COVER PAGE

STUDENT NAME: GODFREY MARIRIDZA

STUDENT NUMBER: M206686

PROGRAMME: Post Graduate Diploma in Project Planning, Monitoring

and Evaluation

COURSE TITLE: RESEARCH METHODS

COURSE CODE: DPME105

PROPOSED TOPIC: AN EVALUATION OF THE SUSTAINABILITY OF MSF’S

PAEDIATRIC HIV PROJECT IN GUTU DISTRICT, ZIMBABWE.
1. Introduction

Zimbabwe is seized with a generalised epidemic of Human Immunodeficiency Virus (HIV) and
Acquired Immunodeficiency Syndrome (AIDS), with a prevalence of 15%, and an annual
incidence rate of 0.98% (Ministry of Health and Child Care, 2017). To attain the eradication of
HIV among population there is need to scale up the paediatric HIV response. Anecdotal evidence
shows that there treatment gaps among children compared to the adult population. There are
glaring disparities between the HIV response among the adult population and the paediatric HIV
response. HIV coverage among children is still below the adult HIV coverage

2. Project Setting/Context

Medecins Sans Frontieres (MSF) is an international medical humanitarian organization that is

active in over 71 countries worldwide. MSF offers emergency medical assistance to populations
in distress, and those affected by man-made and natural disasters. In the Zimbabwean context,
MSF has been operating in the public health arena including, inter alia, cholera, HIV/AIDS as
well as TB treatment since 2000. MSF launched an ambitious HIV and AIDS project for patients
on ART beginning in 2011 in Gutu District. This project was initiated to complement the
government HIV and AIDS response. Screening of HIV infected children is essential to provide
comprehensive HIV intervention and therapy. However, only an estimated 15% of HIV exposed
infants globally go through testing for HIV in their first two months of life thus strategies to
increase identification of HIV infected children are critically needed, (WHO, 2011). Globally,
with the absence of early diagnosis and treatment access, about one-third of HIV positive infants
die prior to the first birthday and half die before their second birthday (MSF, 2015).

MSF, has been supporting the Ministry of Health and Child Care (MOHCC) in Gutu district,
Zimbabwe to provide ART since 2011 with the goal of increasing coverage. However,
nationally, the disparity persists between pediatric and adult (over 18 years of age). ART
coverage in Gutu district is at 19.9% and 82.6% for children and adults respectively. Gutu
district is a demonstration of the gap between paediatric and adult ART coverage in countries
with high HIV prevalence (MSF, 2015). According to Sutcliff (2008), the earlier access to ART
is of importance for HIV children with naturally immature immune systems who are vulnerable
to opportunistic diseases and to common childhood illnesses. MSF sought to address these
treatment gaps when it implemented its HIV and AIDS project in Gutu District.
3. Project Description

Gutu, a rural district in Zimbabwe, has been implementing comprehensive HIV care with the
support of MSF since 2011, decentralising testing and treatment services to all rural healthcare
facilities, (Conan, et al, 2020). According to WHO (2011) adequate testing and treatment
coupled with adherence enabled the HIV infected infants to reach adolescence and adulthood.
The MSF project sought to improve paediatric HIV diagnosis and treatment in Gutu district
through measures such as community-based testing during Expanded Programme on
Immunization (EPI). All HIV-positive children were initiated on ART, irrespective of clinical
condition or immune status. The Paediatric HIV project was a component of the broader HIV
and AIDS response motivated by the persistent gap between HIV positive children and children
currently on ART, (MSF, 2015).

MSF opened a project to improve HIV service delivery. The HIV project aimed to decentralize
ART delivery for the first time in the district through task-shifting from doctors (hospital level)
to nurses (primary health facility level), and clinical mentorship to nurses. Conan et al, 2020).
According to Conan et al (2020) the cascade of care constitutes a critical means by which to
assess programme effectiveness a decade after MSF began its activities in Gutu District.

4. Theoretical Framework

The study uses the Sustainability Theoretical Framework adapted from Iwelunmor et al (2016)
who combined the works of Chambers et al (2013) and Shediac-Rizkallah and Bone (1998). The
theoretical framework incorporates the Dynamic Sustainability Framework (Chambers et al,
2013), and the Sustainability Planning Theory, (Shediac-Rizkallah and Bone, 1998). The
Dynamic Sustainability Framework (DSF) states that projects were crafted in isolation without
contextual application resulting in outcomes that were difficult to implement and projects lacked
continuity, (Chambers et al, 2013). Shediac-Rizkallah and Bone (1998) postulated that,
sustainability planning should be an integral part of project design and implementation.

5. Methodology

5.1 Method
To evaluate the project the study seeks to use the qualitative method. As alluded to by Bryman,
(2016) the qualitative method enables the researcher to obtain a deeper understanding of issues
and meanings of a given phenomenon in its natural setting from the views of the beneficiary. In
keeping with Bryman (2016) the study was undertaken in the natural setting, that is, the context
under which the MSF project was implemented.

5.2 Study Design

The study seeks to adopt the descriptive case study design. As postulated by Hancock and
Algozzine, (2016) the case study design enabled the researcher to focus on a particular case of
the implementation of the HIV project by MSF IN Gutu District.

5.3 Sampling

Following Cresswell (2013) the study seeks to use the purposive sampling technique to select the
study participants. In purposive sampling one selects respondents based on the understanding
that they have relevant information on the subject at hand as well as to increase the plausibility
of the results in agreement with McMillan and Schumacher, (2006) and Cresswell, (2013). The
sample shall be derived from the project beneficiaries for In-Depth Interviews, and key
stakeholders for Key Informant Interviews.

5.4 Data Collection

The primary data collection methods shall be In-Depth and Key Informant Interviews as posited
by McMillan and Schumacher, (2006). For secondary data, document analysis of MSF project
documents and reviews shall be used through triangulation as posited by de Vos et al (2005) who
stated that triangulation utilises varied data sources to compensate the strength s and weaknesses
of another data source.

5.5 Ethics

In keeping with Silverman, (2005) the study shall observe all ethical considerations based on the
principles of doing no harm to subjects, confidentiality, autonomy, informed consent, and
dignity.
 References

Bryman, A, (2016), Social Research Methods, 6th Edition, Oxford, Oxford University Press.

Chambers, D.A, Glasgow, R.E, and Stange, K.C, (2013), "The Dynamic Sustainability
Framework: Addressing the Paradox of Sustainment amid Ongoing Change", Implementation,
8(117).

Conan, N, Coulborn, R.M, Simons, E Mapfumo, A, Apollo, T, Garone, D.B, Casas , E C, Puren,
A.J, Chihana, E.L, and Maman, D, (2020), “Successes and Gaps in the HIV Cascade of Care of
a High HIV Prevalence Setting in Zimbabwe: a Population-Based Survey”, Journal of the
International AIDS Society, at http://onlinelibrary.wiley.com/doi/10.1002/jia2.25613/full |
https://doi.org/10.1002/jia2.25613 (accessed 11 January, 2021)

Creswell, J. W. (2013), Qualitative Inquiry and Research Design: Choosing among Five
Approaches, Thousand Oaks, Sage.

de Vos, A.S, Strydom, H, Schulze, S, and Patel, L, (2005), "The Sciences and the Profession", in
De Vos, A.S, Strydom, H, Fouche, C.B, and Delport, C.S.L, Research at the Grassroots for the
Social Sciences and Human Service Professions, 4th edition, Pretoria, JL Van Schalk Publishers.

Hancock, D.R, and Algozzine, B, (2006), Doing Case Study Research: A Guide for Beginning
Researchers, New York, Teachers College Pres1

McMillan and Schumacher, (2006), Research in Education, Boston, Pearson Education

Incorporated.

Ministry of Health and Child Care, (2017), “Zimbabwe Population-based HIV Impact
Assessment (ZIMPHIA) 2016: First Report, Harare, Government Printers.

MSF, (2015), MSF in Zimbabwe Activity Report, Harare, MSF In Zimbabwe Newletter.

Sarriot E.G, et al, (2004), "Qualitative Research to Make sense of Sustainability in Primary
Health Care Projects Implemented by Non-Governmental Organisations", International Journal
of Health Planning and Management, 19, page 3-22.
Shediac-Rizkallah, M.C, and Bones, L.R, (1998), "Planning for the Sustainability of
Community-based Health Programmes: Conceptual Frameworks and Future Directions for
Research, Practice and policy", Health Education Research, 13(1), page 87–108.

Silverman, D, (2005), Doing Qualitative Research: A Practical Handbook, Thousand Oaks, Sage
Publications.