Opportunities for Response This Situational Analysis report resists the temptation to frame specific prescriptive recommendations that may be presumptive, premature or limiting in scope and scale of response. Instead, this section surfaces a selection of opportunities for response by GALZ, Positive Vibes and their respective constituencies and partners. Several other potential responses may be inferred or implied throughout the report. It is important that practical recommendations be framed through further participation and consultation by the community and service providers themselves as part of their collective forward planning. A. Opportunities for ENGAGEMENT The Situational Analysis exercise demonstrated both the value of and interest in dialogue between service providers and service users, to foster relationship and connection, to expand accountability and shared ownership of the system for health, and to collaborate around improving quality that, in turn, increases demand, utilisation and efficacy of care. Several opportunities for engagement may be possible: 1. The Situational Analysis report itself presents an opportunity for immediate feedback. How might the report be used as a tool to draw together the constituency, to gather around the findings, to analyse and discuss, to interact, test, verify, validate? Whether the community – with or without the service providers, at first (although it will be important to include the latter at some point) – confirms or refutes the findings is less important; invariably, the conversation is more important, and the findings simply a platform from which to deepen reflection, analysis, dialogue and, potentially, programme design and operational planning. 2. GALZ should not lose the momentum or opportunity generated through this Situational Analysis exercise to engage with its specific sub- constituencies – in particular, lesbian and bisexual women and trans men and trans women – to discuss their feelings of marginalisation, exclusion and under-representation. Given the space they often occupy on the fringes of the system for health, it is important that the LGBTorganisation with which they associate themselves acts with proportionally greater effort to amplify their voices in order to afford them equity with their gay and bisexual male counterparts. 3. As was proposed by the Health Facilities themselves, the process and tool used for this Situational Analysis exercise – the simple Mixing Desk metaphor – might be applied as a routine monitoring and quality assurance activity, repeated on a quarterly or sixmonthly basis to test for improvement, with the present findings set as baseline levels. This kind of activity would increase accountability using a standardised framework, and institutionalise community participation in health facility monitoring. 4. Were there interest in taking joint analysis and quality assurance even further, such subjective, qualitative reflection of the type surfaced through this exercise might be augmented by quantitative data, in an area of interest or priority to service users and service providers. For example, on a periodic basis (eg. once a month; once a quarter; etc.) service providers and community members might gather for a ‘Technical Programme Review’. Each Review meeting might focus on a specific programme/ service offered through the facilities (eg. HIV-testing; cervical cancer screening; STItreatment; contact tracing; TB-testing, treatment and cure rate; etc.). Service providers could prepare statistical data relevant to the KP community to present for reflection, analysis and discussion (eg. utilisation numbers; user demographics – whether gay, lesbian, trans; etc.) and have Key Populations and clinic staff engage together around what the data shows, what gaps exist, and how to adapt services to improve for each particular technical programme. B. Opportunities for INFLUENCING There are at least three (and likely several other) policy-related influencing opportunities that present themselves, significant in that: a. They lead easily and legitimately to further evidence-gathering and ‘research’ work in order to strengthen an advocacy argument. b. They offer an opportunity to use a health and health services entry point to directly increase the profile of LGBT identities; in so doing, they advance a rights discourse, but from a safer, more accessible entry-point. c. They potentially create a way that GALZ and health providers (at the operational level) might collaborate in an influencing agenda, rather than have the providers be an advocacy target for GALZ. d. Making progress on any one of these issues (or several of them simultaneously, since they are conceivably interrelated) has a direct benefit on service-provision and health outcomes of LGBT people. PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 42