregating data on service utilization by age
accommodate such as a Christian organization and if they and sex of young people and students. Evidence for utilization
are there, they make sure that they are not known and if their of collected data in decision making was only available at
identity is revealed they usually transfer quietly. We are very NUST and MITC. Guidelines/SOPs for self-monitoring of the
allergic to that group as a college”. Dean of Students. quality of care provided to young people were only observed
at MSUAS, CUT, MITC, Mutare Polytechnic, UZ and NUST
“No! we are a parastatal, lesbianism and homosexuality is clinics. CUT, GZU, NUST, UZ, and Mutare Polytechnic are the
regarded as illegal so we cannot support it but when those only HTEIs with clinics which has guidelines/SOPs on the
things come, we provide counselling and usually they do not reward for and recognition of highly performing staff. Client
pop-up regularly. At one instant I had a student who came satisfaction exit interviews with students and young people
and addressed that he was introduced to homosexuality had only been conducted at CUT, GZU, NUST, UZ, Mutare and
and his guy had gone to another boyfriend the student was Masvingo Polytechnics. Majority of the clinics (including PSMI
now lonely it was a very hard scenario to deal with”. Dean of Hillside Hospital) except HIT, Harare Polytechnic, and MITC
Students had suggestion boxes for receiving feedback on the quality
of services from young people and students. However, their
“…in line with the National Constitution. We do not want purpose and utilization modalities were not clear among
to hear that. And if we have an organization advocating for students and young people:
that, we separate ways, because it is a criminal activity in
Zimbabwe. So, for record purposes, we do not want to hear “There is little participation of the young people beyond the
that. But other key populations like disability and things like SRC… however with regards to the suggestion boxes at the
that, we are fortunate to say as a ……., we don’t have high clinic for evaluation, young people rarely use them … the
population of those”. Dean of Students problem is we don't know what these suggestions are really
for”. Male FGD participants
“No, we treat everyone equally because they are all students”.
Nurse Aid SOPs on engagement of young people in the planning,
monitoring and evaluation of health services and service
“I do not select from the groups because all of them are young provision were not available in most clinics, except at CUT,
people so I can’t say, this person is……”. Nurse Aid UZ, NUST, Mutare polytechnic and Masvingo polytechnic. The
assessment however established that all the 11 clinics did not
“We do serve such here. We actually have some coming have SOPs on how to involve minority groups (e.g., LGBTQ,
here to collect their medications and commodities”. Clinic those living with HIV and with disabilities) of young people
support staff. in the planning, monitoring and evaluation of health services
and service provision.

33

5. Conclusion and Recommendations

There is a strong national drive and ii. The national YFHS standard guidelines were only available
commitment towards strengthening at CUT, GZU, NUST, UZ, Masvingo and Mutare Polytechnic
CSE and YFHS delivery in HTEIs, with campus-based clinics. In addition to the unavailability
a special focus on young people in of these guidelines in some clinics, they are not yet fully
Zimbabwe. contextualized to the different categories of HTEIs. The
assessment also established that the minimum of package
This is being reflected through existing networking and of services provided by the guidelines is limited to SRH
coordination platforms on HTEIs, policy and strategic and HIV. There is the need to review and contextualize
guidance/frameworks and current processes for developing the guidelines to the different categories of HTEIs,
a standard CSE curriculum framework for CSE in HTEIs and including expanding the scope of services beyond
the current drive to adapt the clinical guidelines (YFHS SRH and HIV and the monitoring tools (observation
standards) to HTEI settings. The commitment of HTEIs towards checklist) for the certification processes by the MoHCC
designating clinics and establishing medical aid schemes for on YFHS.
students is another sign of commitment by HTEIs to provide
quality health services for students and young people. HTEIs iii. The assessment established that students and young
have devised mechanisms for engaging and networking people’s participation in planning and monitoring is limited
with other line ministries, parastatals, and civil society for CSE to the student representative council and peer educators.
and YFHS delivery. A number of successful initiatives such as There is the need to generate evidence about CSE
student orientation, peer educators training, resource centres, and health service delivery as experienced by young
provision of IEC materials, medical aid schemes, stakeholder people through provision of feedback mechanisms to
collaboration and youth engagement exist across all HTEIs. duty bearers and service providers in HTEIs. There is
University clinics largely have better infrastructure, staff the need to develop youth led social accountability
establishments and commodity supplies for quality health CSE and YFHS score cards and develop the capacity
service delivery than polytechnics and industrial training of young people to utilize them meaningfully. The
centres. score cards can be adapted from the Youth 2030 score
card and the 2019 International Planned Parenthood
The assessment has identified a number of opportunities, Federation (IPPF) guidance.
gaps, and challenges, which range from policy, strategy, and
programming, through which the following recommendations iv. The assessment established that there are no standard
are premised on. The recommendations therefore address designs or plans to guide the construction of clinics in
the policy, infrastructure, human resources, service delivery, the various categories of HTEIs. The MoHTEISTD need to
partnerships, young people and service providers’perspectives consider adapting the public sector clinics’ standard
at national, provincial, district and HTEI levels. design/plan from the MoHCC, to guide construction or
expansion of existing clinics for the various categories
National level of HTEIs (e.g., universities, polytechnics, industrial
training centres). This will help match the clinic
i. The unavailability of a standard curriculum on infrastructure to the ever-increasing student enrolments
comprehensive health education for HTEIs is a huge and the current scope/package of health services as new
gap towards effective structured delivery of health and evidence and needs continue to emerge.
life skills sessions by the lecturers. As such, the allocated
time for health and life skills sessions is not being fully v. Availability of youth-friendly nurses was only reported
utilized for the purpose. There is the need for a high- by young people in clinics which had received YFHS
level policy commitment by both the MoHTEISTD training. However, even in these situations, YFHS was not
and the HEXCO on strengthening health and life skills facility-wide (only limited to trained nurses) only. There
education, as the main entry point for CSE. The policy is the need for capacity building of both lecturers,
will need to be implemented or delivered through nurses, and support staff in CSE and YFHS through a
a standard curriculum contextualized to all the training of trainers, as an entry point for on-the-job
different categories of HTEIs in Zimbabwe. This will continuous mentoring and training of core staff. This
ensure standardized and quality delivery (including training will also clarify the different interpretation of
documentation and monitoring) of health and life the constitution, laws, and policies on sensitive SRH
skills course. issues such as termination of pregnancy, LGBTQ, post
abortion care and SGBV, with HTEI management for
consensus building.

34

vi. The assessment established that the student enrolments HTEI level
have been increasing in all HTEIs across the country yet
the staff establishments for polytechnic and industrial i. HTEIs need to expand the public – private sector
training centres’ clinics have not been expanding. There partnerships to construct and/or expand the size of clinics
is the need to advocate and support the review of the to match the ever-increasing student enrolments and
staff establishments of these HTEIs with the public the expanding scope/package of health services as new
service commission, through the MoHTEISTD, to align evidence emerges.
with the increasing scope or package of services,
demand for after hours and weekend opening hours ii. The assessment established that the clinics were at
by students and the long waiting periods by students different stock levels for essential medicines and supplies.
in some campus clinics. Most required medicines, supplies and equipment were
available in majority of the clinics. However, examination
vii. Majority of all the assessed HTEI clinics did not have staff lights, haemoglobinometers, lactate strips, nasogastric
members able to communicate in sign language. This tubes, pap smear test kits, implants, atenolol, cotrimoxazole
is also worsened by the unavailability of IEC materials in suspension, glibenclamide, omeprazole, magnesium
braille in most HTEIs. There is the need for the Public sulphate, pre-exposure prophylaxis (PrEP), post exposure
Service Commission, the MoHTEISTD, MoHCC and prophylaxis (PEP) and antiretroviral drugs (ARVs) were not
HTEIs to consider integrating sign language training available in majority of the clinics, especially polytechnics
in both pre-and in-service training of service providers and industrial training centres. There is the need for HTEIs
beyond health education and service delivery. to routinely conduct stock checks and replenishment
to sustain service provision. These stock checks need
Provincial and district levels to be integrated with the quarterly participatory
administration of the observation YFHS checklist.
i. Though reported in a few HTEIs, the coverage of YFHS and
CSE trainings in HTEIs have remained largely on nurses iii. Most HTEI clinics have unfriendly opening hours for
and the health and life skills focal persons, excluding young people as they remain closed during the weekends
other academic, support and ancillary staff. There is the (except PSMI Hillside Hospital, CUT, NUST and UZ), when
need to develop and roll out capacity building plans students expressed having less pressure with academic
of HTEI staff in CSE (including a training of trainers work and motivation to seek both preventive and curative
for lecturers) and YFHS delivery approaches for the services. There is the need for polytechnics and
essential health services, in collaboration with MoHCC industrial training centres to open health clinics after
and ZNFPC. lecture hours and on weekends. However, awaiting
the review of staff establishments, HTEIs need to
ii. The assessment established various existing partnership consider rotating nursing staff to cover weekends,
arrangements for HTEIs. However, visibility of issues accommodate at least one of the nursing staff on
affecting students in HTEIs have remained low in provincial campus for after lecture hours services and avail
CSE and YFHS related networking and coordination selected non-clinical services (e.g., HIV self-testing)
platforms such as the provincial ASRH coordination through youth-led platforms such peer educators and
forums, the Family Planning Technical Working Groups, resource centres.
PAAC and DAAC meetings. Adoption of a setting-based
approach, as defined by the national guidelines on SRH
services to young people to these meetings is therefore
critical to ensure equity in discussions. This also can
be strengthened through joint and multisector
monitoring visits by the MoHCC, key parastatals
(e.g., ZNFPC and NAC) and CSOs to HTEIs within their
respective catchment areas, to generate evidence and
lessons critical for decision making and improved
quality service delivery.

35

iv. Health education and service delivery approaches in HTEIs
do not fully mainstream disability and key populations.
Health education approaches targeted for young people
with disabilities were only noted at the MSUAS, UZ
and NUST, UZ, and the MSUAS. There is the need to
further explore disability-friendly health education
approaches beyond development of IEC materials in
braille. Stigmatization and discrimination of the LGBTQ
is still a challenge in HTEIs, especially among higher
authorities and young people themselves. As such, all
the HTEIs commodity security systems lack recognition
of LGBTQ supplies such as lubricants. There are still mixed
feelings among young people regarding acceptability of
the LGBTQ community. HTEIs need to develop inclusive
policies which do not discriminate against the LGBTQ,
including inclusion of the essential supplies. Lessons
can be drawn from New Start Centres and MoHCC
public health facilities implementing the national
key populations programme. Deliberate efforts for a
youth led human rights-based approaches to health
education and counselling need to be adopted to
address stigma and discrimination.

v. Opportunities for young people’s participation in planning
and monitoring quality of CSE and health service delivery
remain limited to the SRC and peer educators. There is
the need for HTEIs to popularize the use of suggestion
boxes, client exit satisfaction surveys and implement
youth-led social accountability score cards.

vi. Apart from the health and life skills education courses’
delivery approaches being perceived as unattractive
and boring by young people, the assessment also
established that the CSE activities are largely centered on
the orientation weeks for the first-year students. Student
led approaches to CSE and periodic mobile outreach
services to HTEIs need to be considered so as to
complement the health and life skills course and the
static services.

vii. Theunavailabilityofadequateaccommodationforstudents
on campus is a huge gap for advancing health education
and service delivery, especially after hours and weekends
as majority of students stay off-campus. There is the need
for HTEIs to explore and establish public – private
sector partnerships for improving accommodation for
HTEIs to reduce the risks associated with staying off
campus. These partnerships will also enable disability
friendly infrastructural adjustments.

36

37 © stock.adobe.com

Annex 1

Information, Education and Communication (IEC) & Services and Services
Availability

Chinhoyi University of
Technology
Danhiko Industrial Training
Centre
Great Zimbabwe University
Harare Institute of
Technology
Harare Polytechnic
Manicaland State University
of Applied Sciences
Masvingo Polytechnic
Mupfure Industrial Training
College
Mutare Polytechnic
National University of
Science and Technology
University of Zimbabwe
Westgate Industrial Training
Centre -PSMI Hospital
Total available (n=12)

Outside the facility

Surroundings of the Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes 10
facility is clean and creates
a welcoming environment

The health facility Yes No Yes Yes No No No No No Yes Yes 5
signboard is clearly visible

The signboard mentions No No No No No No No No No No No No 0
facility operating hours

The health facility has, in the waiting area, up-to-date information, communication and educational materials (posters, brochures, leaflets)
specifically developed for young people or that target young people on the following topics

Emergency contraception Yes Yes Yes No No Yes Yes No Yes Yes Yes No 8

Contraception Yes No Yes No No Yes Yes Yes Yes Yes No No 7

Early pregnancy and Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes 10
consequences

Pre exposure prophylaxis Yes No Yes No No No Yes Yes Yes Yes Yes No 7

Post exposure prophylaxis Yes No Yes No No No Yes Yes Yes Yes Yes No 7

Healthy and unhealthy Yes No Yes Yes No Yes Yes No Yes Yes Yes 8
relationships

Drug and alcohol use Yes No Yes Yes No Yes Yes No Yes Yes Yes 8

Male circumcision Yes Yes Yes No No No Yes Yes Yes Yes Yes No 8

Mental health Yes No Yes Yes No Yes Yes No Yes Yes Yes No 8

Prevention, care, and Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No 10
treatment of HIV
including living with HIV

Sexually transmitted Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No 10
infections

Safer Sex and condom use Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No 10

Sexuality, including Yes No Yes Yes No No Yes No Yes Yes Yes No 7
sexual orientation, gender
identity, and positive
sexuality

How to prevent gender- Yes Yes Yes Yes No Yes Yes No Yes Yes Yes No 9
based violence and seek
services

38

Chinhoyi University of
Technology
Danhiko Industrial Training
Centre
Great Zimbabwe University
Harare Institute of
Technology
Harare Polytechnic
Manicaland State University
of Applied Sciences
Masvingo Polytechnic
Mupfure Industrial Training
College
Mutare Polytechnic
National University of
Science and Technology
University of Zimbabwe
Westgate Industrial Training
Centre -PSMI Hospital
Total available (n=12)

COVID-19 prevention, Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes 11
management, and
vaccinations

Safe abortion care and Yes No Yes Yes No No Yes No No Yes Yes No 6
treatment

Healthy living (nutrition, Yes Yes Yes Yes No Yes No Yes Yes Yes Yes No 9
exercise, etc.)

Rights of young people Yes No No Yes No Yes No No No Yes Yes No 5
are displayed.

The information, No No No No No Yes No No No Yes Yes No 3
communication, and
educational materials
(posters, brochures,
leaflets) are also available
in Braille

Other information dissemination channels in addition to the IEC material

Information is distributed Yes No Yes Yes No Yes Yes Yes No Yes Yes 8
through social media
and other Internet based
content

Peer educators/other Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 10
providers distribute
informational publications
to young people

Videos with relevant No No No Yes No No No No Yes Yes No 3
information for young
people are played in the
waiting area

Group discussions are Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes 10
convened to provide
SRH and other health
information to young
people

Committee/Technical Working Group to address young people's SRH issues

A well-represented Yes Yes Yes No Yes Yes Yes Yes No No Yes No 8
Committee/Technical
Working Group with a
young person , which
seeks to address and
advance young people's
SRH in place

Minutes of the No No Yes No No No No No No No Yes No 2
Committee/ Technical
Working Group meetings
are available

Relevant policies, guidelines and procedures in place that define the required package of health information, counselling, diagnostic, treatment,
and care services and enable its provision at this level of health service (i.e., health post, health centre/clinic, hospital)

Relevant policies, Yes No Yes Yes No Yes No Yes Yes Yes Yes No 8
guidelines, and
procedures in place

39

Chinhoyi University of
Technology
Danhiko Industrial Training
Centre
Great Zimbabwe University
Harare Institute of
Technology
Harare Polytechnic
Manicaland State University
of Applied Sciences
Masvingo Polytechnic
Mupfure Industrial Training
College
Mutare Polytechnic
National University of
Science and Technology
University of Zimbabwe
Westgate Industrial Training
Centre -PSMI Hospital
Total available (n=12)

Required package of health information, counselling, diagnostic, treatment, and care services.

Contraceptives Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
Contraceptive counselling

Emergency contraception Yes Yes Yes No No Yes Yes No Yes Yes No No 7

Oral contraception Yes Yes Yes No No Yes Yes Yes Yes Yes Yes No 9

Condoms Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12

Injectable Yes Yes Yes No No Yes Yes Yes Yes Yes Yes No 9

IUD Yes Yes Yes No No Yes No No Yes Yes Yes No 7

Implant Yes Yes Yes No No Yes Yes No Yes Yes Yes No 8

Safe motherhood

Pregnancy testing Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12

Antenatal Care Yes Yes No Yes No No No Yes No No Yes No 5

Postnatal Care Yes Yes No No No No No Yes No Yes Yes No 5

HIV and other STIs

Pre exposure prophylaxis No Yes Yes No No No Yes Yes Yes No Yes Yes 7

Post exposure prophylaxis Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes 9

Pre-/post HIV test Yes No Yes No No Yes Yes Yes Yes Yes Yes Yes 9
counselling

HIV testing Yes No Yes No No Yes Yes Yes Yes Yes Yes Yes 9

STI screening and Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
treatment methods

TB screening Yes Yes Yes Yes No No No Yes No Yes Yes Yes 8

Medical male circumcision Yes Yes No No No No No Yes Yes No Yes No 5

ART and adherence to Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes 11
treatment counselling

Cancer Screening

Manual breast Yes No Yes Yes No Yes Yes Yes Yes No Yes Yes 9
examination

Pap smear or other No Yes No No No No No No No No No No 1
cervical cancer screening
method

Abortion & post abortion care

Induced medical abortion Yes No No No No No No Yes No No Yes No 3

Treatment for incomplete Yes No Yes Yes No No No Yes No Yes No Yes 6
abortion

Pre-/post-abortion Yes Yes Yes No No Yes Yes Yes Yes Yes Yes No 9
counselling

40

Chinhoyi University of
Technology
Danhiko Industrial Training
Centre
Great Zimbabwe University
Harare Institute of
Technology
Harare Polytechnic
Manicaland State University
of Applied Sciences
Masvingo Polytechnic
Mupfure Industrial Training
College
Mutare Polytechnic
National University of
Science and Technology
University of Zimbabwe
Westgate Industrial Training
Centre -PSMI Hospital
Total available (n=12)

Sexual Gender Based Violence (SGBV)

Screening for SGBV Yes Yes Yes Yes No Yes Yes Yes No Yes Yes No 9

SGBV management and Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes 10
referral

Mental health

Assessment of mental Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
health problems,
treatment, and referral

Suicide risk screening Yes No Yes Yes No Yes Yes No Yes Yes Yes Yes 9

Therapy for suicide Yes No Yes No No Yes Yes No Yes Yes Yes No 7
ideation

Stress counselling/ Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes No 10
therapy for stress

Chronic health conditions

Screening for chronic Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
health conditions

Treatment of chronic Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12
health conditions

Alcohol, tobacco, and drug use

Alcohol, tobacco, and Yes No No No No No No Yes No Yes Yes No 4
drug use screening

Alcohol, tobacco and drug Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No 10
use prevention services or
programmes

Alcohol, tobacco, and Yes No Yes No No Yes Yes Yes Yes Yes Yes Yes 9
drug use treatment and
referral

COVID-19

COVID-19 screening Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 12

COVID-19 testing No No No No No Yes No Yes No Yes Yes Yes 5

COVID-19 referral Yes Yes Yes Yes No No Yes No Yes Yes No Yes 8

Other

Sex and sexuality Yes No Yes Yes Yes Yes Yes No Yes Yes Yes No 9
counselling

Relationship counselling Yes No Yes Yes No Yes Yes Yes Yes Yes Yes No 9

Life skills counselling Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No 11

Nutritional needs and Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes 10
healthy eating counselling

41

Annex 2

Health facilities characteristics

Characteristic or item Chinhoyi University of
Technology
Danhiko Industrial Training
Centre
Great Zimbabwe University
Harare Institute of
Technology
Harare Polytechnic
Manicaland State University
of Applied Sciences
Masvingo Polytechnic
Mupfure Industrial Training
College
Mutare Polytechnic
National University of
Science and Technology
University of Zimbabwe
Available (Yes) total

Policy and / or standard operating procedure (SOP)

Policy and / or standard operating Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes 10
procedure (SOP)

Operating hours convenient to young people:

Facility is open after institution's Yes Yes No No No Yes Yes No Yes Yes Yes 7
lecture hours i.e., evening

Facility is open over weekends Yes No No No No No No Yes No Yes Yes 4

Waiting area:

The facility is clean and welcoming. Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes 10

There is adequate and comfortable Yes Yes Yes Yes Yes No Yes No Yes Yes Yes 9
furniture in waiting area with
enough space for social distancing

There is adequate and comfortable Yes Yes No Yes Yes No Yes No Yes Yes Yes 8
furniture in consulting rooms.

There is drinking water available Yes No Yes No Yes Yes No Yes Yes Yes Yes 8

There are hand hygiene materials Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes 10
and sanitizers

The facility has basic amenities:

Functional and clean toilet(s) Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes 10

Toilet has functional hand hygiene Yes Yes Yes Yes Yes Yes No No Yes Yes Yes 9
facilities

Disposal bin in toilet(s) Yes No Yes Yes Yes Yes No No Yes Yes Yes 8

Electricity during working hours Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 11

General waste disposal Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes 9

Storage and disposable bin for Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes 10
sharps

Safe storage of clinical waste and Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes 10
disposal of items that came in
contact

Adequate hand hygiene materials Yes No Yes Yes No Yes Yes No Yes Yes Yes 8
located in or adjacent to
examination room

Visual and auditory privacy features:

Communication between the Yes Yes Yes Yes Yes Yes No Yes Yes No Yes 9
reception staff and visitors is
private and cannot be overheard
including from the waiting room.

42

Characteristic or item Chinhoyi University of
Technology
Danhiko Industrial Training
Centre
Great Zimbabwe University
Harare Institute of
Technology
Harare Polytechnic
Manicaland State University
of Applied Sciences
Masvingo Polytechnic
Mupfure Industrial Training
College
Mutare Polytechnic
National University of
Science and Technology
University of Zimbabwe
Available (Yes) total

The consultation areas are away Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes 10
from public view.

There is separation in the Yes Yes Yes Yes Yes Yes No No Yes Yes Yes 9
consultation room between
consultation and exam

There are closed doors and curtains Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 11
in consultation rooms.

Policies and procedures are in Yes Yes Yes Yes Yes Yes No No Yes Yes Yes 9
place to protect the privacy and
confidentiality of young people

The consultation rooms are marked Yes Yes Yes Yes Yes Yes No No Yes Yes Yes 9
in a neutral way (no name of the
service provided), so as to avoid
stigmatization.

The clients' files are stored securely, Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes 10
so that only the relevant service
provider(s) can access them.

The registration register has the Yes No Yes No Yes Yes No Yes Yes Yes Yes 8
name and code, but the service
register has only the code (if
anonymous registration is asked
for).

The information in laboratory Yes No Yes No No No No Yes Yes No Yes 5
registers (if applicable) is registered
using codes.

The registers are kept under lock Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes 10
and key outside operating hours.

For electronically stored No Yes No Yes No Yes No No Yes Yes No 5
information, measures are applied
to prevent unauthorized access.

Facility medicines, supplies and equipment available:

Adult weighing scale Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes 10

Clinical thermometer Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 11

Communication equipment (phone Yes Yes Yes Yes No Yes No No Yes Yes Yes 8
or short-wave radio)

Computer with email and internet Yes Yes Yes Yes No Yes No No No Yes Yes 7
access

Diagnostic sets Yes No Yes Yes No Yes No No Yes Yes Yes 7

Penis model for demonstration Yes No Yes No No Yes Yes Yes Yes Yes Yes 8

Disposable needles Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes 10

Disposable syringes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 11

Examination couch Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 11

Examination light Yes No No Yes No No No No No No Yes 3

Examination screens Yes No Yes Yes No No Yes No Yes Yes Yes 7

43

Characteristic or item Chinhoyi University of
Technology
Danhiko Industrial Training
Centre
Great Zimbabwe University
Harare Institute of
Technology
Harare Polytechnic
Manicaland State University
of Applied Sciences
Masvingo Polytechnic
Mupfure Industrial Training
College
Mutare Polytechnic
National University of
Science and Technology
University of Zimbabwe
Available (Yes) total

Glucometer testing strips Yes No No Yes No Yes Yes Yes Yes Yes Yes 8

Glucometer Yes No Yes Yes No Yes Yes Yes Yes Yes Yes 9

Haemoglobinometers No No No No No Yes Yes No No No No 2

Height meter Yes No Yes Yes No Yes Yes Yes No Yes Yes 8

Lactate strips No No No No No Yes No No No No No 1

Latex gloves Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 11

Measuring tape Yes Yes No Yes Yes Yes No Yes Yes Yes Yes 9

Nasogastric tubes Yes No No No Yes No No No Yes Yes Yes 5

Nebulizers Yes No No Yes Yes Yes Yes No Yes Yes Yes 8

Oxygen bottle Yes Yes Yes Yes Yes No No No Yes No Yes 7

Pap smear set No No No No No No No No No Yes Yes 2

Pregnancy strips Yes No No Yes Yes Yes No Yes No Yes Yes 7

HIV Testing kits Yes No Yes No No Yes Yes No Yes Yes Yes 7

Pregnancy tests Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 9

Refrigerator Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes 10

Small size speculum Yes No Yes Yes No No Yes No Yes Yes Yes 7

Medium size speculum Yes No Yes Yes No No Yes No No Yes Yes 6

Sterilizing Unit/ equipment Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes 10

Stethoscope Yes Yes No Yes Yes Yes Yes Yes No Yes Yes 9

Suction machine Yes No Yes Yes No No Yes No No Yes Yes 6

Urine test strips Yes No No Yes Yes No Yes Yes No Yes Yes 7

Vaginal model No No No No No Yes Yes Yes Yes Yes Yes 6

The facility has the following in place for medicines and supplies procurement, controls, and storage:

A visible system of procurement Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes 10
and stock management of the
medicines and

The facility has an inventory of Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes 10
drugs that is up to date, legible
and com

The medical supplies stored in a Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 11
secure pharmacy store or medicine
room

The pharmacy, dispensary or Yes No Yes No No Yes Yes No Yes Yes No 6
medicine room has air conditioning
and a room

There is sufficient space in the Yes Yes Yes Yes Yes Yes No No Yes Yes Yes 9
storage area to keep medical
supplies and

44

Characteristic or item Chinhoyi University of
Technology
Danhiko Industrial Training
Centre
Great Zimbabwe University
Harare Institute of
Technology
Harare Polytechnic
Manicaland State University
of Applied Sciences
Masvingo Polytechnic
Mupfure Industrial Training
College
Mutare Polytechnic
National University of
Science and Technology
University of Zimbabwe
Available (Yes) total

The facility has the following medicines and supplies

Condoms Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes 10

Oral contraceptive pills Yes No Yes No No Yes Yes Yes Yes Yes Yes 8

Emergency contraceptive pills Yes No No No No Yes Yes No Yes Yes Yes 6

Injectable contraceptives Yes No Yes No No Yes Yes Yes Yes Yes Yes 8

Contraceptive implants Yes No Yes No No Yes Yes No No Yes No 5

Intravenous fluids Yes No Yes Yes Yes Yes Yes Yes No Yes Yes 9

Paracetamol Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 11

Amoxicillin Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 11

Atenolol No No Yes No No Yes No No Yes No No 3

Ceftriaxone Yes No No Yes Yes No No Yes Yes Yes Yes 7

Ciprofloxacin Yes No Yes Yes Yes Yes Yes No Yes No Yes 8

Cotrimoxazole suspension No No No No No Yes Yes No Yes No Yes 4

Diclofenac Yes No No Yes No Yes Yes No Yes Yes Yes 7

Glibenclamide Yes No Yes No No No No No No Yes Yes 4

Omeprazole Yes No No No No No No No No Yes Yes 3

Salbutamol Yes No Yes Yes No Yes Yes No Yes Yes Yes 8

Diazepam Yes No No No No Yes Yes Yes Yes No Yes 6

Magnesium sulphate Yes No No No Yes No Yes Yes No No No 4

Vaccines Yes No Yes No No No No Yes Yes Yes Yes 6

Pre exposure prophylaxis Yes No No No No No No Yes No No Yes 3

Post exposure prophylaxis Yes No No No No No No Yes No Yes Yes 4

ARVs Yes No Yes No No No No Yes No Yes Yes 5

45

Annex 3

Terms of Reference: Health Facility Assessments

UNESCO is seeking the services of 2. Scope of the Health Facility Assessments
a National Consultant to conduct
Health Facility Assessments across The Health Facility Assessments (HFAs) will be conducted
10 higher and tertiary education across 10 HTEIs in Zimbabwe. The Consultant is expected to
institutions (HTEIs) in Zimbabwe. develop data collection tools in line with the methodology
under section 4 below, as well as update the existing Facility
1. Background and Context Observation Tool, which will be provided by UNESCO as
necessary.
Our Rights, Our Lives, Our Future (O3 )PLUS project seeks to
ensure that young people in higher and tertiary education 3. Research Questions
institutions (HTEIs) in Zambia and Zimbabwe realize positive
health, education, and gender equality outcomes through The key research questions to be answered by the Health
sustained reductions in new HIV infections, unintended Facility Assessments (HFAs) are:
pregnancy and sexual and gender-based violence. The project
will thus enable them to reach their full educational potential 1. What are the existing youth-friendly health services
and contribute more effectively to the development of their (YFHS) guidelines, standards, and policies in Zimbabwe?
countries and region as graduates, professionals, and young How do the guidelines, standards and policies align with
leaders. With support from the Swiss Agency for Development international guidelines i.e., WHO Global Standards for
and Cooperation, the project will be implemented across 20 Quality Healthcare Services for Adolescents and Youth? Is
Higher and Tertiary Education institutions (HTEIs) in Zambia delivery of health care services at health facilities in tertiary
and Zimbabwe from January 2021 to December 2024. institutions in-line with the guidelines, standards, and
policies?
Working closely with relevant regional structures, national
ministries, higher and tertiary education institutions, and 2. What type of services are offered at health facilities in HTEIs,
key partners, UNESCO will support innovation in access to and what is the quality of these services as per the existing
Life Skills Based Comprehensive Sexuality Education (CSE) standards and guidelines? Do the health facilities have the
and sexual and reproductive health (SRH) services for HTEI necessary resources i.e., infrastructure, human capacity,
students while advocating for policy and practice changes to financial etc. to ensure effective service provision? Are there
make campuses safe and inclusive learning environments for any guidelines or minimum standards for infrastructure
students and staff. In doing so, the project will institutionalize of health facilities in tertiary institutions? Which ministry
health and well-being programs for students while engaging is responsible for the administration of health facilities in
leadership for long-term commitment and sustainability. HTEIs? Is there clear ownership and linkages of the health
facilities in HTEIs with district, provincial and national level
The work will be delivered through four complementary Ministry of Health and Child Care? What are the major
pillars or work streams as follows: institutional strengthening sources of funding for the HTEIs?
for sustainability; student health and well-being; safe and
inclusive campus environments; and evidence building and 3. What are the perspectives of health providers on health
knowledge sharing platform. service delivery for young people in HTEIs? What are
perspectives of young people in HTEIs on the health
Under the student health and wellbeing work stream, UNESCO services provided at the health facilities? What factors
is commissioning a health facility assessment study across enable or hinder young people’s access to health services
the HTEIs in order to collect comprehensive information on at the health facilities in HTEIs?
health service delivery for young people in line with existing
international youth-friendly services (YFS) guidelines and 4. How can the health facilities be improved/strengthened
standards and make recommendations for investments to ensure effective health service provision to young
required for the health facilities to be fully functional and people? What resources or capacities are required i.e.,
deliver services effectively. infrastructure, equipment, human resources, training etc.?

4. Methodology

46

The HFAs will use a combination of methods, where primary • In-depth interviews with health care service providers at
data collection will be in-person and virtually where feasible. the health facilities to examine operational realities, assess
The Consultant is therefore expected to adhere strictly to service provision and capacity related issues; examine
national guidelines and regulations on COVID19 during in- perspectives on health service delivery for young people,
person data collection. and identify areas for improvement to strengthen service
provision.
The proposed data collection methods include, but are not
limited to the following: • Focus Group Discussions with young people, including
young people with disabilities, HIV and from the LGBTIQ
• Desk Review of relevant literature including policies and community, to assess knowledge and use of services;
guidelines such as WHO Global Standards for Quality determine factors that enable or hinder access to the health
Healthcare Services for Adolescents and Youth; reports on services; examine expectations in relation to delivery of
research, evaluations, assessments, or reviews on youth- services at the health facilities, and recommendations for
friendly health service delivery, reports on health facility improvement.
assessments, as well as relevant government policy,
strategy, guidance documents, etc. • In-depth interviews with young people, including young
people with disability, HIV and from the LGBTIQ community,
• Observation and administration of facility observation who have used the health facility to assess knowledge and
checklist/tool to assess the following: availability of use of services, examine experiences, and satisfaction with
medication, type of equipment, infrastructure etc. services received. Emphasis will be on young people who
would have immediately used the health facility (client
• In-depth interviews with representatives from Ministry of exit interviews).
HTEI, MoHCC, and CSOs that are active in relation to health
and wellbeing in HTEIs, to understand more about the Table below shows the research questions and the
ownership of HTEI health facilities; any existing guidelines corresponding data collection methods.
or minimum standards for infrastructure of health facilities
in tertiary institutions; funding from both Treasury and the
ministries, key barriers/challenges to service provisions,
and recommendations for strengthening health service
provision for young people in health facilities in tertiary
institutions.

Research Question and Sub-questions Methods

What are the existing adolescent and youth-friendly health services (AYFHS) guidelines, Desk review; Observation
standards, and policies in Zimbabwe? How do the guidelines, standards and policies align checklist; In-depth interviews
with international guidelines i.e., WHO Global Standards for Quality Healthcare Services for with representatives from Ministry
Adolescents and Youth? Is delivery of health care services at the tertiary institutions’ health of HTEI, MoHCC etc.; In-depth
facilities in-line with the guidelines, standards, and policies? interviews with health care service
providers

What type of services are offered at health facilities in HTEIs, and what is the quality of Observation checklist/tool; In-depth
these services as per the existing standards and guidelines? Do the health facilities have the interviews with health care service
necessary resources i.e., infrastructure, human capacity, financial etc. to ensure effective service providers; In-depth interviews with
provision? Are there any guidelines or minimum standards for infrastructure of health facilities representatives from Ministry of
in tertiary institutions? Which ministry is responsible for the administration of health facilities HTEI, MoHCC, CSOs etc.
in HTEIs? Is there clear ownership and linkages of the health facilities in HTEIs with district,
provincial and national level MoHCC? What are the major sources of funding for the HTEIs?

What are the perspectives of health providers on health service delivery for young people in In-depth interviews with health
HTEIs? What are perspectives of young people in HTEIs on the health services provided at the care service providers; Focus Group
health facilities? What factors enable or hinder young people’s access to health services at the Discussions with young people; In-
health facilities in HTEIs? depth interviews with young people

How can the health facilities be improved/strengthened to ensure effective health service In-depth interviews with
provision to young people? What resources or capacities are required i.e., equipment, human representatives from Ministry
resources, training etc.? of HTEI, MoHCC etc.; In-depth
interviews with health care service
providers; Focus Group Discussions
with young people

47

5. Ethical Clearance • Draft report which will be submitted to UNESCO on 9th
April 2021. The report will also be presented to UNESCO
The Consultant is expected to obtain ethical clearance from and key stakeholders by the Consultant, at a virtual
relevant authorities prior to commencement of data collection. validation workshop of which the date will be agreed.
Costs related to the ethical clearance are the responsibility of The Consultant will facilitate this workshop which will be
the Consultant. aimed at discussing preliminary findings and conclusions.

6. Duration • A final report, which incorporates comments from the
validation workshops, will be submitted to UNESCO on
It is expected that the Health Facility Assessments will 28th April 2021. The proposed structure for the report is as
commence in February 2021 for an estimated duration of 30 follows:
working days and conclude by 28th April 2021.
- Executive Summary
7. Deliverables - Project description
- Objectives and Research questions
The deliverables are as follows: - Methodology
- Findings
• Research Protocol which will be submitted to UNESCO 7 - Recommendations and conclusions
days after the inception meeting. The research protocol - Annexes
will outline in detail, the research questions; methodology;
data collection tools, data management and analysis plan, • A PowerPoint presentation summarizing the contents of
data quality assurance plan, ethical considerations, etc. the final report will be submitted to UNESCO on 28th April
2021.

Table below shows the expected deliverables and
corresponding timeframes.

Task/Activity Deliverable Indicative number of days
7 days
Briefing/Inception meeting with UNESCO, Research protocol February 2021
representatives from participating HTEIs and
other key stakeholders including ministries 20 days
of HTEI and Health, CSOs and parastatals Data collection: 10 days (1 day/institution)
working in HTEIs on health and well-being Data analysis and report writing: 8 days
etc.; desk review, development of data March 2021
collection tools, including revision of Facility
Observation Tool 1 day
April 2021
Data collection, analysis, and compilation of Draft report structured as follows:
draft report
• Executive Summary
• Project description
• Objectives and Research questions
• Methodology
• Findings
• Recommendations and conclusions
• Annexes

Validation workshop where the Consultant
will present findings to UNESCO and wide
range of stakeholders etc.

Revision of draft report to incorporate Final report with annexes. 2 days
comments/feedback from the validation April 2021
workshops. PowerPoint presentation summarizing
contents of the final report

48