In 1992, three major external reviews were conducted—by the World Bank, WHO, and the Swedish International Development Authority (SIDA)—which revealed that, although each of the above seven functional units had achieved major success, their combined efforts had failed to slow the spread of the epidemic. In effect, increased knowledge among the general population about the dangers of HIV/AIDS and its modes of transmission had not translated into safer sexual behavior. There was a growing realization that all prevention and control efforts were too medically focused, and that there was an urgent need to develop a multisectoral response to the epidemic. At the same time, there was also the need to improve condom distribution and make STD services more accessible.

In response to these reviews, the government, recognizing the need for a broad participatory approach, organized a 3-day consensus workshop in May 1993 in Livingstone as a basis for preparing the second Medium-Term Plan. To ensure the broadest possible base for consensus, the Ministry of Health invited to the workshop over 60 participants from other government ministries and departments, local and international nongovernmental organizations and parastatal organizations operating in Zambia, and representatives from bilateral and multilateral donors. The consensus workshop was followed by technical workshops in the areas of youth, women, the workplace, defense, management, and behavioral change.

The planning process for the second Medium-Term Plan coincided with a change in political structure and ongoing health reform. The Ministry of Health has now moved toward a decentralized model, with responsibility for decision making transferred to the district level.

In 1994, the National AIDS/STD/TB & Leprosy Programme produced its strategic plan for 1994-1998 and launched its enhanced prevention strategies and mitigation/care efforts. Currently, the National AIDS Programme is part of the National AIDS/STD/TB & Leprosy Programme. It is situated in the Ministry of Health, and the program manager reports to the Deputy Director of Medical Services (Primary Health Care). The onset of the AIDS epidemic has coincided with a period of general economic malaise in the country, so that resources for health education and prevention have become even scarcer than usual. Consequently, the National AIDS Programme has been forced to rely heavily on the generosity of the international community. Foreign donors fund virtually all of Zambia's HIV/AIDS prevention and mitigation activities. For example, a large share of prevention activities is implemented through a 3-year, US $8.24 million Morehouse University School of Medicine project funded by the U.S. Agency for International Development (USAID). At the same time, Overseas Development Aid (ODA) is developing a model of home-based care for people with AIDS, and UNICEF is working with orphans. An immediate and important constraint for the National AIDS Programme is a lack of condoms for free distribution.



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