Tropical Health and Education Trust Ministry of Health UNITED KINGDOM ZAMBIA
MAIN REPORT
Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions under the Ministry of Health
Submitted to:
The Executive Director Tropical Health and Education Trust (THET) 210 Euston Road, London NW1 2BE UNITED KINGDOM
and
The Permanent Secretary Ministry of Health Ndeke House, Haile Selassie Avenue PO Box 30205, Lusaka ZAMBIA
August 2007 CAN Investments Limited 26 Wusakili Crescent, Northmead PO Box 39485, Lusaka, Zambia Tel/Fax: 260-1-230418, E-mail: [email protected] MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
CONTENTS PAGE
ACRONYMS USED...... III FOREWORD AND ACKNOWLEDGEMENTS...... V 1 EXECUTIVE SUMMARY...... 1
1.1 INTRODUCTION...... 1 1.2 METHODOLOGY AND APPROACH ...... 1 1.3 EXISTING HEALTH LINKS ...... 1 1.4 POTENTIAL AREAS FOR FUTURE LINKS ...... 2 1.5 PROPOSED PROCESS FOR IDENTIFYING FUTURE LINKS...... 3 1.6 CONCLUSION...... 3 2 CONTEXT...... 4 3 BACKGROUND ...... 5
3.1 INTRODUCTION...... 5 3.2 DEFINITION OF LINKS...... 6 3.3 THE TROPICAL HEALTH AND EDUCATION TRUST ...... 6 3.4 METHODOLOGY AND APPROACH ...... 7 3.5 PROBLEMS ENCOUNTERED...... 9 4 THE HEALTH DELIVERY SYSTEMS IN ZAMBIA...... 10
4.1 DEMOGRAPHIC AND SOCIAL-ECONOMIC CONTEXT...... 10 4.2 ORGANISATION AND MANAGEMENT ...... 11 4.3 MAIN PROBLEMS AND CONSTRAINTS...... 16 4.4 THE HUMAN RESOURCE CRISIS...... 17 4.5 SECTOR STRATEGY AND PRIORITIES ...... 20 4.6 SECTOR PERFORMANCE ...... 21 5 EXISTING HEALTH LINKS...... 23
5.1 OVERVIEW ...... 23 5.2 PROVINCIAL HEALTH OFFICES AND DISTRICT HEALTH MANAGEMENT TEAMS ...... 23 5.3 CENTRAL HOSPITALS (“3RD LEVEL HOSPITALS”)...... 24 5.4 PROVINCIAL AND DISTRICT HOSPITALS (1ST AND 2ND LEVEL HOSPITALS) ...... 32 5.5 HEALTH CENTRES AND HEALTH POSTS...... 39 5.6 HEALTH TRAINING INSTITUTIONS ...... 39 5.7 STATUTORY BOARDS AND OTHER UNITS ...... 40 6 POTENTIAL AREAS FOR FUTURE HEALTH LINKS...... 45
6.1 OVERVIEW ...... 45 6.2 GENERIC POTENTIAL AREAS FOR FUTURE LINKS...... 45 6.3 PROVINCIAL AND DISTRICT HEALTH MANAGEMENT LEVEL ...... 46 6.4 HOSPITALS AT ALL LEVELS ...... 46 6.5 HEALTH CENTRES AND HEALTH POSTS...... 48 6.6 HEALTH TRAINING INSTITUTIONS ...... 48 6.7 STATUTORY BOARDS ...... 49 7 PROPOSED PROCESS FOR IDENTIFICATION OF FUTURE LINKS...... 52
August 2007 i CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
8 APPENDICES...... 53
APPENDIX I: TERMS OF REFERENCE ...... 1 APPENDIX II: TRENDS FOR TOP 10 MAJOR DISEASES IN ZAMBIA, 2000-2006 ...... 1 APPENDIX III: STAFFING LEVELS AND WORKLOADS...... 3 APPENDIX IV: DISTRIBUTION OF CORE HEALTH WORKERS BY PROVINCE ...... 5 APPENDIX V: CONSOLIDATED LIST OF EXISTING LINKS...... 1 APPENDIX VI: LIST OF INSTITUTIONS AND PERSONS INTERVIEWED ...... 1 APPENDIX VII: LIST OF DOCUMENTS/LITERATURE CONSULTED ...... 1 APPENDIX VIII: REPORTS/FEEDBACK FROM LINK PARTNERS...... 3
August 2007 ii CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
ACRONYMS USED
Acronym used Definition
AU African Union The Consultant CAN Investments Limited CBOH Central Board of Health Chainama Chainama Hills Hospital and College for Health Sciences CHAZ Churches Health Association of Zambia COMESA Common Market for East and Southern Africa CPs Cooperating Partners DRC Democratic Republic of Congo DTSS Director of Technical Support Services DHMT District Health Management Board DHMBs District Health Management Boards DHMTs District Health Management Teams FNDP Fifth National Development Plan FNDP Fifth National Development Plan GNCZ General Nursing Council of Zambia Global Fund Global Fund against HIV/AIDS, TB and Malaria HCs Health Centres HMIS Health Management Information System HPs Health Posts HSSP Health Services Support Program HIPC Highly Indebted Poor Countries HIPC Highly Indebted Poor Countries HMBs Hospital Management Boards HMTs Hospital Management Teams HIV/AIDS Human Immuno-Deficiency Virus/Acquired Immunity Deficiency Syndrome HR Human Resources HR Plan Human Resources for Health Strategic Plan CPs International Cooperating Partners JLI Joint Learning Initiative on Human Resources for Health and Development Links Long-term International Health Links MMR Maternal Mortality Ratio MCZ Medical Council of Zambia MTEF Medium Term Expenditure Framework MDGs Millennium Development Goals MOH or the Ministry Ministry of Health M & E Monitoring and Evaluation NDP National Development Plan NHSP National Health Strategic Plan NHSP 2006/10 National Health Strategic Plan 2006/10 August 2007 iii CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health NHSP National Health Strategic Plan 2006-10 PRA Pharmaceutical Regulatory Authority PRSP Poverty Reduction Strategy Paper PRSP Poverty Reduction Strategy Paper PHO Provincial Health Office STIs Sexually Transmitted Infections SADC Southern African Development Community SAP Structural Adjustment Programme SAP Structural Adjustment Programme ToRs Terms of Reference Zambia or the Government The Government of the Republic of Zambia TDRC Tropical Disease Research Centre THET Tropical Health and Education Trust TB Tuberculosis UK United Kingdom UN United Nations USA United States of America USA United States of America UNZA University of Zambia UTH University Teaching Hospital UTH University Teaching Hospital ZHIP Zambia Integrated Health Programme ZNBTS Zambia National Blood Transfusion Service ZNFDS Zambia National Flying Doctor Services
August 2007 iv CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
FOREWORD AND ACKNOWLEDGEMENTS
Zambia is currently faced with the challenge of achieving the Millennium Development Goals (“MDGs”) by 2015 and national health priorities. Even though the country has shown commitment to this aim, there are a number of significant problems and constraints, undermining its efforts. These problems are diverse and require concerted efforts by all the main stakeholders.
The country has identified “partnerships” as one of the key strategies for addressing some of its problems and constraints, and has embarked on the process of strengthening partnerships with all the key stakeholders, including the communities, the private sector, the civil society and the international community. In this respect, one type of partnerships that has been identified is the establishment of international health links (“Links”) between the public health service and training institutions in Zambia, with their counterpart institutions in other countries. Even though currently there are just a few institutions benefiting from Links, it is generally recognized that Links provide significant opportunities for meaningful and sustainable improvements in the health sector.
The mapping of Links is considered as the first step towards the establishment of an appropriate strategic framework for the promotion, planning, coordination and management of the Links, to ensure that full benefits are derived. It is also considered as the beginning of a long-term partnership between the Zambian Ministry of Health (“MOH”) and the Tropical Health and Education Trust (“THET”) of the United Kingdom (“UK”).
Even though this assignment was complex and challenging, I am pleased to note that, through our joint efforts, it has been successfully completed. In this regard, I wish to take this opportunity to acknowledge, with thanks, all the people and institutions that contributed to this process. Special thanks go to: Dr. S K Miti, Permanent Secretary, MOH, for providing leadership to this process, and Nicholas Chikwenya, for coordinating the assignment; members of the counterpart team from THET; and CAN Investments Limited, led by Alex Chikwese, who were the consultants on this assignment. Last, but not the least, I wish to thank all the Zambian health service and training institutions, and the international Links partners which participated in this mapping.
I thank you all.
Dr. David Percy Director of Health Strategy Tropical Health and Education Trust
August 2007
August 2007 v CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
1 EXECUTIVE SUMMARY
1.1 Introduction
The Zambian health sector is faced with the challenge of achieving the health related MDGs and National Health Priorities. At the same time, the sector is inundated with significant problems and constraints, particularly the human resource crisis, which is significantly undermining its performance.
In their efforts to find solutions to some of these problems, some health service and training institutions have established Links with counterpart institutions abroad, which have provided opportunities for capacity building, staff training, technical exchange programmes and material support to these institutions. However, most of these Links are not properly coordinated at both the institution and sector levels, and do not therefore fully address the sector priorities. In view of the foregoing, MOH has entered into a strategic partnership with THET to develop an appropriate strategic framework for the promotion, coordination and management of the Links, so as to focus them at sector priorities and realize their full potential.
Given this background, THET, in conjunction with MOH, engaged CAN Investments Limited, a Zambian registered management consulting firm, to conduct a mapping of the existing Links between the public health service and training institutions in Zambia, and their counterpart institutions in other countries. This report presents the findings of the mapping and recommendations on the potential areas for future Links.
1.2 Methodology and Approach
The methodology and approach adopted for this assignment involved:
Breaking down the assignment into the following phases: project inception; desk review and requirements definition; field visits and feedback from existing Links; and reporting; Visiting and contacting a large number of health service and training institutions throughout the country; and Designing and application of an interview tool/questionnaire, which was used for structured interviews during the field visits.
1.3 Existing Health Links
The mapping established and confirmed the following:
The concept of Links is not widely understood and applied by most health service and training institutions within the public health sector in Zambia;
August 2007 1 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Some public health service and training institutions in Zambia have successfully established Links with international counterpart organizations from various countries; The Links are mainly concentrated at a few institutions, while majority of the institutions do not have any Links. The institutions identified with the highest numbers of Links include: The University of Zambia (“UNZA”) School of Medicine, together with its associated hospital, the University Teaching Hospital (“UTH”); The Chainama Hills Hospital and College for Health Sciences (“Chainama”) in Lusaka; St. Francis Mission Hospital in Katete, Eastern Province; Chilonga Mission Hospital in Mpika, Northern Province; and Monze Hospital in the Southern Province; Most of the hospitals, including Ndola Central Hospital, Kitwe Central Hospital and Arthur Davison Children's Hospital, which are among the four largest hospitals in the country, have never had any Links; and Currently, there is no framework to guide and promote the targeting, establishment, coordination, monitoring and evaluation of the Links, particularly at sector level.
1.4 Potential Areas for Future Links
All the institutions visited by the mapping team acknowledged the importance of Links and expressed interest in developing appropriate Links with counterpart institutions in the UK and other countries. On the other hand, most of the major problems faced by these institutions are similar, and as such, the potential areas for future Links are mostly generic. In this respect, the following have are identified as the potential areas for focusing future Links:
Technical exchange programmes involving staff at various levels, particularly in specialized core areas, aimed at providing knowledge and skills transfer; Short and long-term secondment of consultants and other experts in specialized areas, with emphasis on core service areas at every level, on a gap filling basis; Staff training and capacity building for both medical, technical and support staff, through short and long-term training programmes, including: Short-term training programmes conducted by visiting professors and experts from Link partners, in specialized areas; and Scholarships for medium and long-term training; Collaboration in research and development activities; Support to systems development in technical fields, including core health programmes, supervision, and monitoring and evaluation;
August 2007 2 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Support to knowledge sharing and continuing education, through the provision of e- learning opportunities and promotion of the use of modern ICTs, including facilitation of internet connectivity, internet-based knowledge exchange with the British National Formulary and other international sources of essential medical journals and publications; Specialist support to repairs and maintenance of medical equipment. Currently, there are no in-house expertise in this area, resulting into frequent breakdowns and pre- mature write-offs of various equipment; and Material support in identified priority areas, including infrastructure development, equipment and auxiliaries, drugs and medical supplies, and other forms of material support, on a gap filling basis.
Actual scoping of focus areas for each individual institution should be based on the priorities and status of the particular institution, and on gap filling basis.
1.5 Proposed Process for Identifying Future Links
In order to improve the coordination and management of Links, it is proposed that the process of identifying priority areas for Links should be linked to the health sector planning process and be aligned to the national health strategic plan. The process should form part of the each institution’s medium term expenditure framework (“MTEF”) and annual action planning process. Further, implementation of Link activities should be managed in a transparent and accountable manner, and captured under the monitoring and evaluation arrangements, which are in practice within MOH and the respective institutions.
1.6 Conclusion
Even though the concept of Links has not been widely understood and applied in the Zambian health sector, some institutions have established significant numbers of Links. It is generally acknowledged that, if properly planned and managed, Links provide significant opportunities for health sector strengthening and capacity building, for long- term sustainable development. All the institutions which participated in the mapping expressed their interest in developing Links. The mapping provides a sound basis for the development of an appropriate strategic framework for planning, coordination and management of Links, which is urgently needed for the sector to realize full benefits from the Links.
August 2007 3 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
2 CONTEXT
The Zambian health sector is faced with the challenge of achieving the health related MDGs and National Health Priorities, aimed at improving the standards of health service delivery and health status of the people throughout the country. At the same time, the sector is inundated with significant problems and constraints, including: a high and complex disease burden; the human resources crisis, with critical shortages of qualified health workers at all levels of health service delivery; erratic supply of drugs and medical supplies; poor conditions of infrastructure, particularly in rural areas; and shortages of transport and communication.
The country has identified the human resources crisis in the health sector as one of the most significant factors undermining its efforts to improve health service delivery, and also a major obstacle to achieving the MDGs and national health priorities. In order to address this crisis, the Government has developed a five year Human Resources for Health Strategic Plan 2006/10 (“HR Plan”). It has also prioritised human resources in the National Health Strategic Plan 2006/10 (“NHSP 2006/10”) and the Fifth National Development Plan (“FNDP”).
One of the key strategies identified in the HR Plan is the need to establish and strengthen partnerships with key stakeholders, including the need to develop new and strengthen the existing long-term Links between the Zambian health service delivery and associated training institutions, and their counterpart institutions from other countries, particularly the developed countries. Such Links are expected to significantly contribute to the mitigation of the impact of the human resources crisis and the other major problems and constraints affecting the health sector, through various initiatives, including technical exchange programmes, training and capacity building for health personnel, material support to individual health service and training institutions, and other means.
In line with this strategy, in January 2007, the MOH established a strategic partnership with THET, the coordinating body for international Links in the United Kingdom (“UK”). Under this partnership, THET would facilitate the promotion and establishment of appropriate, efficient and effective Links between hospitals and health training institutions in the Zambian public health sector, with their counterparts in the UK and other developed countries. In this respect, THET, in collaboration with MOH, engaged CAN Investments Limited (“Consultant”), to conduct a mapping of existing Links and identify potential areas that would require new Links. This exercise is expected to form the basis for the development of a strategic framework to guide and facilitate the efficient and effective promotion, coordination and management of the Links, in line with the priorities set out in the HR Plan, NHSP 2006/10 and FNDP.
This report presents the findings, observations and recommendations of the mapping assignment, conducted between February 2007 and August 2007. The report has been prepared in line with the guidelines provided in the terms of reference for this assignment. August 2007 4 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
3 BACKGROUND
3.1 Introduction
The global community is currently faced with a critical shortage of qualified health workers, which is adversely affecting health service delivery and undermining the efforts to achieve the MDGs in the developing poor countries. In 2004, the Joint Learning Initiative on Human Resources for Health and Development (“JLI”), which is a collaborative effort of more than 100 experts, estimated the global shortage of human resources for health at 4 million doctors, nurses and midwives (J Ambulatory Care Manage, Vol. 29, No. 1, 2006, pp. 98-100). The crisis is reported to have been most severe in Sub-Saharan Africa, where shortages of core health workers was estimated at 1 million, representing approximately two times the core health workers currently in posting. While the crisis is attributed to several factors, such as the low outputs from health training institutions and the increased mortality levels among health workers due to HIV/AIDS, migration of health workers from these countries to richer countries is by far the biggest problem. It is estimated that during 2002/2003 alone, more than 3,000 nurses from Ghana, Kenya, Nigeria, South Africa, Zambia and Zimbabwe were registered to practice in the UK (Buchan and Dolvo, 2004).
In Zambia, the shortage of appropriately qualified health workers has since reached a severe crisis and is a serious obstacle to the country’s efforts to implement the MDGs and national health priorities, in line with the NHSP 2006/10, the FNDP and Vision 2030. This crisis is largely attributed to:
The poor terms and conditions of service in the public health sector, which have led to migration of core health workers from the public health institutions to the private sector within the country, and overseas, mostly to the UK, Australia, New Zealand and the United States of America (“USA”); The high mortality levels among core health workers, due to HIV/AIDS; The impact of the HIV/AIDS epidemic on the disease burden, consequently increasing the workloads for core health workers; and The dwindling outputs at the various health training institutions.
The most affected facilities are secondary and tertiary level hospitals, which have lost both qualified and experienced consultants, doctors, nurses and other paramedics. Training institutions have equally been affected, through the migration of lecturers and tutors in search of better conditions of service. In its efforts to address the crisis, the Ministry is employing various approaches, including the recruitment of doctors from overseas and establishment of Links. In this respect, in 2005, approximately 44% of the doctors in post were non-Zambians. Further, managers at some health facilities and training institutions have established Links between their respective institutions and counterpart institutions abroad.
August 2007 5 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Through such Links, medical experts from foreign countries have visited hospitals and training institutions to provide services, teaching or service development, material and technical support, on a gap filling basis. There have also been some reciprocal teaching visits and attachments by Zambian staff overseas. While such Links have resulted in transfer of knowledge and skills to health workers in Zambia, and capacity building for the affected institutions, there are concerns that such efforts might have resulted in fragmentation and duplication of efforts by the parties. In most cases, such Links have been through individual efforts and have not fully addressed the priority areas requiring capacity building within the respective health institutions.
Given this background, MOH has identified the need to improve the management, coordination, monitoring and evaluation of the Links, through the identification of already existing Links and using a holistic approach to identifying areas and institutions requiring capacity building, in line with the NHSP 2006/10 and the HR Plan. In this respect, MOH in partnership with THET, has identified the need to conduct a mapping of Links in the Zambian health service delivery and associated training institutions under the Ministry, which would form the basis for the development of the strategic framework to facilitate appropriate coordination and management of the Links.
3.2 Definition of Links
Links are generally understood as long-term partnerships between health institutions in less developed countries and their counterpart institutions overseas. The primary aim of the Links is to strengthen health care by supporting the development of skills of health care workers, and strengthening health care systems and processes. Health institutions involved in Links are initially hospitals, but often also involve their associated academic training institutions – medical, nursing and allied health professional schools – to address curriculum and faculty needs. Fully developed Links are interdisciplinary, and responsive to priorities determined by the partner based in the less developed country. This makes them relevant to the local context and sustainable in the long run (Extract from: THET, An Introduction to International Health Links).
3.3 The Tropical Health and Education Trust
THET is a UK based coordinating body for Links, with over 15 years experience in supporting Links. It is an independent charity supported by international partners, volunteers, several donors and the UK Government. THET’s vision is to facilitate the development of Links between UK health institutions, their associated academic partners, such as medical, nursing and allied health professional schools in the UK universities, and equivalent health care institutions in other parts of the world (Extract from THET’s website, thet.org.uk). Currently, THET’s main support is concentrated in Ethiopia, Ghana, Malawi, Uganda and Somalia. They also provide advice and guidance to UK Links in other least developed countries [as defined by the UN] and countries with a critical shortage of health workers [as defined by the WHO 2006 World Health Report].
August 2007 6 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
3.4 Methodology and Approach
In order to fully address the TORs (See Appendix I) and ensure high quality deliverables, the methodology and approach adopted involved breaking down the assignment into the following phases:
3.4.1 Project Inception
The primary objective of the inception stage was to provide the Consultant with an opportunity to clearly understand the assignment, scope the work, develop and agree with THET and MOH on the project work plan, methodology/approach and coordination of the assignment, and also to complete the administrative formalities for the assignment. This phase culminated into the inception report, submitted by the Consultant at the commencement of the assignment.
3.4.2 Desk Review and Requirements Definition
This phase was intended to help the Consultant to fully appreciate the background and context of the assignment, the health sector, the extent of the human resources crisis and also to determine the requirements for the assignment. The main tasks included: a) Identification and collection of the relevant data and information. A list of the documents collected and consulted is provided at Appendix VII. These included:
Information on THET and the Links, particularly on its mandate, objectives and activities, and the concept of Links and how they operate. This involved reviewing the available documentation on THET obtained from MOH and through searching on the internet, particularly on the THET website; Information on the public health sector and the human resources crisis. Key documents collected and reviewed included the 2000 National Census Report, FNDP, NHSP 2006/10, HR Plan, Mid-Term Review report, list of health facilities in Zambia, Health Facilities Mapping Report 2006, Joint Annual Review Reports for 2005 and 2006, and Annual Action Plans and Progress Reports for 2006 for MOH head office and the health facilities covered by the mapping; and Other documents included local and international papers on the human resources for health situation in the world and in Zambia, and other relevant documents obtained from MOH and other sources; b) Review of these documents to establish the current situation and determine the requirements; and c) Identification of critical issues and impediments, and proposing the way forward.
August 2007 7 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
3.4.3 Field Visits and Feedback from Existing Links
Extensive field visits were conducted, covering all the nine provinces of Zambia. In this respect, a total of 68 facilities were visited, comprising: 27 hospitals, 21 health training institutions, 4 statutory boards and 24 other health related institutions, to collect information on the human resource situation, existing Links and the need for new Links. A list of facilities surveyed is provided at Appendix VI. The main tasks included the following:
Reviewed the list of hospitals and health training institutions, and identified the facilities to be visited and those to be just contacted in writing, including their locations and contact details. This was later discussed and agreed with MOH; Designed a standard questionnaire for circulation to all the hospitals and health training institutions in the public health sector. A letter requesting for appointments was sent out to the targeted facilities, with the questionnaire and letter of introduction from the Permanent Secretary of MOH; Carried out physical site visits to the targeted facilities to discuss the Links and collect relevant data. Discussions with these facilities took the form of semi- structured interviews. The documents collected included corporate profiles, actions plans, progress reports, reports on the past and existing Links and other documents relevant to this assignment; Sent out a letter, together with the questionnaire and letter of introduction from the Permanent Secretary, to the facilities that were not going to be visited, requesting for written submissions; and Identified foreign institutions involved in the existing Links, the nature of their links and their contact details. Wrote to these institutions, via e-mail, requesting feedback on their involvement and evaluation of their Links. Also searched the websites of some of these Links, to obtain more information.
3.4.4 Reporting
During the course of this assignment, three reports were prepared and submitted to MOH and THET, as follows:
Inception report, which was submitted at the beginning of the assignment and provided the roadmap for this assignment; Draft main mapping report, describing the process, findings and recommendations. Submitted for review and comments; and This final version of the main mapping report, which has taken into account the comments and corrections obtained from all the reviewers.
August 2007 8 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
3.5 Problems Encountered
During the course of this assignment, a number of challenges were encountered which had an impact on the conduct of the assignment. The major ones included:
3.5.1 Field Visits
The TORs required the Consultant to contact all the hospitals and health training institutions under MOH, in both urban and rural areas. Considering the vastness of the country and the accompanying physical barriers, including poor conditions of the roads in most of the rural areas, it was not feasible to physically visit all these facilities within the duration of this consultancy. In this respect, the Consultant and MOH had to agree on the list of facilities to be physically visited, while the rest of the facilities were to be contacted in writing and/or by telephone.
Securing appointments for the visits also presented some difficulties. In some cases, the appointments were rescheduled several times, resulting in significant delays. Further, in most cases, documentation on the existing Links was not available, particularly regarding the scope of activities covered, quantification of the support provided and evaluation of the Links.
3.5.2 Written Feedback from the Facilities
Feedback from institutions which were not visited was generally poor. Most of them did not respond.
3.5.3 Feedback from the Links
Contacting those identified to have Links with Zambian health sector institutions also presented its own challenges. Whilst some institutions provided us with contact details of their Links, others did not have such information. This made it difficult to contact these contacts, which made us resort to internet searches. This led to significant delays. However, not withstanding these problems a number of Link partners responded. Some of these reports are provided at Appendix VIII.
August 2007 9 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
4 THE HEALTH DELIVERY SYSTEMS IN ZAMBIA
4.1 Demographic and Social-Economic Context
Zambia is a landlocked country located in the southern part of Sub-Saharan Africa. It covers approximately 752,614 square kilometres and shares borders with eight countries, namely, Tanzania and the Democratic Republic of Congo (DRC) in the north, Malawi and Mozambique in the east, Zimbabwe, Botswana and Namibia in the south, and Angola in the West. Zambia is a former colony of Great Britain and a member of a number of international and regional social-economic groupings, including the Commonwealth, United Nations (“UN”), African Union (“AU”), Southern African Development Community (“SADC”), and Common Market for East and Southern Africa (“COMESA”). The capital city is Lusaka and the official language of communication is English.
The population is currently estimated at 11.7 million people (UNAIDS, 2006) and distributed equally at 50% males and 50% females. The average annual population growth rate is 2.7% and life expectancy at birth is at 47.5 years for males and 51.7 years (CSO, 2000). The country is sparsely populated, with an average population distribution rate of 16 people per square Kilometre, and a high dependency ratio, with 47% of the total population being under the age of 15 years, and 38% of the population living in urban areas. All these factors present significant obstacles and challenges to social- service delivery.
Currently, Zambia is among the Sub-Sahara African countries faced with significant social-economic challenges, including a weak economy, high poverty levels and weak social service delivery systems, particularly in the rural areas. The country is now listed among the least developed countries, with an overall poverty incidence rate of 67% and 72% of its rural population classified as being in extreme poverty. The health sector is challenged by various factors, including a high and complex disease burden, compounded by: the high incidence of malaria, HIV/AIDS and other epidemics; critical shortages of qualified health workers; erratic supply of essential drugs and medical supplies; under- developed infrastructure, particularly transport and communication infrastructure in rural areas; and inadequate funding for basic health care services.
Notwithstanding this difficult situation, the country is committed to significantly improve its social-economic condition, including the standards of living and health status of its people. In this regard, the country has made commitments to several regional and international initiatives focused at social-economic development, including the MDGs, the Highly Indebted Poor Countries (“HIPC”) initiative, and the Abuja and Maputo Declarations on health. The country, in collaboration with its international cooperating partners (“CPs”), has also initiated various local initiatives aimed at ensuring meaningful and sustainable social-economic development, which have included: the Structural Adjustment Programme (“SAP”); the Poverty Reduction Strategy Paper (“PRSP”); the FNDP and Vision 2030 and the NHSP 2006/10. August 2007 10 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
However, even with all these initiatives and the associated significant achievements, the health sector is still faced with significant constraints and challenges, requiring concerted efforts and collaborative actions by the Government and other key stakeholders, including need to further strengthen collaboration with both local and international partners for development.
4.2 Organisation and Management
4.2.1 Overview
Since 1992, the Zambian health sector has been undergoing comprehensive reforms, aimed at enhancing the capacity of the sector to significantly improve health service delivery and health standards of the people. These reforms included organizational and management restructuring, based on the principles of decentralization and partnership, aimed at devolving key management responsibilities and resources to district level, and strengthening broader participation in the management of public health services. This was addressed through the establishment of three important mutually complementary organization structures, namely:
The MOH head office, responsible for policy formulation, supervision, monitoring and evaluation of the whole sector; A structure providing for popular public participation, responsible for policy interpretation, decision-making and control of health service delivery at various levels. This structure included: the Central Board of Health (“CBOH”) board, at national level; District Health Management Boards (“DHMBs”), at district level; Hospital Management Boards (“HMBs”), at hospital level; and Neighbourhood Health Committees and Health Centre Committees, at community level; and A structure providing for efficient and effective management and technical implementation of service delivery. This structure was intended to ensure that health services are managed and implemented in a technically competent manner and conform to best practices. The structure included: management teams at MOH and CBOH, at national level; Provincial Health Offices (“PHOs”), at provincial level; District Health Management Teams (“DHMTs”), at district level; and Hospital Management Teams (“HMTs”), at hospital level.
To provide for efficient and effective support and regulatory services to the core health service delivery facilities, the Government also established two types of statutory boards, the service and statutory boards.
However, following over 12 years of implementation of these reforms, the government identified a number of weaknesses associated with the established organization and management system. The main weaknesses and problems included the observed duplication of some roles and responsibilities among the MOH and CBOH head offices,
August 2007 11 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health at national level, and the obstacles related to the huge financial outlays required for separation of employees transferred from the civil service to the new structures, as they were expected to enter into direct employment contracts with their respective boards.
In this respect, since 2005, the public health sector has been undergoing another major restructuring, which has led to the dissolution of the CBoH, together with the hospital and district health management boards. Under this new arrangement, the functions of MOH and CBOH at the top, have been merged and the management and control of all state- owned health facilities and services is now directly under MOH, through the Provincial Health Offices. However, in order to ensure continued popular public participation in the management of health services, the hospital and district management boards are being replaced with advisory councils, while the hospital and district management teams have been maintained. The restructuring process has now reached its final stages.
4.2.2 Health Sector Structure
The health sector in Zambia is liberalized and comprises of three types of service providers, namely, state-owned health facilities, faith-based health facilities, under the coordination of the Churches Health Association of Zambia (“CHAZ”), and the private sector.
4.2.2.1 State-Owned Health Facilities
The public health sector combines state-owned and faith-based health facilities. However, the organization and management of faith-based health facilities is discussed separately in Section 4.2.1.2 below.
Most state-owned facilities are owned and controlled by MOH, with a few falling under the Ministry of Defence and Ministry of Home Affairs. The Ministry of Defence has only one hospital, the Maina Soko Military Hospital in Lusaka, and a few clinics located at the various military locations around the country. On the other hand, the Ministry of Home Affairs does not operate any hospitals, but has some clinics at their police and prison service stations. State-owned health facilities under MOH are located in all the 72 districts of the country and include 3rd Level hospitals, 2nd Level hospitals, 1st Level hospitals, health centres (“HCs”) and health posts (“HPs”).
4.2.2.2 Faith-Based Health Sector
Faith-based health facilities are owned by various religious organisations, predominantly Christian organizations from different denominations and countries. These facilities are spread across Zambia, mainly in rural areas, and include 31 hospitals, 69 rural health centres and 25 community-based organisations. Administratively, these facilities are independently managed by their respective sponsors.
August 2007 12 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
However, in order to provide for appropriate technical support and coordination, they are organized under the Churches Health Association of Zambia (“CHAZ”), which is an inter-denominational non-governmental umbrella organisation for Christian church health facilities in Zambia. It is the second largest provider of health care services in Zambia, after the Government, and currently contributes 30% of the overall health care services in Zambia, and 60% in rural health areas.
Although these facilities are owned and managed by their respective sponsoring faith- based organizations, they provide free medical care services to the general public, and supplement the Government’s efforts. These facilities are officially recognized as public facilities and are therefore provided with Government grants for staff salaries and operations. They also have a strong linkage with the District Health Management Teams (“DHMTs”), which are responsible for coordinating all public and faith-based health service delivery institutions within the respective districts. In addition, they also receive financial and technical support from their respective sponsoring faith-based organizations, and other well wishers and Links.
4.2.2.3 Private Health Sector
The private health sector includes hospitals and health centres/clinics owned by private investors, the privatized mining companies and the civil society/non-governmental organizations (“NGOs”). Private health facilities provide basic health care services at health centre level, and general medical and specialized services at hospital level. The contribution of this sub-sector could be estimated in the range of 10% to 15%. These facilities are predominantly concentrated in the mining and other urban areas, with minimal presence in rural areas. Private health facilities are registered corporate entities and managed as private businesses. Currently, the supervision, monitoring and evaluation of the performance of this sector by MOH is weak and needs further strengthening.
4.2.2.4 Traditional Health Practitioners
Alongside modern medical facilities, traditional health therapy is also offered by various individuals and registered entities. They mainly offer herbal remedies and spiritual healing services. Whilst these services are managed as private businesses, they are coordinated by the Traditional Health Practitioners of Zambia (“THPAZ”), an association formed and registered to promote and advocate for traditional health therapy. Currently, there are increasing claims by various traditional health practitioners that they have discovered herbs to cure HIV/AIDS, which claims are still being subjected to scientific verifications and trials.
August 2007 13 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
4.2.3 Existing Health Facilities
Health service facilities include: the core facilities, such as hospitals, health centres and health posts; statutory boards; and health training institutions; all operating at different levels of service delivery.
4.2.3.1 Core Health Service Delivery Facilities
Table 1 below presents a summarised analysis of the existing core health service delivery facilities in Zambia:
Table 1: Summary of Existing Health Facilities in Zambia Health Hospitals Centres Health Posts Total Type of Provider Number Number Number Number Public/Government 58 1,052 19 1,129 Faith-based/CHAZ 39 69 25 133 Private 17 97 1 115 Total 114 1,218 45 1,377 Source: Ministry of Health and Churches Health Association of Zambia, 2007
Below are the summarized descriptions of these facilities, starting from the health posts, at community level, to central hospitals, which are the highest and most sophisticated referral facilities:
Health Posts (“HPs”): Are intended to serve small communities with populations of approximately 500 households (3,500 people) in the rural areas, and 1,000 households (7,000 people) in the urban areas, and are supposed to be established within 5Km radius for sparsely populated areas. The number of HPs required throughout Zambia is 3,000, however only 45 are currently available, including 1 private facility; Health Centres (“HCs”): These include Urban Health Centres, intended to serve urban communities with catchment populations of between 30,000 and 50,000 people, and Rural Health Centres, servicing catchment areas of 29 Km radius or population of 10,000 people. The national target for HCs is 1,385, but currently 1,218 are available, including Government, faith-based and private HCs; 1st Level Referral Hospitals: These are hospitals at district level, intended to provide referral services in medical, surgical, obstetric and diagnostic services, including all clinical services to support HC referrals. Such facilities are found in most of the 72 districts and are intended to serve catchment populations of between 80,000 and 200,000 people. Currently, there are a total of 89 such facilities, comprising 72 government/Faith-based facilities and 17 private facilities;
August 2007 14 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
2nd Level Hospitals: These are provincial general hospitals, intended to provide sub- specialised referral services in internal medicine, general surgery, paediatrics, obstetrics and gynaecology, dental, psychiatry and intensive care services. They are also intended to act as referral centres and provide technical back-up for 1st level hospitals, and offer training services. These facilities are intended to cover catchment populations of between 200,000 to 800,000 people. Currently there are a total of 20 second level hospitals. Two provinces, namely Southern and Copperbelt, have 5 and 3 second level hospitals respectively. MOH has observed the need to rationalize the distribution of these facilities through right-sizing; and 3rd Level Hospitals: These are also known as central hospitals and are meant to provide specialised services in internal medicine, surgery, paediatrics, obstetrics, gynaecology, intensive care, psychiatry, training and research, and also act as referral centres for 2nd level hospitals. The scope of coverage for such facilities is a catchment population of 800,000 people and above. Currently there are only 5 such facilities in the country, including the UTH and Chainama in Lusaka and 3 others on the Copperbelt Province, namely, Ndola Central Hospital, Kitwe Central Hospital and Arthur Davison Children’s Hospital in Ndola.
4.2.3.2 Health Statutory Boards
Two types of statutory boards, regulatory and service, have also been established to provide support to the Ministry and the health delivery system. Statutory boards play an important role in the implementation of the overall Government health policy and regulation of the health sector. Regulatory boards are responsible for enforcing specific Government Laws and policies, while service statutory boards provide support services to the core health service delivery facilities. Administratively, statutory boards are managed by boards of directors appointed by the Minister of Health, in accordance with the relevant statutes, and are technically responsible to MOH, through the office of the Director of Technical Support Services (“DTSS”).
Regulatory boards currently include the Medical Council of Zambia (“MCZ”), General Nursing Council (“GNCZ”), Pharmaceutical Regulatory Authority (“PRA”), Food Safety and Food Quality Control Services Unit, Environmental Health and Epidemiological Trends Unit, Radiation Protection Board, Radiology and Medical Devices Control Unit and the Medical Laboratory Regulatory Services Unit. On the other hand, service statutory boards are responsible for providing specific services in support of the health delivery system and include the National Food and Nutrition Commission (which is partially regulatory and partially service), Zambia National Flying Doctor Services (“ZNFDS”), Zambia National Blood Transfusion Service (“ZNBTS”) and the Tropical Disease Research Centre (“TDRC”).
August 2007 15 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
4.2.3.3 Health Training Institutions
The public health sector also includes a number of health training institutions providing various types of pre- and in-service training for health workers. These institutions play a pivotal role in the production of appropriately trained health workers, including medical doctors, nurses, clinical officers and paramedical staff for the Zambian health sector. These institutions include:
UNZA School of Medicine, Lusaka. This is the only medical school in the country for producing medical doctors. The school also offers training at lower levels in various health disciplines, including BSc. Degree Bio-Medical Sciences, Degree in Post-Basic Nursing, Degree in Anaestasia, and others; Chainama Hills College of Health Sciences, Lusaka. Chainama College commenced its operations in 1936 and is the oldest health training institution in Zambia. It produces medical cadre in various disciplines, at diploma and advanced diploma levels, including environmental health, clinical medicine (general), clinical medicine (mental health), clinical medicine (medical licentiate), nursing (various specializations), counseling and other fields; Nursing training schools for registered and enrolled nurses, located throughout the country. Currently, there are a total of 19 nursing schools in the country. During 2007, MOH is committed to renovating and re-opening 3 nursing schools; 2 colleges for training of medical laboratory technologists, which include the Evelyn Hone College in Lusaka, the Ndola School for Bio-Medical Sciences on the Copperbelt; and Other training institutions for other health cadres, paramedics, including the UTH School of anaestasia and the Lusaka Dental School.
4.3 Main Problems and Constraints
MOH is committed to the successful implementation of the NHSP 2006/10, whose vision is to ensure “Equity of access to assured affordable health care services, as close to the family as possible”. However, there are a number of constraints and challenges which are adversely affecting the health sector.
These include:
High and complex disease burden, compounded by the effects of HIV/AIDS and malaria. According to the Health Management Information System (“HMIS”) report for 2006, the top five leading causes of morbidity and mortality included: malaria, respiratory infections (non-pneumonia), diarrhea (non-blood), trauma (accidents, injuries, wounds, burns) and eye infections. Even though HIV/AIDS is not included in this list, it is responsible for a larger portion of morbidities and mortalities. HIV/AIDS has seriously devastated the health sector and overstretched the limited human, financial and material resources available;
August 2007 16 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Critical shortages of appropriately qualified core health workers and teaching staff in training institutions; Inadequate funding to the health sector. The Government has made a commitment to increase funding to the health sector to 14% of the national budget, however, this has not been achieved yet and funding is now about 12% of the budget. However, the Government and its international cooperating partners are making significant efforts to continue improving funding to the sector; Erratic supply of essential drugs and medical supplies, and poor logistics management. This problem has significantly undermined health service delivery, specially in the rural areas, which are difficult to reach; Inadequate and poor state of essential health infrastructure and equipment, including mothers’ shelters, basic equipment and tools; Poor transport and communication facilities to facilitate efficient and effective communication and transportation in support of health services. This is due to a combination of factors, including poor geographical access, poor state of public transport and communication infrastructure and lack of reliable motor vehicles and communication systems; and Inadequate facilities and systems to support efficient and effective information, education and communication of health programmes and messages to the public. This includes the inadequate investment in appropriate modern ICT, which has made it difficult for the health sector to benefit from the new technological innovations, with potential to significantly improve health service delivery.
4.4 The Human Resource Crisis
Zambia is among the Sub-Saharan African countries that are most affected by the critical shortages of human resources for health, with severe shortages of appropriately qualified health workers at all levels of the health service delivery system and training institutions. Over the past three to four decades, the number of doctors has actually declined from 1,283 in 1975 to 646 in 2005, whilst the population has continued to grow at over 2.7%. In 2005, staffing levels in the health sector were estimated at 23,176, representing 47% of the recommended staff establishment of 49,360 (HR Plan, MOH, Zambia, 2005). Consequently, the workloads for health workers have drastically worsened, as evidenced by the Doctor to Population ratio, which has continued to deteriorate and is currently estimated at 17,589:1, against the recommended 4,940:1. Table 2 presents a summarised analysis of staffing levels and staff workloads in the Zambian health sector. A more detailed analysis is presented at Appendix III.
August 2007 17 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Table 2: Health Sector: Staffing Levels and Workloads (Summary), Zambia STAFFING LEVELS STAFF/POPULATION RATIOS Recommended Recommended Existing Staff/ Establishment Existing Staff/Population Population Staff Category (2005) Staff Variance Ratios, 1: Ratios, 1: Medical Doctors 2,300 646 1,654 4,940 17,589 Nurses 16,732 6,096 10,636 679 1,864 Mid Wives 5,600 2,273 3,327 2,029 4,999 Clinical Officers 4,000 1,161 2,839 2,841 9,787 Other Health Workers 20,728 13,000 7,728 548 874 Total 49,360 23,176 26,184 230 490 Source: MOH HRIS database / NHSP 2006/30, MOH, Zambia
The situation is compounded by the inequitable distribution of the available health workers, which has continued to favour urban areas at the expense of rural areas. Currently, it is estimated that approximately 23% of rural health centres in Zambia are operating without any qualified health worker, while 50% of them operate with only one qualified health worker (Joint Annual Review 2006 Report, MOH, Zambia). Health training institutions have equally suffered severe shortages of teaching staff and in the current state do not have the required capacities to expand their outputs in line with the demands of the HR Plan. The distribution of clinical and nursing staff in Zambia is as analysed in Table 3 and Appendix IV.
Table 3: Distribution of Clinical and Nursing Staff per 100,000 Populations by Province, Zambia Zambia Zambia Clinical Registered Enrolled Registere Enrolled Province Doctors Officers Midwives Midwives d Nurses Nurses Total 1) Urban Regions: Lusaka Province 12.0 14.7 6.6 19.5 26.0 62.9 142 Copperbelt Province 7.8 9.8 6.2 22.2 24.2 56.5 127 2) Rural Regions: Southern Province 2.8 13.1 3.5 28.6 9.9 50.8 109 North Western Province 1.8 8.3 2.1 6.9 6.3 48.4 74 Western Province 1.8 9.3 1.6 10.1 6.7 33.6 63 Central Province 0.7 8.8 2.5 13.0 6.1 24.6 56 Eastern Province 1.0 6.7 0.9 11.6 6.6 28.3 55 Luapula Province 2.1 6.6 0.6 6.6 7.3 30.9 54 Northern Province 0.9 6.1 0.9 8.9 8.0 20.5 45 Source: Joint Annual Review Report for 2006, Ministry of Health, April 2007, Zambia
August 2007 18 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
The human resource crisis in Zambia is not only severe but also complex. It includes actual shortages of the required numbers of essential health workers, shortages of the right skills and skills mix, poor geographical distribution and a high and complicated disease burden. The crisis has been largely caused by a combination of factors, including: high staff attrition levels; inadequate staff training capacities; and impact of HIV/AIDS.
4.4.1 High Staff Attrition Levels
Despite the fact that there are no reliable sources of data on the attrition levels for health workers in Zambia, it is generally acknowledged that the prevailing levels are high. An analysis of the human resources crisis in the Zambian health sector estimated the annual attrition rates for 2003 at 9.8% for medical doctors, 5.3% for nurses, 4.2% for pharmacists, 3.5% for laboratory technologists, and an overall average of 5.4% for the year (G Kombe et.al, Human Resources Crisis in the Zambian Health System: A Call for Urgent Action, Abt Associates Inc., 2005).
One of the main contributing factors to staff attritions in Zambia is the brain-drain or migration of core health workers from the public health institutions to either the private sector within the country or to overseas countries, mostly to the United Kingdom (“UK”), Australia, New Zealand and the United States of America (“USA”), in search of better remuneration and conditions of service. The available data indicates that, in 2004, the number of Zambian doctors practicing in the USA and Canada alone was more than 10% of those who were practicing in Zambia (Hagopian et al., 2004). Similarly, the number of nurses leaving the country has kept on increasing.
Training institutions have equally been affected through migration of lecturers and tutors in search of better conditions of service overseas. According to the Nursing and Midwifery Council of the UK, between 1998 and 2003, a total of 461 Zambian nurses were recruited to work in the UK. Currently, it is believed that approximately 300 Zambian doctors are practicing abroad (HR Plan, MOH, Zambia). The other major factor contributing to high staff attritions in the health sector is the increase in mortality levels among the core health workers due to HIV/AIDS. The most affected are the secondary and tertiary level hospitals, which have continued to loose significant numbers of qualified and experienced clinicians, nurses and other paramedics.
4.4.2 Inadequate Staff Training Capacities
The capacities at the various health training institutions, making it difficult for these institutions to expand their outputs and meet the ever increasing demand for health workers. Currently, Zambia has only one medical school, at the University of Zambia (“UNZA”), the Chainama College of Health Sciences, 19 nursing schools and three technical colleges for laboratory technologists and pharmacists.
August 2007 19 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
However, in 2004, all these training facilities only produced 49 doctors, 540 nurses, 38 laboratory technologists and 20 pharmacists, which were far below the outputs required to maintain staff levels (G Kombe et.al, Human Resources Crisis in the Zambian Health System: A Call for Urgent Action, Abt Associates Inc., 2005).
4.4.3 Impact of HIV/AIDS
Zambia is among the Sub-Saharan African countries that are most affected by the HIV/AIDS epidemic, with an average HIV prevalence rate of 16% among the adult population and 27% in urban areas (Zambia Demographic Health Survey 2001/2002). The impact of HIV/AIDS on the staff crisis is in two ways, namely: the direct impact on the mortality levels for core health workers; and the increase in the disease burden, which in turn increases the workloads for health workers. In this respect, the fight against HIV/AIDS is among the areas that have been prioritised in the NHSP and FNDP.
4.5 Sector Strategy and Priorities
The current health sector strategy is outlined in the NHSP 2006/10 and the health chapter of the FNDP. It is based on a set of national health priorities, which take into account the commitments to regional and international initiatives in health, particularly the MDGs, and the Abuja and Maputo Declarations on health. Below is the summarized framework.
4.5.1 Vision, Goal, Principles and Priorities
The vision, goal, key principles and national health priorities identified for the period from 2006 to 2010 are as follows:
Vision: To ensure equity of access to assured quality, cost-effective and affordable health care services as close to the family as possible, and significantly contribute to the human and socio-economic development of the nation.
Overall Goal: To establish a society in which Zambians create environments conducive to health, learn the art of being well and provide basic level health care to all.
Key Principles: Equity of access; Affordability; Cost-effectiveness; Accountability; Partnerships; Decentralisation and Leadership.
Theme: Towards the attainment of the Millennium Development Goals and National Health Priorities.
National Health Human resource crisis; Integrated Reproductive Health (“IRH”); Priorities: Child Health; HIV/AIDS; malaria; tuberculosis; epidemics control and public health; and environmental health and food safety. August 2007 20 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
4.5.2 Main Objectives
The main objectives include:
To provide a well motivated, committed and skilled professional workforce; To reduce the under 5 Mortality Rate (“>5MR”) by 20%, from 168 per 1,000 live births in 2005, to 134 by 2010; To reduce the Maternal Mortality Ratio (“MMR”) by one quarter, from 729 per 100,000 live births in 2005, to 547 by 2010; To halt and begin to reduce the spread of HIV/AIDS and Sexually Transmitted Infections (“STIs”); To halt and begin to reduce the spread of Tuberculosis (“TB”), through effective interventions; To halt and reduce the incidence of malaria by 75% and malaria related under 5 mortality by 20%; To ensure availability of adequate, quality, efficacious, safe and affordable essential drugs and medical supplies at all levels; and To significantly improve the availability, distribution and condition of essential infrastructure and equipment, so as to provide for equity of access to essential health services.
4.6 Sector Performance
The performance of the health sector is being seriously undermined by the various constraints and challenges highlighted earlier. Despite this situation, over the past 5 years ended 2006, the performance of the health sector has shown some improvements. Most of the selected healthcare delivery indicators have improved. The healthcare OPD per capita attendance increased from 0.73 in 2002 to 0.86 in 2006, first antenatal attendance coverage improved from 89% to 92%, supervised deliveries increased from 49% to 61%, and the fully immunized coverage under 1 year increased from 76% to 87%. Table 4 below, presents more details on the performance.
Table 4: Trends of Selected Healthcare Delivery Indicators, 2002 -2006 Indicators 2002 2003 2004 2005 2006 Health Centre OPD per Capita Attendance 0.73 0.86 0.76 0.78 0.86 First Antenatal Coverage (%) 89 95 97 93 92 Average Antenatal visits 3.4 3.3 3.1 3.0 2.9 Supervised Deliveries (%) 49 55 61 62 61 Fully Immunised Coverage under 1 year (%) 76 74 80 82 87 Under Weight Prevalence (%) 22 21 17 16 14 New Family planning accepters rate 111 123 127 138 140 Health Centre Staff Load Contacts 16 17 17 17 18.2 Drug Kits opened per 1,000 patients 0.69 0.73 0.93 1.08 0.99 Source: Ministry of Health HMIS/JAR 2006
August 2007 21 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
On the other hand, despite the significant commitment and resources invested in the sector by the Government and its partners and the subsequent improvements in the key health service delivery indicators, the disease burden has remained high and is not improving. According to the HMIS report for 2006, over the past 7 years, most of the top leading causes of morbidity and mortality have continued to deteriorate.
Malaria has continued to head the list of the 10 leading causes of morbidity and mortality, with the incidence rate increasing from 316 cases per 1,000 population in 2000 to 410 cases in 2006 and the number of malaria cases increasing from 3.6 million in 2000 to 4.9 million in 2006. However, number of deaths due to malaria declined from the 8,952 in 2000 to 6,471 in 2006. The incidence rate for respiratory infections (non-pneumonia) increased from 119 per 1,000 population to 192, while the cases increased from 1.3 million to 2.3 million. An analysis of the trends for the top ten causes of morbidity and mortality is presented at Appendix II.
August 2007 22 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
5 EXISTING HEALTH LINKS
5.1 Overview
In Zambia, the concept of Links is not widely understood and appreciated. However, in trying to address the staffing problems and capacity limitations that are being experienced in the health sector, some health service facilities and training institutions have established Links with counterpart institutions in foreign countries. Through such Links, medical experts from foreign countries have visited these institutions to provide services, teaching or service development, on a gap filling basis. In some cases, these institutions have also received significant technical, material and financial support, through the same Links. There have also been reciprocal professional attachments and teaching visits by Zambian staff. Such Links are largely concentrated in Lusaka and are most common at the UTH, the UNZA School of Medicine and at Chainama hospital and college. Outside Lusaka province, only a small number of health facilities and training institutions indicated that they have Links, with St. Francis Hospital, a Catholic owned facility in the town of Katete, Eastern Province, standing out with the highest number of Links among the institutions outside Lusaka.
Even though it is acknowledged that Links have added value to the beneficiary institutions and that they have led to significant transfers of knowledge and skills to health workers and institutions in Zambia, the lack of a framework for management and coordination of the Links in the country has led to fragmentation and duplication of efforts of the Link parties. In view of this situation, some of the Links do not address the institutional and sector priorities requiring capacity building and in most cases, such Links are established through individual efforts and therefore do not fully address the capacity needs of the respective institutions. Given this background, MOH has identified the need to establish an appropriate framework for promotion, management, coordination, monitoring and evaluation of the Links in the Zambian health sector.
This part of the report discusses the existing Links, identified during the mapping exercise. The section is structured to analyse the Links by the types and levels of health institution, in the following order: provincial health offices, district health management teams, hospitals, health centres/health posts, training institutions and statutory boards.
5.2 Provincial Health Offices and District Health Management Teams
5.2.1 Brief Profile
Provincial health offices (“PHOs”) are responsible for providing technical support and supervision to all public health institutions in their respective provinces. This is done through the direct supervision of District Health Management Teams (“DHMTs”), hospitals and health statutory boards, which are in turn, responsible for providing technical support and supervision of the health facilities and training institutions at district level. August 2007 23 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
The main roles and responsibilities of PHOs include, interpretation and dissemination of health sector policies to DHMTs and other health institutions within their jurisdiction, coordinating the planning process at provincial level, supervising the implementation of sector policies, monitoring and evaluation of the performance of the DHMTs, hospitals, health centres, health posts, statutory boards and training institutions within their respective provinces. Each PHO is headed by a Provincial Health Director (“PHD”), who is answerable to the Permanent Secretary of MOH, with technical oversight from the Director of Technical Support Services (“DTSS”). Each PHD is supported by a team of managers and specialists in core health and support service areas. On the other hand, DHMTs are responsible for the management, coordination, supervision, monitoring and evaluation of health facilities at district level, including district hospitals, health centres and health posts in their respective districts. DHMTs are headed by District Health Directors, supported by complements of managers and specialists in core health and support service areas.
5.2.2 Existing Links
Except for the Livingstone DHMT, none of the PHOs and DHMTs reported to have established any Links. The Livingstone DHMT has established a Link with NORDKAPP –KOMMUNE of the Norway, who are providing technical and financial support to the mental rehabilitation programme. The main activities under this Link include:
A staff exchange programme, restricted to staff below the age of 35 years; and A community based rehabilitation programme for mental patients. This includes training and capacity building for members of staff and the communities involved in the rehabilitation of mental patients.
5.3 Central Hospitals (“3rd Level Hospitals”)
Central Hospitals are also known as 3rd Level hospitals. These are the largest and most sophisticated hospitals in Zambia, intended to provide specialised services in internal medicine, surgery, paediatrics, obstetrics, gynaecology, intensive care, psychiatry, training and research, and also to act as referral centres for Provincial General Hospitals (2nd Level hospitals). Currently, there are only 5 such facilities in the country, namely, the UTH and Chainama Hospital in Lusaka, Ndola Central Hospital (“NCH”) and Arthur Davison Children’s Hospital (“ADH”) in Ndola, and Kitwe Central Hospital in Kitwe. The main constraints and challenges faced by these facilities are more or less similar and include:
Critical shortages of health workers. These facilities are currently operating at below 50% of the staff establishment, with the attendant effects;
August 2007 24 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Shortages of specialist consultants and doctors, in the required numbers and specialist areas, has significantly undermined the delivery of specialised services expected from such facilities. For example: Ndola Central Hospital only has 9 consultants, against the establishment of 25, and even though the intensive care unit exists, there are no trained expertise to manage the unit; and ADH does not have enough doctors and mainly depends on interns, who only come on temporal deployments. Currently there is only 1 paediatrician, who is also the Executive Director, 2 surgeons, 1 dentist and 2 paediatric surgeons, which are far below the establishment levels; Erratic supply of essential drugs and medical supplies, especially at lower hospitals and health centres, combined with the poor adherence to referral procedures at lower levels, has resulted into over congestions at these facilities. This increases staff workloads and overstretches the available health workers; The poor state of essential infrastructure and equipment, including basic tools and accessories, has significantly restricted the capacities of these institutions to offer specialised services and negatively affects the quality standards of services rendered; and Poor transport and communication, particularly ambulances and radio message systems, is making it difficult to attend to emergency evacuation services. Moreover, even the few available ambulances are not equipped with appropriate basic life-saving equipment.
The mapping of Links revealed that, out of the 4 central hospitals, only the UTH/UNZA School of Medicine have established Links. The other 3 facilities, which are all based on the Copperbelt, reported that they have not established any Links. Below are summarised reports by facility.
5.3.1 The University Teaching Hospital /UNZA School of Medicine
5.3.1.1 Brief Profile
The UNZA School of Medicine is one of the schools of the University of Zambia (“UNZA”) and the only national medical school in Zambia. It was established in 1965 and became an independent school of UNZA in 1970. The school, together with the UTH, which is the accredited hospital, are located in Lusaka. The pre-clinical and other departments of the school are located at the Ridgeway campus, while the clinical departments and the dean’s administrative offices are located within the premises of the UTH. The school currently offers graduate and post-graduate programmes in the following fields of study: joint Bachelor of Medicine and Bachelor of Surgery Degrees; Master of Medicine in surgery, obstetrics and gynaecology, paediatrics and child health, medicine and orthopaedic surgery; and Master of public health.
August 2007 25 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
It also offers Bachelor Degrees and high level training and education in nursing, pharmacy, physiotherapy and biomedical sciences. Since its opening, the school has produced more than 1,200 medical doctors.
UTH is the hospital accredited to the School, even though it operates under MOH. It is a specialised hospital and the largest hospital in the country, with bed capacity of 1,800. Through the established working relationships between the school and UTH, the joint functions of these two institutions are threefold, namely: medical training, research and clinical care.
5.3.1.2 Existing Links
UTH and the School of Medicine have established a significant number of Links, and local and international collaboration programmes covering research, and student and staff exchange programmes. The existing Links at UTH/UNZA School of Medicine are provided in Table 5 below.
Table 5: Existing Links at UTH/UNZA School of Medicine S/N Link Partner Nature of Link 1. University College, A long-term collaboration has been established between this London Medical university and UZA/UTH under the ZAMBART project, a 10 School, UK. year collaboration project in TB research. Under this project, a building has been constructed at the UNZA Ridgeway campus, to support the activities of this project. 2. Kent State University, Under this link, some staff members of UTH have been sponsored UK. for PhD studies. Currently, one member of staff is pursuing a PhD in Nursing. 3. Sussex and Brighton This Link includes exchange programmes for nursing staff and Medical School and students, and comprehensive capacity building support to Teaching Hospital, UNZA/UTH. and Brighton University, UK. 4. University of Under this programme, the University of Bradford has been Bradford, UK. providing physiotherapy equipment to UTH/UNZA. 5. Institute of Child This Link includes collaboration in research, exchange visits Health University involving research staff, infrastructure support and scholarships in College, London, UK. Public Health. 6. Harvard University, Harvard University and UNZA/UTH are involved in a number of USA. collaborations in research including, Sickle cell diagnostic (screening of sickle cell disease and establishing the levels of sickle cell in Zambia) and capacity building in diagnosis of sickle cell in rural areas. 7. University of Emory, Collaboration in research and scholarships for master’s degree in USA. Public Health.
August 2007 26 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
8. Kent State University, Staff exchange, capacity building and research. One member of USA. staff has been awarded a scholarship and is still pursuing a PhD programme at the Kent State University. 9. University of The link with this university was established through a former Nebraska, USA. member of staff of the UNZA department of pediatrics. This link is in the area of research in cancer, HIV/AIDS and Malignant for post graduate students. The contact person at the University of Nebraska is Charles Wood. 10. University of Through this Link, a center of excellence building has been Alabama, USA. constructed at the UTH. Other activities include the CIRDZ/University of Alabama- Research activities, MPH scholarships and institutional strengthening. 11. University of Miami, This project has come to an end, but Links with the school in the USA. area of capacity building are still open, even though not active.
12. Yale University Under this Link, UNZA and the University of Yale have been School of medicine, carrying out research in Malaria at Macha hospital in Choma. USA. 13. Mehari University Link between Mehari University and UNZA School of Medicine on research collaboration, and student and staff collaboration on microbicides. Under this arrangement, UNZA shares resources with UTH. 14. Kalorinska Institute, Institutional collaboration project funded by SIDA. The Sweden department of Post Basic Nursing at UNZA has benefited from technical support and exchange visits. Two professors have been appointed as visiting professors. Under the nursing and staff exchange programme, both institutions are supposed to do the following: send up to two exchange students each year during the duration of the agreement, unless the number is varied by mutual agreement; and share information on a regular basis; and recognise that the academic credit of the studies abroad is the responsibility of the degree granting institution. 15. Helsinki Polytechnic Staff and student exchange programmes, and implementation of Stadia, Finland. the Malawi –Zambia health care project during the spring of 2005 and academic year 2005-2006. This included short term staff and student exchange programmes. 16. MIE University of Exchange programme between the two institutions. However the Japan. Zambian counterparts have not been able to get sponsorship for this programme. 17. University of Bergen, Collaboration with this university was through the NUFU Project Norway. 20002 to 2006. This project was designed to strengthen UTH and UNZA in HIV/AIDS related interventions and capacity building. Under this project, two students where sponsored for PhD programmes at the University of Bergen.
August 2007 27 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
18. Copenhagen Partnership and collaboration in research. University’s Center for Medical Parasitology (CMP), Denmark: 19. Yamananshi This research project came to an end in 2006. Under this project University, Japan. a research laboratory was constructed and two UTH members of staff were trained up to PhD level and one up to Masters level. 11. Marie Master Collaboration on sickle cell management. University. 12. Communication for The Dreyfus Health Foundation of New York, USA, is the Better Health sponsor of this programme. The main activities under this (“CBH”). collaboration include support to the medical library and helping out in dissemination of health information to front line health professionals in the rural areas of Zambia. 13. International Atomic This agency has been supporting the following projects: Tumor Energy Agency market project; Tissue culture project; and The newborn (“IAEA”). screening and nuclear project. 14. Other Links: University of Queensland, Australia: Collaboration in schizophrenia research). University of Ain Shams, Cairo, Egypt. University of Malawi, Malawi. University of Bergen, Norway. University of Bergen, Norway. University of Pretoria, South Africa. University of Nottingham, UK: Collaboration in communication research. Institute of Psychiatry, London, UK. University College, London Medical School, UK. Bradford University, UK. Gordon University, UK. The London School of Tropical Medicine-UK. Medical Research Council, UK. Leeds University, UK. Michigan State University, USA: Collaboration in epilepsy and stigma research, and in neurological. State University, Nebraska, USA: Collaboration in telemedicine. University of Nairobi, Kenya. University of Miami, USA. University of Nebraska-USA. Massachusetts Institute of Technology-USA.
August 2007 28 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
15. Other collaborating The World Federation for Medical Education (“WFME”); partners include: The Foundation for Advancement in MEDICAL Education and Research (“FAIMER”); The Society for Directors of Research in Medical Education (“SDRME”). Prevention of Maternal Mortality in Africa (“PMM”) The Surgical Society of Zambia. Collaboration in surgery. College of Surgeons of East, Central and Southern Africa. World Orthopaedic Concern (“WOC”). Pharmaceutical Society of Zambia.
5.3.2 Chainama Hills Hospital and College for Health Sciences
5.3.2.1 Brief Profile
Chainama is a government facility located in Lusaka and comprises of a 3rd level referral hospital and a college for health sciences. The hospital is the only facility in the country offering specialist referral services in mental health. Apart from specialist referral services in mental health, the hospital also offers other clinical services. The Chainama College is the second largest health training institution, after the UNZA medical school, to which it is also affiliated. It is also the oldest health training institution in Zambia, opened in 1936. The college claims that it produces approximately 70 to 80% of frontline health workers in Zambia.
Chainama offers a wide range of training programmes at diploma and advanced diploma levels. These include: diploma in environmental health, diploma in clinical medicine (general), diploma in clinical medicine (mental health), diploma in orthomic nursing (post-basic programme), diploma in counselling, advanced diploma in medicine (medical licentiate programme in various specialisations), registered mental nursing course, and the centre for continuing education, providing a wide range of courses.
5.3.2.2 Existing Links
Chainama is among the few health institutions that are benefiting from Links with international institutions. The following Links were reported:
Table 6: Existing Links at Chainama Hospital and College S/N Link Partner Nature of Link 1. Leeds Metropolitan Training support, through Degree Programs’ and scholarships. University, UK Leads Metropolitan University is currently running Masters in Public Health; and Doctor of Philosophy in public health programs at Chainama Hills College. Sends lecturers to support these programmes which are quarterly/modular based. A new intake of 3 started in March 2007.
August 2007 29 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
2. The University of Training support, MPH and PHD in Public Health scholarships Manchester, UK. for members of staff. From 2000 to 2002, Manchester University conducted a Masters of Education in Primary Health programme at Chainama College. 3. Michigan University, Health Care support. USA. 4. University of Mehari Training support, Masters in Nero Psychiatry. (Medical School. 5. Mental Health Trust, Providing support in form of teaching at the college. Also UK. supporting the hospital in health service provision and staff training. 6. Sight Savers Technical and material support to the orthomology programme. International, UK. 7. Operation Eyesight, Has pledged to support the college in infrastructure Canada. development. 8. Beit Trust, UK. Has pledged to provide financial support to construct a lecture theatre. Project awaiting finalization of building plans by the Ministry of Works and Supply. 9. Lothian Health Board, Providing support in form of providing specialists. Scotland. 10. VVOB, Belgium. Collaboration in teaching. Providing technical advisors and supporting workshops. Support to the computer laboratory. 11. Prime – UK NGO Training support, Medical School. 12. HSSP/JPIGHO, USA Support to curriculum development. 13. University of Zambia. Support to Palliative Care. 14. National Malaria Institutional collaboration. Center , Zambia.
5.3.3 Ndola Central Hospital
5.3.3.1 Brief Profile
The Ndola Central Hospital (“NCH”) is the second largest hospital in Zambia. It is a specialised hospital catering for the Ndola and Masaiti districts, with a combined population of approximately 600,000 people. The hospital also serves as a referral facility for the Northern, Luapula, Central and North-Western provinces, and other towns of the Copperbelt Province. NCH was established in 1972 and has a bed capacity of 851 beds and 97 cots. The hospital consists of 26 wards, one school of nursing and midwifery, and one biomedical sciences college. It is designed to provide secondary and tertiary care services to adults in the following fields: Medicine, general surgery, obstetrics and gynaecology, psychiatry, ophthalmology, skin and STIs, dentistry, pathology, laboratory support services, radiology, orthopaedics, physiotherapy, urology and anti-retral viral treatment (“ART”). However, due to lack of a district hospital in Ndola, NCH is compelled to also offer first level services, in addition to its normal services.
August 2007 30 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
5.3.3.2 Existing Links
The hospital does not have any existing Links, except for some institutional support arrangements with:
The Zambia Prevention, Care and Treatment (“ZPCT”) is a 6 year collaboration project between Zambia and the United States of America aimed at strengthening and expanding existing HIV/AIDS services in five selected provinces. ZPCT is working closely with the hospital on the HIV/AIDS programme, with emphasis on ART; and ORET programme, which is about to commence the rehabilitation of the operating theatre and provide new X-ray and ultra-sound machines.
5.3.4 Kitwe Central Hospital
5.3.4.1 Brief Profile
Kitwe Central Hospital (“KCH”) is the third largest general hospital in Zambia and is located in the city of Kitwe on the Copperbelt province and comprises of the hospital itself and the nursing and midwifery school. KCH provides specialised services to the adult population. The services offered include secondary and tertiary care to adults in the following of fields: Medicine, general surgery, obstetrics and gynaecology, psychiatry, ophthalmology, skin and STI, dentistry, pathology, laboratory support services, radiology, orthopaedics, physiotherapy, urology and ART.
5.3.4.2 Existing Links
KCH does not have and has never had any Links with any international counterpart institutions.
5.3.5 Arthur Davison Children’s Hospital
5.3.5.1 Brief Profile
The Arthur Davison Children’s Hospital (“ADH”) is situated in the city of Ndola, on the Copperbelt province, and is the only specialized children’s hospital in Zambia. It is a third level referral institution with an official bed capacity of 250, which at peak periods from September to June, increases to nearly 300. Due to high demand, ADH is also compelled to provide second level services. Most of its clients are drawn from the districts of Ndola, Luanshya, Masaiti, Mpongwe and Lufwanyama on the Copperbelt. Other provinces sending patients for specialist treatment at ADH include Luapula, Northern, North-Western and Central provinces. The clients of the hospital are mainly children up to the age of 14 years.
August 2007 31 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
The services provided by ADH include both curative and rehabilitative health care services, which include: outpatients, medicine, surgery, dentistry, radiology, pathology, neonatology, otolaryngology, physiotherapy, orthopedics, ultrasound and echocardiography, ophamology, ART services, psychosocial, PMCT, VCT, mortuary and pharmaceutical services. It also provides teaching to a variety of students from medical and nursing schools, paramedical and technical colleges. There are several factors affecting the performance of ADH.
In addition to the generic problems being experienced by the hospitals, ADH is experiencing the following problems:
Shortages of pediatric formulation in efavirenz, lack of coordination between the public and private health sectors in terms of commencements of ARVs in order to avoid early placement of children on second line treatment, and inconsistent supply of adequate drugs to treat opportunistic infections; Inadequate space, for example, the ART clinic is always crowded due to the increased numbers of children accessing ART services. This calls for construction of an ART family centre for both children and their guardians to access ART services; No appropriate equipment to carry out ARV drug resistance profiles, especially with children exposed through PMTCT; No PMTCT referral system to detect the neonates who were exposed to ARVs; and Shortages of appropriate equipment and reagents to detect creptococcal meningitis, toxoplasmosis and tuberculosis in children.
5.3.5.2 Existing Links
Currently, ADH does not have any Links. However, in 2006, they received 5 student volunteers from the USA, who only came for one week. The Northrise University of Ndola also brought in some experts on a one-off visit basis.
5.4 Provincial and District Hospitals (1st and 2nd Level Hospitals)
5.4.1 Brief Profile
Provincial and District Hospitals (1st and 2nd Level hospitals) are also faced with similar constraints and challenges as the other health service delivery institutions. The most critical ones include:
Critical shortages of human resources; Erratic supply of essential drugs and medical supplies; Poor transport, logistics and communication infrastructure; and Poor condition of essential infrastructure.
August 2007 32 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
However, at this level, the situation is more severe than at the Central Hospitals (3rd Level hospitals), especially that a large number of provincial and district hospitals are located in rural areas. In this respect, Provincial and District Hospitals need various forms of support, including the establishment of Links, to enable them improve the standards of service delivery.
5.4.2 Existing Links
Out of a total of 74 District (1st Level) Hospitals and 19 Provincial (2nd Level) Hospitals in the country, 17 reported to have established some Links of some kind. However, only 4 of these had significant numbers of Links to talk about, namely: Chainama Hills Hospital/Health Training College in Lusaka; St. Francis Mission Hospital in Katete, Eastern Province; Chilonga Mission Hospital in Mpika, Northern Province; and Monze Hospital in the Southern Province.
Whilst a list summarizing the existing Links, by institution, is provided at Appendix V, we present below, as an example, descriptions of Links existing at St. Francis Hospital, Chilonga Hospital and a summary list for the other Provincial and District level hospitals.
5.4.2.1 St. Francis Hospital, Katete
St. Francis hospital is a mission hospital located in the town of Katete in the Eastern province of Zambia. The mapping revealed that St. Francis is probably has the highest number of Links compared to other provincial and district hospitals. St. Francis is a good example of how Links could benefit health facilities in improving the standards of health service delivery. In view of the established Links, even though St. Francis is classified as a 2nd Level hospital, it attends to referrals from all over the country. The hospital’s success in establishing and maintaining Links is largely attributed to the existing and past expatriate volunteer managers and specialists, who have continued to be very committed to supporting this hospital. The following Links were reported at St. Francis Hospital:
Table 7: Existing Links at St. Francis Hospital S/N Link Partner Nature of Link 1. Zambia Society Trust, The society has been supporting the AIDS Orphans programme, UK. through the AIDS project. 2. Hands Around The This organization was founded by Dr. David Steiner, who used World (“HATW”), UK. to work at the hospital as a doctor in the early 1990’s. The aim of this organization is to assist by sending skilled volunteers for short periods to share their skills. A number of volunteers have visited and assisted in the pharmacy, maternity and ultrasound sections.
August 2007 33 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
3. Friends of St Francis’, Friends of St. Francis Hospital is an organization that keeps UK. former members of staff of the hospital in touch with each other and up to date with news from the hospital. It also raises a substantial amount of funding for the hospital. The funds come in all various forms, including personal donations from former staff and other friends of the hospital, church groups, special fundraising events, such as marathons, birthdays (whereby birthday gifts are donated to the hospital) and stalls at exhibitions. They also assist with recruitment of volunteers, mainly doctors, from the UK. A donation of £10,000 was made a few years ago and the bank interest on this amount has been used to fund staff training. Most of the funds raised go towards procurement of drugs and medical supplies, which are sent annually by container, supplementary salaries for senior doctors and other key staff, and support to staff training. 4. Lothian Health Board, A team from Lothian Health Board visited the hospital in 2004, Scotland. comprising of clinical staff and a health information specialist, on a fact-finding mission to identify areas of support and collaboration. The information specialist also spent some time working with hospital records staff. 5. Scottish Borders Africa The Group has been supporting the hospital’s AIDS project, AIDS Support Group. through fundraising.
6. United Society for the USPG was formed by merging two mission societies, namely Propagation of the the Universities Mission to Central Africa (“UMCA”) and the Gospel (“USPG”). Society for the Propagation of the Gospel (“SPG”). The link with UMCA dates back to the founding of the hospital in 1948 by Fr. Francis Trefusis, a missionary with UMCA. Many of the early members of staff at the hospital were UMCA missionaries. UMCA/USPG support to the hospital has continued, through provision of medical doctors and other qualified health workers and financial and material support. In this respect, the current Executive Director and Pediatrician, Dr. Shelagh Parkinson and the Manager Administration, Ian Parkinson are USPG missionaries. They have also taken particular interest in supporting HIV programmes and, for a number of years, have been sending HIV infection prevention kits, containing HIV test kits, gloves, syringes, needles, disinfectants and sharps boxes, and have also been piloting a post exposure prophylaxis policy, aimed at reducing the risks of staff getting infected by HIV upon being accidentally pricked by contaminated needles. 7. Summer Concert, The summer concert event was introduced nine years ago. This Netherlands. is an outdoor summer music concert held in Laren, the Netherlands, every year to provide entertainment to the general public and raise funds for St. Francis hospital. Funds raised at these concerts are often supplemented by the Netherlands Government and sent to St. Francis hospital.
August 2007 34 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
8. Medical Support The Medical Support Group (“MSG”) was founded by former Group, Netherlands. members of staff of St Francis’ Hospital, living in the Netherlands. The main aim of MSG is to provide support to the hospital, which is being done in a number of ways, including fundraising, material support and establishing linkages between the hospital and various donors. MSG has also been providing support to capital projects and the workshop. In this respect, on several occasions, they have been sending senior members to St Francis to physically assist with building projects and provide support to the workshop. Over the years, the MSG has also been providing material support in form of drugs and equipment donated to the hospital. 9. Bed Sponsorship A bed sponsorship scheme has been introduced as a fundraising Scheme, Netherlands: activity for the hospital. Under this scheme, organizations and individuals sponsor specific beds in the hospital at $1,500 per bed per year. The hospital provides the sponsors quarterly reports on the performance of the sponsored beds. Most of the money raised by this scheme is used on the procurement of drugs for the hospital. 10. Gooi Noord Hospital, For some years there has been a relationship with this hospital. Netherlands. This relationship was strengthened by Dr. Jan Croft, Chirug (Surgeon) when he retired from Gooi Noord. Dr. Croft had also used to work at St. Francis’. The support has varied, ranging from sending short term personnel to assist in the laboratory, equipment and financial support through Bed Sponsorship Scheme. It is hoped that the relationship could be developed further. 11. Cordaid, Netherlands: Cordaid has been supporting the hospital’s HIV/AIDS project for many years. They have since taken over the role of lead donor, helping to co-ordinate communications with the other donors to the programme. Cordaid have in the past assisted with staffing, particularly doctors. 12. Simavi, Netherlands. Simavi is a Dutch Organisation currently supporting the project aimed at improving water supply at the hospital. They have also previously funded the procurement of an x-ray machine for the hospital. 13. Episcopal Relief and Recently started to support the AIDS project. It was with their Development (“ERD”), support that the new vehicle for the AIDS project was USA. purchased in 2004. 14. Catholic Medical CMMB are part of the AIDS Relief Consortium and were very Missions Board instrumental in St. Francis being selected as one of the first five (“CMMB”), USA. AIDS Relief sites in Zambia. CMMB have also recruited a doctor from USA to work at the hospital. 15. Catholic Relief CRS is the lead organization in the AIDS Relief consortium. Services (“CRS”), USA.
August 2007 35 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
16. Jersey Overseas Aid Over the years, JOA has supported the hospital through sending (“JOA”), USA. of workgroups, funding of building projects, such as the recent housing project, and procurement of drugs and medical supplies. 17. Direct Relief DRI has been supporting the hospital with donations of drugs International (“DRI”), and medical supplies and medical equipment. The first USA. container of drugs, medical supplies and equipment from DRI was received by the hospital in 2004. 18. Katho College, This Link started in 2003, largely through the initiative of Dirk Belgium. Monbaliu. The college trains nurses and midwives, among many other professions. The training support programme focuses at providing students with opportunities to spend part of their time in a different environment. As a result of this support, a group of nursing and midwifery students came and spent 12 weeks at the hospital, gaining experience on the wards as well as theoretical learning. Two of their tutors also spent some time at the hospital, both with their own students and also the hospital’s own nursing students. Katho College has also provided financial support to the hospital, particularly to support the school library. The programme will continue. 19. Christian Aid. Supported the hospital’s AIDS project for many years. They have also previously made other donations, such as the upgrade of the Special Care Baby Unit. 20. Guernsey Overseas Aid GOA has funded the construction of 4 staff houses for the (“GOA”). hospital. They have also been providing financial support through MSG. 21. Lions International The Lions have supported the hospital’s eye work for a number (The Lions). of years. In 2005, they donated a vehicle for eye outreach activities. They have also provided funds for motor vehicle repairs, funded eye camping sessions and sponsored staff training programmes. 22. Missio Austria. Mission has been supporting the HIV/AIDS project for ten years. 23. Old Catholics, Bonn, Supports the hospital AIDS project. Germany. 24. Sandy Logie Fund. Support for treatment of HIV patients. 25. Zambia Anglican Has been providing financial grants to the hospital. Through the Council (“ZAC”, Administrator Revd Rogers Banda, they also assist with Zambia. processing immigration and medical council papers for expatriate staff and clearing through customs and Ministry of Finance of all items coming from overseas.
August 2007 36 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
5.4.2.2 Chilonga Hospital, Mpika
Chilonga is a mission hospital operated by the Catholics. The hospital is a level 2 facility based in the town of Mpika, Northern Province. The following are some of the Links that were identified at Chilonga Hospital:
Table 8: Existing Links at Chilonga Hospital S/N Link Partner Nature of Link 1. Action Medior, Germany Drugs, once in a while 2. BD, USA Laboratory technology 3. Bridge of Friendship, Germany Second hand equipment 4. Bridge of Friendship. Germany Dr. Muller, visiting Gynaecologist 5. CORDAID, The Netherlands Small Projects, HR recently infrastructure 6. Development Cooperation Ireland (DCI) Infrastructure-Midwifery School Friends of Chilonga Foundation, 7. Netherlands Former Doctors who worked at Chilonga 8. MISEREOR, Germany Funds and Equipment 9. Streekziekenhuis Midden Twente, Hengelo Based on proposals 10. The Beit Trust, UK Infrastructure –building 11. Trace, Tanzania Human Resources Development
5.4.2.3 Monze Hospital, Southern Province
Monze Hospital is a Level 1 hospital based in Monze, Southern Province. The following Links were reported:
Table 9: Existing Links at Monze Hospital S/N Existing Links Nature of Link 1. AIDS Health Care Foundation. Support to HIV/AIDS and ART activities. 2. VSO, UK. Volunteer staff from overseas. 3. Hands Around the World. Extension of the Children's ward, male ward and completion of the ICU. Also provides support to staff development. 4. Misereor –Germany. Support to HAART Project. 5. Other Links: Michigan State University, USA Canadian Food for Children Catholic Mission Board
August 2007 37 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
5.4.2.4 Existing Links - Other Provincial and District (1st and 2nd Level) Hospitals
A number of Links were also identified at some provincial and district level hospitals. However, again it appeared that such Links are mainly concentrated at a few facilities. Further, some of the Links were not described. Below are the Links identified at the other 1st and 2nd Level hospitals:
Table 10: Existing Links at other Provincial and District Hospitals S/N Institution/ Hospital Existing Links Nature of Link
1. Chikankata Mission Boston University, USA. Research Program on Malaria Hospital, Southern Management in rural areas (2 year Province. program). Michigan State University, Joint Research (2 year renewable) USA. on adherence to ART in rural setting. Swedish Rotary Doctor, Visiting Swedish doctors. Sweden. 2. Kabwe General Massachusetts General Research on Maternal and Infant Hospital, Central Hospital, USA. Health Improvement Province 3. Kabwe Mine Massachusetts General Systems strengthening and staff Hospital, Central Hospital, USA. training. Province. 4. Lewanika General University of Moto in Surgery, Infrastructure, Equipment Hospital, Western Czech Republic. & Training. Province. 5. Livingstone General Center for Disease Control Support to counseling services, Hospital, Southern (CDC), USA. laboratory services, equipment, Province infrastructure development. Johnson and Johnson Yale Post graduate doctors for University, USA. experience and research Rapids –World vision Psycho-Social support program for children living with HIV/AIDS, Orphans and Vulnerable Children (will run up to 2010). Zambezi – Physiotherapy Student exchange program 6. Mansa General Indirect link through Rotary Provision of equipment and drugs. Hospital, Luapula Club of Mansa Direct Province. Relief International. 7. Kaoma DHMT/ FMC (Former Dutch Doctors) Help out in new hospital construction Hospital Orange Babies of Netherlands Construction of maternity Ward Touch of Ireland Short term /Construction of children’s Ward
August 2007 38 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
5.5 Health Centres and Health Posts
Health Centres (“HCs”) and Health Posts (“HPs”) are distributed throughout the country in both urban and rural areas. They are the first points of access for health services by the general public. These facilities are the most affected by the various problems and constraints currently being experienced by the health sector. Currently, a large number of the HCs and HPs, especially those in rural areas are severely affected by the critical shortages of qualified health workers and are, in some cases, forced to depend on untrained personnel, they are also more exposed, when it comes to the erratic distribution of drugs and medical supplies, and are significantly affected by the poor state of infrastructure, transport and communication.
During the process of this assignment, we did not find any HCs or HPs with established Links. This probably could be due to the fact that the focus for this mapping was on hospitals and training institutions.
5.6 Health Training Institutions
Health training institutions play an important role in providing the health sector with appropriately trained health workers. The institutions providing training for health workers in Zambia include: the UNZA School of Medicine; Chainama College of Health Sciences; Nursing and Midwifery Schools; Science Laboratory Training Colleges; and training schools for other paramedics. Currently, these institutions are faced with significant challenges, including the critical shortages of teaching staff, shortages of teaching materials and aids, inadequate capacities and general dilapidation of infrastructure. Scaling up of training and development is one of the main strategies proposed in the HRH Strategic Plan for resolving the human resource crisis.
5.6.1 Existing Links
During the mapping of Links, a total of 21 health training facilities were identified throughout the country, including the UNZA School of Medicine. Out of these, a total of 9 were found to have established Links. The Links for UNZA School of Medicine have already been discussed together with the UTH, under the section on Level 3 Hospitals. Provided in Table 11 are the Links identified at the other training institutions.
Table 11: Existing Links at Health Training Institutions S/N Training Institution Existing Links Nature of Link 1. Ndola College of Bio- Irish Aid (Dublin in Infrastructure, Staff Medical Science, Ndola. Institute of Technology) up development, 18 staff members 2006. have been trained. 2. UTH - Nursing School Johnson & Johnson Capacity building. Karolin’s, Sweden Staff and student exchange.
August 2007 39 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
CIMO – Finland Staff and student exchange. (www.stadia.fi ) 3. Kasama School of University of Ireland, Training and capacity building. Nursing, Northern Galway. Province. 4. Chikankata College of Plans to link with the Research purposes. Bio-Medical Sciences, University of Boston. Not Southern Province. yet finalized. University of Michigan Staff Development and through UNZA. exchange programme. University of Michigan, Research at the College and through UNZA. clinical, diagnostic laboratory, and staff development and exchange. 5. Livingstone School of Kristianstad University – Tutor and Student exchange Nursing, Southern Department of Health programme. Province. Science (Sweden) Norway –SOGN OQ Tutor and Student annual FJORDANE University – exchange programme. Faculty of Health Studies
5.7 Statutory Boards and Other Units
There are two types of statutory boards in the Zambian health sector, namely, regulatory and service boards. Regulatory boards are mainly responsible for enforcing specific pieces of the legislation governing the health sector, for and on behalf of MOH, whilst service statutory boards are responsible for providing specific support services to the core health service delivery systems. The findings revealed that the following Links existed at this level.
5.7.1 The Medical Council of Zambia
5.7.1.1 Brief Profile
MCZ was established under the Medical Council Act of Zambia and is the institution responsible for regulating the medical profession in the country. To practice in Zambia, medical professionals are required to register and continue meeting the professional and ethical requirements of MCZ. Currently, MCZ only operates one office, in Lusaka, but plans are underway to decentralise the operations by setting up branches at provincial level throughout the country.
August 2007 40 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
5.7.1.2 Existing Links
MCZ has no established any Links, except for the collaboration in information sharing with the Association of Medical Council of Southern Africa (14) countries, and the General Medical Council (GMC), UK. However, with the help of THET, they are in the process of developing a Link with the UK Regulatory Authorities, focusing on the following areas:
Supporting the MCZ restructuring process by providing a consultant to provide appropriate technical advisory to the restructuring process; Information and knowledge sharing; and Professional collaboration.
5.7.2 The General Nursing Council
5.7.2.1 Brief Profile
The GNCZ was established under the Nurses and Midwives Act of 1970. This Act was later revised and replaced with the Nurses and Midwives Act of 1997, which redefined the functions of the GNCZ and expanded the scope of practice for nurses and midwives. GNCZ is the only institution mandated by MOH to set, enforce, monitor and evaluate performance standards for nursing and midwifery training, clinical practice, management and research in Zambia. Currently, GNCZ is faced with significant challenges, including the shortages of staff, inadequate capacity to efficiently and effectively fulfil its mandate, and inadequate financial support.
5.7.2.2 Existing Links
GNCZ has in the past established and benefited from a number of Links, on a project basis. However, most of the projects supported by these Links have been completed, leaving significant gaps, which still require filling. A number of past and existing Links were identified at the GNCZ, which are briefly described in Table 12.
Table 12: Existing Links at the General Nursing Council S/N Link Partner Nature of Link 1. Swedish International Institutional collaboration. This Link was established 1997. The Development key technical partner was Karolinska Institutet, a Medical Cooperation Agency University based in Stockholm, Sweden (“Karolinska”). College (“Sida”). of Health Sciences (“CCHS”), Evelyn Hone College, Zambia Integrated Health Project (“ZIHP”), World Health Organisation (“WHO”), the Central Board of Health (“CBOH”) and MOH. Implementation of the activities under this Link also involved the participation of other Zambian institutions, namely, UNZA School of Post-Basic Nursing, UNZA School of Medicine, UTH School of Nursing and Midwifery, Chainama.
August 2007 41 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Programme focused at needs assessment and capacity building for all health training institutions in Zambia. The assessment revealed critical shortages of staff, especially teaching staff, shortages of teaching materials and teaching aids and significant deteriorations in essential infrastructure. Following these findings, a number of activities were conducted, which included: The Problem-Based Learning Group: Through the work of this group, the problem based learning approach was introduced in health training institutions; The Research Group: Tasked to carry out capacity building in research for tutors. Significant capacity building and training of tutors in research was conducted. As a result, a number of research activities were undertaken and a number of books were produced by the tutors; The Books and Libraries Group: Tasked to take inventory of books available in all training institutions. Following this assessment, in 2006, significant quantities of appropriate books and study materials were procured in bulk and distributed to the various training institutions. Procuring of the remaining 50% of the allocation has already started; The Training Assessment and Curriculum Development Group (“TNACD”): Key activities of this group included the review of existing curricula, development of new curricula and training materials, and providing updates for students and teaching staff. The group also produced a handbook on malaria for nurses and midwives; and The Writers Group: This group was tasked to develop a plan on the future long-term sustainability of the activities supported by the Link, once this arrangement has come to an end. The main aim is to identify the key constraints and make appropriate recommendations. 2. John Hopkins This Link focused at the review and development of the University’s Capacity curriculum for midwifery training. Even though the project came Building Programme, to an end in 2004, the following planned activities were not with support from completed and are still relevant: Sensitization activities for the JHPIEGO/USAID. newly developed curriculum; and staff training in continuous assessment. 3. ZHIP/USAID The Zambia Integrated Health Programme (“ZHIP”), with Support. support from the USAID, provided financial and technical support towards curriculum review for nurses and midwives. Also provided one motor vehicle for M&E. This project has since come to an end. 3. Health Services The Health Services Support Program (“HSSP”) is a USAID Support Program sponsored programme. HSSP has been providing financial and (HSSP), Zambia. technical support to some programmes on specific activity basis.
August 2007 42 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
5.7.3 The Tropical Disease Research Centre
The Tropical Disease Research Centre (“TDRC”) is located in Ndola. It is a statutory board mandated to support the health sector with research and development services in tropical diseases. During the mapping visit, it was reported that TDRC has established several Links. However, management offered to make a written submission, which until the time of finalizing this report had not been submitted.
5.7.4 The Zambia National Flying Doctor Service
5.7.4.1 Brief Profile
The Zambia National Flying Doctor Service (“ZNFDS”) was established in 1965 as a service statutory board responsible for providing outreach health care services to most remote areas of the country. The ZNFDS head office is based in Ndola, on the Copperbelt province, and its main services include preventive, curative and general health care services, and emergency evacuation services. ZNFDS flies medical doctors from urban areas to provide outreach medical care services in the remote, difficult to reach rural areas, and also facilitates referral services by flying patients from remote areas to urban hospitals. Currently, the operations of ZNFDS are significant constrained by the following problems and challenges:
Only 2 small aeroplanes available, which do to meet the needs. Previously, had 4 aeroplanes; The available aeroplanes are not pressurized and do not have life-saving equipment and therefore not appropriate for this purpose; Transport problems. Have only one old ambulance for emergency evacuations between the hospital and the airport in Ndola; While a clinic at their base in Ndola, the facility lacks basic equipment; Poor state of communication facilities and equipment. Largely dependent on an old and unreliable radio messaging system; Lacks the necessary ICT equipment and software. Currently, the entire institution has only 6 stand alone desktop computers, and only one of these is connected to the internet; and Inadequate funding, aggravated by the high costs of repairs and maintenance for the aeroplanes.
5.7.4.2 Existing Links
Currently, ZNFDS does not have any Links. However, in the past they had a Link with Oxfarm. This Link, which has since come to an end, focused on providing material support to ZNFDS, in form of boats for transportation of patients to the ZNFDS established points and clinics.
August 2007 43 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
5.7.5 Other Statutory Boards
The other statutory boards are equally experiencing significant constraints and challenges, including critical shortages of appropriate staff, and inadequate funding to the core programmes. Existing Links at the remaining statutory boards have not been identified. However, some of statutory boards receive technical and financial support from bilateral and multilateral donors, on project basis, which may not be classified as Links.
August 2007 44 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
6 POTENTIAL AREAS FOR FUTURE HEALTH LINKS
6.1 Overview
During the mapping exercise, potential areas for future Links were discussed. The areas identified are summarized below, under the following categories: generic, provincial and district management offices, central hospitals, provincial and district hospitals, health centres and health posts, training institutions and statutory boards.
6.2 Generic Potential Areas for Future Links
The problems and constraints being experienced by health service institutions at different levels are to a large extent similar, except for a few which are specific to some institutions. In this respect, most of the potential areas proposed for future Links are generic and could benefit most of the health sector institutions. The areas include:
Technical exchange programmes involving staff at various levels, particularly in specialized areas, to provide for knowledge and skills transfer; Short and long-term secondment of consultants and other experts in all specialized areas, with emphasis on core service areas at every level, on a gap filling basis; Staff training and capacity building for both medical, technical and support staff, through short and long-term training programmes: Short-term training programmes conducted by visiting professors and experts from Link partners, in specialized areas, targeting various levels; Development of standard operating procedures; and Long-term training could be in form of scholarships; Collaboration in research and development activities; Support to systems development in technical fields including core health programmes, supervision, and monitoring and evaluation; Support to knowledge sharing, through provision of e-learning opportunities and promotion of the use of modern ICTs, including facilitation of internet connectivity, internet-based knowledge exchange with the British National Formulary and other sources of essential medical journals and publications;; Specialist support to repairs and maintenance of medical equipment. Currently, there are no in-house expertise in this area, resulting into frequent breakdowns and pre- mature write-off of various equipment; and Material support in identified priority areas, including infrastructure development, provision of equipment and auxiliaries, drugs and medical supplies, and other forms of material support, on a gap filling basis.
August 2007 45 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
6.3 Provincial and District Health Management Level
In addition to the generic potential areas for Links, PHOs and DHMTs would require support aimed at addressing their specific needs, including:
Capacity building and skills strengthening in supervision skills, monitoring and evaluation; and Transport and communication to strengthen routine and adhoc supervision, and monitoring and evaluation.
6.4 Hospitals at all Levels
The following are the additional potential areas for future Links for the hospitals, based each facility’s specific needs:
6.4.1 UTH/UNZA School of Medicine
The UTH/UNZA School of Medicine have already developed a significant number of Links with various international counterpart institutions. However, these Links appear to be fragmented by departments and sections, and are not coordinated both at the institution and sector levels. In view of the foregoing, what would be required is to analyse these Links in detail, align them to institutional and sector objectives and priorities, identify the gaps and develop an appropriate framework for coordination, monitoring and evaluation.
6.4.2 Ndola Central Hospital
Through performance assessments and other studies, the Copperbelt PHO and the Ndola central hospital management team have identified the following as some of the specific areas requiring Links at the Hospital:
A Link with an obstetrics unit of a major teaching hospital to provide continuous technical support to the doctors at the hospital; and Secondment of consultants in: Maternal care, to provide support in the establishment of an obstetrics and gynaecology post-graduate training school; Neonatal care, including the introduction of latest guidelines on neonatal resuscitation and kangaroo care method; and Training of biomedical engineers.
In Ndola district, Maternal Mortality Ratio (“MMR”) is currently estimated at 230-330 per 100,000 live births. A review of maternal deaths for 2006 attributed most of the maternal deaths to lack of supervision of the intern doctors, due to the critical shortage of obstetricians and gynaecologists at the hospital.
August 2007 46 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Establishment of a Link with an obstetrics unit of a major teaching hospital would therefore be of great benefit as it would mitigate the current shortages of these specialists. The benefits to the UK doctors would be to gain experience in attending to women in the Tropical African environment, surgical repairs of fistulas, advanced cervical cancer and treatment of acute septic abortions that are not commonly found in the UK. This could take the form of exchange visits of about 3-6 months or longer, if an obstetrician could be 'posted' to the hospital to train the intern doctors and those specializing in obstetrics and gynaecology. If possible, establishment of a permanent training centre for Obstetrics and Gynaecology in Ndola would make a major contribution.
Neonatal care is another challenge for the Ndola Central Hospital. There is need to establish a Link with a neonatal/paediatrics unit of a major teaching hospital. Neonatal mortality is extremely high, and yet staff shortages do not allow for dedicated nurses to be in attendance of neonates at all times. The use of kangaroo care or “skin to skin” method of caring for the neonates is not practiced. Further, oxygen and suction are used in resuscitation, instead of ambu bags. Introduction of the “skin to skin” method of caring for neonates, as practiced at Monse hospital in Zambia, would be ideal. Also required are skills updates and adherence to the American Association of Neonatal resuscitation guidelines. Such a Link would be of significant benefits to both parties.
Maintenance and repair of medical equipment is a challenge. There is no training programme for biomedical engineers, although a local college and UNZA provide training for technicians and degrees in electrical and electronic engineering, respectively. The Netherlands has made commitments to support the establishment of an ongoing training programme to supplement the graduates from these colleges to become medical equipment technicians and medical engineers.
6.4.3 Kitwe Central Hospital
KCH’s needs for future Links are, to a large extent, similar to those outlined under generic potential areas of future Links and those for Ndola Central Hospital. In addition, KCH needs to establish an obstetric unit, including theatre and equipment, to replace the smaller unit that now exists. The hospital serves 31 health centres for complicated cases and several districts for 3rd level referrals.
6.4.4 Arthur Davison Children’s Hospital
Due to its specialised nature, in addition to the list of generic potential areas for future Links, ADH also requires long-term secondment of consultants and other experts in all the specializations, especially in neonatal and child health care, HIV/AIDS, malaria and tuberculosis, which all rank high on the major cases at ADH.
August 2007 47 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
6.4.5 Provincial and District Hospitals (Level 1 and 2 Hospitals)
In addition to the generic needs for Links, these categories of hospitals would require Links in support to:
Support to maternal and child health, including expertise, infrastructure and transport support. Most of the district hospitals are located in rural areas and face significant challenges in the management of expectant mothers and children, due critical shortages of staff, poor state of infrastructure and shortages of transport and communication facilities for Emergency Obstetrics Care (“IMOC”); and Support to HIV/AIDS programmes, including prevention and treatment, particularly in rural areas. Rural areas are significantly disadvantaged as far as distribution of experts and capacities to manage ART programmes.
Specific priorities for each facility could be identified from their Strategic Plans and Annual Action Plans.
6.5 Health Centres and Health Posts
HCs and HPs are probably the most affected in terms of shortages of qualified staff, essential drugs and medical supplies, communication, transport, logistics and poor state of infrastructure. HCs and HPs could benefit from Links focused at:
Support to service delivery in form of secondment of personnel, including doctors, nurses, clinical officers, probably to the DHMTs, so that they form a pool of qualified staff who could be covering all the HCs and HPs in the particular district, on a gap filling basis; Staff training and capacity building in core programme areas and maintenance of medical equipment. Again, such training could combine staff from various HCs and HPs; Institutional capacity building, including support to infrastructure, communication and transport.
6.6 Health Training Institutions
One of the main strategies proposed in the Human Resource Plan is the need to expand training outputs of health training institutions. This requires significant strengthening of capacities at training institutions, including renovations and expansions of infrastructure, improving on the availability of teaching staff and teaching aids. In this respect, this area has significant potential for establishment and strengthening of partnerships with international health training institutions, through Links. In addition to the list of generic needs for Links, training institutions would require Links in the following areas:
Long-term secondment of teaching and other experts from the Links;
August 2007 48 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Continuous curriculum reviews and introduction of modern teaching methods; Material support in identified priority areas, requiring gap filling. These include the provision of teaching aids, study materials and text books, both electronic and hard copies, upgrading the standards of the libraries and laboratories; and Support to infrastructure development, including classrooms and hostels.
6.7 Statutory Boards
6.7.1 The Medical Council of Zambia
MCZ requires Links to develop appropriate capacity to regulate the medical profession in a more efficient and effective manner. In addition to the generic areas for potential Links, MCZ has identified the following areas:
Technical support in organization and management, preferably in form of a long-term technical advisor; Systems development in technical fields including supervision, monitoring and evaluation; and Technical collaboration with similar institutions abroad.
6.7.2 The General Nursing Council
GNCZ has continued to face significant challenges, particularly in respect of shortages of staff, inadequate financial and technical support to its core programmes, transport and logistics. Whilst the previous Links have proved very useful, they have left gaps that need to be filled. GNCZ has identified the following as the specific areas requiring future Links:
Technical expertise and financial support towards the following activities: Curriculum reviews; Development and procurement of study materials and text books; Information, education and communication of core activities; Programme supervision, monitoring and evaluation, including provision of transport; Exchange programmes and attachments for staff from GNCZ and nurse and midwifery training institutions on an exchange basis; and Research and development programmes; Support to the development and enhancement of the use of ICTs at GNCZ and in nursing and midwifery training institutions; and Support towards infrastructure development. GNCZ would like to construct an office block for their operations, a centre of excellence and a resource centre.
August 2007 49 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
6.7.3 The Tropical Disease Research Centre
The mapping of health Links established that TDRC has a number of Links. Management offered to make a written submission on the existing and required Links. However, the same had not been received by the time of finalizing this report.
6.7.4 The Zambia National Flying Doctor Service
The following were identified as the priority areas for future Links:
Technical and financial support towards: pressurizing and equipping the available aeroplanes with emergency life-saving equipment; equipping the clinic with the necessary basic equipment and provision of additional appropriately equipped ambulances; Staff training, especially for core staff, i.e. doctors and nurses, in handling of emergencies; Improvements in communication systems. Replacement of the old radio messaging system with modern radio communication systems; and Improving the availability and access to modern ICTs, including provision of hardware, software, networking and improved access to the internet.
6.7.5 Medical Imaging and Radiology
In Zambia, radiology was introduced in the early 1930s, initially providing conventional x-ray services. Over the years, other forms of imaging services such as ultrasound, nuclear medicine and, later, computerized tomography, have gradually been introduced. Medical Imaging is important in the provision of the Basic Health Care Package (BHCP), as it provides essential diagnostic services for clinical policy decisions making. It is estimated that, currently, approximately 70% of cases in Zambian hospitals are referred to radiology at some stage of case management.
Even though significant progress has been achieved in the development of medical imaging in Zambia, there are still significant problems and constraints in this area. The major ones include shortages of appropriately qualified staff, obsolete equipment, poor infrastructure, shortages of essential consumables, no clear policy and standard operating procedures, lack of educational facilities for advancement in education, and poor public awareness on hazards of radiation.
August 2007 50 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Medical imaging is one area which could significantly benefit from establishment of appropriate Links with counterpart institutions in the UK and other developed countries. In June 2007, a team of experts from the Zambian Ministry of Health, led by the Director of Clinical Care and Diagnostic Services, conducted a study tour of the United Kingdom, under the THET programme. The main objective of this tour was to discuss development of medical imaging services, through education and training.
The Zambian team also held discussions with officials from the South Bank University and the Society and College of Radiographers, where issues of education and training were widely deliberated. Through this process, the following were identified as potential areas for future Links:
Development of a Link in form of twinning of the Radiography Department at South Bank University with the Department of Radiography at the University of Zambia; South Bank University to provide Continued Professional Development through Lecturer upgrade in various fields under the leadership of Professor Mary Lovegrove. Some funds have already been set aside for the initial part; Collaboration with the College of Radiographers in area of Teaching Aid Materials and Journals; Training of some Zambia Radiographers beyond first-degree qualification, with advanced practice as front line practitioners in radiology; South Bank University interested in reviewing the Zambian BSc. Radiography Curriculum before validation and adoption by the University of Zambia Senate; and Seeking UK Lecturers to kick start the BSc Degree Programme whilst Zambian lecturers undergo upgrade training.
It was also agreed that the South Bank University should conduct a Situation Analysis of Medical Imaging Services Education and Training in Zambia, which could form a basis to identification of needs.
6.7.6 Other Statutory Boards
Most of the statutory boards could greatly benefit from Links covering the following areas:
Technical support, including secondment of technical advisors to support core programme areas; Staff training and technical exchange programmes in core business areas; and Material support, on a gap filling basis, in identified priority areas.
August 2007 51 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
7 PROPOSED PROCESS FOR IDENTIFICATION OF FUTURE LINKS
As earlier discussed in the background and also observed from the findings, even though the concept of Links is not widely understood and applied in Zambia, there are a number of health institutions that have taken initiative to establish Links. However, these Links lack an appropriate framework for effective organisation, management, and monitoring and evaluation. As a result, they are not properly coordinated and in some cases not linked to the sector and institutional priorities.
In order to improve on this situation and ensure that the Links are properly coordinated and targeted at the right priorities, it is recommended that the process of identifying priority areas should be linked to the planning process. The areas for Links should be identified from the sector and institutional priorities outlined in the national health strategic plans, medium term expenditure framework and annual action plans. In the same spirit, implementation of Link activities should be managed in a transparent and accountable manner, and be clearly reflected in the plans and progress reports, and captured under the monitoring and evaluation arrangements in practice within the Ministry and the relevant institutions.
August 2007 52 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
8 APPENDICES
S/N Description/Title Appendix I Terms of Reference Appendix II Trends for Top 10 Major Diseases in Zambia, 2000-2006 Appendix III Staffing Levels and Workloads Appendix IV Distribution of Core Health Workers By Province Appendix V Consolidated List of Existing Links Appendix VI List of Institutions and Persons Interviewed Appendix VII List of Documents/Literature Consulted Appendix VIII Reports Links Partners
August 2007 53 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Appendix I: Terms of Reference
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Terms of Reference for Mapping Health Links in the Zambia Health Services and Associated Academic Institutions
Background The health sector in Zambia is faced with a human resources crisis due to migration of core health workers from the public health institutions to the private sector within the country and overseas, mostly to the UK, Australia, New Zealand and the USA. The root cause of attrition is poor conditions of service in the public health system. Death among core health workers due to HIV/AIDS is another cause of attrition.
The most affected facilities are secondary and tertiary level hospitals which have lost both qualified and experienced consultants, nurses and other paramedics. Training institutions have equally been affected through migration of lecturers and tutors in search of better conditions of service overseas. In order to address the staffing problems faced by health facilities and training institutions, managers within these facilities have established Health Links [hereafter referred to as Links] with partner institutions in foreign countries. Through such Links, medical experts in foreign countries have visited hospitals and training institutions to provide services, teaching or service development on a gap filling basis. There have sometimes been reciprocal teaching visits by Zambia staff overseas. Such Links are very common at the University Teaching Hospital and the School of Medicine at the University of Zambia. While such Links have resulted in a transfer of knowledge and skill to health workers in Zambia, there are concerns that such efforts might have resulted in fragmentation and duplication of effort by the parties. In certain instances, such Links have not addressed the key priority areas that require capacity building in the health institution. In most cases, such Links have been through individual efforts and did not fully address the capacity needs of respective institutions. The Ministry of Health [MOH] has acknowledged that there is need to better co-ordinate Links between the health facilities in Zambia and overseas institutions through identification of already existing Links and using a holistic approach to identifying areas and institutions that require capacity building through such efforts, in line with MOH’s strategic plans.
In order for the MOH to establish Links that will address the capacity needs of the country it, together with the Tropical Health and Education Trust [THET], intends to undertake a mapping exercise of existing Links and to identify areas that will require Links in future in collaboration with THET and similar organisations in other countries. Through this effort it is expected that the MOH will better co-ordinate its capacity building efforts through Links with foreign institutions.
Definitions Links are developmental partnerships which build capacity in Zambia’s health staff and the health care delivery system at primary, secondary and tertiary levels including in medical, nursing and other health related colleges or schools. They also have advantages for the non-Zambia partner/s through the acquisition of new knowledge, skills, and awareness. In Links one partner must be in Zambia and the other/s from another country. Some partnerships will have more than two partners and may involve several countries. Partnerships can involve individuals, departments, whole institutions, districts, professional associations or networks. Note; during the research and in the Zambia context this definition may need refining and this should be done in agreement with THET and the MOH Planning Department.
August 2007 1 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Purpose The outcomes of the research will be used:
By the MOH to identify areas and institutions that require capacity building through Links. This will enable the MOH to prioritise better institutions that will require capacity building through Links By the MOH to strategically influence future Links with all overseas partners By THET to facilitate the creation of Links with the UK within the MOH’s strategy By other researchers to identify field sites to assess the impact of Links on the Zambia Health Services and on the other partners.
Accountability The consultant will be in contract to THET who will work with the Zambia MOH Planning Department to manage the contract. The outcomes should be made available to the MOH and THET.
Context The Zambia Ministry of Health has already mapped existing health services/facilities in Zambia and they have also mapped large donors. THET has agreed with the MOH that for the purpose outlined above mapping is needed of Links.
Specification The consultant should:
1. Contact all Zambia Health Facilities and “map” existing Links including the name of the partners, the focus of the partnership and the frequency and type of activities. 2. This will include such information as the number of people involved, numbers trained, exchanges and activity plans. 3. Identify the sources and level of resources [human and financial] supporting the Link. 4. Collect from Links copies of their evaluations or of evidence and stories which fall short of evaluations but give useful indications of the impact of their activities. 5. Produce a report which should include the following outcomes: A brief description of the methods used to collect the information. A description of Links in Zambia including their location, name of the partners, the focus or foci of the partnership and the frequency and type of activities. A description of the sources and level of resources [financial and human] available to support the Link. A collation of evaluations already undertaken of the Links. An analysis of trends and themes emerging from Link activities that would inform future policy on Links by MOH and THET. A description of health service processes and institutions that could benefit from capacity building through Links, particularly those that are highlighted in MOH plans.
August 2007 2 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Appendix II: Trends for Top 10 Major Diseases in Zambia, 2000-2006
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Trends for Top 10 Major Diseases in Zambia, 2000-2006 S/N Disease Name Indicator 2000 2002 2004 2005 2006 1. Malaria Incidence/1,000 316 388 383 373 410 Cases 3,591,621 4,101,169 4,328,485 4,361,436 4,947,096 Deaths 8,952 9,021 8,289 7,737 6,471 2. Respiratory Incidence/1,000 119 148 153 161 192 Infection: Non- Cases 1,340,283 1,565,430 1,726,597 1,883,618 2,322,362 pneumonia Deaths 1,269 1,057 1,436 911 687 3. Diarrhoea: Non- Incidence/1,000 65 80 75 75 81 blood Cases 739,055 846,336 843,423 875,077 977,138 Deaths 2,795 2,996 2,725 2,931 2,427 4. Trauma: Incidence/1,000 34 42 46 46 48 Accidents, Cases 390,869 447,278 525,039 538,359 576,495 injuries, Deaths 646 787 833 829 806 wounds, burns 5. Eye Infections Incidence/1,000 47 43 40 40 41 Cases 471,743 451,346 448,280 461,881 498,884 Deaths 72 8 5 - 1 6. Skin Infections Incidence/1,000 28 37 42 42 41 Cases 309,758 393,384 472,746 491,858 493,864 Deaths 135 126 125 88 103 7. Respiratory Incidence/1,000 35 45 44 42 39 Infection: Cases 402,643 475,389 494,040 493,765 474,996 Pneumonia Deaths 4,254 4,484 4,186 4,273 3,425 8. Ear/Nose/Throat Incidence/1,000 21 25 23 24 26 Infections Cases 238,403 260,058 259,877 277,421 314,470 Deaths 49 31 34 79 31 9. Intestinal Incidence/1,000 20 22 17 16 16 Worms Cases 217,142 227,856 197,639 188,733 197,701
Deaths 49 14 6 10 3 10. Anaemia Incidence/1,000 13 16 15 13 13 Cases 155,149 166,241 170,846 148,948 158,544 Deaths 2,761 2,612 2,381 2,474 2,507 Source: Health Management Information System (HMIS) Report 2006, Ministry of Health
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Appendix III: Staffing Levels and Workloads
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
STAFFING LEVELS STAFF/POPULATION RATIOS Recommended Existing Staff/ Recommended Existing Establishment Existing Population Ratios, Staff/Population Staff Category Staff (2005) Variance Staff 1: Ratios, 1: Doctors 646 2,300 1,654 646 17,589 4,940 Nurses 6,096 16,732 10,636 6,096 1,864 679 Mid Wives 2,273 5,600 3,327 2,273 4,999 2,029 Clinical Officers 1,161 4,000 2,839 1,161 9,787 2,841 Pharmacists 24 42 18 24 473,450 270,543 Pharmacy Tech 84 120 36 84 135,271 94,690 Lab. Scientists 25 50 25 25 454,512 227,256 Lab. Technologists 100 210 110 100 113,628 54,109 Lab. Technician 292 1,300 1,008 292 38,914 8,741 EHO 53 120 67 53 214,393 94,690 EH Technologist 32 220 188 32 355,088 51,649 EH Technicians 718 1,300 582 718 15,826 8,741 Dental Surgeon 14 33 19 14 811,629 344,327 Dental Technologist 40 300 260 40 284,070 37,876 Dental Therapist 2 300 298 2 5,681,402 37,876 Physiotherapist (Degree level) 0 50 50 0 - 227,256 Physiotherapist (Diploma level) 86 250 164 86 132,126 45,451 Radiologists 3 33 30 3 3,787,601 344,327 Radiographers 139 200 61 139 81,747 56,814 Paramedics 320 6,000 5,680 320 35,509 1,894 Nutritionist 65 200 135 65 174,812 56,814 Support Staff 11,003 10,000 -1,003 11,003 1,033 1,136 Total 23,176 49,360 26,184 23,176 490 230 Source: Ministry of Health HRIS database/NHSP
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust Mapping of Health Links in the Zambian Health In conjunction with Services and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Appendix IV: Distribution of Core Health Workers By Province
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Table 1: Distribution of Core Health Workers by Province Zambia Zambia Environmental Clinical Registered Registered Enrolled Enrolled Pharmacy Lab. Paramedical Health Province Doctors Officer Midwives Nurse Midwives Nurse Staff Staff Staff Technologists Total Central 35 132 60 84 242 388 9 37 46 93 1,126 Copperbelt 202 187 126 357 505 1,160 33 110 140 79 2,899 Eastern 29 138 15 103 159 506 8 28 38 95 1,119 Luapula 15 65 10 36 39 274 5 25 21 55 545 Lusaka 256 212 129 421 305 1,014 5 103 162 58 2,665 North Western 21 55 5 38 41 281 7 18 20 73 559 Northern 22 107 18 94 149 320 5 30 35 90 870 Southern 38 174 31 117 359 663 16 48 53 126 1,625 Western 28 91 16 38 64 350 4 18 30 81 720 Total 646 1,161 410 1,288 1,863 4,956 92 417 545 750 12,128 Source: HRHSP 2006/10, MOH, Zambia
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services In conjunction with and Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Appendix V: Consolidated List of Existing Links
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Consolidated List of Existing Links
Province Institution Link Partner Type of Link Central Kabwe General Hospital, Massachusetts General Hospital, Research on Maternal and Infant Health Improvement Kabwe USA Central Kabwe Mine Hospital, Kabwe Massachusetts General Hospital, Systems strengthening and staff training. USA Copperbelt Ndola College of Bio-Medical Irish Aid (Dublin in Institute of Infrastructure, Staff development, 18 staff members have been trained. Science, Ndola Technology) up 2006. Eastern St. Francis Hospital, Katete Summer Concert, Netherlands. The summer concert event was introduced nine years ago. This is an outdoor summer music concert held in Laren, the Netherlands, every year to provide entertainment to the general public and raise funds for St. Francis hospital. Funds raised at these concerts are often supplemented by the Netherlands Government and sent to St. Francis hospital. Eastern St. Francis Mission Hospital Simavi, Netherlands. Simavi is a Dutch Organisation currently supporting the project aimed at improving water supply at the hospital. They have also previously funded the procurement of an x-ray machine for the hospital.
Eastern St. Francis Mission Hospital, Bed Sponsorship Scheme, A bed sponsorship scheme has been introduced as a fundraising Katete Netherlands: activity for the hospital. Under this scheme, organizations and individuals sponsor specific beds in the hospital at $1,500 per bed per year. The hospital provides the sponsors quarterly reports on the performance of the sponsored beds. Most of the money raised by this scheme is used on the procurement of drugs for the hospital. Eastern St. Francis Mission Hospital, Catholic Medical Missions Board CMMB are part of the AIDS Relief Consortium and were very Katete (“CMMB”), USA. instrumental in St. Francis being selected as one of the first five AIDS Relief sites in Zambia. CMMB have also recruited a doctor from USA to work at the hospital. Eastern St. Francis Mission Hospital, Catholic Relief Services (“CRS”), CRS is the lead organization in the AIDS Relief consortium. Katete USA. Eastern St. Francis Mission Hospital, Christian Aid. Supported the hospital’s AIDS project for many years. They have also Katete previously made other donations, such as the upgrade of the Special Care Baby Unit.
August 2007 1 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Eastern St. Francis Mission Hospital, Cordaid, Netherlands: Cordaid has been supporting the hospital’s HIV/AIDS project for Katete many years. They have since taken over the role of lead donor, helping to co-ordinate communications with the other donors to the programme. Cordaid have in the past assisted with staffing, particularly doctors. Eastern St. Francis Mission Hospital, Direct Relief International DRI has been supporting the hospital with donations of drugs and Katete (“DRI”), USA. medical supplies and medical equipment. The first container of drugs, medical supplies and equipment from DRI was received by the hospital in 2004. Eastern St. Francis Mission Hospital, Episcopal Relief and Development Recently started to support the AIDS project. It was with their support Katete (“ERD”), USA. that the new vehicle for the AIDS project was purchased in 2004.
Eastern St. Francis Mission Hospital, Friends of St Francis’, UK. Friends of St. Francis Hospital is an organization that keeps former Katete members of staff of the hospital in touch with each other and up to date with news from the hospital. It also raises a substantial amount of funding for the hospital. The funds come in all various forms, including personal donations from former staff and other friends of the hospital, church groups, special fundraising events, such as marathons, birthdays (whereby birthday gifts are donated to the hospital) and stalls at exhibitions. They also assist with recruitment of volunteers, mainly doctors, from the UK. A donation of £10,000 was made a few years ago and the bank interest on this amount has been used to fund staff training. Most of the funds raised go towards procurement of drugs and medical supplies, which are sent annually by container, supplementary salaries for senior doctors and other key staff, and support to staff training. Eastern St. Francis Mission Hospital, Gooi Noord Hospital, Netherlands. For some years there has been a relationship with this hospital. This Katete relationship was strengthened by Dr. Jan Croft, Chirug (Surgeon) when he retired from Gooi Noord. Dr. Croft had also used to work at St. Francis’. The support has varied, ranging from sending short term personnel to assist in the laboratory, equipment and financial support through Bed Sponsorship Scheme. It is hoped that the relationship could be developed further. Eastern St. Francis Mission Hospital, Guernsey Overseas Aid (“GOA”). GOA has funded the construction of 4 staff houses for the hospital. Katete They have also been providing financial support through MSG.
August 2007 2 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Eastern St. Francis Mission Hospital, Hands Around The World This organization was founded by Dr. David Steiner, who used to work Katete (“HATW”), UK. at the hospital as a doctor in the early 1990’s. The aim of this organization is to assist by sending skilled volunteers for short periods to share their skills. A number of volunteers have visited and assisted in the pharmacy, maternity and ultrasound sections. Eastern St. Francis Mission Hospital, Jersey Overseas Aid (“JOA”), Over the years, JOA has supported the hospital through sending of Katete USA. workgroups, funding of building projects, such as the recent housing project, and procurement of drugs and medical supplies. Eastern St. Francis Mission Hospital, Katho College, Belgium. This Link started in 2003, largely through the initiative of Dirk Katete Monbaliu. The college trains nurses and midwives, among many other professions. The training support programme focuses at providing students with opportunities to spend part of their time in a different environment. As a result of this support, a group of nursing and midwifery students came and spent 12 weeks at the hospital, gaining experience on the wards as well as theoretical learning. Two of their tutors also spent some time at the hospital, both with their own students and also the hospital’s own nursing students. Katho College has also provided financial support to the hospital, particularly to support the school library. The programme will continue. Eastern St. Francis Mission Hospital, Lions International (The Lions). The Lions have supported the hospital’s eye work for a number of Katete years. In 2005, they donated a vehicle for eye outreach activities. They have also provided funds for motor vehicle repairs, funded eye camping sessions and sponsored staff training programmes. Eastern St. Francis Mission Hospital, Lothian Health Board, Scotland. A team from Lothian Health Board visited the hospital in 2004, Katete comprising of clinical staff and a health information specialist, on a fact-finding mission to identify areas of support and collaboration. The information specialist also spent some time working with hospital records staff.
August 2007 3 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Eastern St. Francis Mission Hospital, Medical Support Group, The Medical Support Group (“MSG”) was founded by former Katete Netherlands. members of staff of St Francis’ Hospital, living in the Netherlands. The main aim of MSG is to provide support to the hospital, which is being done in a number of ways, including fundraising, material support and establishing linkages between the hospital and various donors. MSG has also been providing support to capital projects and the workshop. In this respect, on several occasions, they have been sending senior members to St Francis to physically assist with building projects and provide support to the workshop. Over the years, the MSG has also been providing material support in form of drugs and equipment donated to the hospital. Eastern St. Francis Mission Hospital, Missio Austria. Mission has been supporting the HIV/AIDS project for ten years. Katete Eastern St. Francis Mission Hospital, Old Catholics, Bonn, Germany. Supports the hospital AIDS project. Katete Eastern St. Francis Mission Hospital, Sandy Logie Fund. Support for treatment of HIV patients. Katete Eastern St. Francis Mission Hospital, Scottish Borders Africa AIDS The Group has been supporting the hospital’s AIDS project, through Katete Support Group. fundraising. Eastern St. Francis Mission Hospital, United Society for the Propagation USPG was formed by merging two mission societies, namely the Katete of the Gospel (“USPG”). Universities Mission to Central Africa (“UMCA”) and the Society for the Propagation of the Gospel (“SPG”). The link with UMCA dates back to the founding of the hospital in 1948 by Fr. Francis Trefusis, a missionary with UMCA. Many of the early members of staff at the hospital were UMCA missionaries. UMCA/USPG support to the hospital has continued, through provision of medical doctors and other qualified health workers and financial and material support. In this respect, the current Executive Director and Pediatrician, Dr. Shelagh Parkinson and the Manager Administration, Ian Parkinson are USPG missionaries. They have also taken particular interest in supporting HIV programmes and, for a number of years, have been sending HIV infection prevention kits, containing HIV test kits, gloves, syringes, needles, disinfectants and sharps boxes, and have also been piloting a post exposure prophylaxis policy, aimed at reducing the risks of staff getting infected by HIV upon being accidentally pricked by contaminated needles.
August 2007 4 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Eastern St. Francis Mission Hospital, Zambia Anglican Council (“ZAC”, Has been providing financial grants to the hospital. Through the Katete Zambia. Administrator Revd Rogers Banda, they also assist with processing immigration and medical council papers for expatriate staff and clearing through customs and Ministry of Finance of all items coming from overseas.
Eastern St. Francis Mission Hospital, Zambia Society Trust, UK. The society has been supporting the AIDS Orphans programme, Katete through the AIDS project. Luapula Mansa General Hospital, Indirect link through Rotary Club Provision of equipment and drugs. Mansa of Mansa Direct Relief International Lusaka Chainama Hills Hospital and Beit Trust, UK. Has pledged to provide financial support to construct a lecture theatre. College Project awaiting finalization of building plans by the Ministry of Works and Supply. Lusaka Chainama Hills Hospital and Lothian Health Board, Scotland. Providing support in form of providing specialists. College Lusaka Chainama Hills Hospital and Mental Health Trust, UK Providing support in form of teaching at the college. Also supporting College the hospital in health service provision and staff training. Lusaka Chainama Hills Hospital and HSSP/JPIGHO, USA Support to curriculum development. College, Lusaka Chainama Hills Hospital and Training support, through Degree Programs’ and scholarships. Leads College, Lusaka Metropolitan University is currently running Masters in Public Health; Leeds Metropolitan University, Lusaka and Doctor of Philosophy in public health programs at Chainama Hills UK College. Sends lecturers to support these programmes which are quarterly/modular based. A new intake of 3 started in March 2007. Lusaka Chainama Hills Hospital and Michigan University, USA Health Care support. College, Lusaka Lusaka Chainama Hills Hospital and National Malaria Control Center, Institutional collaboration. College, Lusaka Zambia Lusaka Chainama Hills Hospital and Operation Eyesight, Canada Has pledged to support the college in infrastructure development. College, Lusaka Lusaka Chainama Hills Hospital and Prime – UK NGO Training support, Medical School. College, Lusaka Lusaka Chainama Hills Hospital and Sight Savers International, UK. Technical and material support to the orthomology programme. College, Lusaka
August 2007 5 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Lusaka Chainama Hills Hospital and The University of Manchester, UK Training support, MPH and PHD in Public Health scholarships for College, Lusaka members of staff. From 2000 to 2002, Manchester University conducted a Masters of Education in Primary Health programme at Chainama College. Lusaka Chainama Hills Hospital and University of Mehari (Medical Training support, Masters in Nero Psychiatry. College, Lusaka School Lusaka Chainama Hills Hospital and University of Zambia (UNZA), Support to Palliative Care. Affiliation to INZA College, Lusaka Zambia Lusaka Chainama Hills Hospital and VVOB, Belgium. Collaboration in teaching. Providing technical advisors and supporting College, Lusaka workshops. Support to the computer laboratory.
Lusaka General Nursing Council WHO Various areas, including capacity building Lusaka General Nursing Council of Health Services Support Program The Health Services Support Program (“HSSP”) is a USAID Zambia (“GNCZ”) (HSSP), Zambia. sponsored programme. HSSP has been providing financial and technical support to some programmes on specific activity basis. Lusaka General Nursing Council of John Hopkins University’s This Link focused at the review and development of the curriculum for Zambia (“GNCZ”) Capacity Building Programme, midwifery training. Even though the project came to an end in 2004, with support from the following planned activities were not completed and are still JHPAIEGO/ZHIP/USAID. relevant: Sensitization activities for the newly developed curriculum; and staff training in continuous assessment. Lusaka General Nursing Council of Swedish International Institutional collaboration. This Link was established 1997. The key Zambia (“GNCZ”) Development Cooperation Agency technical partner was Karolinska Institutet, a Medical University based (“Sida”), Sweden in Stockholm, Sweden (“Karolinska”). College of Health Sciences (“CCHS”), Evelyn Hone College, Zambia Integrated Health Project (“ZIHP”), World Health Organisation (“WHO”), the Central Board of Health (“CBOH”) and MOH. Implementation of the activities under this Link also involved the participation of other Zambian institutions, namely, UNZA School of Post-Basic Nursing, UNZA School of Medicine, UTH School of Nursing and Midwifery, Chainama.
Programme focused at needs assessment and capacity building for all health training institutions in Zambia. The assessment revealed critical shortages of staff, especially teaching staff, shortages of teaching materials and teaching aids and significant deteriorations in essential infrastructure. Following these findings, a number of activities were conducted, which included: The Problem-Based Learning Group: Through the work of this
August 2007 6 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
group, the problem based learning approach was introduced in health training institutions; The Research Group: Tasked to carry out capacity building in research for tutors. Significant capacity building and training of tutors in research was conducted. As a result, a number of research activities were undertaken and a number of books were produced by the tutors; The Books and Libraries Group: Tasked to take inventory of books available in all training institutions. Following this assessment, in 2006, significant quantities of appropriate books and study materials were procured in bulk and distributed to the various training institutions. Procuring of the remaining 50% of the allocation has already started; The Training Assessment and Curriculum Development Group (“TNACD”): Key activities of this group included the review of existing curricula, development of new curricula and training materials, and providing updates for students and teaching staff. The group also produced a handbook on malaria for nurses and midwives; and The Writers Group: This group was tasked to develop a plan on the future long-term sustainability of the activities supported by the Link, once this arrangement has come to an end. The main aim is to identify the key constraints and make appropriate recommendations. Lusaka General Nursing Council of ZHIP/USAID Support. The Zambia Integrated Health Programme (“ZHIP”), with support Zambia (“GNCZ”) from the USAID, provided financial and technical support towards curriculum review for nurses and midwives. Also provided one motor vehicle for M&E. This project has since come to an end. Association of Medical Council of Lusaka Medical Council of Zambia Southern Africa (14) countries Information Sharing on professionals (Collaboration) General Medical Council (GMC), Lusaka Medical Council of Zambia UK; Information sharing (long term) UTH - Department of Child Advocacy International Lusaka Pediatric (CAI) Student Exchange, Research UTH - Department of Lusaka Pediatric Copenhagen / Denmark Research Collaboration London School of Tropical Health ( International Federation of Lusaka UTH - EYE Unit opthmology- CANON Education Capacity building /Staff Training
August 2007 7 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Trust Operation Eyesight University/ Lusaka UTH - EYE Unit Irish Aid Human Resources Development , Clinical, Instrument Technician, Operation Eyesight University/ Lusaka UTH - EYE Unit Irish Aid Infrastructure Development Operation Eyesight University/ Lusaka UTH - EYE Unit Irish Aid Program administration Lusaka UTH - EYE Unit Vision Aid Overseas Human Resources Development , Clinical, Instrument Technician, London School of Tropical Lusaka UTH - Labs Hygiene (ZAMBART) TB Research University College of London Lusaka UTH - Labs Middlesex Pediatrics 4 yrs Lusaka UTH - Labs University of Alabama Birmigham Research , CIDARZ Lusaka UTH - Labs University of Alabama Birmigham Placenta transmission of HIV/AIDs (research finished Lusaka UTH - Nursing School Johnson & Johnson Capacity building Lusaka UTH - Nursing School Karolin’s, Sweden Staff and student exchange programmes Lusaka UTH - Nursing School CIMO – Finland (www.stadia.fi ) Staff and student exchange World Federation of Lusaka UTH - Anesthesia School Anesthesiologist Supply of Literature UTH - Department of Lusaka Pediatric Harvard University Area of Sickle Cell, Screening, Capacity building UTH - Department of Lusaka Pediatric Marie Master University Research Capacity building UTH - Department of Lusaka Pediatric Medical Research Council (MRC) Measure of drugs UTH - Department of Lusaka Pediatric Mehari University Student Exchange UTH - Department of Lusaka Pediatric MIE University Japan Research on ROTA virus ( vaccine) UTH - Department of National Atomic Energy 2001 for Lusaka Pediatric 3 yrs & renewed 2004 Technical Co-operation UTH - Department of Lusaka Pediatric Pharmaco- Kinetics (prof Chintu) ARV – for children – Metabolism; fixed dose, UTH - Department of Lusaka Pediatric University of Yale (USA) Research Collaboration Lusaka UTH - Department of WHO Sickle Cell management
August 2007 8 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Pediatric UTH - Department of Lusaka Pediatric WHO-TDRC Multi-lateral Malaria Research and ICT communication infrastructure Brighton Sussex University Lusaka UTH - EYE Unit Hospital Provide Spectacles Lusaka UTH - EYE Unit Sight Server International & Human Resources Development , Clinical, Instrument Technician, JICA (Yamanashi University (5yrs Lusaka UTH - Labs has ended) Setup Lab, Provided staff, Trainined, PHD, Msc Lusaka UTH - Nursing School Brighton University Departmental Training for nurses UTH - Obstetrics & Academic exchange program –lecturers- Curriculum & Teaching Lusaka Gynecology Department Brighton University method UTH - Obstetrics & Lusaka Gynecology Department CIDARZ Clinical care on PMTC UTH - Obstetrics & DFID through MRC UK Medical Lusaka Gynecology Department Research Center Multiple site trials in Mazabuka Microbicides UTH - Obstetrics & Lusaka Gynecology Department Harvard University Collaboration (MOU in place to setup School of midwifery UTH - Obstetrics & Lusaka Gynecology Department HSSP Post Abortion Care Training Center for PAC UTH - Obstetrics & Lusaka Gynecology Department JHPIEGO Malaria Program –injection safety UTH - Obstetrics & London School of hygiene and Lusaka Gynecology Department Tropical Medicine Active Research Infant feeding & health UTH - Obstetrics & Lusaka Gynecology Department NISIR Collaboration UTH - Obstetrics & Lusaka Gynecology Department TDRC Collaboration UTH - Obstetrics & Lusaka Gynecology Department UNFP family Planning- setup center of excellence UTH - Obstetrics & Lusaka Gynecology Department University of Alabama CIDARZ, Research on Cervices Cancer UTH - Obstetrics & Lusaka Gynecology Department WHO Various Research UTH - UNZA School of Medicine Department of Lusaka Surgery Anthony Matani (Individual) Has been donating spinal and surgical implants for the past 5years
August 2007 9 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
UTH - UNZA School of Medicine Department of Eurolink – Based in the United Lusaka Surgery Kingdom They have been donating Urology equipment UTH - UNZA School of Medicine Department of European Urology Association – Lusaka Surgery based in Paris They donate Urology and microscopic equipment UTH - UNZA School of Medicine Department of Lusaka orthopedics and Research Has been supplying Orthopedic Implants and Training. They have Lusaka Surgery Trust (LORET) been supporting the department for over 6 years UTH - UNZA School of Medicine Department of Midland Region Ent Unit Tullmort Lusaka Surgery (Ireland) Experts visits twice a year. They come to teach and operate UTH - UNZA School of Medicine Department of Lusaka Surgery Rotary Club of Lusaka Weekly donation of food and has adopted a ward UTH - UNZA School of Medicine Department of Surgical College of Surgeons for Build skills laboratory for post graduates. The skills laboratory is Lusaka Surgery East, Central and Southern Africa based at the Department of Surgery UTH - UNZA School of Medicine Department of Lusaka Surgery Surgical Society of Zambia The Surgical Society of Zambia conduct for post graduates UTH - UNZA School of Medicine Department of Infrastructure Development of Orthopedic Department. (building and Lusaka Surgery Vision 2020 equipment Lusaka UTH / UNZA School of Communication for Better Health The Dreyfus Health Foundation of New York, USA, is the sponsor of Medicine (“CBH”) this programme. The main activities under this collaboration include support to the medical library and helping out in dissemination of health information to front line health professionals in the rural areas of Zambia. Lusaka UTH / UNZA School of Copenhagen University’s Center Partnership and collaboration in research. Medicine for Medical Parasitology (CMP), Denmark Lusaka UTH / UNZA School of Harvard University, USA. Harvard University and UNZA/UTH are involved in a number of Medicine collaborations in research including, Sickle cell diagnostic (screening of sickle cell disease and establishing the levels of sickle cell in Zambia) and capacity building in diagnosis of sickle cell in rural areas.
August 2007 10 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Lusaka UTH / UNZA School of Helsinki Polytechnic Stadia, Staff and student exchange programmes, and implementation of the Medicine Finland Malawi –Zambia health care project during the spring of 2005 and academic year 2005-2006. This included short term staff and student exchange programmes. Lusaka UTH / UNZA School of Institute of Child Health This Link includes collaboration in research, exchange visits involving Medicine University College, London, UK. research staff, infrastructure support and scholarships in Public Health. Lusaka UTH / UNZA School of International Atomic Energy This agency has been supporting the following projects: Tumor Medicine Agency (“IAEA”). market project; Tissue culture project; and The newborn screening and nuclear project. Lusaka UTH / UNZA School of Kalorinska Institute, Sweden Institutional collaboration project funded by SIDA. The department of Medicine Post Basic Nursing at UNZA has benefited from technical support and exchange visits. Two professors have been appointed as visiting professors. Under the n ursing and staff exchange programme, both institutions are supposed to do the following: send up to two exchange students each year during the duration of the agreement, unless the number is varied by mutual agreement; and share information on a regular basis; and recognise that the academic credit of the studies abroad is the responsibility of the degree granting institution. Lusaka UTH / UNZA School of Kent State University, UK. Under this link, some staff members of UTH have been sponsored for Medicine PhD studies. Currently, one member of staff is pursuing a PhD in Nursing. Lusaka UTH / UNZA School of Kent State University, USA. Staff exchange, capacity building and research. One member of staff Medicine has been awarded a scholarship and is still pursuing a PhD programme at the Kent State University. Lusaka UTH / UNZA School of Marie Master University Collaboration on sickle cell management. Medicine Lusaka UTH / UNZA School of Mehari University Link between Mehari University and UNZA School of Medicine on Medicine research collaboration, and student and staff collaboration on microbicides. Under this arrangement, UNZA shares resources with UTH. Lusaka UTH / UNZA School of MIE University of Japan Exchange programme between the two institutions. However the Medicine Zambian counterparts have not been able to get sponsorship for this programme.
August 2007 11 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Lusaka UTH / UNZA School of Other Links/Collaborating Partners These include: Medicine University of Queensland, Australia: Collaboration in schizophrenia research). University of Ain Shams, Cairo, Egypt University of Malawi, Malawi University of Bergen, Norway University of Bergen, Norway University of Pretoria, South Africa Institute of Psychiatry, London, UK University College, London Medical School, UK. University of Nottingham, UK: Collaboration in communication research. Bradford University, UK Gordon University, UK. The London School of Tropical Medicine-UK. Medical Research Council, UK Leeds University, UK. Michigan State University, USA: Collaboration in epilepsy and stigma research, and in neurological. State University, Nebraska, USA: Collaboration in telemedicine University of Nairobi, Kenya University of Miami, USA University of Nebraska-USA Massachusetts Institute of Technology-USA The World Federation for Medical Education (“WFME”) The Foundation for Advancement in MEDICAL Education and Research (“FAIMER”); The Society for Directors of Research in Medical Education (“SDRME”). Prevention of Maternal Mortality in Africa (“PMM”) The Surgical Society of Zambia. Collaboration in surgery College of Surgeons of East, Central and Southern Africa World Orthopaedic Concern (“WOC”). Pharmaceutical Society of Zambia
August 2007 12 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Lusaka UTH / UNZA School of Sussex and Brighton Medical This Link includes exchange programmes for nursing staff and Medicine School and Teaching Hospital, and students, and comprehensive capacity building support to UNZA/UTH. Brighton University, UK. Lusaka UTH / UNZA School of University of Alabama, USA. Through this Link, a center of excellence building has been Medicine constructed at the UTH. Other activities include the CIRDZ/University of Alabama- Research activities, MPH scholarships and institutional strengthening. Lusaka UTH / UNZA School of University of Bergen, Norway Collaboration with this university was through the NUFU Project Medicine 20002 to 2006. This project was designed to strengthen UTH and UNZA in HIV/AIDS related interventions and capacity building. Under this project, two students where sponsored for PhD programmes at the University of Bergen. Lusaka UTH / UNZA School of University of Bradford, UK. Under this programme, the University of Bradford has been providing Medicine physiotherapy equipment to UTH/UNZA. Lusaka UTH / UNZA School of University of Emory, USA. Collaboration in research and scholarships for master’s degree in Medicine Public Health. Lusaka UTH / UNZA School of University of Miami, USA. This project has come to an end, but Links with the school in the area Medicine of capacity building are still open, even though not active.
Lusaka UTH / UNZA School of University of Nebraska, USA. The link with this university was established through a former member Medicine of staff of the UNZA department of pediatrics. This link is in the area of research in cancer, HIV/AIDS and Malignant for post graduate students. The contact person at the University of Nebraska is Charles Wood. Lusaka UTH / UNZA School of Yale University School of Under this Link, UNZA and the University of Yale have been carrying Medicine medicine, USA. out research in Malaria at Macha hospital in Choma. Lusaka UTH / UNZA School of Yamananshi University, Japan This research project came to an end in 2006. Under this project a Medicine research laboratory was constructed and two UTH members of staff were trained up to PhD level and one up to Masters level. UTH / UNZA School of Medicine Department of Lusaka Surgery World Orthopedic Concern (WOC) Donate orthopedic implants and conduct Orthopedic courses Lusaka UTH / UNZA School of University College, London A long-term collaboration has been established between this university Medicine, Lusaka Medical School, UK. and UZA/UTH under the ZAMBART project, a 10 year collaboration project in TB research. Under this project, a building has been constructed at the UNZA Ridgeway campus, to support the activities
August 2007 13 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
of this project.
Operation Eyesight University/ Lusaka UTH EYE Unit Irish Aid Eye equipment procurement UTH -Obstetrics & Lusaka Gynecology Department Break through Cancer Trust Have adopted B21 ward Northen Kasama School of Nursing, University of Ireland, Galway. Training and capacity building. Northern Province. Chilonga Mission Hospital, Northern Mpika Action Medior, Germany Drugs, once in a while Chilonga Mission Hospital, Northern Mpika BD, USA Laboratory technology Chilonga Mission Hospital, Northern Mpika Bridge of Friendship, Germany Second hand equipment. Dr. Muller, visiting Gynaecologist. Chilonga Mission Hospital, Northern Mpika CORDAID, The Netherlands Small Projects, HR, and recently, infrastructure Chilonga Mission Hospital, Development Cooperation Ireland Northern Mpika (DCI) Infrastructure-Midwifery School Chilonga Mission Hospital, Friends of Chilonga Foundation, Northern Mpika Netherlands Former Doctors who worked at Chilonga Chilonga Mission Hospital, Northern Mpika MISEREOR, Germany Funds and Equipment Chilonga Mission Hospital, Streekziekenhuis Midden Twente, Northern Mpika Hengelo Based on proposals Chilonga Mission Hospital, Northern mpika The Beit Trust, UK Infrastructure –building Chilonga Mission Hospital, Northern Mpika Trace, Tanzania Human Resources Development Northern Kasama school of Nursing University of Ireland , Galway Capacity building Mungwi District Health Limbelzel International of Northern Management Team Germany Capacity building
August 2007 14 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Southern Chikankata College for Bio- University of Michigan, through Support to research at the College and to the diagnostic laboratory, and Medical Sciences, Southern UNZA. staff development and exchange. Province. Chikankata College of Bio- Plans to link with University of Boston for research purposes. Not yet Southern Medical Sciences University of Boston, USA finalized Southern Chikankata Mission Hospital, Boston University, USA. Research Program on Malaria Management in rural areas (2 year Southern Province. program). Southern Chikankata Mission Hospital, Michigan State University, USA. Joint Research (2 year renewable) on adherence to ART in rural Southern Province. setting. Southern Chikankata Mission Hospital, Swedish Rotary Doctor, Sweden. Visiting Swedish doctors. Southern Province. Livingstone District Health Southern Management Team Africa Impact Volunteers come to assist in rural centers Mental Rehabilitation program – exchange program only restricted to Livingstone District Health 35 yrs and below. Community Based Rehabilitation Program Southern Management Team NORDKAPP –KOMMUNE (training) in mental health. Southern Livingstone General Hospital, Center for Disease Control (CDC), Support to counseling services, laboratory services, equipment, Southern Province USA. infrastructure development. Southern Livingstone General Hospital, Johnson and Johnson Yale Post graduate doctors for experience and research Southern Province University, USA. Southern Livingstone General Hospital, Rapids –World vision Psycho-Social support program for children living with HIV/AIDS, Southern Province Orphans and Vulnerable Children (will run up to 2010). Southern Livingstone General Hospital, Zambezi – Physiotherapy Student exchange program Southern Province Southern Livingstone School of Kristianstad University – Tutor and Student exchange programme. Nursing, Southern Province. Department of Health Science (Sweden) Southern Livingstone School of Norway –SOGN OQ FJORDANE Tutor and Student annual exchange programme. Nursing, Southern Province. University – Faculty of Health Studies Southern Monze Mission Hospital AIDS Health Care Foundation. Support to HIV/AIDS and ART activities. Southern Monze Mission Hospital Canadian Food for Children Southern Monze Mission Hospital Catholic Mission Board
August 2007 15 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions In conjunction with under the Ministry of Health The Ministry of Health of Zambia
Southern Monze Mission Hospital Hands Around the World. Extension of the Children's ward, male ward and completion of the ICU. Also provides support to staff development. Southern Monze Mission Hospital Michigan State University Southern Monze Mission Hospital Misereor –Germany. Support to HAART Project. Southern Monze Mission Hospital Other Links These include: Michigan State University, USA Canadian Food for Children Catholic Mission Board Southern Monze Mission Hospital VSO, UK. Volunteer staff from overseas. Western Kaoma DHMT FMC (Former Dutch Doctors) Help out in new hospital construction Western Kaoma DHMT Orange Babies of Netherlands Construction of maternity Ward Western Kaoma DHMT Touch of Ireland Short term /Construction of children’s Ward Western Lewanika General Hospital, University of Moto in Czech Surgery, Infrastructure, Equipment & Training. Western Province. Republic.
Western Lewanika Hospital Project Educate Capacity building University of Moto in Czech Western Lewanika Hospital Republic Surgery ,Infrastructure, Equipment & Training
August 2007 16 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and In conjunction with Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Appendix VI: List of Institutions and Persons Interviewed
August 2007 1 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and In conjunction with Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
List of Institutions Visited, Officials Interviewed and Contact Addresses PROVINCE DISTRICT INSTITUTION/ CONTACT STAFF INTERVIEWED POSITION DETAILS Central Chibombo Chibombo District Hospital 1. Mrs Veronica Mwape 1. Manager (Liteta) Administration Central Kabwe Kabwe General Hospital 1. Dr K Malama 1. Executive Director 2. Mr. Elias K Sililo 2. Senior Personnel officer Central Kabwe Kabwe Mine Hospital 1. Dr K Malama 1. Executive Director 2. Mr. Elias K Sililo 2. Senior Personnel officer Central Kabwe Kabwe School of Midwifery 1. Dr K Malama 1. Executive Director 2. Mr. Elias K Sililo 2. Senior Personnel officer Central Kapiri Kapiri Mposhi Distric 1. Dr Charles Mwinuna 1. Executive Director Mposhi Hospital Central Mkushi Mkushi District Hospital 1. Dr. Mwanza 1. Executive Director Central Serenje Serenje District Hospital Hospital Administration Doctors Team consisting of the 1. Matron following: 2. Acting Principal 1. Dr. Ngozi Igbasi Clinical Officer 2. JK. Hamir 3. Acting Nursing Officer 3. Mr John W. Nchelenje 4. Acting Hospital 4. Harrison Chilufya Administrator 5. Mr. Raymond K. 5. Radiographer Mukupa 6. Senior Environmental 6. Mr Royd Simuchembu Technologist 7. Mr Mutale Alexander Copperbelt Kitwe Kitwe Central Hospital, 1. Dr. Anthony Mutiti 1. Acting Director , Telefax 02-228604 Email: Clinical Services [email protected] Copperbelt Kitwe Kitwe District Health 1. Dr C. John Banda 1. Director Management Team Copperbelt Ndola Arthur Davison Hospital 1. Mr. CCG Mulinda 1. Acting Human Resources Manager Copperbelt Ndola Ndola Central Hospital 1. Dr Malawo 1. Director Telephone : 612590, Fax: 612204, Email: [email protected] Copperbelt Ndola Ndola College of Bio-Medical 1. Mr Nguluta 1. Principal/Director Science 2. Mr Mulenga 2. Assistant Director Copperbelt Ndola Ndola District Health 1. Dr. Kakungu 1. Director Management Team Email: Simpungwe 2. Manager Planning mkakungusimpungwe@yahoo 2. Dr Nyendwa 3. Administrative Officer .co.uk 3. Mr A.K. Musaba 4. Human Resources 4. Mr S. Ngandwe Officer Copperbelt Ndola Ndola School of Nursing 1. Mrs Kakungu 1. Nursing Education Manager Copperbelt Ndola Provincial Health Office c/o 1. Florence Kashita 1. Human Resources Data Management Specialist Specialist,Email: [email protected]
August 2007 2 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and In conjunction with Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Eastern Chipata Chipata General Hospital 1. Dr Charles Fanata 1. Acting Executive P.O Box 510119 Director Telefax 221427, Mobile 0977480095, 0955545355 Eastern Chipata Chipata School of Nursing 1. Dorothy HS Banda 1. Acting Principal Tutor P.O Box 510119 Telephone 06-222808 Fax: 06-223638 Email: [email protected] Eastern Katete Private bag 11, Katete 1. Dr. Parkinson 1. Executive Director Telephone: 06-252344 Fax : 06-25278 email: [email protected] Eastern Lundazi Lundazi District Hospital 1. Mr Evaristo Chikwanka 1. Acting Hospital P.O Box 530013, Lundazi Administrator Telephone :06-480055 Fax :06-480055 Eastern Nyimba Nyimba District Hospital 1. Dr. Simwaba Davies 1. Executive Director (DHMT) P.O Box 570013 Telephone: 06-374271 Fax : 06-374271 Mobile : 0977414826 Eastern Petauke Petauke District Hospital 1. Mr. Jere G 1. Principal Clinical (DHMT) Officer P.O Box 56008 Telephone : 06-371075 Fax : 06-371029 Email: [email protected] Luapula Mansa Luapula Province Health 1. Dr. E Bwalya 1. Director Office,Telefax 02-821235, 2. Mr Mpofu 2. Clinical Specialist Email: [email protected] Luapula Mansa Mansa General Hospital 1. Dr. Francis Bwalya 1. Director Tele/fax; 02-821188/821635 2. Justin Kapenda 2. Hospital Administrator Email: [email protected] Luapula Mansa Mansa Nursing School, 1. Mr. AM Luboya 1. Principal Mobile 09789778 2. Mr. Mulenga 2. Tutor 3. Mr. Mwila 3. Tutor 4 Mr. Kanswata 4. Tutor Lusaka Lusaka Anaesthesia School 1. Mr. Banda T. 1. Head of Department Lusaka Lusaka Chainama Hospital 1. Dr. Welani Chilengwe 1. Executive Director 2. Dr. Mudenda 2. Director Training 3. Mr. Nsama 3. Registrar Lusaka Lusaka CHAZ 1. Dr Simon Mphuka 1. Executive Director Lusaka Lusaka Chest Diseases Laboratory
August 2007 3 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and In conjunction with Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Lusaka Lusaka Department of Pediatric 1. Dr Evans Mpabalwan1 ( we need to make follow ups 2. James Chipeta 2. Lecturer school of with staff members in this 3. Dr Tendai Msoka pedratics dept) 4. Dr Somwe 3. 5. Professor Chintu 4. Head of Department 6. Dr Kankasa Lusaka Lusaka Dept of Obstetric & 1. Dr. Kasonka 1. Head of Dept Gynaecology 2. Dr. Maureen 2. Consultant Obstetrician Chisembele Lusaka Lusaka Eye Unit 1. Dr. Grace Mutati 1. Head of Department Lusaka Lusaka General Nursing Council of 1. Mrs Chipepo 1. Acting Registrar (Edu Zambia 2. Mrs Dorcas Phiri & Train.Mg) 3. Mrs Stella Chisuuka 2. Standards & 4. Mrs Theresa Sikaleyo Compliance Manager 5. Mrs Judith Chileshe 3. M&E Specialist 4. Examination & Education Specialist 5. Accountant Lusaka Lusaka Lusaka Dental School 1. Dr Muteba 1. Principal P.O Box 33987, 2. Dr Nalumino Sayela 2. Dental Surgeon Telefax 01-239789 Email: [email protected] Lusaka Lusaka Medical Council of Zambia 1. Mr. Malijani Alfred 1. Inspection Officer P.O Box 32554, 2. Mr. B.B. Bwalya 2. Registration Officer Telephone 01 236241 Fax: 01- 239317 Email: [email protected] Lusaka Lusaka UNZA Department of 1. Professor Mullah 1. Head of Department Medicine Lusaka Lusaka UNZA Department of Surgery 1. Professor Desai 1. Head Department of Surgery Lusaka Lusaka UTH Administration Dr. Peter Mwaba Managing Director Lusaka Lusaka UTH Laboratory Department 1. Dr. Mudenda 2. LAB Manager Lusaka Lusaka UTH School of Nursing 1. Beatrice Zulu 1. Acting Principal 2. Josephine Himoonga 2. Principal Tutor 3. Honestor Banda 3. Acting principal Tutor North Solwezi NW Provincial Health Office 1. Mr Enock Kalambo 1. Clinical Care Specialist Western 08-821997 2. Ms Lukonde Jennifer 2. Office Administrator 3. Mr Ngoma Robert 3. Human Resources Specialist 4. Environmental Specialist
North Solwezi Solwezi District Health 1. Mr Dawson Kabwita 1. District Health Western Management Team 2. Mr Mutesi Elliott Information Officer 2. Manager Administration North Solwezi Solwezi General Hospital 1. Job Moonga 1. Hospital Manager Western North Solwezi Solwezi School of Nursing 1. Florence Mukupa 1. Senior Tutor Western
August 2007 4 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and In conjunction with Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Northern Kasama Kasama General Hospital 1. Dr. Simon Mukosa 1. Director Mobile: 097848960 2. Mrs D. Mwape 2 Nursing Officer Tele/fax: 04-221304, Email: 3. Mr. Sandala 3.Acting Hospital [email protected] Administrator Northern Kasama Kasama School of Nursing 1. Mr. Elson muulu 1. Principal Tutor P.O Box 410056 Telefax 04-221024 Email: [email protected] Northern Kasama Provincial Health Office, P.O 1. Dr Fabian Kabulubulu 1. Director Box 410026, Kasama, 2. Mrs. Mugala 2. Clinical Officer Telefax: 04-221501, Email: 3. Mrs. Elizabeth Mvula 3. Human Resources [email protected] Officer Northern Luwingu Luwingu District Health 1. Dg Ilunga 1. Director Management Team (Hospital) Mobile : 097713504 Northern Mpika Chilonga Mission Hospital 1. Sister Mutamba 1 Administration Manager P.O Box 450030 Elizabeth Mpika Zambia Email: [email protected] g Manageradmin.art.chilonga@ gmail.com Mobile: 096355163 096645548 099742838 Fax: 04-370112
Northern Mpika Mpika District Heath 1. Mr. Mwansa Bernard 1. Director Management Team 2. Mr. Martin Mbao 2. Human Resources P.o Box 450046 3. Mrs. Mwaba Officer Mpika 3. Manager Email: Administration [email protected] Mobile :097210673 Northern Mpika Mpika General Hospital 1. Dr. Mulindwa 1. Medical Officer P.O Box 450011, Mpika 2. Mr. Victor Chimbala Incharge Mobile: 097756337 3. Mr. John Mwelwa 2. Hospital Administrator 099376036 4. Mr. Charles W. Mumba 3. Senior Nursing Officer 097853805 5. Mrs Dorothy 4. Nursing Officer 095439139 Siambelele Email: [email protected] Northern Mungwi Mungwi District Health 1. Grace Nanyiza 1. Director Management Team Telefax: 04-230035 Mobile : 099402930 Southern Choma Choma District Helath 1. Dr. Mkandawire 1. District Health Director Management Team Southern Kalomo Kalomo District Health 1. Mr Sakala 1. Acting Manager Management Team Planning
August 2007 5 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and In conjunction with Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Southern Livingstone Livingstone Central Hospital 1. Dr. Phiri 1. Executive Director 2. Mrs Nchengamwe 2. Senior Nursing Officer 3. Mr. D. Makando 3. Manager 4. Dr. Robert Fubisha Administration 4. Manager Clinical Care Southern Livingstone Livingstone District Health 1. Mrs C. Sikazwe 1. Manager Planning and Management Team 2. Clarence Musumo Development 3. Rose Banda 2. District Health Information Officer 3. Acting Environmental Health officer Southern Livingstone Livingstone School of Nursing 1. Mrs. H. Simaubi 1. Acting Senior Nurse Tutor Southern Livingstone Provincial Health Office 1. Dr Alisheke Lutangu 1. Provincial Health Director Southern Mazabuka Chikankata College of Bio- 1. Jane Banda Chisenga 1. Lecturer Medical Sciences 2. Wilner Chiyota 2. Clinical Instructor 3. Linda Mabumba 3. Lecturer 4. Mr. Potipher Pilingana 4. College Manager
Southern Mazabuka Chikankata Mission Hospital 1. Richard Bradbury 1. Manager Administration Southern Mazabuka Chikankata School of Nursing 1. Mr. Mhango 1. Principal Tutor and Midwifery Southern Monze Monze Mission Hospital 1. Dr John Y. Mvula 1. Executive Director 2. Joshua Maimo 2. Human Resources Officer Southern Choma General Hospital 1. Mr. Munyanya 1. Human Resources Mubiana Officer Southern Mazabuka District Hospital 1. Mrs Chilima 1. Matron Haboombe Western Kaoma Kaoma District Hospital 1. Mr. E. Phiri 1. Manager Planning & P.O Box 94009, Kaoma 2 Mr M. Muyunda Development Fax 360227, Tele 360093 3. Mr M. Pumulo 2. Manager Email: [email protected] Administration 3. TB/ Leprosy Officer Western Mongu Lewanika General Hospital 1. Dr. Andrew Silumessii 1. Executive Director P.O Box 910147, Fax 221233 2. Mr Munsanje Paul 2. Information Officer Telephone: 221012 Email: [email protected]
Western Mongu Lewanika School of Nursing 1. Biemba Maliti 1. Acting Principal P.O Box 910147, Fax 22347 Telephone: 221468 Email: [email protected]
August 2007 6 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and In conjunction with Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Appendix VII: List of Documents/Literature Consulted
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and In conjunction with Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
List of Literature Consulted S/N Document Title/Description 1. Annual Action Plans from institutions visited 2. Economic Report for 2005 and 2006 3. Fifth National Development Plan (NDP 2006-10) – Health Chapter 4. Health Sector Joint Annual Review Reports – 2005, 2006 5. HMIS Annual Bulletins for 2005, 2006 6. Institutional and Organisational Appraisal Report (MOH/CBoH), 2004 7. Mid-Term Expenditure Framework (MTEF) Plans for MOH 8. MOH Action Plan – 2006 (Narrative/ABB) for 2006, 2007 9. MOH Annual Reports – 2005, 2006 10. MOH HIV/AIDS and STIs Action Plan 2006 and Progress Reports 11. MOH Human Resource Strategic Plan 2006-2010 and Action Plan for 2006 12. MOH Institutional Strategic Plan, 2005 – 2009 13. MOH Progress Report on ART 14. MOH Progress Reports and Accounts to the SAG and Minutes 15. NAC Mid-Term Review Report 16. NAC Progress Report 2006 17. National Budget (Yellow Books) – 2006, 2007 18. National Budget (Yellow Books) – 2007 19. National Budget Speeches – 2006, 2007 20. National Health Strategic Plan (NHSP 2006-2010) 21. Poverty Reduction Strategy Paper (PRSP) 22. Recent Review/Surveys on HR Issues 23. Several research papers on human resources for health 24. THET Publications and Website 25. Zambia Health Demographic Survey 2001/02 (and Status for 2006) 26. Zambian Health Sector Support – Mapping Report, DFID, 2006
August 2007 CAN Investments Limited Lusaka, Zambia MAIN REPORT The Tropical Health and Education Trust (THET) Mapping of Health Links in the Zambian Health Services and In conjunction with Associated Academic Institutions The Ministry of Health of Zambia under the Ministry of Health
Appendix VIII: Reports/Feedback from Link Partners
(Submitted Separately)
August 2007 CAN Investments Limited Lusaka, Zambia