Improving Access to Healthcare in Rural Zambia

by On Call Africa
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Improving Access to Healthcare in Rural Zambia
Kanyanga Health Post
Kanyanga Health Post

Over the last year On Call Africa have been through a year of change and review of how we could come up with ever better ways of strengthening rural health systems. Following a period of consultation with Ministry of Health, health workers, community health workers and community leaders, we have developed a new pilot project to develop model service packages for rural health facilities. Over the last few months we have begun delivery of this new approach, with the help of skilled volunteer doctors. Dr Greenan, one of our current volunteers, provides her reflections on our new approach, and how it differs from her previous volunteer experiences with On Call Africa.

"What a difference a year can make! When I had to leave Zambia in March 2020, after just 5 weeks of doing On-Call Africa (OCA)’s mobile clinics, I knew I’d be back again – and after completing my GP training in early April, the timing was perfect (pandemic aside) for a return trip. And so, two months ago, armed with a negative COVID test, paperwork proving my need to travel to work and a bag packed with as much PPE as I could carry, I set off from Heathrow.

Coming back to somewhere I had worked before had its advantages – I knew Livingstone well, knew some of OCA’s staff and had experience of the Zambian healthcare system, so in some ways I knew what to expect. However, the way we are working now has changed drastically. With mobile clinics out of the question as long as the pandemic is ongoing (and who knows when it will end?), OCA set about working out a new, even more sustainable model of working. Instead of running mobile clinics in three different outreach posts each week, coordinated with the local rural health facilities, volunteers are now placed in one rural health facility for the duration of their placement, working together with and supporting staff to identify and implement quality improvement projects. And so Ellie and I, the guinea pigs of this new model, have found ourselves splitting our time between the base in Livingstone and Kanyanga, a rural health post in Zimba district. 

Kanyanga, as a Rural Health Post, should serve a population of 3500. Instead, almost 25000 people live in its catchment area (which also covers 15 outreach posts up to 40 km away), and are served by two nurses, one clinical officer, one environmental health technician, and eight community health volunteers – these are unpaid volunteers who work incredibly hard to serve their communities. As you can imagine, its a busy clinic! In our time here so far, we’ve seen everything from axe-wounds to inhaled foreign bodies, malnutrition and liver disease, as well as the endless stream of minor illness and coughs and colds visiting the clinic.

As well as helping out in the clinics, our role is to observe the general running of the health post and try to find solutions to some of the problems. On my first day at Kanyanga, I was overwhelmed by the challenges I saw: the nearest hospital (Zimba Mission Hospital) is 2 hours away on poor roads, and transport is infrequent and too expensive for many to use, which results in more complex cases being managed at the clinic. District-level drug shortages lead to medication stock-outs (for example there have been no asthma medications at Kanyanga for at least 6 months), and poverty and water scarcity combined with poor levels of health literacy mean there is a high level of preventable disease seen. We clearly cannot ‘fix’ everything during our three months here, however we can start to make suggestions and implement small changes. Some of the projects we have started include, improving the antibiotic prescribing rates by training staff and educating patients in order to try and tackle both the risk of resistance but also the frequent drug stock-outs. We have also been working on improvements to the maternity assessment and referrals system to try and get the most high-risk pregnancies identified early and referred to Zimba for delivery, but there is still significant fear and resistance to this among patients. For those who rely on the monthly outreach services to access healthcare (staff travel out on the clinic motorbike), we are trialing a new outreach kit this week to try and streamline the services provided – and this has been well-received by the staff!

And this is all just phase 1 of the project: more volunteers will arrive after we leave to continue the projects we have started and develop others. Similar cycles of assessment and implementation will also take place at other rural health facilities. As part of the bigger picture, OCA plans to tackle some of the larger infrastructure problems by installing solar panels so that the maternity unit will have power, and a new bore hole to improve access to water at Kanyanga. We are also looking at ways to fundraise for a new mother’s shelter: this is where pregnant women, who often have to travel long distances to attend Kanyanga, stay in the lead-up to delivery to ensure that they are close to the clinic for delivery: the current shelter is very basic and not an appealing place for a heavily pregnant woman to stay.

One of the major benefits of this new way of working is that there is the potential for sustainable long-term improvements. By embedding ourselves within the community and working alongside the Zambian healthcare staff, we can work together to come up with solutions to problems. We’ve had meetings with staff, patients, village headmen and the District Health Office director to ensure that any suggestions we have are realistic and in-line with the community’s needs and ministry of health aims. The goal of sustainable improvements is what drew me to OCA last year, and we spent a lot of time then training community health workers and carrying out health promotion sessions with the communities we worked in to try and achieve this. The new way of working feels like an even bigger step forwards in that direction.

Having experienced both mobile clinics and rural health post placements, I think that the new model has some clear advantages in terms of long-term sustainability, which has always been part of the ethos of OCA (as it should be within the aims of any NGO). I’m really excited to keep in touch with OCA and its future volunteers based at Kanyanga to see how it continues to develop once I’ve returned to the UK. Who knows, I may even return one day to see the changes first hand!"


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Responding to COVID-19

In March 2020 we made the difficult decision to pause our direct delivery in rural communities to reduce the risk of spreading of COVID-19 as we move between urban and rural areas, and the gather large groups in rural communities. We had hoped to re-commence our programmes this month, however, the presence of SARS-COV-2 in Zambia has led to a rapid rise in cases in the last few months, resulting in us adapting our programmes once again, to ensure that our work meets the most pressing needs of the health system. Our team have worked tirelessly to adapt our programme and we are delighted that our team of nine volunteer doctors have begun delivering our adapted programme today.

Project outline 2021

Over the next 12 months we will support the immediate needs of the health system in Southern Province, while supporting long term health system strengthening, and improved health outcomes through strategic planning and quality improvement projects at different levels of the health system. We will do this through the following activities:

· Deliver direct consultations, advice and treatment within Livingstone, Kazungula and Zimba district hospitals, where they are currently overwhelmed due to an increasing number of Covid-19 cases in the region. Doctors will be placed based on their specialism, to match the needs of these hospitals. The volunteer doctors will also form part of their respective District Incident Management teams for Covid-19, to support strategic planning to improve the response

· Support the Community Health Unit at the Ministry of Health to develop minimum standards for Rural Health Centres and health posts, and support them to pilot these in the communities that we work. We will also support the unit to develop a standardised Community Health Worker programme to improve the quality of care in remote communities, and begin roll out of the programme.

· Run strategic planning sessions with Livingstone, Zimba and Kazungula District Health Offices to identify the biggest health concerns in their districts and support the development of public health intervention plans to address these. We will then support the district health offices to implement and test their plans.

· Medical students will be placed on the wards as our volunteers, where they will have the opportunity to work with and learn from specialists that they would otherwise not been exposed to. Students will also participate in our strategic planning sessions with district health offices and the community health unit, as part of the public health aspect of their courses.

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Chalimongela RHC  to benefit from solar power
Chalimongela RHC to benefit from solar power

2020 has been a challenging year for many small charities, and On Call Africa is no exception, but we are proud of how we have responded, with the help of our staff, trustees and volunteers, to support the Zambian health system. Over the last 6 months we have worked with the Ministry of Health to develop the national guidelines for Community Health Workers and safety officers in response to COVID19. At a regional level we have provided PPE, handwashing facilities, medicines, hand sanitiser and oxygen concentrators to the health centres and hospitals that needed it most. We have also provided training to partner organisations and worked with partners and district health offices to carry out community sensitisation in high risk areas.

In March we made the difficult decision to cease our core delivery, and our volunteers returned to the UK. As we look to return to project delivery in January, we are really excited to be doubling our reach from 9 to 18 communities, and to be moving into a new base that will accommodate our volunteers, act as a training centre, and collaborative space for us and our partners. While 2020 has been a challenging and busy year for On Call Africa, we are really excited about all that we have achieved to support our future growth in size and impact. Alongside our work to support COVID-19 response, we have developed a new strategy which places a greater emphasis on the sustainability of our impact through increased capacity building of the rural health system, and collaborative partnerships to improve health outcomes at community level. In 2021 we are excited to be partnering with Vero Power to provide solar power to our partner Rural Health Centres, and WaterAid to improve Water, Sanitation, and hygiene at both health centre and community level.

Over the coming months we will be looking to raise funds to support developments at our new base that will enhance the quality of Community Health Worker training that we can offer, and improve the working spaces for our team and our partner organisations such as the Ministry of Health, WaterAid and Vero Power.

We are incredibly grateful for the support of our donors and volunteers that have helped to make such a challenging year positive for the communities that we work with.

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community sensitisation
community sensitisation

In March we made the difficult decision to send our volunteers home, and cancel clinics for the forseeable future. We felt that the risk of bringing doctors into Zambia, from the UK represented too great a risk. We also felt that the mobile nature of our clinics that transports people from urban areas into rural areas, where we bring together large groups of people, would represent a significant risk to rural populations where the health system is ill equipped to support them.

National level response

In order to ensure that we could continue to support our Community Health Workers (CHWs), and the communities that we support, we contacted the Ministry of Health (MoH) to better understand what response they had planned for rural communities and how we could contribute to this. It became apparent that the Ministry of Health was focussing its efforts on preventing the spread, and had not yet considered how it would protect and support rural communities. On Call Africa were asked to share our thoughts on how we intended to support our CHWs remotely, and whether this could be scaled nationally. After consulting with various partners and exploring options we put together a proposal for consideration by the community health unit at the MoH. The community health unit asked On Call Africa to join the units response to COVID-19, and asked us to present to partners on our activity, encouraging them to work through the MoH to ensure a co-ordinated response.

At the first meeting of the Community Health COVID-19 response network partners expressed concerns about the lack of standardised protocols and guidelines for all organisations to work towards. In response to this the MoH asked On Call Africa to develop protocols and guidelines for national use. We responded quickly, recruiting a team of virtual volunteers who were all working with COVID-19 in the UK, and had experience of working in rural Zambia. Working in partnership with MoH, CIDRZ and DfID, the team rapidly developed guidelines. Partner organisations were given the opportunity to contribute and feedback before the guidelines were finalised and adopted. We were later approached t support the develop of continuation of TB services protocols by MoH.

Southern Province

Within the Southern Province we have supported the response by acting as a link between the Provincial Health Office, NGO partners and the communities that we work in. Our efforts have been focussed in the following ways:

  • Advising NGO's on how to best support the communities they work in
  • Advising NGO's on how to best support a co-ordinated response through the provincial health office
  • Poviding handwashing facilities, disinfectants and PPE to provincial health office
  • Donating medicines and facilitating deliveries to health centres
  • Supporting the district health offices to conduct community sensitisation

Over the next few months we will continue to support a co-ordinated response at a regional level, and support the adaptation of national guidelines as the situation evolves.

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The World Health Organisation has categorised Zambia as one of the high risk areas for Coronavirus (COVID-19), due to high levels of tourism and the low capacity of the health system to deal with an outbreak of the virus. While there have been no reported cases of COVID-19 in Zambia to date, we recognise that this does represent a big risk to the communities we work in, and the nation as a whole. We also know from extensive research carried out in the areas that we work that there is poor access to handwashing faclities, and limited understanding of when and how handwashing should be carried out.

In February and March, alongside our usual clinical activity, we have placed an increased focus on health education around handwashing, recognising the symptoms of coronavirus, and limiting travel to Livingstone to avoid the spread of the virus if it comes to Coronavirus. Our aim is to prepare communities and limit risk should COVID-19 reach Zambia. In addition to providing health education about handwashing, we have also provided handwashing facilities and soap at key locations, such as schools, churches, health posts and key meeting points to ensure that communities have the facilities to put their learning into practice.

Improving handwashing will also go a long way to reducing the spread of communicable diseases in the communities, and will help to tackle the rising number of cases of Diarrhoea that we have been seeing since the drought started in Zambia in 2019. Our health education sessions have been fun and interactive, particularly in schools where our volunteer doctors have been setting students handwashing challenges, competitions and races, as well as using songs to help enforce key messages in an interactive way.

"Thank you  for visiting and donating the hand basins to the school.  We really appreciate for they will help avert pending tropical diseases among our pupils in the school. Thank you for the health talk you gave and the demostration of your and love. God bless you. We hope to see more of you."
Esther, Simonga Primary School Headteacher.
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Organization Information

On Call Africa

Location: Livingstone, Southern - Zambia
Facebook: Facebook Page
Twitter: @OnCallAfrica
Project Leader:
Kirsty Luescher
Livingstone, Southern Zambia
$8,786 raised of $18,000 goal
135 donations
$9,214 to go
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