• Jane Coombes

Zvandiri ECHO Hub - Moving Knowledge, Not People.

COVID-19 and related lockdowns and travel restrictions threatened to disrupt the vital work of Africaid’s Zvandiri Programme and, in turn, to have a negative impact on the health outcomes of children, adolescents and young people living with HIV. Africaid’s response, with the support of the Elma Foundation, has been to establish the Zvandiri-ECHO Hub, a centre for expertise, virtual knowledge-sharing and support in paediatric and adolescent HIV.

The Zvandiri model of best practice has traditionally depended on home and clinic visits, support groups and face-to-face trainings, and its success has led to adoption and adaptation of the model in eight countries across Africa. The onset of COVID-19 meant potential disruption to this work, and was a catalyst for Africaid to seek innovative ways of working. The result – our exciting new Zvandiri-ECHO Hub, which uses the ECHO Model™ (Extension for Community Healthcare Outcomes).

ECHO is about ‘moving knowledge, not people’, and is an evidence-based ‘hub’ and ‘spoke’ model that brings knowledge, learning and support closer to communities. The approach is based on the sharing of real cases, and enables peer-to-peer learning, guided and facilitated by subject experts. Based on the principle of ‘all teach – all learn’, community healthcare providers learn from specialists, as well as from each other, and specialists learn from community healthcare providers. In this way, we create a ‘learning loop’ between those on the frontline of healthcare, and multi-disciplinary teams of experts working in paediatric and adolescent HIV across Zimbabwe, as well as regionally, across Africa. Project ECHO® is enabling us to share best practice and build capacity virtually, in a cost- and time-efficient way.

Through our comprehensive package of programmes, we are continuing to work with the Ministry of Health and Child Care in Zimbabwe, other government partners, ministries, implementing partners, our CATs and Zvandiri Mentors, to build capacity and provide support through virtual clinical case management, training and e-mentorship, ultimately improving service delivery and health outcomes for children and adolescents living with HIV.

The technology

The ECHO model is a virtual telemedicine approach that uses Zoom, and requires very little technical equipment or bandwidth, enabling participants in even the most low-resource settings to access vital knowledge and support where they need it – in healthcare facilities and communities.

The Programmes

Some of our ECHO programmes will simply adapt our Zvandiri tried and tested face-to-face trainings for use on the ECHO virtual platform. In addition, we have developed some new learning initiatives, for example, multi-disciplinary and multi-country case management and e-mentorship, and ‘journal clubs’ to review latest research and guidelines. The ECHO model can be used for any individuals or groups of learners and on any topic, enabling us to adapt and tailor programmes.


  • In June 2020, in two pilot districts in Zimbabwe, we began our first Case Management Zvandiri-ECHO Programme with Zvandiri Mentors, enabling them to manage complex cases without leaving their communities. Using the ECHO principle of ‘all teach, all learn’, the Zvandiri Mentors themselves run the sessions, facilitating, guiding discussions, presenting didactic sessions and supporting each other, while a multi-disciplinary hub team is on hand comprising a clinical doctor and a psychologist. To date the sessions have covered enhanced adherence counselling and issues of mental health and psychosocial support: loss and grief, sexual identity, emotional and physical abuse.

  • In collaboration with the Ministry of Health and Social Services in Namibia, we delivered our first Zvandiri-ECHO Teen Club Leaders Training. Support groups are important for the health and wellbeing of young people living with HIV, to provide a safe space where they can go for information, to develop skills, and to learn more about living with HIV. There they can meet people who are living similar lives, who they can share experiences with. These groups are facility-based and led by healthcare workers. A total of 53 healthcare workers in Khomas and Oshana regions gathered for the four-day trainings, which guided them through topics ranging from the effects of HIV on young people, to ARVs and adherence; disclosure; stigma; getting help with abuse; relationships and family; contraception, and, very importantly, positive living and hopes, dreams and goals.

  • In Zimbabwe, in collaboration with the Ministry of Health and Child Care (MoHCC), we piloted our first virtual Zvandiri-ECHO Enhanced Adherence Counselling Trainings with Zvandiri Mentors in two districts. The aim was to support MoHCC to promote ART continuation and viral suppression among children, adolescents and young people living with HIV during the COVID-19 pandemic. Mentors were also able to share their experiences and learn from each other about the impact of COVID-19 on adherence. Zvandiri Mentors participated in sessions about treatment failure; supporting young people to understand their viral load; managing high viral load; and a refresher session on counselling skills. Despite this being the first virtual EAC training, the sessions included practical sessions, role plays and feedback sessions, with participants doing them at home with family members.

  • ·We have moved our Implementing Partner Mentorship Programme onto the ECHO platform, enabling our Technical Support Unit to continue to provide management and programme support to IPs regionally.

  • We are in the process of moving our CATS 1 and 2 trainings onto the ECHO platform for roll out in October 2020.

  • We are also in discussions with the MoHCC in Zimbabwe to support their Clinical Mentorship/Case Management Programme, and our ambition is to run regional, multi-country Case Management ECHOs.

  • Africaid has a partnership agreement with the ECHO Institute at the University of New Mexico, and we have a dedicated team of ECHO Account Representatives supporting the Zvandiri-ECHO Hub.

  • We have established a core Zvandiri-ECHO Hub Team and 11 members of Africaid staff, including clinical staff and members of the Technical Support Unit, have completed ECHO immersion training with the University of New Mexico.

  • We have a dedicated Zvandiri-ECHO Hub room at Zvandiri House in Harare, which is equipped with the necessary technical and audio-visual equipment to host our ECHO programmes.

  • The Ministry of Health and Social Services (MoHSS) in Namibia has already joined the ECHO movement and, as key Africaid partner, we will be able to learn from their experiences.

  • In Ghana, we are in discussion with the Ministry of Health (MoH) to roll out clinical training and support with The National AIDS Control Program (NACP) and four facilities using the ECHO model.

  • In Rwanda, the Ministry of Health, the Rwanda Biomedical Centre (RBC)and one of our implementing partners, Dream Village, are setting up ECHO in clinics in Kigali.

  • The Africaid Zvandiri-ECHO Hub is part of the Africa MetaECHO Collaborative, an Africa-wide community which meets monthly to share resources, best practices and technical support.

  • We have an ever-growing following on Twitter @Zvandiri, @ZvandiriJane and @ZvandiriApril. Join us!

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