Country

Development
Cooperation
Strategy

2016 -2021

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USAID/Zimbabwe CDCS

Acronyms and Abbreviations

AfDB African Development Bank

AIDS Acquired Immune Deficiency Syndrome
AIPPA Access to Information and Protection of Privacy Act
ART Antiretroviral Therapy
AU African Union
CBO Community-Based Organization
CCF Complex Crisis Funds
CDA Country Data Analytics
CDCS Country Development Cooperation Strategy
CIDA Canadian International Development Agency
CLA Collaborating, Learning, and Adapting
CPI Consumer Price Index
CSO Civil Society Organization
DCHA USAID Bureau for Democracy, Conflict, and Humanitarian Assistance
DFID Department for International Development (UKAID)
DHS Demographic and Health Survey
DO Development Objective
DOTS Directly Observed Therapy-Short Course
DRG Democracy, Rights, and Governance
EG Economic Growth
EU European Union
FP Family Planning
FP/RH Family Planning/Reproductive Health
GBV Gender-Based Violence
GCC Global Climate Change
GDP Gross Domestic Product
GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
GHG Greenhouse Gases
GNU Government of National Unity
GOZ Government of Zimbabwe
HDI Human Development Index
HH Household
HIV Human Immunodeficiency Virus
IFI International Financial Institution
IR Intermediate Result
LAPM Long Acting and Permanent Methods
LUCF Land Use Change and Forestry
M&E Monitoring and Evaluation
MCHIP Maternal and Child Health Integrated Program
MDR-TB Multi-Drug-Resistant Tuberculosis
MEL Monitoring, Evaluation, and Learning
MFI Micro-Finance Institution
MNCH Maternal, Newborn, and Child Health
MOHCC Ministry of Health and Child Care
MP Member of Parliament
MSME Micro, Small, and Medium Enterprises
NATF National AIDS Trust Fund

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USAID/Zimbabwe CDCS

NGO Non‐Governmental Organization

NMCP National Malaria Control Program
NPL Non-Performing Loan
OVC Orphans and Vulnerable Children
OVT Organized Violence and Torture
PAD Project Appraisal Document
PEA Political Economy Analysis
PEPFAR President’s Emergency Plan for AIDS Relief
PMI President’s Malaria Initiative
PMP Performance Management Plan
PMTCT Prevention of Mother-to-Child Transmission of HIV
POSA Public Order and Security Act
POZ Parliament of Zimbabwe
PPR Performance Plan and Report
RAU Research and Advocacy Unit
RF Results Framework
RH Reproductive Health
RMNCH Reproductive, Maternal, Newborn, and Child Health
SADC Southern African Development Community
SDG Sustainable Development Goal
SERA Strategic Economic Research and Analysis
SIDA Swedish International Development Cooperation Agency
TB Tuberculosis
TRACE Transparency, Responsiveness, Accountability, and Citizen Engagement
US United States
UN United Nations
UNAIDS United Nations Program on HIV/AIDS
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
VCT Voluntary Counseling and Testing
VMMC Voluntary Medical Male Circumcision
WASH Water, Sanitation, and Hygiene
WB World Bank
WHO World Health Organization
ZANU-PF Zimbabwe African National Union - Patriotic Front
ZDERA Zimbabwe Democracy and Economic Recovery Act of 2001
ZEC Zimbabwe Electoral Commission
ZIMSTAT Zimbabwe National Statistics Agency
ZPF Zimbabwe People First

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USAID/Zimbabwe CDCS

Executive Summary
Zimbabwe was once one of Southern Africa’s most vibrant, productive, and resilient countries. However,
for close to two decades, the nation has faced a series of political and economic shocks, the roots of which
come from decades of poor governance and deeply entrenched and growing levels of corruption.

Zimbabwe has an estimated population of 14.2 million people, of whom about 10 million live in rural
areas. Life for the average Zimbabwean is increasingly difficult, with 63 percent of all households living
in poverty and 16 percent in extreme poverty. At the root of this poverty is a lack of economic
opportunities caused by a failure to adhere to rule of law, recognize property rights, and create a secure
environment for domestic and foreign investment. Exacerbating Zimbabwe’s economic woes is the
growing impact of climate change 1. The collapse of the commercial agricultural sector resulted in an
over-reliance on small scale, rain-fed agriculture. As Zimbabwe’s climate becomes more erratic, farmers
have found it more difficult to produce sufficient yields, greatly contributing to the country’s recurrent
food insecurity.

Not surprisingly, Zimbabwe’s Human Development Index (HDI) value is 0.509 – a score that places the
country in the low human development category. The country’s high mortality and morbidity rates are a
result of an under-resourced health delivery system, which is overstretched by high rates of HIV,
tuberculosis, malaria, and maternal and childhood illnesses. More than a decade of worsening economic
conditions and rising costs have eroded a once vibrant health system, which now functions largely due to
donor assistance. That said, the health sector has produced notable results, such as an HIV prevalence
rate that declined from 20 percent in 2006 to a current rate of 15 percent.

Zimbabwe’s future remains uncertain as President Robert Mugabe, now 92 years old, continues as one of
Africa’s longest serving dictators. There are no clear plans for succession, which is increasingly creating
political factionalism and in-fighting within the ruling party, as well as an an unpredictable and fluid
environment. To remain flexible in such a fluid operating environment, the Mission has developed a
scenario-based strategy to position itself to respond to emerging opportunities.

Goal
There are opportunities for progress, despite the challenging environment. It is these opportunities that
produced USAID’s current successes, which include reductions in HIV prevalence and stunting rates, and
more resilient communities. The Mission will continue to capitalize on these openings in the quest to
achieve the goal, which is aspirational in nature – an aspiration shared by those within the Mission and
the Country Team. USAID/Zimbabwe’s goal is:

Inclusive, accountable governance and a healthy, engaged citizenry drive social,

political, and economic development with equal opportunity for all

This is a 15-20 year goal. The interests of the U.S. Government are ambitious, and it requires a long-term
vision for Zimbabwe to transition to a more open and accountable country, where citizens actively engage
with their leaders, live healthier lives, and are more economically secure.

In crafting this statement, Mission staff agreed that the goal must address the need to create opportunities
for citizens to become drivers of social, political, and economic change that is characterized by good
governance. In acknowledging the principal root causes of Zimbabwe’s current social, political, and
economic situation, assessing USAID’s comparative advantage, and recognizing the role of other donors,

1
See Annex 4: Climate Change Considerations
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 USAID/Zimbabwe CDCS

the Mission selected three development objectives to achieve this goal. These development objectives
form the basis for the CDCS results framework and include the following crosscutting issues: gender,
youth, local champions, and good governance.

Goal: Inclusive, accountable governance and a healthy,

engaged citizenry drive social, political, and economic
development with equal opportunity for all

DO 3: Improved
DO 1: Expanded inclusive DO 2: Increased number of
accountable, democratic
and sustainable economic Zimbabweans live longer and
governance that serves an
opportunities healthier lives
engaged citizenry

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USAID/Zimbabwe CDCS

I. Development Context, Challenges, and Opportunities

Country Context and Challenges Box 1: Zimbabwe’s Recent History in Brief
Zimbabwe was once one of Southern Africa’s most
vibrant, productive, and resilient countries. Long Zimbabwe’s recent history is one marred by poor
considered the breadbasket of Africa, the last two economic and political decisions that continue to create
decades have brought a series of political and and exacerbate shocks. In late 1997, President Mugabe
economic shocks, the roots of which come from agreed to unbudgeted payouts to war veterans, causing
decades of poor governance and increased levels of a 70 percent drop in the value of the Zimbabwean
corruption. It is within this context that dollar. In 2000, the Government of Zimbabwe (GOZ)
Zimbabweans struggle to forge an optimistic path implemented a land reform program where war
for the future. veterans carried out government-orchestrated farm
invasions. This led to the almost complete collapse of
commercial agriculture, and by 2008 production had
Political Context and Challenges
declined by 62 percent. Hyperinflation peaked in 2008,
Zimbabwe’s political future remains uncertain as reaching 250 million percent, contributing to a severe
President Robert Mugabe continues as one of food security crisis where half of the rural population
Africa’s longest serving presidents, ruling the was dependent on humanitarian assistance for survival.
country for the last 36 years. At age 92, he is the
world’s oldest serving leader, and there are no Additionally, 2008 was marked by excessive electoral
plans to discuss succession. Since independence in violence. Due to internal and external pressure,
1980, Zimbabwe has held regular national President Mugabe and the opposition leader Morgan
elections, but these elections have been deemed Tsvangirai reached a power sharing agreement and
significantly flawed by international observers. formed the Government of National Unity (GNU). The
The dominance of a single party since 1980 has GNU (2009-2013) offered respite with implementation
meant that Zimbabwe has failed to develop strong of more economically sound policies and practices,
democratic foundations, and ruling party structures including the formalization of the U.S. dollar as the
have become conflated with the state. main currency and the drafting of a new constitution.

Economic Context Flawed elections in 2013 marked the return to

Zimbabwe has an estimated population of 14.2 dominance by a single party and failed economic
million people, 2 of whom about 10 million live in policies. The 2013 Constitution has not been
rural areas. Life for the average Zimbabwean is implemented fully, and the economy began to decline
increasingly difficult. The most recent government with company closings and high levels of
unemployment. A brain drain, particularly with health
figures state that in 2012, 63 percent of all
professionals, also took its toll creating a diaspora that
households were living in absolute poverty and 16
is estimated to be as many as three million people,
percent were in extreme poverty. 3 At the root of approximately 18 percent of Zimbabweans.
this poverty is a lack of economic opportunities
caused by a failure to adhere to rule of law, Today’s situation is not bright as Zimbabwe is
recognize property rights, and create a secure currently embroiled in political infighting amongst the
environment for domestic and foreign elites, with economic growth projected to be 1.5
investment. Since the early 2000s, Zimbabwe has percent. Additionally, the country is in its second year
continued to deindustrialize, currently operating at of an El Niño-related drought, with the number of food
only 34 percent of its capacity. 4 Not surprisingly, insecure projected to peak at 4.1 million from January
to March 2017.
2
Central Intelligence Agency, The World Factbook, Zimbabwe.
3
Poverty numbers for Zimbabwe vary with figures as high as 72 percent. The 63 percent for absolute poverty and
the 16 percent for extreme poverty are both from the 2011/2012 Poverty, Income, Consumption, and Expenditure
Survey (PICES) conducted by the Zimbabwe National Statistics Agency (ZIMSTAT).
4
Confederation of Zimbabwe Industries Manufacturing Sector Survey Report, 2015.
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USAID/Zimbabwe CDCS

the economy has shifted from formal to informal, with 94.5 percent of employment reported as informal
as of 2014. 5

This disproportionally affects women in what is referred to as the feminization of poverty. 6 As women
and men compete for fewer jobs, the gender-based differentials that permeate all aspects of society
become more apparent; men move into sectors traditionally dominated by women, decreasing their
earning opportunities. Even in sectors where women dominate, such as agriculture where they make up
more than 65 percent of total employment, women often do not control economic resources having to
defer to male family members to conduct transactions such as selling livestock.

As Zimbabwe’s economy continues to contract, the Government of Zimbabwe (GOZ) is desperately

seeking an influx of assets. The dollarization of the economy means that the GOZ does not control
money supply, and the current policy environment has resulted in very limited foreign investment and a
serious liquidity crisis. With few options, factions within the ruling party are pursuing a re-engagement
strategy with the West. A major thrust involves working with the international financial institutions
(IFIs) to clear current debt arrears with an eye toward resumed access to international borrowing. With an
external debt estimated at 7.1 billion dollars (51 percent of the GDP), Zimbabwe currently has an
estimated 5.6 billion dollars of debt in arrears. 7

It is uncertain whether the arrears clearance will come to fruition, and even if Zimbabwe manages to
clears its arrears to the IFIs, there are significant hurdles to new borrowing. The potentially positive
aspect to this process is that with limited options it could force the GOZ to engage in meaningful
economic and governance reforms.

Climate Change
Exacerbating Zimbabwe’s economic woes is the growing impact of climate change. The collapse of the
commercial agricultural sector resulted in an over-reliance on small scale, rain-fed agriculture by farmers
who often are not trained and frequently lack inputs. As Zimbabwe’s climate has become more erratic,
farmers have found it harder to produce sufficient yields to meet demand. This has greatly contributed to
the recurrent food insecurity as small-scale farmers, many of whom do not have access to irrigation,
provide approximately 70 percent of Zimbabwe’s staple crops. 8 With a pattern of crop failures happening
in every three out of five years, food and nutrition security remains a persistent problem. 9 Furthermore,
climate change is likely to alter the patterns of water- and vector-borne diseases such as malaria, increase
conflict around water access, as well as reduce access to clean water. The concern is that these new
stresses will further erode coping strategies and pose additional threats to health and livelihoods.

In addition to food security, the tourism and industrial sectors are also experiencing the repercussions of
climate change. As water scarcity affects livestock and humans, it also affects wildlife. This does not
bode well for a sector dependent on a vibrant wildlife population. Already burdened by erratic utilities,
industries also face climate-related challenges in the form of increased power shortages due to lower

5
Zimstat Labour Force Survey, 2014.
6
Beyond Income: Gendered Well-being and Poverty in Zimbabwe,
http://www.unicef.org/zimbabwe/ZIM_resources_beyondincome.pdf
7
Munyati, Chido, Why US Reengagement Is Critical to Zimbabwe’s Debt Arrears Clearance Strategy,
http://www.foreignpolicyjournal.com/2016/03/04/why-us-reengagement-is-critical-to-zimbabwes-debt-arrears-
clearance-strategy/
8
IRIN, Zimbabwe short-changing it’s small-scale farmers, http://www.irinnews.org/report/99548/zimbabwe-short-
changing-its-small-scale-farmers
9
FEWSNET, Zimbabwe Food Security Brief, 2014
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USAID/Zimbabwe CDCS

water levels in hydroelectric dams. As the country entered the second year of the 2014-2016 drought,
estimates were that the Kariba dam, which both Zimbabwe and Zambia rely heavily on for electricity,
only had sufficient water to supply electricity for six months.10 Recent rains may provide some relief, but
these concerns are indicative of Zimbabwe’s vulnerability to climate change. (Please see Annex 4 for
more details on climate change impacts on Zimbabwe.)

Human Development
Zimbabwe has amongst the highest HIV prevalence and maternal mortality rates in the region. Not
surprisingly, Zimbabwe’s Human Development Index (HDI) value is 0.509 – a score that places the
country in the low human development category. The country’s high mortality and morbidity rates are a
result of an under-resourced health delivery system, which is overstretched by the high burden of HIV,
tuberculosis (TB), malaria, and maternal and childhood illnesses. A decade of worsening economic
conditions and rising costs have eroded a once vibrant health system, which now functions largely due to
donor assistance.

The health sector has produced notable results in the areas of HIV; TB; malaria; maternal, newborn and
child health (MNCH); and family planning/reproductive health (FP/RH). The national response to the
HIV epidemic has scaled up prevention and treatment interventions, resulting in an estimated 290,000
lives saved through antiretroviral treatment (ART) since 2009 and a 50 percent decrease in the number of
new HIV infections over the last ten years.11 The TB treatment success rate increased from 67 percent in
2006 to 80 percent in 2015, which meets the National TB program objective and World Health
Organization recommendations. 12 Malaria incidence declined by 79 percent, from 136/1,000 in 2000 to
29/1,000 in 2015. 13 Although the maternal mortality rate declined significantly from 960 deaths per
100,000 live births in 2010/11 to 614 deaths per 100,000 live births in 2014, 14 this rate remains too high
by regional standards. The contraceptive prevalence rate increased from 60 percent in 2006 15 to 67
percent in 2014. 16 These are noteworthy gains given the general economic decline and political context
and speak to the technical and financial support provided by the donor community. Sustaining these
gains will require both continued donor engagement and collaboration with the Ministry of Health and
Child Care (MOHCC) to improve the systems and implementation of policies that surround the delivery
of health services.

Opportunities
While the current environment is difficult and unpredictable, there are windows of opportunity in which
USAID can continue to affect positive change. The Mission currently sees the following opportunities on
which to build for continued success:

• Progress on the key health indicators demonstrates potential for further gains while reducing the
influence that high disease burdens have on the economy;
• Mid-level capacity and commitment within selected GOZ ministries can present windows for
positive dialogue on key issues that advance USAID s’ work in Zimbabwe;

10
Reuters, Zimbabwe's main hydro power dam running out of water after drought,
http://www.reuters.com/article/us-zimbabwe-drought-powerstation-idUSKCN0VS1GM
11
MOHCC, National HIV/AIDS Estimates, 2015
12
World Bank, http://data.worldbank.org/indicator/SH.TBS.CURE.ZS?page=1
13
Zimbabwe Malaria Program Performance Review, March 2016.
14
Zimbabwe Demographic and Health Survey, 2010-11.
15
Ibid.
16
Zimstat Multiple Indicator Cluster Survey, 2014.
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USAID/Zimbabwe CDCS

• Implementation of the 2013 Constitution, which establishes a progressive framework for rights
and freedoms can be an avenue for advancing democratic reforms and protecting human rights;
• An active and resilient civil society, which is interested in building skills, knowledge, and
experience;
• Openings within the GOZ for policy reform due to economic stagnation; and
• Well-educated adult population presents a wide base of human capital for the country’s
development.

The other window of opportunity is the Zimbabwean people. Zimbabweans have demonstrated a
remarkable resilience and willingness to work hard despite any circumstances, and many remain
committed to building a democratic and prosperous nation. Should the political and economic picture
improve, they certainly still have the human capacity and motivation to reverse the decades of decline.
Certainly, the progress that occurred during the GNU is indicative of the country’s potential. It is because
of this potential that USAID adopted an aspirational 15 to 20 year goal to assist with the transition to a
more open and accountable country, where citizens actively engage with their leaders, live healthier lives,
and are more economically secure.

II. Results Framework

USAID/Zimbabwe approached the development of a new results framework (RF) from several vantage
points. In addition to conducting the necessary analysis (see Annex 3), the Mission also took into
consideration U.S. national security interests; the United Nation’s Sustainable Development Goals
(SDGs) for Zimbabwe; Zimbabwean expertise; and lessons learned from the Mission during the design
and implementation of the last CDCS, from implementing partners and from other donors. The process
culminated in what was dubbed the “Big Weeks,” four weeks that the Mission devoted to listening,
discussing, debating, and eventually formulating a RF that is well rooted in the Zimbabwean context,
supports U.S. national interests, and will assist Zimbabwe in obtaining their SDG targets.

Sustainable Development Goals

USAID’s focus in Zimbabwe is consistent with the SDGs and with the countries priorities. Of the 16
goals under the new strategy, USAID projects will cover the following nine:

• Peace, justice, and strong institutions • Clean water and sanitation

• Gender equality • Decent work through economic growth
• Reduced inequalities • Good health and well being
• Reducing poverty • Climate action
• Ending hunger

This significantly overlaps with the GOZ’s SDG priorities, although there is not complete alignment. The
GOZ has chosen to focus on the following that support several SDGs:

• Poverty reduction and food security

• Sustainable social and economic infrastructure
• Health equity
• Universal primary and secondary education
• Climate change adaptation and mitigation

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USAID/Zimbabwe CDCS

Goal
USAID/Zimbabwe, through a collaborative, Mission-wide process, developed a goal that represents a
vision for Zimbabwe in 15 to 20 years. This vision is aspirational in nature – an aspiration shared by
those within the Mission and the Country Team. USAID/Zimbabwe’s goal is:

Inclusive, accountable governance and a healthy, engaged citizenry drive

social, political, and economic development with equal opportunity for all

In constructing this statement, Mission staff agreed that the goal must address the need to create
opportunities for citizens to become drivers of social, political, and economic, change that is characterized
by good governance.

In acknowledging the principal root causes of Zimbabwe’s current social, political, and economic
situation, assessing USAID’s comparative advantage in providing development assistance, and
recognizing the role of other donors, the Mission selected three development objectives to help achieve
this goal. These development objectives form the basis for the CDCS results framework and include the
following crosscutting issues: gender, youth, local champions, and good governance.

Goal: Inclusive, accountable governance and a healthy,

engaged citizenry drive social, political, and economic
development with equal opportunity for all

DO 3: Improved
DO 1: Expanded inclusive DO 2: Increased number of
accountable, democratic
and sustainable economic Zimbabweans live longer and
governance that serves an
opportunities healthier lives
engaged citizenry

Crosscutting Themes
Accountability and Governance
Increasing accountability and improving governance, both political and economic, is at the foundation of
achieving progress in Zimbabwe.

The challenge is how to foster processes that allows citizens to find voice and agency to demand that
public servants and elected officials become accountable and able to respond. Championing local leaders
and agents of change, the Mission is already seeing cases where women assume the leadership of the
community-led construction of a dam, for example. This is both breaking gender norms as well as
increasing opportunities for effective collaboration between communities and local leaders. As the
Mission moves forward with the new strategy, addressing accountability and governance will continue as
a crosscutting theme and an essential component of project design.

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USAID/Zimbabwe CDCS

Gender
Gender dynamics represent critical concerns and important opportunities in Zimbabwe. The 2015
Southern African Development Community (SADC) Gender Protocol declared the low political,
economic, and social status of the majority of women in Zimbabwe as one of the country’s major post-
2015 development challenges. Women experience higher levels of food insecurity, lower participation as
political candidates, greater barriers to accessing credit and finance, and higher HIV prevalence rates than
men do. 17 Zimbabwean women are hardworking, but time and resource poor. Marrying young, youthful
childbearing, and the increased likelihood of being relegated to the informal sector are just some of the
reasons Zimbabwe ranks 110 out of 149 on the Gender Inequality Index. 18, 19

Additionally, gender-based violence (GBV) permeates society; approximately three women in 10 have
been victims of physical violence, with family relatives as the main perpetrators. According to the
Demographic and Health Survey (DHS), one in four females report having had forced sex before the age
of 15 years. As with physical violence, almost all assaults were by partners. 20 The implications for future
physical, reproductive, and emotional problems are self-evident. The growing numbers of child
marriages and the related health issues are of deep concern and signal a need for greater knowledge of the
constitutional guarantees of the girl child. 21, 22

Youth
Youth now comprise 61 percent of Zimbabwe’s population, while 41 percent are under the age of
fifteen. 23 Referred to as “born frees” – those born after Zimbabwean independence in 1980, today’s
youth face dim prospects as they grow up in households with staggering rates of poverty and declining
access to quality health and education services, clean water and proper sanitation, and other basic services
necessary to produce productive citizens.

This youth bulge can be a potential power for growth. However, given the current levels of despair, they
could easily become participants in unrest or mass action as has happened in the past. The challenge is
how to harness this latent energy, when youth face a multitude of cultural barriers, including entrenched
patriarchal and hierarchical structures and norms that prevent them from voicing their views.
Zimbabwe’s youth are in ‘waithood’ – a status of waiting to be adults, a status that is now prolonged due

17
Zimbabwe DHS, 2010-2011. For example, young women (15-24 years) are nearly twice as likely to be HIV
positive as men are.
18
ZIMSTAT and UNICEF, “Multiple Indicator Cluster Survey, 2014 Key Findings,” 24% of women ages 15-19 are
married or in union.
19
For 2013, Zimbabwe’s score is 0.516. This index is a composite measure, which captures the loss of achievement
within a country due to gender inequality. It uses three dimensions reproductive health, empowerment, and labor
market participation.
20
92%
21
Child marriage almost exclusively affects the girl child.
22
Young girls are more vulnerable to infection, including HIV; lack power to negotiate safe sex; are at higher risks
of maternal mortality and morbidity; and miscarriage or other delivery complications. Other issues that are
devastating to their well-being include loss of educational opportunity; treatment as domestic servants; and total
dependency on the ‘husband’ and “often suffering repeated rape, physical and psychological abuse with no recourse.
They have weak psycho-social support structures as their families and extended family networks are ashamed of
being identified with them because of either religious, and or moral reasons.” See RAU, “Child Marriages – the
Arguments,” 2015.
23
Using Agency definition of 0-24 years of age; culturally, in Zimbabwe youth can extend until such time as a
person has work, a spouse, and children – in other words an adult is someone who has demonstrated responsibility.
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USAID/Zimbabwe CDCS

to the increasing social and economic difficulties the country faces. The result is the marginalization of a
significant portion of Zimbabwe’s population, potentially sabotaging the country’s future.

III. Development Objectives

Development Objective 1: Expanded Inclusive and Sustainable Economic
Opportunities

Development Hypothesis: If the business operating and investment environment is improved,

competitiveness increased, nutrition improved, and resilience to climatic and other shocks built,
then there will be a strong foundation for target populations to take advantage of inclusive and
sustainable economic opportunities.

Illustrative DO 1 Indicators
● Prevalence of poverty (and/or depth of poverty)
● Global Competitiveness Ranking (from the World Economic Forum)
● Stunting rates for children under 5 years of age (gender disaggregated) 24

Context
With high rates of poverty and an increasingly informal economy, the average Zimbabwean has seen a
sharp decline in standard of living, which has led to recurrent food security issues. Poverty is more
prevalent in rural areas where 68 percent of people live, and the majority of those people depend directly
or indirectly on agriculture for employment and food security. 25 The economy as a whole, once heavily
reliant on agriculture for employment and poverty reduction, now generates only 14 percent of total GDP
from the sector. Major crop yields are only about half of pre-2000 levels before the advent of the Fast
Track Land Reform Program and the associated takeover of commercial farms. 26 Agriculture,
nevertheless, remains an important source of income, employing a third of the formal labor force. The
collapse of commercial farming not only caused unemployment, it led the country on a path of food
insecurity and food deficits, leaving behind severely damaged upstream and downstream agribusinesses
that previously provided inputs and processing. Moreover, the general decline in formal employment has
forced many workers into poorly remunerated and insecure informal jobs and thus had a direct impact on
both poverty and hunger. 27 The dollarization of Zimbabwe’s currency in early 2009 helped to stabilize
certain aspects of the economy; however, it has not been nearly enough to overcome policy choices that
have caused a downward economic spiral, resulting in an uncompetitive economy with high levels of
poverty and food insecurity.

While generally declining, the share of food insecure households varies from year-to-year, reflecting the
strong reliance on rain-fed agriculture. The result is significant periodic spikes in the numbers of food
insecure people during the lean season based on rainfall patterns. An over-reliance on subsistence
agriculture on rain-fed land means that farmers are facing the harsh reality of climate change. While

24
Source: Zimbabwe Demographic and Health Survey
25
Source: Zimbabwe Poverty, Income Consumption and Expenditure Report 2011/2012, April 2013, ZimStat.
26
Based on data from the Commercial Farmers Union for 20 major agricultural products including maize, wheat,
tobacco, cotton soya beans, groundnuts, sugar, dairy and beef.
27
In 2011, 94% of paid employees received an income equal to or below the total consumption poverty line for an
average family of five, while three out of every four employed persons in Zimbabwe are classified as being in
‘vulnerable employment.’
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USAID/Zimbabwe CDCS

climate and rainfall variability have been high across southern Africa for the past century, evidence
suggests that climate change will likely cause rainy seasons to be shorter, with increasing temperatures,
higher variability in weather patterns, more frequent droughts, and occasional flooding. To adapt to these
changes, farmers need to build resilience to shocks by harvesting and storing water, using it more
efficiently, and shifting away from maize towards small grains and seed varieties that tolerate new
climatic realities. However, Zimbabwe is a country that prefers to grow maize despite the changing
climate and increasing concerns regarding water scarcity. This preference is reinforced by the
government, which distributes maize rather than other seeds thereby frequently undermining free market
incentives. Unfortunately, many Zimbabweans have yet to accept fully the realities of climate change and
its implications. This year, which is the second year of an El Niño-related drought, approximately 28
percent of the rural population was estimated to be food insecure during the peak of the lean season from
January to March 2016. This number is expected to increase in anticipation of El Niño’s continued effect
on Zimbabwe.

In recent years, several major studies documented and emphasized the link between good nutrition and
economic growth. 28 With Zimbabwe’s stunting prevalence at 28 percent, 29 the GOZ acknowledges the
importance of nutrition in its strategic and policy documents. 30 These policies and plans are consistent
with USAID’s policy emphasizing adequate nutrition in the first 1,000 days of a child’s life, and USAID
will encourage their full implementation.

Crosscutting Issues
The consequences of a weak economy and increased food insecurity do not affect Zimbabweans equally.
Youth and gender dynamics represent critical concerns, but also important opportunities. Young adults
from the ages of 15 to 35 are the most affected by unemployment or underemployment and the most
prone to the social and political manipulation that has contributed to past violence and instability. 31 As
youth remain a potential source of social upheaval, they are a segment of the population that cannot be
ignored. In response, activities will seek to mobilize and engage youth positively in economic activities
in order to transform the youth bulge from a potential burden to a key driver of growth.

Gender dynamics are also critical, as Zimbabwe’s economic decline does not affect men and women
equally. Women play a critical role in agriculture in Zimbabwe but have limited access to and ownership
of productive assets such as land and agricultural inputs. This is not the only barrier for greater female
participation in the economy. A labor market assessment carried out by USAID in FY 2015 identified the
following primary barriers to gender equality in the labor force:

● An inadequate legal framework ● Lack of access to means of production

● Low female representation in leadership ● Negative cultural practices
● Absence of skills among women ● Gender stereotypes
● Sexual harassment at work ● Male dominance in a variety of trades and roles

28 World Bank, “Repositioning Nutrition as Central to Development,

http://siteresources.worldbank.org/NUTRITION/Resources/281846-1131636806329/NutritionStrategy.pdf.
According to the report, malnutrition is costing countries up to 3% of their GDP.
29
Zimbabwe “Multiple Indicator Cluster Survey,” 2014.
30
The Food and Nutrition Security Policy, the Zimbabwe National Nutrition Strategy (2014-2018) and the
Zimbabwe National Food Fortification Strategy. The goal is to “promote and ensure adequate food and nutrition
security for all people at all times in Zimbabwe, particularly amongst the most vulnerable and in line with our
cultural norms and values and the concept of rebuilding and maintaining family dignity.”
31
Zimbabwe 2014 Labour Force Survey. ZimStat. March 2015.
13
USAID/Zimbabwe CDCS

In response, under DO 1, USAID will continue to promote more equitable household and community
decision-making, thereby enabling women to participate more fully in transforming the economic status
of their households, communities, and the country. Current and future activities will also strive to
empower women to increase their control and ability to influence decisions over income and assets
alongside men. The Mission already has had success in this endeavor and will build on existing
interventions. For example, Food for Peace (FFP) resources will continue to empower women with
farming skills, introducing them to new technologies and management practices to engage better in
commercial value chains and increase income. FFP activities will also continue to promote women’s
leadership in farmer groups, community asset management committees, and village savings and lending
groups. These activities will continue to be complemented by Feed the Future (FTF) programs, which
address women’s lack of economic decision-making power within the household and lack of access to
technical training, technology, and tools for productive livelihoods.

Broadly speaking, DO 1 will support transparency, accountability, and good governance through
evidence-based policy research by non-government and government organizations. This is to inform
better economic policy processes and decision-making, and to encourage inclusive economic growth and
investment. DO 1 will also build the fundamentals of accountability and good governance at a grassroots
level through participatory and inclusive activity components. Examples include community-led disaster
risk reduction committees and asset management committees, which oversee the use and maintenance of
communal assets created or rehabilitated.

Because the factors that negatively affect the economy are broad, the Mission designed an integrated DO
that addresses the most relevant factors impeding inclusive, sustainable economic growth. The IRs in DO
1 complement one another by improving the economic and business environment to foster opportunities
for equitable growth, while simultaneously building the capacity and resilience of the most vulnerable to
engage in the broader economy. Food security is woven into the DO by improving the economic
environment that ensures a sufficient supply of food, as well as opportunities for households to access
food. The Mission will continue to ensure that FTF and FFP complement and leverage one another so
that whenever feasible, the impact of these activities will be expanded through co-location, joint targeting,
or strategic alignment. There are opportunities to explore the greater integration related to FTF and FFP
activities under DO 1, as well as between these activities and the Maternal Child Health and Nutrition
activities under DO 2. 32

Critical Assumptions and Risk Factors

● Relative consistency in political and economic conditions
● Low levels of domestic and foreign investment and low capacity utilization in businesses do not
significantly worsen
● Southern African Development Community economic climate does not significantly worsen
● Increasing climatic variability makes current agricultural practices increasingly susceptible to erratic
(or low) yields, depressing the agriculture sector and increasing food insecurity (Risk)

32
Funding for Feed the Future and MCHN in Zimbabwe is modest, and the geographic overlap of these ongoing
activities is restricted to several wards in one province, so the potential for extensive integration is limited.
14
 USAID/Zimbabwe CDCS

DO 1
Expanded inclusive and sustainable
economic opportunities

IR 1.1 IR 1.2 IR 1.3 IR 1.4

Business operating Micro and small/ Nutrition outcomes Resilience to shocks
and investment medium enterprise of target improved for
climate improved competitiveness communities vulnerable
increased improved Zimbabweans

Intermediate Result 1.1: Business Operating and Investment Climate Improved

This IR addresses the institutional, policy, and procedural constraints that discourage investment, inhibit
competitiveness, and undermine nutrition and food security. USAID will accomplish this result by
supporting policy dialogue and strengthening business/farm organizations’ and other stakeholders’
advocacy capacity, improving evidence-based participatory decision-making by the state, and facilitating
the implementation of pro-growth policy reforms.

Interventions will promote the use of evidence-based policy research to inform advocacy efforts and build
the capacity of a wide range of business, farm, and other stakeholder organizations to create demand for
reform. By increasing availability and access to high-quality public information, the expected result is
that there will be more effective pressure for reform and dialogue regarding the policy environment
needed to foster inclusive economic growth. USAID will emphasize those policies that support inclusion
of the poor and vulnerable, including women and youth, in economic activities, asset ownership,
leadership, and decision-making.

The policy and advocacy interventions will be complemented by assistance to help business and farm
organizations enhance their management capacity, improve their member support services, grow
membership, build financial strength, and improve understanding of gender dynamics. Key actors include
labor unions, farmers unions, commodity associations, business and trade associations, and other private
or public entities.

Box 2: A Focus on Men: Intermediate Result 1.2: Micro and Small/Medium

Reducing the Workload of Women Enterprise Competitiveness Improved
This IR will improve the competitiveness of micro, small,
Understanding the gender dynamics in rural and medium farms; agri-businesses; and other enterprises
areas, USAID looked at workload issues as it by enhancing agricultural productivity, strengthening
relates to improving the nutritional status of market linkages, enabling access to finance and technology,
children under two. The result was re- and expanding entrepreneurship and employment
examining how activities interact with women opportunities. The agriculture sector will be the primary
and with men. Through social behavior focus due to its importance to the rural economy and food
change messaging, USAID now encourages insecurity.
young men to participate in childcare practice
groups. These groups help shift gender Most Zimbabwean businesses are characterized by very low
dynamics and spread childcare responsibilities
productivity, high costs, limited access to critical inputs
within households. Men care groups have
become popular and, anecdotally, it appears 15
that gender norms are beginning to change as
men gain a greater appreciation of work at the
household level and participate more with
raising their children.
USAID/Zimbabwe CDCS

such as finance and technology, and unreliable access to water and electricity. USAID will work with
businesses to help mitigate the negative impact of the challenging environment and improve their
competitiveness. USAID will also support interventions that seek to link the informal and formal
markets.

As a result of the collapse of the formal sector, employment opportunities have shrunk dramatically,
leaving youth, particularly those in rural areas, with few prospects. Consequently, many rural youth
migrate to cities or cross the border searching for opportunity, but most end up unemployed or eking out a
few dollars a day in the informal sector. For those seeking to enter formal employment, in partnership
with the private sector, USAID will help youth to build job-related and communication skills, confidence,
a work ethic, resiliency, and a network of contacts. For youth looking to become entrepreneurs, USAID
will provide the skills and assistance to start their own businesses successfully.

Finance, even in the formal sector, is consistently the most frequently reported constraint to business
operations. 33 For informal enterprises without a credit history or collateral, access to finance is even more
difficult. Under this IR, USAID will increase access to finance with an emphasis on women and
smallholder farmers.

Intermediate Result 1.3: Nutrition Outcomes of Target Communities Improved

This IR responds to the growing awareness of the importance of nutrition in a nation’s economic
development. With the wide acceptance that good nutrition is essential for individual and community
productivity and that the first 1,000 days of life are critical for a child’s future cognitive development, the
Mission understands the importance of nutrition in achieving expanded economic opportunities that are
inclusive and sustainable in nature. This IR tackles malnutrition and stunting by improving the diversity
and adequacy of household diets, supporting adoption of appropriate nutrition behaviors, and improving
access to reliable water and sanitation.

USAID will use a comprehensive approach that employs complementary interventions to improve
nutritional outcomes. These will likely include increasing dietary diversity and use of less-commonly
consumed nutrient-dense local foods, encouraging essential nutrition behaviors and practices, promoting
exclusive breast feeding and hygienic food handling practices, and providing micronutrient-enhanced
supplementary food for pregnant and lactating women and young children. DO 1 activities will
coordinate as appropriate with activities under DO 2 that have maternal and child health components. By
focusing on activities that improve access to clean water and sanitation facilities as well as the resilience
activities in IR 1.4, USAID expects to have a significant impact on malnutrition and stunting.

Intermediate Result 1.4: Resilience to Shocks Improved for Vulnerable Zimbabweans

Resilience to shocks, particularly among vulnerable and highly food-insecure communities, is a
fundamental platform needed for inclusive development. This IR will strengthen the absorptive, adaptive,
and transformative capacities of communities to reduce their vulnerability to climate, natural, and
economic shocks. Activities under this IR will also strengthen the ability of communities to understand,
predict, and cope with the negative effects produced by shocks. Accordingly, USAID will focus on
interventions that diversify and strengthen livelihoods, protect and enhance community assets, establish
risk mitigation systems, and provide timely and sufficient humanitarian assistance when necessary. These
efforts will prevent households from resorting to negative coping mechanisms and suffering the loss of
critical assets in times of crisis.

33
According to the 2011 World Bank Enterprise Survey and the 2015/2016 Global Competitiveness Report.
16
USAID/Zimbabwe CDCS

This is part of USAID’s continued support of Zimbabwe’s transition from dependence on humanitarian
assistance to increased resilience and strengthened livelihoods, which will ultimately enable the
vulnerable to participate in the broader economy. The focus will be on helping the most vulnerable
households cope with shocks without falling further into poverty.

Development Objective 2: Increased Number of Zimbabweans Living Longer and

Healthier Lives
Development Hypothesis: If the burden of disease is reduced by strengthening health systems and
addressing the leading causes of illness and death, then Zimbabweans will live longer and healthier lives.

Illustrative DO 2 Context Indicators

● Under-5 mortality rate ● TB incidence rate
● Maternal mortality rate ● Malaria incidence rate
● HIV incidence rate

Context
High levels of preventable deaths, a heavy disease burden, and an under-resourced health service delivery
system all contribute to a low life expectancy and poor health status of Zimbabweans. The delivery
system is weak and overstretched by the high burden of HIV; TB; malaria; and maternal, newborn and
childhood (MNCH) illness, disease burdens that are complex and intertwined. HIV, TB, and malaria are
the most common causes of death in pregnant women and children under the age of five. 34 The single
most significant contributing factor to the TB burden is the AIDS epidemic with 68 percent co-infection
rates. 35 Malaria is the third leading cause of mortality
and morbidity. 36 Three-quarters of maternal deaths are Box 3: Addressing Gender-Based Violence
preventable, 37 and nearly half of women who die of
pregnancy-related complications are infected with HIV. 38
GBV is widespread in Zimbabwean society, and
While the Ministry of Health and Child Care (MOHCC) despite Zimbabwe’s relatively strong GBV legal
has policies that address the most prevalent health risks framework, women and children remain
and are aligned with the World Health Organization vulnerable to multiple forms of violence. A
(WHO) guidelines, more is needed to ensure these recent United Nations report on GBV showed
standards are appropriately implemented nationwide. that all forms of GBV, especially physical and
sexual violence, remain high in Zimbabwe. The
Zimbabwe’s prolonged economic crisis is at the root, risk of experiencing GBV increases substantially
leading to an eroded health system that is now heavily as women move into adulthood and enter into
dependent upon donors. Currently, health receives about marital and other forms of sexual relationships
8 percent of the total government budget as compared to with men. A National Baseline Survey on the
39
the 15 percent called for in the Abuja Declaration. Life Experiences of Adolescents found that 33
Although the national budget’s contribution to the health percent of women in Zimbabwe had experienced
sector had been declining, it has stabilized in the last few sexual violence by age 18 and that only 2.7
40 percent of them received professional help for
years to around $330 million annually for MOHCC.
any incident of sexual violence. USAID will
34 focus its GBV interventions on mitigation,
MOHCC National Health Profile
35
World Health Organization Global TB report, 2015.
education, and prevention, incorporating men and
36
MOHCC National Health Profile. women as well as youth and adults into GBV
37
Annual Report for Notified Institutional Maternal Deaths: activities. Activities will focus on providing
2010-2011. services to address physical and sexual violence
38
Maternal and Perinatal Mortality Study, 2007. against adolescent girls, as well as political
39
2016 National Budget Statement. intimidation and violence targeting women.
40
Ibid.
17
USAID/Zimbabwe CDCS

The majority is allocated for salaries although the GOZ has placed a freeze on hiring of nurses.
Alternative financial mechanisms, such as the national AIDS levy and results-based financing schemes,
help support the sector, but donor dependency will continue to be a major issue given the large gaps
between needs and GOZ resources.

Given Zimbabwe’s significant disease burden, USAID/Zimbabwe is taking a highly focused approach to
improving the health and wellbeing of Zimbabweans by targeting the major causes of morbidity and
mortality and coordinating closely with the GOZ, who is the largest provider of health services. Since
HIV, malaria, and TB are the top three causes of illness and death, efforts to improve prevention, care,
and treatment services for these diseases have the highest potential to reduce morbidity and mortality in
Zimbabwe. Also included are reproductive health (RH) and MNCH, given the links and the importance
of reducing maternal child mortality. Interventions will be prioritized according to the major causes of
disease and deaths, with a preference given to activities that have the highest potential to increase the
number of Zimbabweans living longer lives and to achieve the greatest impact on the health status of the
population.

Crosscutting Issues
DO 2 has a specific crosscutting theme based on the critical role that health systems play in improving
health status. The DO focuses on the major disease problems and the leading causes of mortality and
morbidity, but will also support a harmonized approach to health systems strengthening that cuts across
the four IRs. This is particularly important in the areas of human resources for health, data use for
decision-making, supply chain and logistics management, and implementation of policies and guidelines.
Due to the MOHCC’s limited financial capacity, USAID and other donors (including the Global Fund to
Fight AIDS, Tuberculosis and Malaria and the World Bank) support the majority of health systems
strengthening activities, such as human resources for health and health financing. Donor coordination
will continue and resources leveraged in this area, as health systems strengthening remains critical to
achieving health outcomes.

While working to strengthen elements of the health system described above, USAID will target its
interventions in geographic areas and populations where the greatest disease or health risk burdens exist. 41
Approaches will specifically target youth and women, as they are the most vulnerable. For example,
women 15-24 years old are nearly twice as likely to be HIV-positive as men are, with 7 percent
prevalence compared to 4 percent in young men. 42 Pregnant women, particularly those in their first
pregnancy, are more susceptible to developing malaria due to decreased immunity during pregnancy. The
spacing and prevention of unwanted pregnancies is a well-known intervention that can drastically
improve health outcomes in women of reproductive age.

USAID will work across the four IRs to improve accountability and governance within the health system.
For example, in supply chain management, USAID will increase GOZ capacity to effectively forecast,
procure, and distribute drugs and other health commodities. Working with local government authorities
on provision of public health services also presents an opportunity to address a gap in policy adoption and
implementation by promoting appropriate and timely implementation of internationally recommended
policies. Lastly, upholding the patient charter (which defines client rights and standards of care) and

41
E.g., in order to reach 80% ART coverage nationally, the focus is on 36 priority districts where 80% of the HIV-
positive individuals live. For malaria control focus is the three eastern rural provinces that account for about 83% of
all malaria cases and 50% of all malaria deaths in 2014. MNCH activities will target Manicaland where the
maternal mortality rate is one of the highest in the country and malaria transmission is also high.
42
ZDHS 2010/2011
18
USAID/Zimbabwe CDCS

ensuring informed consent for various health services will continue to be offered as part of quality service
delivery.

In the health sector, youth face specific challenges that limit their access to health services, including
family planning, reproductive health, and HIV and AIDS. Some of these barriers are due to age-
differentials between them and the provider, unavailability of services in areas where youth tend to
gather, and health messages that are not tailored to youth as a specific audience. USAID will continue to
provide youth-friendly services to reach this population in family planning, reproductive health, and HIV
and AIDS. Activities include peer education, community HIV treatment support groups, mass media and
social marketing campaigns, and trainings for health care providers on how to interact with youth clients.

Women and girls are at the center of DO2. Given the high levels of maternal mortality, unacceptable
levels of GBV, and the large percentage of women infected with HIV, this strategy identifies women and
girls as a critical target population and primary intended beneficiaries of improved essential health
services. The ability of mothers to access essential health services and health-related knowledge is
fundamental to the health of Zimbabwean families. USAID’s approach towards addressing gender
concerns is wide reaching, focusing on barriers to improving health status.

GBV is particularly problematic as it permeates Zimbabwean society; approximately three women in 10

have been victims of physical violence, with family relatives as the main perpetrators. (See Box 3)
According to the 2011 Demographic Health Survey (DHS), one in four females report having had forced
sex before the age of 15 years. As with physical violence, almost all of assaults were by partners. The
implications for future physical, reproductive, and emotional problems are self-evident. The growing
numbers of child marriages and the related health issues are of deep concern and signal a need for greater
knowledge of the constitutional guarantees of the girl child. 43

USAID has focused its GBV interventions on mitigation, education, and prevention, incorporating men
and women as well as youth and adults into GBV activities. USAID’s GBV activities focus on providing
services to address physical and sexual violence against adolescent girls, as well as political intimidation
and violence targeting women. Zimbabwe has been experiencing a rise in early marriages due to
religious, economic, and social factors, and USAID seeks to address these issues across its foreign
assistance program. In each relevant IR, service delivery will include care, treatment, and referral
services for survivors of GBV, which is a significant development issue in Zimbabwe.

Critical Assumption and Risk Factors

● GOZ and donor funding for the health sector remains stable
● The AIDS levy is discontinued or levy revenues diminish (Risk)
● Disease outbreaks drain public sector and donor resources for health (Risk)
● The health worker hiring freeze continues to affect the human resource base (Risk)

43
Child marriage almost exclusively affects the girl child. Young girls are more vulnerable to infection, including
HIV; lack power to negotiate safe sex; are at higher risks of maternal mortality and morbidity; and miscarriage or
other delivery complications. Other issues that are devastating to their well-being include loss of educational
opportunity; treatment as domestic servants; and total dependency on the ‘husband’ and “often suffering repeated
rape, physical and psychological abuse with no recourse. They have weak pyscho-social support structures as their
families and extended family networks are ashamed of being identified with them because of either religious, and or
moral reasons.” See RAU, “Child Marriages – the Arguments,” 2015.
19
USAID/Zimbabwe CDCS

DO 2
Increased number of Zimbabweans
who live longer and healthier lives

IR 2.1 IR 2.2 Enhanced IR 2.3 IR 2.4

Accelerated HIV coverage of Increased coverage of Improved maternal
response for malaria control quality services and and child health
epidemic control and elimination responsive systems for status in targeted
measures TB control populations

Intermediate Result 2.1: Accelerated HIV Response for Epidemic Control

HIV and AIDS remains the leading cause of mortality and morbidity in Zimbabwe, with more than
38,600 people having died of AIDS related causes in 2014 (3,218 deaths per month). The HIV
prevalence rate among people aged 15-49 is estimated to be 16.7 percent, and the total number of people
living with HIV was around 1.6 million in 2014. In 2014, about 54,762 people were newly infected with
HIV. 44 The U.S. Government’s President’s Emergency Plan for AIDS Relief (PEPFAR) program
supports the national HIV program in prevention, testing, treatment, and care and support activities. In
the 36 scale-up districts in Zimbabwe, improved services and community outreach will benefit the entire
population while some activities will target high-risk and vulnerable groups.

Current funding for antiretroviral therapy (ART) is insufficient to achieve high coverage and epidemic
control on a national scale. To address this gap, this strategy will include an increased emphasis on
providing treatment services for HIV-positive Zimbabweans, in line with the shift in PEPFAR priorities
toward a more concentrated effort on treatment. Activities will focus on identifying HIV-positive
Zimbabweans and getting them onto appropriate treatment, with the goal of identifying 90 percent of the
HIV-positive population, getting 90 percent of HIV-positive individuals on treatment, and achieving viral
load suppression within 90 percent of those on treatment. Through these accelerated efforts, the PEPFAR
program aims to achieve epidemic control in Zimbabwe during the CDCS period.

Intermediate Result 2.2: Enhanced Coverage of Malaria Control and Elimination Measures
Malaria is the third leading cause of death and illness in Zimbabwe. 45 While the total number of reported
malaria cases decreased from 1.8 million in 2006 to 536,000 in 2014, from 2012 to 2013 malaria
incidence rose 32 percent from 22 to 29 per 1,000. In 2014, the rate increased again to 39 per 1,000, a 34
percent increase from 2013. 46 While this trend may partly be due to increased diagnostic capacity, it is
likely that the consistent application and adoption of malaria prevention measures may have declined in
some communities or households.

44
MOHCC National HIV Estimates Report, 2014.
45
MOHCC National Health Profile.
46
MOHCC National Malaria Control Programme Annual Report, 2014.

20
USAID/Zimbabwe CDCS

USAID will continue to provide assistance as part of the U.S. President’s Malaria Initiative (PMI) that is
coordinated with national efforts led by the GOZ’s National Malaria Control Program (NMCP). Some
districts remain in the malaria control phase, while others are beginning the transition to pre-elimination
of malaria. Interventions will seek to reduce the transmission of malaria by scaling up either indoor
residual spraying (IRS) or long-lasting insecticide-treated nets as effective vector control interventions to
90 percent of the population residing in malarious districts. As two of the major malaria donors in
Zimbabwe, PMI and the Global Fund to Fight AIDS, Tuberculosis and Malaria will continue to
coordinate efforts under the leadership of the NMCP to achieve the vector control coverage goal. In
addition, activities will seek to improve country capacity and strengthen systems to ensure accurate
quantification, procurement, distribution, prescription, and use of diagnostic tools and medicines to
improve case management.

Intermediate Result 2.3: Increased Coverage of Quality Services and Responsive Systems for TB
Control
TB is the second leading cause of mortality and morbidity in Zimbabwe. Between 2012 and 2014, the
national mortality rate increased from 38 to 40 per 100,000 while TB incidence (including HIV+TB)
decreased from 562 to 552 cases per 100,000. 47 As HIV is an important determinant of TB, there is a
need to improve and scale-up integrated TB and HIV care and treatment. While the TB treatment success
rate remains high at 81 percent, 48 the National TB Program Strategic Plan recognizes that treatment and
prevention efforts are hampered by a wide-reaching set of issues. These include inadequate human
resource capacity, the burden of TB/HIV co-infection, a weak national laboratory network, inadequate
diagnostic capability for childhood TB, and insufficient engagement of individuals and communities
infected or affected by TB.

The TB burden in Zimbabwe is a complex problem, but at the core is the need to prioritize strengthening
the programmatic and diagnostic management and leadership of TB. TB detection, care, and
management approaches will be more integrated with other services and focus on children, women, and
key priority populations like those with HIV, those working in mines, migrants, and clients with non-
communicable diseases and hepatitis. Support will be provided to expand and improve TB infection
control measures within the health care service delivery system, as part of improved prevention and
control efforts. In addition, TB operational and management systems will be strengthened to ensure a
more responsive environment for effective delivery of TB services. These include investments in
laboratory and specimen transport, capacity building of health staff, and increased routine use of data for
decision-making.

Intermediate Result 2.4: Improved Maternal and Child Health Status in Targeted Areas
Although the maternal mortality rate has declined from 960 deaths per 100,000 live births in 2010/2011 49
to 614 in 2014, 50 it remains unacceptably high. Three-quarters of maternal deaths are preventable and are
largely due to postpartum hemorrhage, sepsis, malaria, eclampsia, and anemia. Similarly, despite a
decrease in the under-five mortality rate in recent years, it also remains high at 75 per 1000 live births. 51
Again, these deaths are all preventable. Zimbabwe’s contraceptive prevalence rate increased from 59
percent in 2010 52 to 67 percent in 2014. 53 Yet the total fertility rate that had declined since 1988
increased between 2006 and 2011 with higher rates among rural women (4.8 vs. 3.1). 54

47
National TB Program Annual Report.
48
National TB Program Annual Report.
49
Zimbabwe Demographic and Health Survey, 2010-11.
50
Zimstat Multiple Indicator Cluster Survey, 2014.
51
Zimstat Multiple Indicator Cluster Survey, 2014.
52
Zimbabwe Demographic and Health Survey, 2010-11.
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USAID/Zimbabwe CDCS

For optimal use of available resources, USAID will focus on the province with the highest maternal and
infant morbidity and mortality rates. Practices and barriers, such as early marriage, early sexual
encounters, and limited decision-making power among women and girls, impede access to services for
pregnant women and girls, and a significant number of births still occur without a skilled health provider.
Interventions to encourage health-seeking behaviors, increase use of services, and identify and treat
women and girls affected by GBV, will be evidence-based, targeted, and sensitive to Zimbabwe’s
sociocultural context and changing demographics. Most women have limited access to long acting and
permanent methods (LAPM) of contraception, especially in rural areas. Interventions will focus on
increasing access to family planning (FP) through outreach services in rural areas to bring LAPM
contraction options to rural populations.

Development Objective 3: Improved Accountable, Democratic Governance that

Serves an Engaged Citizenry
Development Hypothesis: If Constitution-driven reforms are advanced and if the democratic principles
of participation, inclusion, transparency, and accountability are strengthened within government and
civil society institutions, then Zimbabwe will develop more accountable, democratic governance systems
that are informed and influenced by active citizen engagement that will serve the interests of all
Zimbabweans.

This DO reflects the assessment that weak systems of accountability underpin Zimbabwe’s broader
development challenges and need to be addressed through several vantage points. Decreasing barriers to
participation, especially for women and youth, is critical and must be carefully balanced with efforts to
increase accountability of government institutions so that they can adequately respond to citizen demands.

Context
Though imperfect, Zimbabwe’s 2013 Constitution enshrines unambiguous respect for fundamental human
rights, gender equality, and a framework for tackling the legacy of human rights abuses. Citizens have a
basis for discussing development problems in the context of their social, political, economic, and civil
rights. Although the current environment is fluid, the Mission believes there is a window of opportunity
to build on the Constitution and promote accountability, human rights, and active citizenship, while
fostering more inclusive, representative structures and processes for participation. To achieve these goals,
barriers to civic participation by women and young people, who make up the vast majority of the
population must be reduced. 55

Crosscutting Issues 56
Women and youth face significant and particular barriers to participation in political processes. On the
other hand, partially in recognition to the barriers women face, Zimbabwe’s new constitution mandates
that the government must take measures to ensure equal representation of women and men at all levels of
the government and dictates a temporary quota for women’s seats in Parliament until 2023. The 2013
53
Zimstat Multiple Indicator Cluster Survey, 2014.
54
Zimbabwe Demographic and Health Survey, 2010-11.
55
According to the Zimbabwe 2012 Census, women represent 51.9% of the population, while 76.8% is under the
age of 35. Those figures suggest that approximately 89% of the population is either female or under the age of 35.
Of that, 35.9% of the population is between the ages of 15 and 34 while children under the age of 15 make up
41.1%.
56
Please note that accountability and governance are core to this DO and as such, affect the other DOs. Therefore,
are not included as cross-cutting issues.
22
USAID/Zimbabwe CDCS

general election brought women’s representation in Parliament from 20 percent to 35 percent. Women
now chair 40 percent of the 20 Parliamentary committees.

Youth face additional obstacles to participation in political and governance processes, and USAID will
continue its focus on empowerment, looking at both marginalized youth and youth in leadership
positions.

O3
DO 3
Improved accountable, democratic
governance that serves an engaged citizenry

3. 3. 3.3
IR 1: Constitution- IR 2: Systems of IR 3: Citizen
driven reforms accountability engagement
advanced strengthened increased

Intermediate Result 3.1: Constitution-driven Reforms Advanced

Although the Constitution has been in effect since 2013, around 400 existing laws have yet to be aligned,
including key legislation affecting protection of human rights and freedom of the press and assembly.
Thus, this IR focuses on increasing awareness of constitutional rights, roles, and responsibilities and
advancing Constitutional alignment of laws, policies, and procedures. USAID will accomplish this by
working with CSOs to use a variety of platforms to provide information and support dialogue about
constitutional rights, roles, and responsibilities. Across all DOs, USAID will seek opportunities to foster
learning and discussion about the Constitution, which not only includes rights such as the right to human
dignity and personal security, but also the right to education, health care, water, food, and property.

Intermediate Result 3.2: Systems of Accountability Strengthened

This IR will foster stronger accountability systems in Zimbabwe. This will be achieved by increasing the
independence and effectiveness of Parliament; improving democratic electoral processes to reflect better
citizen voices; and activating mechanisms for citizen advocacy and oversight. The absence of
accountability lies at the root of Zimbabwe’s development failures – the government has not responsibly
served or safeguarded its citizens, and citizens have been unable to hold their government to account.
Throughout activities under this IR, USAID will seek ways to foster systems of accountability that
incorporate active participation and oversight from citizenry in the expectation that this will lead to
greater transparency and create incentives for government responsiveness. USAID will broaden its
previous focus on election events to encompass the entire electoral cycle, environment, and institutions,
with an emphasis on civic and voter education.

Intermediate Result 3.3: Citizen Engagement Increased

This IR will reduce barriers to the participation of youth, women, and other vulnerable groups, improve
civil society’s representation of informed citizen views, and improve the ability of solution holders to
work effectively with citizens.

23
USAID/Zimbabwe CDCS

IV. Monitoring Evaluation and Learning Plan

USAID’s monitoring, evaluation, and learning (MEL) activities will be oriented towards collaborating,
learning, and adapting (CLA). The Mission will focus MEL on ensuring good tracking of progress of
ongoing activities, learning from MEL activities as well as adapting programs and activities to emerging
learning and the evolving context within Zimbabwe. Within four to six months of CDCS approval,
USAID will develop a performance management plan (PMP). 57

Collaborating, Learning, and Adapting

USAID has begun crafting a deliberate approach to foster an environment that not only values, but also
actively promotes and seeks to expand CLA. The CDCS is a living document that requires review,
examination, and adjustment to consistently assess the soundness of the development hypothesis and
ensure that the Mission remains on the best course to advance its development objectives. These
processes occur through CLA. It is an iterative yet systematic and planned process that involves
development, testing, and refinement of various processes, methods, and applications meant to enhance
Mission and partner knowledge and allow for nimble, evidence-based course corrections. USAID views
CLA as a means toward an end: improved development effectiveness through joint problem analysis,
resolution and prioritization.

While the CLA plan represents the Mission’s first step in articulating its CLA approach, it will be refined
throughout the CDCS timeframe. In accordance with emerging Agency guidance, the Mission will first
develop a full CLA plan as part of formulating the Mission-wide PMP, which will occur four to six
months after approval of the CDCS. Thereafter, the Mission will produce complementary materials and
processes that aid both staff and implementing partners in practical and utilization-focused CLA
applications. These applications will lead to deeper coordination and integration, evidence-based
knowledge that incorporates input from an increasingly diverse set of stakeholders, and management
processes and techniques that provide USAID managers with a menu of adaptive management options
allowing for agile corrective actions.

In conducting the CDCS development process and reflecting upon internal practices, it is apparent that the
Mission already carries out numerous CLA activities that lead to collaboration and learning. The Mission
will leverage these endeavors to strengthen CLA resulting in intentional collaboration and learning, and
the systemization of these practices will form the basis of a coherent, Mission-wide CLA system.

Monitoring. Monitoring will inform routine adaptive management of activities through data collection,
synthesis and reporting. The Mission will use existing mandatory USAID program cycle requirements to
track activities progress. As per standard requirements, implementing partners will be required to submit
an M&E plan detailing standard and custom indicators as well as targets and baselines for awards. During
the quarterly and annual reporting periods, implementing partners will be required to report on these
indicators. USAID and implementing partners will use these reports to discuss progress and challenges
and decide on any changes or management decisions.

The Mission’s performance against the results framework will be measured through the PMP. During the
portfolio review processes, the Mission will deliberate on achievement of annual targets and decide on
any adaptive action or management decisions. The implementation-focused portfolio review will also
discuss performance on PPR indicators.

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The PMP will provide more details on indicators, data quality assurance, data collection, analysis and reporting
procedures, evaluation plan and a detailed CLA plan.

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Evaluation. In line with the USAID evaluation policy, evaluation will be geared toward accountability
and learning. Accountability will focus on measuring the effects, progress, and impacts of USAID
programing while learning will inform new program designs and changes or modifications in processes
and practice. A detailed evaluation plan will be provided in the Mission PMP. Using the PMP, the
Mission will track implementation of evaluation recommendations. Some of the major learning agenda
items that the evaluation plan will draw from include:

Development Objective 1:
• Changes to seasons and impact of ideal crop planting calendars and implications of shifting
livelihood zones due to climate change
• With a gender specific focus, in response to climate change in Zimbabwe, how can rural
households best diversify their livelihoods to not only survive, but also thrive in the face of
heightened climate stress and uncertainty?
• Need for more information on GOZ-civil society dialogue and adoption of policy
recommendations

Development Objective 2:
• What is the effectiveness of social franchising in provision of family planning services?
• How do strengthened GBV activities contribute to improved GBV prevention and response?
• How effective is the integration of ART and OVC programing?

Development Objective 3:
• Analyze the barriers for participation for women and youth, and Zimbabweans at large.

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Annex 1: Illustrative DO level indicators

The Mission will develop a full Performance management Plan (PMP) to capture monitoring, evaluation
and learning associated with the CDCS. The indicators stated below are illustrative and will be revised
during the PMP development process.

Illustrative DO 1 Indicators
• Prevalence of poverty / extreme poverty (target areas, gender, age disaggregated)
• Global Competitiveness Report ranking
• Stunting rates for children under 5 years of age (gender disaggregated)
Illustrative DO 2 Indicators
• Maternal mortality rate
• Number of new HIV infections per year
• Malaria incidence rate
Illustrative DO 3 Indicators
• Percentage of Zimbabweans who report some form of civic or political participation
(Afrobarometer Q19-20)
• Freedom in the World index score (Freedom House)
• Worldwide Governance Indicators index score (World Bank)

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Prevalence of Poverty
Annex 2: Maps

Percentage of People
Living in Poverty

<50 %
50-65 %
>65-75 %
>75-96%
Provincial Boundary
District Boundary
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USAID/Zimbabwe CDCS

USAID Operational Districts

DO 1: Inclusive & Sustainable Economic Opportunities

activities (FFP, FTF, and other economic growth activities)
DO 2: Health activities are nationwide
DO 3: Democracy, Rights, and Governance activities
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Provincial boundaries
District boundaries
USAID/Zimbabwe CDCS

Annex 3: Donor Support in Zimbabwe

The GOZ is heavily reliant on donors to provide major financing for the social sectors and the
humanitarian assistance. Donors in Zimbabwe include the United Kingdom (UK), U.S., Global Fund,
European Union (EU), Japan, Germany, Australia, Sweden, Norway, Denmark and Switzerland. Donor
support is declining with Australia significantly reducing their support and Norway and Denmark
planning to withdraw from Zimbabwe next year. The top bilateral donors are the U.S., UK, and the EU
with many of the smaller donors frequently working through the United Nations (UN) system.

Economic Growth and Agriculture

In the agricultural sector, the UK’s Department for International Development (DFID) program,
implemented in partnership with AUSAID, incorporates assistance in agricultural productivity, nutrition,
and markets. It also includes subsidized agricultural inputs and safety nets. DFID and AUSAID’s focus
is primarily the drier parts of the northern half of Zimbabwe. The EU focuses on support to the GOZ
agricultural extension service, agricultural productivity with an emphasis on smallholder irrigation and
livestock, and a small nutrition component. The EU is also funding a significant natural resource
management initiative.

Other donors in the agricultural sector include the Swiss, Australian Aid and the German development
organization. These donors provide support in training in good agricultural practices, market linkages,
community gardens and community seed production, harmonization of seed laws and protocols across the
region, development and expansion of mobile financial services and information, reducing post-harvest
losses through low-cost grain storage technologies, rehabilitation of irrigation schemes, and integration of
climate change in vulnerability assessments and analyses.

Humanitarian Assistance
The field of humanitarian donors is small. USAID is by far the largest traditional donor, followed by
DfID and the European Commission. Non-traditional donors including China and Brazil have
sporadically contributed in-kind food aid, often directly to the GOZ.

Health
In the health sector, the major donors include the Global Fund to Fight AIDS, Tuberculosis, and Malaria,
DFID, EU, SIDA, UN Agencies (WHO, UNAIDS, UNICEF, UNFPA), and the World Bank. Other
NGOs provide support in more focused health areas such as Elma, CHAI, and CIFF. The Health
Transition Fund is a pooled funding basket that aims to improve maternal, child health, family planning,
and reproductive health services. Although opportunities for private sector investments are limited,
several companies such as EcoNet have collaborated with NGOs to utilize technologies for improved
health outcomes. In addition, the Minister of Finance announced at the end of November 2014 that the
AIDS Levy (NATF) would be extended to the mining sector in 2015, which is expected to add
approximately $13 million to the $32 million annual revenue of the Fund.

Democracy, Human Rights, and Governance

Several donors in addition to the U.S. have traditionally supported programming in the DRG sector:
Canada, Australia the European Union, and several European countries (i.e. the UK, Netherlands,
Sweden, Norway, and Denmark) on a bilateral basis.. In particular, DfID, AusAID, and Danida are jointly
funding “Transparency, Responsiveness, Accountability and Citizen Engagement” (TRACE), a civil
society sub-granting mechanism, while the EU also works with Parliament and is planning robust support
for the Zimbabwe Electoral Commission (ZEC). Additionally, the international financial institutions
(World Bank and African Development Bank (AfDB)) have started providing limited assistance in this
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sector. However, the pool of donors has been shrinking since 2000 due to concerns over government
accountability and human rights. The last DRG project by the Canadian International Development
Agency (CIDA) ended in 2013, and the Norwegians and the Danish (Danida) are closing their Embassies
and development programs in 2016-2017, while AusAID funding has been zeroed out. Coordination
meetings with the remaining donors working in the DRG sector take place on a bi-monthly basis. In a
number of sub-sectors, such as electoral assistance, parliament, or civil society, subgroups also meet
regularly to ensure coordination of effort.

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