C. Opportunities for COLLABORATION 1. Under the present configuration, GALZ is engaged with Wilkins Hospital and with PSI in Harare and Bulawayo to provide services to its constituency. Although the intended viability. D. Opportunities for CONCEPTUALISATION outcomes are identical, the partnerships with Wilkins and PSI are independent of each The Situational Analysis suggests a number of opportunities for innovation and thought other. Through GALZ, however, Wilkins and PSI become thematically linked around leadership, for the articulation of concepts that may lead to design and practice-development: Sexual and Reproductive Health to Key Populations. And in that link lies the potential for peer exchange. Each facility has experience, expertise and technical capacity from 1. The development of a framework to describe the components of “Good KP Health which the other might learn, in order to improve the quality of SRH service provision Service Provision”, including the concept of a “system for health”, models for “integrated” in both. and “comprehensive” services, and designs for facility layout and patient flow. 2. The development of a comprehensive package/programme – content, process, tools and measurement – for localised sensitisation of health care service providers to For example: • Wilkins Hospital follows the general guidelines for management of STIs, but has sexual and gender identities, and to sexual and reproductive health for LGBT people. no clinical guidelines specific to Key Populations that may, for instance, highlight 3. The development of a more intensive initiative, possibly applied at multi-country infections that may present symptomatically in the mouth or throat or anus. PSI is level, for the capacity-building of health care providers around sexual and reproductive a non- governmental organisation that has developed an electronic point of care healthcare or LGBT people. Ideally, this initiative should address attitudinal, practice system (EPOC), internal to PSI, with guidelines that include KP-specific treatment and behavioural, and clinical requirements of service providers; may build provider protocols consistent with national guidelines, and diagnostic questions that are capacity to be SOGIE-literate, SOGIE-affirming and respectful of diversity; and provide designed to be, theoretically, non-heteronormative and appropriate for working an introduction to health-related rights and ethics. It may be possible that a similar with KPs. stream be designed for LGBT people who are not clinicians, but have an interest in engaging with the system for health, or for increasing their rights literacy. • PSI claims to offer a service that is ‘integrated’, but is more accurately described 4. Development of a concept where LGBT lay-people might occupy supportive roles as ‘comprehensive’. Clients to PSI move between multiple ‘specialist’ departments within health facilities, to complement clinical staff, and act as a familiar peer-link for specific services, increasing wait time and contact time and exposure. By to care from within the facility, not only at community level. This concept would contrast, Wilkins works as much as possible through a single point of care, require thought around roles, appropriate task-shifting, skills-development, training, providing as many services as possible in one staff member trained to deliver resourcing and supervision. multiple services. 5. The Situational Analysis exercise in Zimbabwe has field-tested a simple methodology to stimulate participatory community monitoring of health facilities by members There may be a role for GALZ to stimulate interest in this kind of technical collaboration, of Key Populations that leads to better engagement with service providers, quality to facilitate an exploration of comparative advantage between the facilities, to support improvement and opportunities for policy engagement around community-identified the convening of the facilities, etc. issues. Might this simple method be capable of application at scale through a multicountry process in a region such as Southern Africa? Such a process could focus 2. Health Facilities are utilising or generating materials, tools, standards, procedures on the use of public health monitoring where the right to stakeholder participation and protocols for training staff or as guidelines to staff for the delivery of care. bridges health and rights, expands citizen action for public accountability, safely Members of Key Populations would have valuable insight to contribute in the reviewing and responsibly increases the visibility of invisible populations to service-providers, of materials to make recommendations around their accuracy, appropriateness and opens a path for accessible interaction by community members with statistical health PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 44