Headline Messages The Situational Analysis highlighted twelve (12) Headline Messages – observations, lessons learned, themes and insights – relevant to design and delivery of health services by service providers, to programming, to advocacy and policy-influence, and to the internal environment – structures, social dynamics, working culture – of GALZ itself. 1. Everyone agrees on a definition – a standard – of “GOOD”. Each focus group discussion or interview throughout the Situational Analysis exercise began with the same simple question: “for you, personally, as a Zimbabwean citizen looking to access a good public health service, what does good look like?” And across all groups – healthcare workers, health facility management, trans men and women, gay and bisexual men, lesbian and bisexual women, and sex workers – in both Bulawayo and Harare, respondents broadly described a similar set of standards and expectations: • Good attitude; welcoming; received with a smile; comforting; non-judgemental; respectful; being treated like a human; non-discriminating; not being treated differently; no bias; nonstigmatising; people are treated with dignity; no strange looks from nurses; no negative questions; time to talk; space to express what I feel, honestly; being listened to; feel free and at ease; able to be open about why I came for services; feel that I’d want to come back again; compassionate; not being judged; not being brushed off; coming out of the place feeling give me the right information about my individual health needs; the staff know what they are doing medically; staff are well-informed about sexual orientation and gender and other social issues; health workers are aware and educated on human sexuality; consultation and examinations are thorough and comprehensive, not like they’re scared to look at me or just want to rush me through; health workers are knowledgeable, confident and composed in their delivery of services. • Affordable; free medication • Acceptable; in line with my culture; people are sensitive with the language they use and the assumptions they make; no unnecessary personal questions just because people are curious; • Service-delivery comes with information so that I understand what is being done. • The services are safe; I can fully disclose my sexuality; service-providers accept me for who I am. These common qualities and expectations are significant for at least three reasons: i. They describe a framework for acceptable standards of decent care and service-delivery for Key Populations (that are, in fact, no different from those standards that should be applied in a general population). ii. They demonstrate that the interests of service providers and service users are not contradictory or oppositional. Health providers can relate at a human level; there is greater capacity for empathy than might be assumed. iii. They illustrate what may seem to matter most to Key Populations in their experience of health services: an affirming environment; a dignified interpersonal interaction; and clinical competence. good, and feeling good about going there; friendly; • Effective; a service that meets my needs; drugs are available; there is continuity of care so that people can be referred for other services that may not be available in one facility. • Efficient; I get what I need without waiting a long time; a short wait time; having enough staff; treating every case with urgency; quick; able to obtain the required medication from the same facility where it is prescribed; not need to go to a pharmacy; served on time • Privacy; a service that is discrete; a good system for handover of cases between staff so I don’t have to tell the same story over and over; confidential; • Accessibility; easy to reach; not too far away • Up to date with the knowledge and technology and equipment; well-sensitised so that staff have the right information to understand me, my sexual orientation; staff are able to PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 9