July 2015
Mapping of RMNCH & Nutrition Programs/Projects in Lusaka and Copperbelt Provinces
Author: Angel Mondoloka
MDGi Program for Accelerating Progress Towards Maternal, Neonatal & Child Morbidity and Mortality Reduction in Zambia
Millennium Development Goal Initiative Accelerating the Reduction of Maternal, Neonatal and Child Mortality
European Union
MDGi: A Joint Programme of the Government of the Republic of Zambia – European Union – United Nations
This publication has been produced with the assistance of the European Union. The contents of this publication are the sole responsibility of the Government of the Republic of Zambia and United Nations and can in no way be taken to reflect the views of the European Union A study to map and analyse Reproductive, Maternal, Newborn and Child Health & Nutrition (RMNCH&N ) programs and projects in Zambia with regard to outcomes and lessons learnt and to, hence, inform the design of MDGi with specific respect to program coordination and its potential catalytic role for system strengthening through convergence, integration, scale-up, and sustainability
Copyright: Government of the Republic of Zambia/2015 Table of Contents
LIST OF TABLES i
LIST OF FIGURES i
LIST OF BOXES i
ACRONYMS ii
ACKNOWLEDGEMENTS iv
PROLOGUE v
EXECUTIVE SUMMARY vi
1. INTRODUCTION 1
2. BACKGROUND 3
3. OBJECTIVES, SCOPE AND DELIVERABLES OF THE STUDY 10 3.1 Specific Objectives of the Study 11 3.2 Scope of the Study 11 3.3 Deliverables of the Study 11
4. METHODOLOGY 12 4.1 Targeting of Respondents 14 4.2 Selection of RMNCH&N Projects and Programs 14 4.3 Interview Questionnaires 14
5. LIMITATIONS OF THE STUDY 15
6. SOURCES OF CRITERIA FOR BEST PRACTICES 17 6.1 The Global Strategy for Women’s and Children’s Health 18 6.2 The Global Investment Framework 18 6.3 The Integration Imperative 21 6.4 The Three Delays Model 22 6.5 Other Sources 22
7. FINDINGS OF THE STUDY 25 7.1 Major recently Completed, On-going or Up-Coming RMNCH&N
Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces and Program and Projects 28 7.2 Lessons Learnt 29 7.2.1 Achievements 30 7.2.2 Implementation Challenges 36 7.2.3 Sustainability Issues Noted 39 7.3 Innovations and Good Practices in RMNCH&N 40 7.3.1 Innovations 40 7.3.2 Good Practices 40 7.4 Synergies through Geographic and Programmatic Convergence 41
8. CONCLUSIONS AND RECOMMENDATIONS 45
BIBLIOGRAPHY 47
APPENDICES 51 Appendix 1 Terms of Reference 52 Appendix 2 List of Interviewees 57 Appendix 3 Key Information Questionnaire – District Health Office 63 Appendix 4 Key Information Questionnaire – District Health Facility 67 Appendix 5 Focus Group Discussion Questionnaire 70 Appendix 6 District-level mapping of RMNCH programs and projects by Key Topic 73 Appendix 7 District-level mapping of RMNCH programs and projects by Program/Project 76 Appendix 8 Count of Projects Cross-Classified by RMNCH&N Component Addressed 79 Appendix 9 Percentage of Projects Cross-Classified by RMNCH&N Component Addressed 79 Appendix 10 Count of Projects Addressing Malaria, WASH, GBV and Systems Strengthening 80 Appendix 11 Percentage of Projects Addressing Malaria, WASH, GBV and Systems Strengthening 80 Appendix 12 National Health Planning Cycles and Context 81 Appendix 13 Synergies for Women’s and Children’s Health between the MDGs 82 Appendix 14 Strategic Elements of the Immunisation Vision and Strategy Framework 83
Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces LIST OF TABLES
Table 1 Trends in maternal and child health 7 Table 2 Selected health status and utilization indicators 7 Table 3 Interview strategy 12 Table 4 Count of Respondents by Type of Organisation 13 Table 5 Count of RMNCH&N programs and projects by size category 28 Table 6 Key elements of the BHOMA project approach 46
LIST OF FIGURES
Figure 1 Demographics 5 Figure 2 Maternal and Newborn Health 5 Figure 3 Equity; Child Health 6 Figure 4 Distribution of Stunting in Zambia 7 Figure 5 A delineation of the deliverables for the mapping study 12 Figure 6 Sample diagram of Zambian national health system 14 Figure 7 The Continuum of Care 19 Figure 8 Places of care giving in the Continuum 19 Figure 9 The global consensus for Maternal, newborn and child health 19 Figure 10 The Conceptual Framework 20 Figure 11 Clarifying the difference between critical enablers and development synergies 21 Figure 12 Priority linkages between SRH and HIV 21 Figure 13 Countdown Countries: Coverage of essential RMNCH interventions along the Continuum of Care 23 Figure 14 Conceptual framework for the BHOMA project 24 Figure 15 The ECD program’s holistic approach 24 Figure 16 Mapping of sex work hot spots in Chipata 21 Figure 17 MNCH pillars and cross-cutting issues 42
LIST OF BOXES
Box 1 Grant to Demonstrate the Possibility of Eliminating all New Infant HIV Infections 26 Box 2 Example of a PPP Around Reproductive Health 29 Box 3 Principles of the 2005 Paris Declaration on AID Effectiveness 40
Mapping of RMNCH & Nutrition Programs/ i Projects in Lusaka and Copperbelt Provinces ACRONYMS
AAR Japan Association for Aid and Relief, Japan AED Academy for Education Development AFP Acute Flaccid Paralysis AGEP Adolescent Girls Empowerment Programme AIDS Acquired Immune Deficiency Syndrome AMACSI African Member Association Country Sustainability Initiative ANC Antenatal Care ARK Absolute Return for Kids ART Anti-Retroviral Therapy ARV Anti-Retroviral ATC Advanced Treatment Centre AYFS Adolescent & Youth-Friendly Services BCP Behaviour Centred Programming BTL Bilateral Tubal Ligation CAC Comprehensive Abortion Care CBD Community-Based Distributor CBO Community-Based Organization CBV Community-Based Volunteers CCP Comprehensive Condom Programming CD4 Cluster of Differentiation 4 CDC Centres for Disease Control CDI Child Development Index CEDAW Convention on the Elimination of All Forms of Discrimination against Women CEMG Cardno Emerging Markets Group CHAMP Comprehensive HIV/AIDS Management Program CHAs Community Health Associations CHWs Community Health Workers CMMB Catholic Medical Mission Board CNGs Community Nutrition Groups COMPACT Community Mobilization for Preventive Action CP Cooperating Partners CRC Convention on the Rights of the Child CS Caesarean Section CSE Comprehensive Sexuality Education CSS Community System Strengthening CT Counselling and Testing CTC Community-Based Therapeutic Care CVCT Couples Voluntary Counselling and Testing DACA District AIDS Coordinating Advisor DANIDA Danish International Development Agency DATF District AIDS Task Force DBS Dried Blood Spot
ii Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces DCHO District Community Health Office DCMO District Community Medical Officer DFID Department for International Development DHAPP US Department of Defense HIV/AIDS Prevention Program DHIO District Health Information Officer DHMT District Health Management Team DHO District Health Office DMO District Medical Officer DOTS Directly Observed Treatment, Short-Course EBF Exclusive Breastfeeding ECD Early Childhood Development EDF European Development Fund EGPAF Elizabeth Glaser Pediatric AIDS Foundation EIB European Investment Bank EID Early Infant Diagnosis EMTCT Elimination of Mother to Child Transmission E-MTTS Emergency Medical Treatment and Triage System ENC Essential Newborn Care EU European Union FBO Faith Based Organization GBV Gender-Based Violence HBB Helping Babies Breathe HBC Home-Based Care HCCs Health Centre Committees HCT HIV Counselling and Testing HII High Impact Interventions HIV Human Immuno-deficiency Syndrome HMIS Health Management Information System HTC HIV Testing and Counselling IDRF International Development and Relief Foundation IEC Information Education and Communication IMAM Integrated Management of Acute Malnutrition IMSAM Integrated Management of Severe Acute Malnutrition iNGO International NGO INH Isoniazid IPAS International Pregnancy Advisory Services IRS Indoor Residual Spraying ITNs Insecticide Treated Nets IYCF Infant and Young Child Feeding KMC Kangaroo Mother Care LARC Long-Acting Reversible Contraception LCS Labour Caesarean Section M&E Monitoring & Evaluation MARPs Most at Risk Populations MC Male Circumcision
Mapping of RMNCH & Nutrition Programs/ iii Projects in Lusaka and Copperbelt Provinces MCH Maternal and Child Health MDG Millennium Development Goal MTCT Mother to Child Transmission NAC National HIV/AIDS/STI/TB Council NACS Nutrition Assessment, Counselling and Support NASF National AIDS Strategic Framework NFNC National Food and Nutrition Commission NFNSP National Food and Nutrition Strategic Plan NHC Neighbourhood Health Committee NMCC National Malaria Control Centre NPA-WGHA National Plan of Action on Women, Girls and HIV/AIDS NZP+ Network of Zambian People Living with HIV/AIDS OVC Orphans and other Vulnerable Children PACA Provincial AIDS Coordination Adviser PACF Positive Action for Children Fund PATF Provincial AIDS Task Force PATH Program for Appropriate Technology in Health PCOE Paediatric Centre of Excellence PHC Primary Health Care PHO Provincial Health Office PLHIV People Living with HIV PM&E Participatory Monitoring & Evaluation PMO Provincial Medical Officer PopART Population Effects of Antiretroviral Therapy to Reduce HIV PPP Public Private Partnership PSAF PANOS Institute of Southern Africa PVO Private Volunteer Organisation RFSU Swedish Association for Sexuality Education RHCC Reproductive Health Change Communications RPR Rapid Plasma Reagin SAfAIDS Southern Africa HIV and AIDS Information Dissemination Service SBC Social and Behaviour Change SDC Swiss Agency for Development and Cooperation SI&E Strategic Information & Evaluation SMAGs Safe Motherhood Action Groups SRH Sexual and Reproductive Health SRHR Sexual and Reproductive Health and Rights STI Sexually Transmitted Infection SUN Scaling Up Nutrition SW Sex Worker TB Tuberculosis TSS Tropical Splenomegaly Syndrome UA Universal Access UTH University Teaching Hospital
iv Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces VAG Village Action Groups VDRL Venereal Disease Research Laboratory VMMC Voluntary Medical Male Circumcision VNGs Volunteer Nutrition Groups WASH Water Sanitation and Hygiene WASHE Water Sanitation and Hygiene Education WG Women’s Group WiLDAF Women in Law and Development in Africa YAAT Youth Advocacy Action Team YAM Youth Action Movement YG Youth Group YPLHIV Young People Living With HIV ZAMBART Zambia AIDS Related Tuberculosis Project ZamNIS Zambia Nutrition Information System ZANEC Zambia National Educational Coalition ZBCA Zambia Business Coalition on HIV and AIDS ZCARD Zambia Center for Applied Health Research and Development ZEHRP Zambia-Emory HIV Research Project
Mapping of RMNCH & Nutrition Programs/ v Projects in Lusaka and Copperbelt Provinces ACKNOWLEDGEMENTS
This study was made possible by the cooperation and support of respondents drawn from Govern- ment departments and agencies and other actors in the development cooperation and non-state arena who shared valuable time and documentation with my research team.
Special authority for the study was granted by the Permanent Secretary at the Ministry of Commu- nity Development, Mother and Child Health, Professor, Elwyn Chomba. Corresponding support for the study was obtained from the Ministries of Health, Gender and Child Development and Finance and National Planning.
Special recognition is also due to the Provincial Medical Officers for the Lusaka and Copperbelt Provinces, and to the District Medical Officers, health facility In-Charges; and, community health groups in the 11 selected districts, for the EU-funded Millennium Development Goals Initiative (MDGi) who were the main respondents for the field inquiries undertaken by the research team.
The study would not have been possible without the facilitation and support of the Provincial Per- manent Secretaries for the Lusaka and Copperbelt Provinces and the, respective, District Adminis- trations in the locations visited by the research team.
The findings, interpretations and conclusions expressed in this report are those of the author and do not necessarily reflect the views of the respondents or any other parties to this study.
vi Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces PROLOGUE
THE IMPERATIVE: Each year, millions of women and children die from preventable causes. These are not mere statistics. They are people with names and faces. Their suffering is unacceptable in the 21st century. We must, therefore, do more for the newborn who succumbs to infection for want of a simple injection, and for the young boy who will never reach his full potential because of malnutrition. We must do more for the teenage girl facing an unwanted pregnancy; for the married woman who has found she is infected with the HIV virus; and for the mother who faces complications in childbirth. Ban Ki-moon, UN Secretary General: Foreword to the Global strategy for Women’s and Children’s Health, September 2010
THE PARADOX OF MATERNAL AND CHILD MORTALITY: “In a world of great knowledge and wealth, no child should die from preventable illness, and no mother should lose her life while giving birth — yet too many women and girls are being left behind,” Ban Ki-moon, UN Secretary General; Maternal, Newborn and Child Health (MNCH) Summit, Toronto, Canada, May 28-30, 2014
CERVICAL CANCER IN ZAMBIA: “Zambia has one of the highest death rates from cervical cancer. Some 1,600 women die of this cancer and it is mainly because of lack of information (but)… The introduction of pro-poor and sustainable social health insurance, by integrating social safety nets such as the social cash transfer scheme and the increased strategic partnerships and bilateral agreements with cooperating partners and NGOs, is helping spread healthcare services to the poor in Zambia… …Chiefs and women in rural Zambia now know basic information on cervical cancer and are telling their political representatives that if they did not deliver those services they would not vote for them at the next elections… The scaling up of services using mobile health services to complement static services has increased demand for services due to the provision of a specialist care, continuum of care and better staff attitudes…” First Lady, Dr. Christine Kaseba, Skoll World Forum 2014, Oxford, England, April 9-11
A RESPONSE TO MALNUTRITION: “The Nutrition, Assessment, Counselling and Support (NACS) approach should be able to succeed and become part of routine health services to prevent, identify, and treat malnutrition.” Dr. Elwyn Chomba, Permanent Secretary, Ministry of Community Development, Mother and Child Health, Strategic Planning Meeting, October 2013
Mapping of RMNCH & Nutrition Programs/ vii Projects in Lusaka and Copperbelt Provinces Executive Summary
The Ministry of Community Development, Mother and Child Health (MCDMCH) and UNICEF Zambia are supporting the implementation of the European Union (EU)-funded Millennium Development Goals Initiative (MDGi) for “Accelerating Progress towards Maternal, Neonatal and Child Morbidity and Mortality Reduction in Zambia”. The aim of the 4-year MDGi project is to improve the availability and quality of health and nutrition services in eleven (11) selected districts; five1 in the Lusaka Province and six2 in the Copperbelt Province. This report presents the findings 1. Lusaka, Chilanga, Kafue, Chongwe, of the programs and projects review component of the MDGi situation analysis for which the Rufunsa. mandate was to map Reproductive, Maternal, Newborn, Child Health & Nutrition (RMNCH&N) 2. Ndola, Luanshya, programs and projects in the eleven districts. Masaiti, Kitwe, Chin- gola, Mufulira.
Despite being among the 75 Countdown3 to 2015 countries which together account for 95% of 3. Countdown is a global movement maternal and child deaths worldwide, Zambia has made significant progress in improving maternal of governments, and child health over the last decade. However, the rate of progress achieved so far remains organisations and individuals that was insufficient to enable Zambia to meet its Millennium Development Goals in this area. For example, initiated in 2003 to track progress in although maternal, neonatal and under-five mortality have each fallen significantly in recent years, Maternal, Newborn & these death rates remain unacceptably high. The overall health status of women and children Child Health (MNCH) in the 75 highest in Zambia continues to be unfavourable and, thus, the MDG targets for reducing maternal and burden countries to promote action and child mortality are unlikely to be met. Much ground remains to be covered, therefore, to improve accountability. maternal and child health and, hence, reduce related mortality rates by preventing HIV/AIDS and other communicable diseases while strengthening health systems to ensure the effective and adequate delivery of the needed health services. This is part of the rationale for the MDGi project.
The objectives of the study were to map and analyse RMNCH&N programs and projects in Zambia with regard to outcomes and lessons learnt and to, hence, inform the design of MDGi with specific respect to program coordination and its potential catalytic role for system strengthening through convergence, integration, scale-up, and sustainability. The mapping was required to include all recently completed, on-going, and/or planned programs and projects whose activities fall with the RMNCH&N arena within the Lusaka and Copperbelt Provinces and which are consistent with the MDGi Program. The deliverables for the study included the analysis contained within the body of this report, a register (Annex A to this report) of RMNCH&N interventions in 11 selected MDGi districts in the Lusaka and Copperbelt provinces and a health profile for each district (Annex B to this report). The approach to the project included a combination of desk review and fieldwork. The desk study was based on reviews of project web sites, where available, complemented by telephone and email outreach in support of the research team’s attempts to secure project documentation from the relevant actors in Government and other sectors. Project documentation of interest included project information documents (e.g. concept notes, proposals, briefs), progress reports (quarterly, semi-annual and/or annual reports); and, monitoring and evaluation (M&E) reports.
To some extent, the study was constrained by timeliness and completeness issues for some of the respondents with regard to their responses to the study team’s inquiries. This was partially a consequence of those respondents’ internal arrangements for document retention and management. Several other respondents also expressed concerns about the confidentiality of their documents the protection of related intellectual property. These respondents insisted that there should be direct confidentiality assurance to them for their “intellectual property” through an appropriately structured non-disclosure agreement binding UNICEF and the research team. In total, these constraints on information and data availability to the research team undermined the scale, scope and granularity of the analysis contained in the latter sections of this report. At the outset, the project start was delayed due to the timing of logistics supporting the study. This had consequences for the staffing of the project and the timing of the work plan. viii Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Bearing the MDGi project’s aspirations for health systems strengthening, health service delivery and community mobilisation, best practice expectations for the study were drawn from the UN Secretary General’s Global Strategy for Women’s and Children’s Health, The Global Investment Framework for Maternal and Child Health; and, the Three Delays Model for maternal health, among other sources.
The gains achieved recently in mother and child health, in Zambia, face actual and potential challenges from emerging and entrenched societal issues that are driven by poverty and other socioeconomic stresses. These include the explosion of sex work and teenage pregnancies which, taken together, point to a potentially resurgent HIV/AIDS epidemic. Meanwhile, unsafe abortions are a key contributor to the high rates of maternal mortality reported in Zambia. Another worrying trend is the high incidence of child sexual abuse as evidenced by the numerous reports in the print and broadcast media. Other issues with maternal and child health implications and impacts include a high incidence of alcohol and substance abuse (ASA) by both men and women and gender- based violence (GBV).
For the purpose of analysis, the programs and projects identified during the study were grouped into three categories: • Large (project cost greater than USD10 million); • Medium (project cost greater than USD1 million and less than or equal to USD10 million); and, • Small (project cost less than or equal to USD1 million.
Where cost information was not available, duration together with qualitative information, such as geographical footprint, was used as a gauge for project size as follows: • Large (duration greater than 5 years); • Medium (duration greater than 2 years and less than or equal to 5 years); and, • Small (duration less than or equal to 1 year).
Annex A to the report contains detailed information and analysis on these projects but the key points are highlighted below.
A total of 68 programs and projects was identified and compiled into the database in Annex A. Of these 68 programs, 44 were active, 3 pipeline and 15 closed. Data on implementation status was not available for 6 projects.
The geographical coverage of the majority of these projects was found to be limited. There are also gaps in thematic coverage relative to the issues confronting communities. These issues range from cultural norms and practices, societal impacts of poverty, the downstream impacts of HIV/AIDS disease, deficits in communication, transportation and water and sanitation infrastructure.The emerging and entrenched issues mentioned above point to a need for more targeted interventions to address issues that are more cross-cutting in nature but which have maternal and child health consequences. As an additional point of concern, stakeholder information in the District Action Plans (DAPs) for the 11 selected districts suggests a lack of awareness, on the part of the District Health Management Teams, of the RMNCH&N programmes and projects being implemented in their districts by various non-state actors. This potentially undermines the ability of the District Health Officers to coordinate activities and rationalise resources aimed at the delivery of preventive and curative health services.
Mapping of RMNCH & Nutrition Programs/ ix Projects in Lusaka and Copperbelt Provinces Subject to the data availability issues noted above, details of the achievements of these projects and the implementation challenges and sustainability issues facing them are recorded in Annex A. The achievements referenced include gains in advocacy in relation to policies, laws and regulations impacting various aspects of sexual and reproductive health, maternal & newborn health and child health; capacity building efforts to strengthen and broaden the skills of health workers and community volunteers; community sensitization to stimulate demand for quality health services; and, investments in healthcare infrastructure and equipment. Challenges impeding implementation vary according to the objectives for intervention, the target locations and demographies; and, the organisations conceiving and implementing the projects. Issues encountered vary from modalities for engagement with various government institutions at the national, provincial and district levels and how to engage targeted communities effectively and in a cost-efficient manner. These challenges reveal significant scope for cross-sectoral collaboration, including public-private partnerships and peer-to-peer partnerships within the non-profit sector. The smartest approaches involved the creation of cooperative working arrangements leveraging the technical know-how of the project implementing agents and partners; on the one hand, and the local knowledge and reach of community-based organisations, on the other. Various other innovations and good practices are also noted for some of the projects.
The underlying prerequisite to the successful development and roll-out of high quality RMNCH&N interventions is the strengthening of the overall health system in Zambia. A core outcome of this HSS imperative should be strengthened capacity for integration on the part of actors across all sectors dealing with health policy, programming and services delivery. This should all happen within a framework that enables vertical integration, or harmonisation, of processes within programs and horizontal integration across projects. At the health facility level, health systems strengthening (HSS) efforts should be complemented by community systems strengthening (CSS) interventions to stimulate and enable informed demand and accountability for high quality health services.
Key gaps in service delivery begin with the cross-cutting issues undercutting health and health care in Zambia. Harmful societal norms and practices include the challenges posed by child marriage and child sexual abuse, alcohol and substance abuse; and, gender-based violence. These are issues that may not be receiving adequate attention and focus and there is, hence, an opportunity for MDGi to contribute to the scaling up of the necessary interventions in these areas. By way of example, in many peri-urban settings in the 11 selected MDGi districts, as is the case elsewhere in Zambia, the deplorable state of sanitation and the lack of reliable access to safe water supplies poses grave public health challenges with drastic implications for maternal and child health outcomes. Appropriate MDGi support to, or coordination with, water and sanitation interventions affecting these locations is strongly advised.
Interventions under the MDGi project should have features of, both, complementarity and additionality to programmes and projects that have proven to be effective. New interventions should also be contemplated under MDGi to mitigate gaps in the current scope of available services. Apart from staff shortages and other consequences of underfunding, the inaccessibility of health services is a serious constraint on demand for health care, especially in the more remote parts of the country. MDGi resources could be used to increase the scale and scope of transport and outreach services provided by each health facility.
x Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces INTRODUCTION
Mapping of RMNCH & Nutrition Programs/ vii Projects in Lusaka and Copperbelt Provinces 1 The Ministry of Community Development, Mother and Child Health (MCDMCH) and UNICEF Zambia are supporting the implementation of the European Union (EU)-funded Millennium Development Goals Initiative (MDGi) for “Accelerating Progress towards Maternal, Neonatal and Child Morbidity and Mortality Reduction in Zambia”. The aim of the 4-year MDGi project is to 4. Lusaka, Chilanga, Kafue, Chongwe, improve the availability and quality of maternal and child health and nutrition services in eleven (11) Rufunsa. 4 5 selected districts; five in the Lusaka Province and six in the Copperbelt Province. 5. Ndola, Luanshya, Masaiti, Kitwe, Chin- gola, Mufulira. As part of the inception phase of the MDGi project, UNICEF commissioned a five-pronged situation analysis to inform the design of the project and to help establish a baseline for monitoring & evaluation (M&E) purposes. This report presents the findings of the programs and projects review component of the MDGi situation analysis for which the mandate was to map Reproductive, Maternal, Newborn and Child Health & Nutrition (RMNCH&N) programs and projects in the eleven districts.
2 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces BACKGROUND
Mapping of RMNCH & Nutrition Programs/ 2 Projects in Lusaka and Copperbelt Provinces 2 Zambia is one of the 75 Countdown6 to 2015 countries which together account for 95% of maternal 6. Countdown is a global movement 7 and child deaths worldwide. Figures 1 to 3 below depict some of the latest key MNCH indicators of governments, organisations for Zambia from which the following highlights are noted: and individuals that was initiated • Neonatal Mortality Rate: 27 per 1,000 live births (Figure 1); in 2003 to track progress in Ma- ternal, Newborn & Child Health • Infant Mortality Rate: 53 per 1,000 live births (Figure 1); (MNCH) in the 75 highest burden countries to pro- • Still Birth Rate: 26 per 1,000 total births (Figure 1); mote action and accountability.
• Maternal Mortality Rate: 440 per 100,000 live births (Figure 1); 7. (WHO, UNICEF, 2013) • Only 47 per cent of births are attended by a skilled health worker (Figure 2);
• More than half (61 per cent) of women do not receive any postnatal care (Figure 2).
• 46 per cent of Children under 5 are Stunted (Chronically Malnourished) (Figure 3);
• 15 per cent of Children under 5 are Underweight (Figure 3);
These statistics represent significant improvements over previous years as demonstrated by the under-five and maternal mortality trend data in Table 1 on page 4. It is worth noting, in addition, that Zambia has been polio free since 2005 and that maternal and neonatal Tetanus was eliminated in 2007 (UNICEF, 2014).
4 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces (Countdown to 2015, 2013) 2015, (Countdown to
8. 8 8 Figure 1: Demographics Figure 2: Maternal and Newborn Health
Mapping of RMNCH & Nutrition Programs/ 5 Projects in Lusaka and Copperbelt Provinces Figure 3: Equity; Child Health 8
6 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Table 1: Trends in maternal and child health
1990 2000 2010 2015 (MDG Target)
U-5 Mortality 193 150 83 64
Maternal Mortality 470 540 440 118
Table 2: Selected health status and utilization indicators9
9. Adapted from (World Bank, Outcome indicators Urban Rural National 2014) Total fertility rate (births per woman)10 4.6 7.0 5.9 10. 2010 Zambia 11 Census of Contraceptive prevalence (% of women ages 15-49) 42.0 27.6 32.7 Population and Housing Chronic malnutrition prevalence (% of under-5 children)12 39.0 47.9 45.4
11 .2007 Zambia HIV prevalence (% of adults aged 15-49 years who are HIV positive)12 19.7 10.3 14.3 Demographic and Health Service coverage indicators Survey Delivered by skilled providers (% of pregnant women) 83.0 31.3 46.5 12. 2012 Zambia National Ma- Full immunization coverage (% of children aged 12-23 months) 71.2 66.2 67.6 laria Indicator Survey ARI treatment coverage (% of under-5 children) 63.4 38.9 46.6
children) 75.7 73.6 74.3
Children with fever who sought treatment from a facility/provider same day/next day (% 25.2 24.3 24.5 of under-5 children)
Children who slept under an ITN last night (% of under-5 children)3 50.9 60.1 57.0
Women who slept under an ITN last night (% of pregnant women) 52.3 60.9 58.2
Figure 4: Distribution of Stunting in Zambia
Mapping of RMNCH & Nutrition Programs/ 7 Projects in Lusaka and Copperbelt Provinces As noted, Zambia has made significant progress in improving maternal and child health in the last decade. The rate of progress achieved so far remains insufficient, however, to enable Zambia to meet its Millennium Development Goals in this area. For example, although maternal, neonatal and under-five mortality have each fallen significantly in recent years, these death rates remain unacceptably high. The overall health status of women and children in Zambia continues to be unfavourable and, thus, the MDG targets for reducing maternal and child mortality are unlikely to be met. Some of the causes of infant and child mortality are related to the status of women such as household income, mother’s education, age at first birth and multiple births. In many of Zambia’s peri-urban areas and squatter compounds, lack of access to clean drinking water, low heath care literacy, poor sanitation and high impacts of malaria and HIV/AIDS combine with reduced access to health care to contribute to high maternal and perinatal mortality rates and low life expectancy, generally. Table 2 illustrates the differences in health needs and services coverage between urban and rural areas while Figure 4 shows the distribution of stunting in Zambia.
Much ground remains to be covered, therefore, to improve maternal and child health and, hence, reduce related mortality rates by preventing HIV/AIDS and other communicable diseases while strengthening health systems to ensure the effective and adequate delivery of the needed health services. This is part of the rationale for the MDGi project.
8 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces OBJECTIVES, SCOPE AND DELIVERABLES OF THE STUDY
Mapping of RMNCH & Nutrition Programs/ 8 Projects in Lusaka and Copperbelt Provinces 3 The objectives of the study were to map and analyse RMNCH&N programs and projects in Zambia with regard to outcomes and lessons learnt and to, hence, inform the design of MDGi with specific respect to program coordination and its potential catalytic role for system strengthening through convergence, integration, scale-up, and sustainability.
3.1 SPECIFIC OBJECTIVES OF THE STUDY
The goals of the mapping exercise were to: (1) help ensure the alignment of the MDGi project with on-going programs and to proactively seek effectiveness and efficiency gains in the 11 selected Districts through close collaboration and convergence (geographic and programmatic); and, (2) document the innovations, lessons learned and best practices to guide the MDGi program.
The specific objectives of the mapping exercise were to: a) Map and describe all relevant recently completed14, on-going and planned RMNCH&N 14. “Completed” or “past” projects were programs and projects and their contributing partners in each of the 11 selected districts to defined as those that had ended identify opportunities for synergies, convergence and collaboration with the GRZ-EU-UN during calendar MDGi Program; years 2013 and 2014. b) Identify strategies, input types and outputs (including resources, tools and job-aids), related to RMNCH&N service delivery systems strengthening and quality improvement developed under recently completed, on-going and upcoming partner-supported programs and projects in the 11 selected districts to avoid duplication and facilitate synergies; c) Analyse lessons learnt in relation to achievements, challenges, and sustainability; d) Identify innovations and good practices in RMNCH& N programming (e.g. innovative delivery strategies, capacity development strategies, incentives, etc). e) Identify relevant opportunities for programmatic and geographic convergence, integration, and scale-up.
3.2 Scope of the Study
As stated earlier, the mapping was required to include all recently completed, on-going, and/or planned programs and projects whose activities fall with the RMNCH&N arena within the Lusaka and Copperbelt Provinces and which are consistent with the MDGi Program. Implementation of these projects was, is being; or is to be, undertaken by relevant entities including the Zambian Government, Government agencies, Cooperating Partners (CPs), international and local non- governmental organizations (NGOs); and, civil society organizations (CSOs). The mapping adopted the systematic approach described in Section 4 to ensure consistency in the description and analysis of the selected programs and projects.
3.3 Deliverables of the Study
The outputs of the mapping study are: a) The “RMNCH&N Register” (ANNEX A) which is an inventory, using a standard template, of the major RMNCH&N programs and projects in the Lusaka and Copperbelt Provinces. Each entry in the Register includes, among other things, a description of the program/project, its outcomes and outputs in addition to an analysis of lessons learnt in relation to achievements, challenges, scale and sustainability, innovations and good practices; b) District Health Profiles (ANNEX B) for the eleven (11) selected districts in the two Provinces. These were based on the District Action Plans (DAPs) obtained from the respective District Health Offices.
10 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces METHODOLOGY
Mapping of RMNCH & Nutrition Programs/ 10 Projects in Lusaka and Copperbelt Provinces 4 The approach to the project included a combination of desk review and fieldwork.The desk study was based on reviews of project web sites, where available, complemented by telephone and email outreach in support of the research team’s attempts to secure project documentation from the relevant actors in Government and other sectors. Project documentation of interest included project information documents (e.g. concept notes, proposals, briefs), progress reports (quarterly, semi- annual and/or annual reports); and, monitoring and evaluation (M&E) reports.
Figure 5 :A delineation of the deliverables for the mapping study
Table 3: Interview strategy
Level Organisation Type Interview Format Informants
Policy or Programming a) Line ministries and Unstructured/informal a) Responsible heads of Government Agencies telephone or in-person department; b) Cooperating Partners interviews (b) to (d) – Executive c) international NGOs Directors, Program d) Local NGOs managers and/or M&E officers
Implementation & a) PHOs a) Informal a) PHOs Coordination b) DHOs b) Structured b) DMOs
Service Delivery Health facilities (health Structured In-Charges centres and health posts)
Service Utilization CBOs Focus Group Discussions Women’s groups (e.g. SMAGs, SBAs), CNGs, Youth Groups
12 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces 4.1 Targeting of Respondents
Organisations targeted for outreach were segmented by level, organisation type, interview format, informant types, as shown in Table 3. The targeting and sequencing of respondents within the national health system was guided by the overview provided by Figure 6.
Key informant interviews involved a total of 153 respondents drawn from line ministries, government agencies, local authorities, health facilities, cooperating partners, international and local NGOs, other civil society organisations and from the private sector. Focus group discussions were held in Chilanga, Chongwe, Kitwe, Mufulira, Lusaka with 41 participants, in total, drawn from neighbourhood health committees, safe motherhood action groups, community nutrition groups and youth groups (see Table 4).
4.2 Selection of RMNCH&N Projects and Programs
The RMNCH&N programs and projects that were relevant to the study satisfied the following three criteria:
a) Geographical relevance: The implementation footprint falls (wholly or partially) within the Lusaka and Copperbelt provinces. Specifically, the implementation footprint falls (wholly or partially) within the eleven 11 implementing districts for the MDGi Program as follows: (i) Lusaka Province – Lusaka, Chilanga, Kafue, Chongwe and Rufunsa districts; (ii) Copperbelt Province – Ndola, Luanshya, Masaiti, Kitwe, Chingola and Mufulira districts. b) Thematic relevance: The project’s thematic coverage includes any component of the RMNCH&N suite of interventions; c) Chronological relevance: All past (ended in 2013 and 2014), on-going and planned programs and projects were relevant to the study.
Within the 11 selected MDGi districts, targeting criteria for beneficiary communities and their health facilities included considerations of location, income, population density, health facility density and accessibility; and, infrastructure. The intention was to learn from a cross-section of communities across the spectrum of vulnerability and health services availability.
Table 4: Count of Respondents by Type of Organisation
Chilanga Chingola Chongwe Kafue Kitwe Lusaka Mufulira Ndola Rufunsa Luanshya Masaiti Total Line Ministry 1 2 3 1 6 11 1 8 5 1 1 40 Government 1 1 Agency Local 5 1 6 Authority Health 2 9 2 3 16 4 11 4 51 Facility Cooperating 22 22 Partners iNGO 21 1 22 NGO 2 6 8 Private 3 3 Sector CBO 7 16 7 4 5 2 41 Total 10 7 28 3 21 81 11 22 9 1 1 194
Mapping of RMNCH & Nutrition Programs/ 13 Projects in Lusaka and Copperbelt Provinces Figure 6: Sample diagram of Zambian national health system15 15. Adapted from (Ar- scott-Mills, Foreman, & Graham, 2012, p. 46)
Central Medical Stores Storage and distribution of Ministry of Health (MOH) medical supplies and Creates health policies and procures commodities and commodities to hospitals equipment for the provision of health Services and district health centres
Provincial Health Office Administrative office that coordinates health services for all Districts located under the Province following MOH policies and procedures
District Health Hospital Hospital located in the district that provides a higher level of health District Health Office services such as management of This office is responsible for planning and supervising the emergencies, surgery, and provision of primary health care; i.e. Organizing the minimum technically complex diagnostics. package of services in line with MOH policy to respond to the District health hospitals provide a health problems and needs of the local population within the higher level of FP services, including District long-acting or permanent methods.
District Health Centre A facility-based centre that provides curative care of acute and chronically sick patients who do not require the attention of a doctor but rather that of a nurse or midwife. Services provided are usually obstetrics, FP, immunizations and growth Community-based health monitoring, and antenatal care. care providers Trusted members of the community who are trained to provide basic health Health Post services, including FP, within A basic service delivery point that tends to be staffed by a lay the community. These health worker from the community who is able to treat basic, workers tend to be common ailments. The lay health worker is part of the public volunteers and are not paid health system and is financially compensated by the MOH. by the MOH.
4.3. Interview Questionnaires
As mentioned in Section 4.1 above, respondents at the programming or policy level (i.e. involving line ministries, government agencies, donors; and, local and international NGOs) included heads of department in Government and executive directors, program managers and/or M&E officers.The interview format for this class of key informants was informal but covered the following standard set of topics:
a) The organisation’s general role, and scope of its activities, in the RMNCH&N arena; b) The existence, or otherwise, within the organisation of a central repository of project information documents, progress reports and M&E reports relating to the organisation’s RMNCH&N-related programs and projects; c) The geographical footprint, thematic emphasis and timing (start date and duration) of the organisation’s RMNCH&N programs and projects; d) Challenges and lessons learned in relation to efficiency and effectiveness of implementation, sustainability, scalability and potential to realise synergies through integration with other programs and/or collaboration with other actors.
At the Implementation & Coordination level (see Table 3), the Provincial Medical Officers (PMOs) provided contact information for the relevant District Health Management Teams (DHMTs). The standard questionnaire in Appendix 3 was administered to District Medical Officers (DMOs) in a structured interview format. At the Service Delivery level (see Table 3), the respective In-Charges for the selected health facilities fielded the questions from the Health Facility Questionnaire in Appendix 4. Finally, at the Service Utilization, focus group discussions (FGDs) were conducted per the guidance in the FGD questionnaire in Appendix 5.
14 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces LIMITATIONS OF THE STUDY
Mapping of RMNCH & Nutrition Programs/ 14 Projects in Lusaka and Copperbelt Provinces 5 To some extent, the study was constrained by timeliness and completeness issues for some of the respondents with regard to their responses to telephone and email inquiries from the research team. This was partially a consequence of those respondents’ internal arrangements for document retention and management. In addition, a number of respondents were reluctant to share project documentation with the study team. This was due to their concerns about confidentiality and intellectual property protection. These respondents insisted that there should be direct confidentiality assurances for their “intellectual property” through an appropriately structured non-disclosure agreement binding UNICEF and the research team. In total, these constraints on information and data availability to the research team undermined the scale, scope and granularity of the analysis contained in the latter sections of this report. At the outset, the project start was delayed due to the timing of logistics supporting the study. This had consequences for the staffing of the project and the timing of the work plan.
15 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces SOURCES OF CRITERIA FOR BEST PRACTICES
Mapping of RMNCH & Nutrition Programs/ 16 Projects in Lusaka and Copperbelt Provinces 6 Part of the focus of MDGi will be on strengthening health systems management and service delivery at the district level. This will also call for efforts to build management capacity at the national and provincial levels. Supply-side interventions for improving the availability and quality of services will be complemented by demand-side measures to stimulate informed demand at the community and household levels. The program’s approach will be to build on past experiences and innovations in Zambia and to consolidate existing strategies and capacities towards the delivery of a comprehensive, district-level, package of care.
With considerations for MDGi’s health systems strengthening, health service delivery; and, community mobilisation aspirations in mind, best practice expectations for the study were drawn from various guidelines including the following:
6.1. The Global Strategy for Women’s and Children’s Health
The Global Strategy for Women’s and Children’s Health responds to the unacceptably high rates of mother and child morbidity and mortality with a call for collective resolve and action to strengthen health systems, ensure universal access to essential health services including family planning, safe childbirth, increased access to vaccines and treatment for HIV/AIDS, malaria, tuberculosis, pneumonia and other neglected diseases (United Nations Secretary-General, 2010). The Global Strategy also advocates exclusive breastfeeding in addition to other simple solutions such as access to clean water, improved nutrition, and health education. The strategy sets out the following key areas where urgent action is required to enhance financing, strengthen policy and improve service delivery:
a) Support for country-led health plans, supported by increased, predictable and sustainable investment. b) Integrated delivery of health services and life-saving interventions – so women and their children can access prevention, treatment and care when and where they need it. c) Stronger health systems, with sufficient skilled health workers at their core. d) Innovative approaches to financing, product development and the efficient delivery of health services. e) Improved monitoring and evaluation to ensure the accountability of all actors for results.
The “Global Consensus for Maternal, Newborn and Child Health” was developed and adopted by a wide range of stakeholders and lays out an approach to speed up progress (see Figure 9). It highlights the need to align policies, investment and delivery around a cohesive set of priority interventions across what health professionals call the continuum of care (See Figures 7 and 8), and offers a framework for stakeholders to take coordinated action (United Nations Secretary- General, 2010). Figure 13 illustrates the coverage of, and related gaps in, essential RMNCH interventions for the 75 Countdown countries along the Continuum of Care.
6.2. The Global Investment Framework
Figure 10 conceptualizes the Global Investment Framework for Women’s and Children’s Health (WHO, PMNCH, UW, 2013). The Framework notes that MDG’s 4 and 5 on child and maternal health and mortality, on the one hand, and MDG 6 on HIV/AIDS, TB and other diseases, on the other, are “inextricably linked”. It observes further that accelerating investments “…is not only affordable (US$5 per annum, per capita, additionally, on top of current investments), but contributes to social and economic development, with up to a ninefold rate of return. This investment is critical to achieving global health and development goals beyond 2015, and allows women and children to achieve that most basic of rights, the right to life” (WHO, PMNCH, UW, 2013, p. 3).
18 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces 16. (Countdown to Figure 7: The Continuum of Care16 2015)
17. (United Nations Secretary-General, 2010, p. 8)
Figure 8: Places of care giving in the Continuum16
Figure 9: The global consensus for Maternal, newborn and child health17
Mapping of RMNCH & Nutrition Programs/ 19 Projects in Lusaka and Copperbelt Provinces The components of the Framework are delineated as: (1) Key Enablers; (2) Effective Interventions; (3) Health and Nutrition Gains; and, (4) Social and Economic Benefits.The Framework proceeds to explain that ‘Key enablers’ make it possible to scale essential interventions based on local context and in a way that is politically, financially, technically and socially sustainable. The ‘key enablers’ cover four broad dimensions known to drive health outcomes: policy, health system, community, and innovation. The Framework includes fifty evidence-based ‘effective interventions’ relating to reproductive, maternal, newborn and child health (RMNCH) selected based on consensus regarding their efficacy. For the analysis, these fifty interventions are grouped into six broad packages, with nutrition featuring within several of them:
(1) Improving maternal and newborn health
(2) Improving child health
(3) Increasing immunization coverage
(4) Making family planning services and commodities available
(5) Addressing HIV/AIDS challenges
(6) Tackling malaria-related mortality and morbidity.
18 Figure 10: The Conceptual Framework 18. Areas with red circles are those included in the quantitative analysis of the economic and social returns on investment
The Framework includes “Health and nutrition gains” estimates in terms of lives saved and morbidity averted, including reduced illness, and stunting. Malnutrition is a significant underlying cause of preventable deaths, thus the prevention and management of malnutrition in women and children can result in better health outcomes, as well as lifelong increased economic productivity.
Finally, ‘Economic and social benefits’ are estimated in terms of direct contribution to the economy through increased labour force participation, as well as productivity as a result of avoiding illness and death. The reduction in unintended pregnancies also yields economic returns through its positive effect on savings rates and investment in education, among other things.
20 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Figure 11 presents the clarification of the difference between critical enablers and development synergies as illustrated. Essentially, critical enablers relate to interventions that have MNCH outcomes as their primary or sole objective. Development synergies, on the other hand, are consequent to interventions that are MNCH-sensitive. That is to say, MNCH outcomes are either incidental to their primary objectives or are one of many outcomes intended for the intervention.
19. Adapted from: Figure 11: Clarifying the difference between critical enablers and development synergies19 (UNDP & UNAIDS, 2012, p. 5).
6.3 The Integration Imperative
The drivers for the integration imperative include the Global Strategy for Women’s and Children’s Health and the Global Investment Framework for Women’s and Children’s Health cited in Sections 6.1 and 6.2 above, respectively. As explained earlier, ‘integration’ refers to the “different kinds of sexual and reproductive health and HIV/AIDS services or operational programs that can be joined together to ensure collective outcomes. This would include referrals from one service to another. It is based on the need to offer comprehensive services”. The underlying need for the integration of interventions and services arises from the interrelatedness of many social ills and pathologies.
20. (WHO, UNFPA, UN- Figure 12: Priority linkages between SRH and HIV20 AIDS, IPPF, 2005)
Mapping of RMNCH & Nutrition Programs/ 21 Projects in Lusaka and Copperbelt Provinces An important linkage, in this regard, is that between sexual & reproductive health (SRH) as recognized in the Stop AIDS Alliance policy position (StopAIDS Alliance, 2012).
“Linking HIV and SRH is not a new concept. In 1994 the International Conference on Population and Development Program of Action stated that SRH programs should address HIV and AIDS (United Nations, 1995). Then in 2004 the Glion Call to Action on Family Planning and HIV/AIDS in Women and Children called for intensified linkages between family planning and prevention of mother-to-child HIV transmission programs (UNFPA, 2004). A follow-up high-level consultation held later in 2004 resulted in the New York Call to Commitment on Linking HIV/AIDS and Sexual and Reproductive Health (UNFPA, 2004). Additionally, the 2001 Declaration of Commitment on HIV/AIDS and both Political Declarations on HIV/AIDS (2006 and 2011) recognised the need to link SRH and HIV”.
Figure 12 illustrates the priority linkages between SRH and HIV/AIDS.
6.4 The Three Delays Model
The Three Delays Model recognises the different barriers women face in achieving the timely and effective medical care needed to prevent deaths occurring in pregnancy and childbirth. The model identifies three groups of factors which may stop women and girls accessing the levels of maternal health care which they need:
Phase 1: Delay in decision to seek care • Low status of women • Poor understanding of complications and risk factors in pregnancy and of when medical interventions are needed • Previous poor experience of health care • Acceptance of maternal death • Financial implications
Phase 2: Delay in reaching care • Distance to health centres and hospitals • Availability of and cost of transportation • Poor roads • Geography e.g. mountainous terrain, rivers
Phase 3: Delay in receiving adequate health care • Poor facilities and lack of medical supplies • Inadequately trained and poorly motivated medical staff • Inadequate referral systems
6.5 Other Sources
The conceptual framework for the Better Health Outcomes through Monitoring and Assessment (BHOMA) project21 provided a useful tool for interpreting the prescriptions of the Global Strategy 21.Project Number 22 in the RM- and the MNCH Investment Framework in terms of practical experience on the ground in Zambia NCH&N Register (i.e. Annex A). (see Figure 14). The BHOMA framework guides the analysis of the root causes underlying the factors contributing to maternal and child morbidity and mortality.
22 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces 22. (PMNCH, 2014) Essentially the framework Figure 13: Countdown Countries: Coverage of essential identifies the immediate causal RMNCH interventions along the Continuum of Care22 factors for maternal and child morbidity and mortality as (1) inadequate coverage of preventive services; on the one hand, and, (2) poor clinical outcomes, on the other. In turn, the framework explains inadequate services coverage and poor clinical outcomes in terms of the community-level (demand-side) and health systems-level (supply-side) factors underlying them and proceeds to demonstrate the cause and effect relationships arising from the demand and supply sides, respectively, culminating in increased rates of maternal and child mortality.
In terms of child health specifically, Figure 15 illustrates the EpiscopalRelief Early Childhood Development Program’s holistic approach to the needs of young children affected by HIV/AIDS.
As depicted in the diagram, the EpiscopalRelief program’s approach is denoted by interventions at four points of a “diamond of care and support” within the child’s immediate environment; namely:
a) Family livelihoods; b) Nutrition & food security; c) Early childhood development; d) Child health
Specific interventions at each denoting point of the diamond are shown in the rectangular boxes in the diagram.
Mapping of RMNCH & Nutrition Programs/ 23 Projects in Lusaka and Copperbelt Provinces Figure 14: Conceptual framework for the BHOMA project23 23. This figure demonstrates the conceptual framework of the intervention. The patient-provider interaction rep- resents a critical interface at which the community meets the health system. If the interaction goes well, the patient is much more likely to have a good outcome. In addi- tion to measuring the overall popula- tion mortality out- comes, the project has implemented data collection measures to quantify each of the intervening steps in the conceptual frame- work. (Stringer, et al., 2013)
Figure 15: The ECD program’s holistic approach
24 FINDINGS OF THE STUDY
Mapping of RMNCH & Nutrition Programs/ 24 Projects in Lusaka and Copperbelt Provinces 7 The gains achieved recently in mother and child health face actual and potential challenges from emerging and entrenched societal issues that are driven by poverty and other socioeconomic stresses. Practically every population centre is facing an explosion of sex work (Figure 16). Meanwhile teenage pregnancies are showing alarming upward trends as partially evidence by a high rate of school pregnancies. On average, 17,600 young girls are dropping out of school in Zambia each year (Lusaka Times, 2014). The high pregnancy rate among teens and young adults suggests a high prevalence of early sexual debut and low rates of condom use both of which point to unmet needs for SRH interventions. Both the explosion of sex work and the high adolescent pregnancy rate point to a potentially resurgent HIV/AIDS epidemic within the foreseeable future added to the high rates of unsafe abortions being witnessed in the country (WHO, 2012). Another worrying trend is the high incidence of child sexual abuse as evidenced by the numerous reports in the print and broadcast media. This has dire consequences for the emotional and physical wellbeing of children including infants, young children and adolescents. Several fatalities have been reported especially of infants and younger children consequent to instances of such abuse. A 2001 UNICEF study found that 72% of female children had experienced some form of sexual abuse (Nkandela, 2001).
Other issues with maternal and child health implications and impacts include alcohol and substance abuse (ASA) by both men and women and gender-based violence (GBV). Media reports and other evidence point to high incidence rates for both phenomena. ASA and GBV both have implications for, or may result from, maternal mental health issues, including post-partum depression. The health centres in the 11 districts scarcely provide any form of psychosocial support or mental health services for women and children.
For instance, one silent consequence of the HIV/AIDS epidemic in Zambia is the vulnerability of children to the direct and indirect health, social and livelihood impacts of the epidemic. According to EGPAF’s Survive and Thrive Project’s 2013 Annual Report, 95,000 children in Zambia are living with HIV (EGPAF, 2013, p. 2). “Because of Zambia’s high HIV prevalence, countless children are affected by HIV or are vulnerable to HIV infection”. As a result of these impacts, “the children may lack access to education, healthcare, proper nutrition or even basic shelter. They also face high risks of illness, abuse or other form of trauma. These factors, added to the fact that many caregivers have little knowledge of the significance of early childhood development, contribute to the underdevelopment of many of the children”. Early learning centres and quality parenting programs for disadvantaged children are virtually non-existent in Zambia despite the clear need for these early childhood development (ECD) services. “While Zambia has a national strategy for supporting children affected by HIV and AIDS, few structured programs exist to meet the needs of children during the most critical period of development—age 5 and younger—in terms of language, cognitive, and socio-emotional skills. Despite the many effects of the HIV epidemic in Zambia, family and community networks remain the most important setting for ECD.”
25 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces 24. (Wright, 2014) Figure 16 Mapping of sex work hot spots in Chipata24
25. (CIDRZ, 2014)
Box 1 Grant to Demonstrate the Possibility of Eliminating all New Infant HIV Infections25
CIDRZ has been awarded a M.A.C AIDS Fund grant to support a pilot research study that aims to demonstrate the possibility of eliminating all new infant HIV infections by addressing the barriers to awareness, uptake, retention, and adherence among HIV-infected pregnant mothers in Zambia.
CIDRZ’s Chief Scientific Officer, Dr Ben Chi, will be the Principal Investigator of the study which will be called Aliyense: Reaching Every Family to End Paediatric HIV. Aliyense which means “everyone” in one of the Zambian languages Nyanja emphasizes the study’s approach to end new infant HIV infections by reaching and providing long-term support for every family through community mobilisation and adequate clinical systems. Aliyense will be conducted at the Chainda South Health Centre in Ibex Hill serving the Kalikiliki community.
The M.A.C. AIDS Fund, established in 1994, provides support for innovative global programs that tackle serious health issues in underserved communities.
Mapping of RMNCH & Nutrition Programs/ 27 Projects in Lusaka and Copperbelt Provinces 7.1 Major recently Completed, On-going or Up-Coming RMNCH&N and Program and Projects
For the purposes of this report, the programs and projects identified during the study were grouped into three categories: · Large (project cost greater than USD10 million); · Medium (project cost greater than USD1 million and less than or equal to USD10 million); and, · Small (project cost less than or equal to USD1 million.
Where cost information is not available, duration together with qualitative information, such as geographical footprint, was used as a gauge for project size as follows: · Large (duration greater than 5 years); · Medium (duration greater than 2 years and less than or equal to 5 years); and, · Small (duration less than or equal to 1 year).
Annex A contains detailed information and analysis on these projects but the key points are highlighted below.
Table 5: Count of RMNCH&N programs and projects by size category
Category Active Closed Pipeline No Data Total
Large 19 6 1 26
Medium 21 3 2 26
Small 6 6 4 16
Total 46 15 1 6 68
A total of 68 programs and projects was identified and compiled into the database in Annex A. From Table 5, which summarises the database in terms of the count by size category and implementation status, it will be noted that the database includes 44 active projects, 3 pipeline projects and 15 closed projects. Data on implementation status was not available for 6 projects. Appendix 6 summarises the database in terms of a district-level mapping of the RMNCH&N programs and projects by key topic. The analysis in Appendix 6 enables the determination that all the 11 selected MDGi districts have, or have had, projects with Family, Planning, Sexual & Reproductive Health (SRH) generally, and HIV/AIDS, in particular; Maternal, Newborn and Child Health (MNCH), Nutrition, health systems strengthening (HSS), community systems strengthening CSS) components; and, early childhood development (ECD). Appendices 8 to 11 show the RMNCH&N components and corresponding structural interventions in terms of counts and percentages of programmes and projects touching on a particular theme. This is subject to the caveat in Section 5 above pertaining to the complements and granularity of the analysis.
Luanshya was the only district for which a project (Golden Lay Limited’s Workplace HIV Programme) with an alcohol and substance abuse (ASA) component was noted. This project’s footprint was, in any event, limited to the Misaka Compound in Luanshya and was, in any event, closed in 2013 (see Project # 6 in Annex A).
The Gender-Based Violence (GBV) Project (Project # 36) covers all the eleven districts and the Zambian Anglican Council-Core Program (Project # 42) covers the 5 Lusaka districts with GBV programming. Two additional projects cover GBV in Luanshya and Chingola, respectively.
28 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces The Tisunge Ana Athu Akazi Coalition (TAAC) project covered child sexual abuse (CSA) and gender-based violence (GBV) in Lusaka but was closed in 2013.
The Childhood Tuberculosis (TB) Control project (Project # 46) is limited to Chilanga district in Lusaka province.
The Child Health and Nutrition Project (Project # 67) includes an Immunisation component but data was not available on its geographic coverage.
Out of the 68 projects selected from across the 11 districts, 27 projects employ some form of behaviour change communication (BCC) strategy.
With each one of these projects, the real issue is the extent of geographical coverage within a given district as most projects only span a single location or an, otherwise, limited number of communities (see the detail presented in Appendix 7 and Annex A). Appendix 7 reveals the projects that correspond to the key topics delineated in Appendix 6.
7.2 Lessons Learnt
As noted above, the geographical coverage of the majority of the projects studied is limited. There are also gaps in thematic coverage relative to the issues confronting communities. These issues range from cultural norms and practices, societal impacts of poverty, the downstream impacts of HIV/AIDS disease, deficits in communication, transportation and water and sanitation infrastructure. The emerging and entrenched issues mentioned at the beginning of Section 7 point to a need for more targeted interventions to address issues that are more cross-cutting in nature but which have maternal and child health consequences. As an additional point of concern, stakeholder information in the District Action Plans (DAPs) for the 11 selected districts suggests a lack of awareness, on the part of the District Health Management Teams, of the RMNCH&N programmes and projects being implemented in their districts by various non-state actors. This potentially undermines the ability of the District Health Officers to coordinate activities and rationalise resources aimed at the delivery of preventive and curative health services.
26. Source: Box 2 Example of a PPP Around Reproductive Health26 (UKZambians, 2012) 45,000 Access Mopani VCT Facilities
MOPANI Copper Mine (MCM) has provided Voluntary Counseling and Testing (VCT) services to 45,000 people through its medical facilities.
MCM Chief executive officer Danny Callow said in a statement… that of the 45,000 people who accessed VCT, 14,000 were receiving free care and treatment to enable them live positively.
Mr Callow said the mining firm had in the last 10 years spent more than US$100 million on the provision of health services including HIV/AIDS related programs.
The HIV/AIDS program was being undertaken in collaboration with cooperating partners that include Comprehensive HIV/AIDS Management Program (CHAMP), Catholic Relief Services and the Zambian Government through the Ministry of Health.
Mr Callow said the partnership in the HIV/AIDS program was a good example of the Public Private Partnership (PPP) initiatives.
Mapping of RMNCH & Nutrition Programs/ 29 Projects in Lusaka and Copperbelt Provinces 7.2.1 Achievements As mentioned earlier, one of the constraints on the study was the non-availability, or inadequacy of project documentation. To the extent that the required information was available, achievements made by individual projects are catalogued in Annex A. By way of illustration, these achievements are summarised below for a few showcase projects: a) Strengthening Early Childhood Development in Zambia (2012 to 2015: Active) — The “Survive and Thrive” focusing on Early Childhood Development (ECD), Child Health; and, Nutrition, and using a health and community systems strengthening (i.e HSS and CSS) approach: (i) Community Systems Strengthening (CSS) approach – Training of community volunteers and community sensitization; (ii) Health Systems Strengthening (HSS) approach – To date, Survive and Thrive has trained 39 health workers from institutions in the project areas, MOH and MCDMCH. These health workers are now able to perform in-depth development assessments. Pre- and post-test results from the healthcare worker trainings indicate an average increase of 11 per cent in knowledge of early childhood development (ECD) and pediatric HIV essentials; (iii) Competent staff and trained community volunteers – The project is managed by a team of well-qualified staff complemented by a pool of 42 trained volunteers; (iv) Community sensitization – The community volunteers sensitizing communities on the work of Survive and Thrive and circulating information on pediatric HIV and child development; (v) Beneficiary targeting and assessment – More than 137 children with developmental problems have been identified and assessed in the first year of the project; (vi) Home visits and record keeping – Volunteers have also begun carrying out home visits and assessments and recording information for monitoring and evaluation (M&E) reports; (vii) Leveraging Community-Based Organisations (CBOs) as implementation partners – Orientation for the sub-grantees provided information on the work and objectives of the project to 70 participants, clarifying the roles and responsibilities of all the stakeholders. This ensured that all the players in the Survive and Thrive project work towards achieving a common goal; (viii) Information and knowledge sharing – Sharing information among Conrad N. Hilton Foundation partners helped determine solutions to issues common among them and has resulted in the increased use of the essential package; (ix) Advocacy for ECD and role clarity – This has provided a platform to advocate for the expansion and improvement of early childhood care, development, and education—especially for the most disadvantaged children—and for greater clarity of the roles of various ministries in ECD.. b) Cecily Eastwood Zambian AIDS Orphans Appeal (May, 2013 to May, 2015: Active) — focusing on Child Health, Sexual & Reproductive Health (SRH) and deploying behaviour change communications (BCC) aimed at orphans of HIV/AIDS and other vulnerable children: · Tuition support for tertiary students – Currently, a total of 29 students are being supported to attend Mukuba University, Mufulira teachers College and Kitwe teachers college in 2013 and a further two students (a medical and an engineering student) are being supported at University of Zambia (UNZA) and Copperbelt University respectively.
30 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces c) Communications Support for Health (CSH) project (July, 2010 to December, 2014: Active) — The aim of the project is for GRZ health communications activities supported by CSH to translate into increased sustainable local capacity and positive behaviour change that contribute to GRZ efforts in five focal areas: (1) HIV/AIDS, (2) malaria, (3) family planning/ reproductive health, (4) maternal and child health and (5) nutrition. Strategies adopted include: Health Systems Strengthening (HSS), Community Systems Strengthening (CSS), Behaviour Change Communications (BCC): (i) Support for evidence-based planning and implementation: · Developed a trainers and participants manual for Behaviour Centred Programming (BCP) that established strong mechanisms to assist in gathering and using evidence in the development of products and tools relating to IEC/ BCC activities; · Is training GRZ partners to conduct formative research and pretesting during the BCP process to inform the development of communications products; · Is assisting MOH, NAC and NMCC to prepare a set of guidelines to guide the process of pretesting and evaluating communication materials, and; · Conducted M&E training, which included evaluation design, to build capacity of 20 GRZ staff at central, provincial and district levels; (ii) At the operational level: · CSH provided technical and financial support to NAC in the design and development of a comprehensive HIV campaign Safe Love that addresses multiple concurrent partnerships (MCP), low condom use and mother to child transmission (MTCT); · CSH provided technical and financial assistance to NMCC in the design and development of communication messages and materials for the national insecticide-treated net (ITN) mass distribution program; · CSH further helped NAC and NMCC in the development of their national HIV and malaria communication strategies for 2011 – 2015 and provided technical assistance to NAC to develop 2011- 2015 National HIV/AIDS M&E Plan; · CSH assisted GRZ in the development of National HIV/AIDS, Malaria and Male Circumcision Communication strategies. These strategies are aligned to national strategic plans and will guide national implementers in designing communication messages and products. · In addition to its direct assistance to GRZ, CSH provided sub-grants to CHAMP and Afya Mzuri for the expansion of the 990 Talkline, and Health Communication Resource Centre, respectively. d) Zambia Led Prevention Initiative (ZPI) Program (August, 2010 to December, 2014: Active) — the project is aimed at increasing the utilization of community-level interventions through a targeted approach and provides technical leadership and expertise on comprehensive, effective, community-based prevention efforts aimed at reducing HIV transmission in Zambia through effective behaviour change communications (BCC): (i) As of June 2012, ZPI reached more than 146,000 members of the target population with individual or small-group HIV preventive interventions; (ii) More than 25,000 persons were reached by individual, small-group or community-level interventions or services that explicitly addressed gender-based violence (GBV) and coercion; (iii) The project has provided testing and counselling services to more than 53,000 individuals, including nearly 13,000 pregnant women; has reached more than 4,000 individuals living with HIV and AIDS with a minimum package of prevention interventions; and has provided economic strengthening services to more than 2,300 adults and children.
Mapping of RMNCH & Nutrition Programs/ 31 Projects in Lusaka and Copperbelt Provinces e) Maternal and Child HIV and AIDS Health Care and Promotion (December, 2011 to February, 2015: Active) — This project aims to improve maternal and child health by improving the understanding of safe breastfeeding practices in order to enable HIV-positive mothers to prevent mother-to-child transmission of HIV. The focus of the project, therefore, is on Maternal and Newborn Health, Child Health using a combination of the following strategies: PMTCT, HSS, CSS; and, BCC (i) Footprint and reach – The project targets the Lusaka district in Zambia and is reaching over 1,500 HIV positive women; (ii) Food security emphasis – The project focuses on strengthening maternal and child health systems related to HIV/AIDS, improving food security for HIV-positive mothers, and fostering community mobilization and education. Activities include: promoting safe breastfeeding; developing food programs for families affected by HIV/AIDS; (iii) Training of health workers (HSS through capacity building) – The project has provided training to 300 health workers providing maternal and infant health care for families affected by HIV/AIDS; (iv) Delivery of comprehensive and gender-sensitive PMTCT services – The projects approach includes a focus on strengthening the capacity of health care workers to provide comprehensive and gender-sensitive PMTCT services; (v) Promoting safe practices, a holistic approach and reducing stigma — The projects results are contributing to reducing stigma for people with HIV, increasing safe practices to prevent HIV, improving the use of best practices for PMTCT, and improving food security, or access to safe, nutritious and sufficient food, for families affected by HIV/AIDS; (vi) Specific results achieved – As of February 2014, the following results were achieved: · 40 health workers were trained in the Prevention of Mother-to-Child Transmission (PMTCT) of HIV; · 30 community volunteers were recruited and trained as outreach workers in PMTCT; · 509 people received health services provided by free health clinics, as well as referrals to other health centres; · 300 women living with HIV were enrolled in a food hamper program and received food on a monthly basis; · 112 women received nutrition training to help them prepare nutritious, local and affordable meals through a community kitchen established by the project; · 2,000 square metres of land was secured, allowing 76 vulnerable women to participate in community gardening; · Drama performances focusing on PMTCT were staged to raise awareness in the community of Kamanga; · Women received on-going health education and counselling; · HIV-positive women were given a safe space to share their experiences through Women’s Empowerment Groups held every two weeks; · Quarterly community meetings were held and 30 community leaders were trained to raise awareness and improve understanding of HIV/AIDS in the community, including understanding maternal, newborn and child health in the context of HIV/AIDS. f) Malaria Booster Project (November, 2010 to January, 2013: Closed) — Areas of intervention included Malaria prevention with a focus on Maternal and Newborn Health; and, Child Health. A health systems strengthening (HSS) approach to improving service delivery was adopted. Achievements of the MBP project include the following:
32 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces (i) Supply of consumables, materials and equipment — Procurement and distribution of Insecticide Treated Nets (ITNs); Rapid Diagnostic Tests (RDTs); Operational costs and equipment and supplies for the Indoor Residual Spraying (IRS) campaign; (ii) Health Systems Strengthening (HSS) — Strengthening the logistics and supply chain management; (iii) Dramatic progress in its fight to control malaria: · Evidenced by results from population based health surveys conducted in 2002, 2006, 2007, 2008, and 2010; · Most notable is the impact on Zambia’s most vulnerable group, its children. In the two years between 2006 and 2008, malaria parasite prevalence in children under age five years was reduced by 54% and severe anaemia was reduced by 69%. · Since 2002, malaria infection and illness in this same age group has decreased substantially, and the all-cause mortality rate for children under age five years has dropped by 29%—meaning an estimated 75,000 lives was saved over the 6 year period. g) EpiscopalRelief Early Childhood Development Program (2012 to 2016: Active) — The ECD programmes addresses the needs of young children affected by HIV/AIDS while equipping their caregivers and communities to support their healthy development. Its areas of focus are ECD, Sexual & Reproductive Health (SRH), Maternal & Child Health with strategies involving community systems strengthening (CSS) and behaviour change communications (BCC). Target communities have taken enthusiastically to the program, with dedicated volunteers carrying out the activities and collaborating organizations providing additional services. There has been an overwhelmingly positive response from families and children. Some early indicators of success include: (i) Attendance at support and playgroups – Caregivers and their children have had consistent attendance at the centres for the support groups/playgroups and growth monitoring sessions; (ii) Children are more active and engaged – Children are playing together regularly and are developing social and language skills; (iii) Greater use of health care cards and increased access to immunization services – More caregivers are taking their children to receive immunizations and using child health cards to ensure the children get the preventive services and treatment when needed. h) Local to Global Initiative (January, 2013 to December, 2015: Active) — The project aims to ensure that the right to survival, protection, development and participation for every Zambian child is attained, and maternal health improved in Zambia by 2015 through breakthroughs in policy and practice that dramatically accelerate sustainable progress towards MDGs 4 and 5. Key topics addressed include Maternal and Newborn Health, and Child Health and strategies adopted include behaviour change communications (BCC). The achievements of the project to date include the following: (i) The neighbourhood health committees (NHCs) in the target areas mobilised and formed 23 Safe Motherhood Action Groups (SMAGs) and Community Nutrition Groups (CNGs) and achieved greater male involvement; (ii) The advocacy skills for the NHCs have been enhanced. For instance two NHCs lobbied and succeeded in mobilising funding from the local council for the construction of mothers shelters and electrification of a health centre; (iii) Use of mobile clinics by CHAMP, an implementation partner on the project, as an entry point to provide maternal and child services in selected communities of Lusaka,
Mapping of RMNCH & Nutrition Programs/ 33 Projects in Lusaka and Copperbelt Provinces (iv) The project has, so far, reached 1,294 women with antenatal and postnatal services. Immunization and growth monitoring (weight and height) services were also provided to 2,597 children. i) HIV Integrated Local Ownership Programme (HILO)- PAEDIATRIC CARE Project (September, 2011 to September, 2016: Active) — The aim of the project is to: (1) Improve retention of paediatric patients in care; (2) Support the development of integrated clinic systems; (3) Support the transition by building clinical and mentoring capacity through joint activities; (4) Promote the delivery of quality paediatric support services; (5) Promote equity of access to ART by disadvantaged children; (6) Provide and transition laboratory testing. Key topics are HIV and Child Health and are supported by as health systems improvement approach (HSS). (i) In the area of support groups, CIDRZ achieved the following: · Formed 16 out of a targeted 20 paediatric support groups; · Formed 14 out of the targeted 20 adolescent support groups; · Conducted a total of 82 support group visitations out of the planned 20; CIDRZ further formed 17 new care giver support groups. (ii) At the operational level: · CIDRZ procured 60 computers, 13 Laptops and 50 UPS’s, to upgrade and run SmartCare; · With help from CDC, 29 Data Associates were employed and deployed to 23 sites. j) HIV Integrated Local Ownership Programme (HILO)-PMTCT Project (September, 2011 to September, 2016: Active) — The aim of this project is to: (1) Provide family-centred, quality, comprehensive, and integrated safe motherhood services; (2) Provide more efficacious PMTCT regimens to ALL HIV positive women; (3) Provide comprehensive HIV prevention, treatment and care services to HIV-exposed babies; (4) Strengthen monitoring and evaluation to enhance data quality and use; (5) Accelerate the expansion of more effective PMTCT services. The project, therefore, has a Maternal and Newborn Health and Child Health focus and employs a behaviour change communications (BCC) approach. The project has achieved the following: (i) Tested 49,610 male partners; (ii) Conducted a total of 112 community sensitizations; (iii) MOH has sourced, finalized and launched the national GBV curriculum; (iv) CIDRZ mentored nurses to review stable ART patients during follow up; (v) A rota system was implemented for Clinical officers to attend to ART patients in MCH. k) Mopani Copper Mines HIV/AIDS program (Data on implementation timeframe and status was not available) — Mopani implemented the HIV/AIDS program to increase access to antiretroviral treatment (ART) and quality care for employees, their dependents and the general public. The intervention includes a BCC component. (i) There has been a reduction in the rate of mother to child transmission of HIV from 37% to 2%; (ii) AIDS-related deaths fell from 4.3% at the program’s inception to 0.4% and hospital admissions for AIDS-related health issues declined significantly; (iii) Through the HIV/AIDS programme Mopani has helped to change hundreds of lives and is currently helping people to live meaningful lives despite being HIV positive; (iv) The non-discriminatory HIV/AIDS programme has greatly helped to influence behavioural change and cut through barriers such as stigma, self-denial and non- willingness to access VCT services, thereby contributing to the reduction in infection rate and increased access to Antiretroviral Therapy (ART).
34 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces l) Konkola Copper Mines - Rollback Malaria Programme (Data on implementation timeframe and status was not available) — The aim of the programme is to protect the people of Chililabombwe and Chingola in the Copperbelt province (including selected dwellings of Kitwe and Kalulushi) and Napundwe central province from the spread of Malaria. A primary strategy adopted is behaviour change communications (BCC). The project has achieved the following, so far: (i) The incidence of malaria in project sites has dropped from 113 cases per 1000 people to 11 cases per 1000 people; (ii) Indoor Residual Spraying (IRS) coverage has increased from 73% to 99%. m) Supporting the National Response to Malaria Control Program (December, 2011 to December, 2015: Active) — The project aims to ensure and maintain programmatic gains made in the fight against malaria. Achievements of the project include: (i) The proportion of children under five sleeping under ITNs has increased by 14 %; (ii) An increase of 30% in pregnant women sleeping under ITNs; (iii) About 72% of Zambian households have at least one mosquito net, and 68% of households have at least one ITN. n) Expanding Access to Comprehensive Abortion Care (CAC) Information and Services in Zambia (2010 to 2013: Closed) — The overall project objective was to increase access to high quality CAC services. This fell under the Family Planning umbrella supported by a behaviour change communications (BCC) approach. Results achieved included: (i) 20 stakeholders from different organizations and the local state authorities pledged their commitment to the project; (ii) Collaboration with like-minded organisations strengthened advocacy around an improved policy environment to provide for safe abortion services; (iii) More members of parliament are more knowledgeable and able to discuss CAC services; (iv) The project increased support from community leaders and learning institutions to mobilise communities and schools for the provision of sexuality education o) Supporting communities in sustainable livelihoods (July, 2009 to June, 2013: Closed) — The project aimed at transforming the lives of people living within and around the communities that KCM operates. · Areas of intervention Nutrition, Maternal and Newborn Health, Early Childhood Development (ECD), Water & Sanitation (WASH), and Gender-Based Violence (GBV) and involved elements of health systems strengthening (HSS). · The project recorded improvements in health, increased household food security, diversified household incomes, gender equity, and increased youth access to social and economic empowerment and increased access to early learning for children p) Expanding Reproductive Health Choices for Young People in Zambia (2010 to 2013: Closed) — The project aimed build support for comprehensive sexuality education (CSE) and sexual reproductive health services for young people. Key topics addressed were Family Planning and Sexual & Reproductive Health (SRH) through a behaviour change communications approach (BCC) and advocacy for Adolescent and Youth-Friendly Services (AYFS). (i) Successful community outreach activities — Empowered young people with information and services in sexual and reproductive health resulting in increased demand and utilization of SRHR services; (ii) Development of curriculum — The enhanced curriculum was piloted in government schools in four provinces and awaits review and integration into the national school curriculum;
Mapping of RMNCH & Nutrition Programs/ 35 Projects in Lusaka and Copperbelt Provinces (iii) Teachers were oriented in comprehensive sexuality education — This orientation enhanced the teachers’ understanding of sexuality education which gave them a basis to support the integration of CSE within the school curriculum; (iv) Empowerment of young people to be advocates of sexual and reproductive health and rights — Equipped them with skills in sexual and reproductive health peer education; (v) Strengthened partnerships — Partner organisations through the course of this project included MoE, UNFPA, UNESCO and Save the Children. q) Partnership for Integrated Social Marketing (August, 2009 to December, 2014: Active) — Overall, the project’s aim is to contribute to Zambia’s achievement of health-related Millennium Development Goals (MDGs). Key topics addressed include Child Health, Sexual & Reproductive Health (SRH), HIV and Malaria. (i) So far, the project has increased the supply and diversity of health products and services to distribute and deliver for disease prevention and control through integrated health service delivery using private sector channels working in conjunction with the public sector; (ii) There is increased awareness of, and demand for, health products and services; (iii) The project has confirmed the ability of a private sector commercial entity to produce and market at least one currently socially marketed health product or service in a sustainable and self-sufficient manner in the Zambian setting.
7.2.2 Implementation Challenges
Past and on-going projects have experienced a variety of challenges depending, among other things, on stage of implementation.
7.2.2.1 Start-Up Challenges
The Survive and Thrive project faced constraints at the start-up phase because of the reassignment of public health responsibility from MOH to MCDMCH in 2011. This called for 27 27. Currently, six collaboration with numerous government ministries , which proved to be time consuming. Similarly, ministries are the creation of new districts resulted in duplication of work in that EGPAF, the implementing agency, involved in ECD: MESVTEE; had to collaborate separately with the respective DHMTs and local authorities in both the old and MLGH; MCDMCH; MGCD; MOH; new districts. MOYS
The Cecily Eastwood Zambian AIDS Orphans Appeal (Cecilys Fund) experienced delays in the 28. Dziwani is Zambia’s leading commencement of its activities due to delayed receipt of funds and related account opening Knowledge Centre for Health, formalities. providing over 3,000 members 7.2.2.2 Operational Challenges and up to 150 daily users with access to a With several implementation partners involved on the Survive and Thrive project, there were comprehensive health disparities in allowances paid to volunteers which presented a challenge in terms of motivating and communications managing the volunteers. resource library, multi-media centre, cyber- A particular operational challenge for the Cecily Eastwood Zambian AIDS Orphans Appeal (Cecilys cafe and high impact learning Fund) was the incompleteness of content on its OVC database. environment at Afya Mzuri’s Afya Mzuri, a partner implementing the Dziwani Knowledge Centre28 under the Communications head offices on Manchinchi Road Support for Health (CSH) project, found that a number its computers were running old operating in Lusaka (http:// www.afyamzuri. systems, such as Vista and Windows XP. This posed a challenge to the deployment of its Cyber org/dziwani). Café due to software and hardware compatibility issues. Problems were also experienced with identifying suitably qualified personnel such as consultants to lead the development of a
36 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces sustainability analysis and business plan for Dziwani. There were also funding challenges to the ability to engage the relevant health professionals. Afya Mzuri also experienced delays in the issuance, by its partners, of copyrights for their materials which delayed the online deployment of these resources.
At the program level, CSH suffered a constraint on its mandate which was national in contrast to MCDMCH’s district and community-level purview. This called for negotiations and decisions on the specific points of engagement and cooperation between CSH and MCDMCHs in relation to the latter’s IEC/BCC activities
In Luanshya district, Golden Lay Limited’s (GLL’s) 3-year project (July, 2010 to June, 2013: Closed) aimed at providing an workplace HIV programme of its staff with complementary services to the company’s surrounding community of some 6,000 to 8,000 people, run into challenges of (1) low attendance by staff at workplace HIV sessions; (2) delays in the launch of GLLs HIV and AIDS policy; (3) non-disclosure of HIV status by staff to their partners; (4) need for a readily available training facility; (5) non-availability of funding for major surveys that would have informed a monitoring and evaluation (M&E) process for the project; (6) competition with proximate employers, such as road construction projects (e.g. the Ndola–Kitwe dual carriage way), for youth whom the GLL project needed to be able to deploy as community peer educators; (7) fear of victimization and non-renewal of contracts contributed to employees’ failure to disclose their HIV status to management.
The challenges noted with respect to the Zambia Prevention, Care & Treatment Partnership 29. ZPCT II Project II (ZCPT II)29 are informative and substantially representative of the issues noted across implementation timeframe and the spectrum of other projects. A particular issue for ZPCT II was that United States Government status: 2010 to 2014, Active. (USG) regulations regarding MOH/MCDMCH, and other GRZ, allowances are restrictive and are, therefore, a disincentive to GRZ employees’ participation in ZPCT II activities. Similarly, the small amounts of allowances paid to community volunteers has limited their willingness to work in health facilities or to travel to undertake follow-ups on treatment adherence, or to promote male circumcision or other HIV/AIDS services. Across the board, the short supply of competent health workers in the various health facilities has affected the ability to provide adequate, high quality services, and to participate fully in ZPCT II training, mentoring and other capacity building activities. In addition, limited funding, and donor (PEPFAR) stipulations on authorized uses of funds, constrains the construction of health facilities which presents obstacles to providing adequate space for CT, PMTCT, ART, and other HIV/AIDS services.
In addition, gender-related obstacles to the effective integration of gender into clinical care were experienced. These arose primarily, from socio-cultural factors that occur at the household and community levels where community volunteers and lay counsellors work. Actions being taken by ZCPT II to address this constraint include the institution of a Steering Committee and the implementation of manuals, guidelines, and a database. In addition, DHO staff were prioritized for gender sensitization and GBV training. Community volunteers and lay counsellors have yet to be trained in gender integration as they engage in BCC when working with households and communities to prevent GBV and to make appropriate referrals as required.
ZPCT II did not meet the requirement to register with the DATF in some of its target districts which presented obstacles to collaboration with NAC and the relevant community structures in these districts. This non-engagement with CBOs undermined community support for ZPCT II’s prevention objectives and community mobilization efforts.
Differences in the project systems used by ZPCT II for planning, supervision, training and monitoring and others affected the project’s ability to integrate with MOH/MCDMCH’s systems. Additionally, differences in ZPCT II and MOH/MCDMCH planning cycles (October to September versus January to December) presented their own obstacles to joint programming.
Mapping of RMNCH & Nutrition Programs/ 37 Projects in Lusaka and Copperbelt Provinces There has also been a problem of role clarity for the data entry clerks employed by ZCPT II who also have a functional reporting line to MOH/MCDMCH. Similarly, the consistency and effectiveness of M&E and supervision on the project was affected by the dual reporting requirement for the ZPCT IIs data entry clerks who had to report to ZPCT II M&E officers and to the DHIOs (MCDMCH).
It was also reported that some DHMTs are not given adequate time to review and discuss the “Recipient Agreements” (i.e. used by ZPCT II to manage the DHMTs handling of USAID the funds disbursed to them) prior to signature. This has limited DHMT capacity for informed decision-making with regard to the financial resources to be used in their districts and may also have constrained the ZPCT II mandate to strengthen MOH/MCDMCH ownership.
With respect to the Malaria Booster Programme, it was noted that the malaria burden remains high despite the gains achieved so far. In particular, there is a potential for resurgence of malaria and for the entrenchment of a malaria epidemic. To address this concern, additional resources are needed to reach and maintain the critical targets for intervention coverage needed to sustain the results. IRS needs to be repeated at least annually and long lasting nets replaced within a 3-year cycle in addition to which the adequacy of curative interventions involving rapid diagnosis and effective treatment with artemesinin-based combination therapies needs to be ensured. The longer term impact of inadequate funding for malaria programming will be a very high financial burden on Zambia’s health system.
The Youth Awake PMTCT Project in Chilanga district encountered the pervasive problem of lack of youth-friendly corners in health centres which makes it difficult for youths to get Family Planning services and pregnancy-related services such as ANC and PNC. The implication is that the project’s 5-year scale-up plan for PMTCT may not be achieved. In addition, not every health centre is a delivery centre which makes it difficult for clients to adhere toART when referred to other health centres after delivery.
The Comic Relief-funded Better Health Outcomes through Mentorship and Assessments (BHOMA) Project (September, 2013 April, 2016: Active) has encountered interruptions in cash flow, a high staff attrition rate; and, uncertainties and shortfalls in the supply chain of drug kits. In addition, the population, or the geographical spread of the area, targeted by the project was found to be much larger than anticipated in comparison to the number of volunteers on the project.
Similar to the challenges encountered by ZPCT II, the HIV Integrated Local Ownership Programme (HILO)-Paediatric Care project implemented by CIDRZ encountered systems and software compatibility issues which impacted the upgrade of SmartCare resulting in a massive data backlog. In addition, process and systems incompatibilities undermined the intended transitioning of project roles from CIDRZ to MOH/MCDMCH.
The HIV Integrated Local Ownership Programme (HILO)-PMTCT project has suffered the constraint of limited district ownership and, hence, inadequate supervision by the districts. There have also been staff shortages due to attrition at the health facility level. Other issues are stock outs of HIV test kits including Dried Blood Spot (DBS) kits, a weak transport system for DBS, Polymerase Chain Reaction (PCR) and CD4 samples and results; and, a long turnaround time for DBS PCR results. Additional challenges are low male involvement, poor record-keeping (patient care notes and follow up plans) by busy clinicians, delays in implementing appropriate data collection and reporting tools in line with the revised PMTCT protocol guidelines; use of unrevised registers and reporting tools; and, inadequate infrastructure
The Expanding Access to Comprehensive Abortion Care (CAC) Information and Services in Zambia project has faced uncertainty surrounding the constitutional clause on when life begins; lack of information added to religious and cultural dogma may have affected the demand for safe
38 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces CAC services (unsafe abortions account for approximately 30% of all maternal mortality in Zambia). There is also a lack of public knowledge concerning the Termination of Pregnancy Act of 1972 which, essentially, legalizes abortion in the event of risk to the mother’s life from the pregnancy (in 2012, Marie Stoppes International were accused of carrying out hundreds of illegal abortions)). Nationally, there is a high level of prejudice against CAC service.
7.2.3 Sustainability Issues Noted
Across the board, a common concern for sustainability is the availability of financial resources to sustain RMNCH&N programmes and projects beyond 2015. This financial sustainability issue is highlighted by the fact that, of the 46 active programs and projects in the database (see Table 5), only six (6) have end dates falling more than one year after December 2015. Funding for thirty two (32) of these active projects is through Official Development Assistance (ODA) from the country’s multilateral and bilateral cooperating partners (CPs). Out of the total complement of 68 projects, 15 projects are already closed and only one is a pipeline project.
Among the 68 projects is the First 1000 Most Critical Days - Three Year Programme, 2013-2015, is funded by GRZ and complementary, pooled funding from the UK, UNICEF, Irish Aid, WFP, World Bank and USAID in addition to direct programme support to districts or communities.
For the portfolio of programmes and projects captured in Annex A, the bulk of funding is from official sources in the form of official development assistance.
Financing by non-state actors is, most likely, very understated on account of the non-reporting into national coordination structures alluded to above. These non-state actors include international and local NGOs, CSOs, FBOs and private sector associations and corporations. The contributions of the private sector are most visible in the mining sector where the RMNCH&N programs of companies such as Konkola Copper Mines (KCM) and Mopani Copper Mines (MCM), and the health facilities they operate, are well recognized (see Box 2 on page 24).
Some lessons highlighted by the actors and projects documented in Annex A include the following: · Speaking of its Strengthening Early Childhood Development in Zambia, EGPAF noted that partnership with other actors and public awareness are key to sustainability; · In respect of the Cecily Eastwood Zambian AIDS Orphans Appeal (Cecilys Fund), Afya Mzuri notes that implementing community-rooted programmes (i.e. leveraging community structures and organisations) is key to sustainability; · Lessons from the Communications Support for Health (CSH) include the following: (1) Staff attrition is deleterious to sustainability and, hence, capacity building should be targeted across beneficiary organisations; (2) Project activities at the community level should be linked to existing structures, including the government recognised Neighbourhood Health Communities (NHCs). In terms of CSH, the creation of Save Love Clubs and Safe Motherhood Action Groups (SMAGs) through partner community health organisations did not guarantee the continuity of community level IEC/BCC activities because CSH had not created links between the clubs and NHCs, which are the GRZ-recognised structures for health delivery at the local level; (3) Government should be kept in the loop on project activities to enable it to perpetuate the projects benefits beyond the implementation period. · Under PPAZ’s Performance and Accountability Initiative for Better Results (PAIR) project, network clinics established strong referral and follow up systems to the University Teaching Hospital for CAC services that the Association could not provide;
Mapping of RMNCH & Nutrition Programs/ 39 Projects in Lusaka and Copperbelt Provinces · The Community Safe Motherhood project built the capacity of community members in the area of Reproductive Health. This contributed to positive change among community members and stimulated a sense of ownership which contributed to the sustainability of the project. · The Expanding Reproductive Health Choices for Young People in Zambia project involved close collaboration with the Government and other stakeholders such as UNESCO and Save the Children. This created an enabling environment for adopting a National CSE framework that could be integrated into the school curriculum across the country, thus, ensuring wide coverage of SRH information and access to services.
7.3 Innovations and Good Practices in RMNCH&N
A small number of projects are listed in this section to showcase their innovations and good practices in relation to service delivery, capacity building, record keeping and incentives (financial and non-financial) for staff and community volunteers. Annex A captures more detail for each project where information was available.
7.3.1 Innovations a) Agents4Change - Reaching Young Women with Integrated Sexual and Reproductive Health and HIV and AIDS information and services: (i) Use of new technology in the form of mobile phones to disseminate information to increase knowledge and awareness on SRH and available services. b) Better Health Outcomes through Mentorship and Assessments (BHOMA) project: (i) Use of neonatal visit forms and follow-up on all deliveries that are recorded; (ii) The system sends respective CHWs messages for follow up of each new born at six days and twenty-eight days after each recorded delivery; (iii) Home visits for mothers after delivery at 2 days, 6 days and 6 weeks of infant life, in order to monitor the general health of the mother and newborn;
7.3.2 Good Practices a) 2014 Zambia NetsforLife Program: (i) Sensitization/Education of individuals in the communities in Chongwe and Rufunsa districts; (ii) Follow up and monitoring of distributed Long-Lasting Insecticidal Nets (LLINs) usage at the household level by Malaria Control Agents ; (iii) Follow up and monitoring of LLINs at the household level by national and district staff;
Box 3 Principles of the 2005 Paris Declaration on AID Effectiveness 1. Ownership: Developing countries set their own strategies for poverty reduction, improve their institutions and tackle corruption. 2. Alignment: Donor countries align behind these objectives and use local systems. 3. Harmonisation: Donor countries coordinate, simplify procedures and share information to avoid duplication. 4. Results: Developing countries and donors shift focus to development results and results get measured. 5. Mutual accountability: Donors and partners are accountable for development results.
40 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces (iv) Registration of beneficiaries; (v) Distribution of 31,000 LLINs to registered beneficiaries; (vi) Sensitization and education of LLIN beneficiaries on malaria and importance of the consistent and correct use of LLINs. b) Agents4Change - Reaching Young Women with Integrated Sexual and Reproductive Health and HIV and AIDS information and services (i) Utilizing peer educators as the primary implementers; (ii) Utilising Community Leaders to carry out advocacy; (iii) The levels of income for CAfC members who were empowered with start-up capitals started increasing and 20 of them had started paying back.
Better Health Outcomes through Mentorship and Assessments (BHOMA) project: (i) At the programme management level, staff motivation activities including team building and short-term training courses were undertaken; (ii) At the health facility level, the TBAs serve as part of the labour ward teams helping with vital signs, urinalysis, HIV testing, dispensing of iron and folate, ARVs (under supervision), measuring of height and weight, health education, breastfeeding education and support, and family planning counselling.
7.4 Synergies through Geographic and Programmatic Convergence
Part of MDGi’s focus is on strengthening service delivery and management at district level, and building the management capacity of the relevant Government institutions at the national and provincial levels towards improving the availability and quality of RMNCH&N services in the 11 selected districts. Given the significance of donor support for RMNCH&N services delivery in Zambia, and the mutual accountability aspirations of the Paris Declaration on Aid Effectiveness (see Box 3), there appears to be a need to broaden this capacity building effort beyond Government, through appropriate coordination measures, to include the Government’s cooperating partners, international and local NGOs and other actors, and to, hence, create complementary competencies amongst them. Realising the synergies embedded within the plethora of past, present and future RMCNH&N interventions in the country will call for the coordination and/or consolidation of resources and activities in order to achieve more (i.e. reach more people and/or provide a broader range of services) with less through scale and scope economies.
Mapping of RMNCH & Nutrition Programs/ 41 Projects in Lusaka and Copperbelt Provinces Figure 17 MNCH pillars and cross-cutting issues
Knowledge and information-sharing is an important tool for coordination. Consolidation (or integration) of supply chains, project activities and project resources (i.e. joint use of inputs including staff, equipment, facilities, etc.), wherever possible, through geographic or programmatic convergence is the next step towards realising these synergies. The cross-training of staff (e.g. ensuring that all general nursing staff also have specialist skills such as midwifery) is a particularly effective tool for broadening the scope of services offered at health facility level. Project activities can be consolidated by main area of intervention: reproductive health, maternal, newborn and child health, nutrition, HIV/TB/Malaria, water and sanitation. Figure 17 is an attempt at demonstrating the interrelationships between these variables and other factors impacting them. The analysis in Annex A includes some specific suggestions for programmatic and geographic convergence through MDGi. The projects below are categorised under thematic focus areas as a starting point for considerations leading to possible consolidation, integration and scale-up at various levels: a) Child Health · Child Aid - Integrated Community Development Project Proposal to HITACHI. · ColaLife Operational Trial Zambia (COTZ) · Integrated Management of Child Illness (IMCI) · Programme for Awareness and Elimination of Diarrhoea (PAED)
42 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces b) ECD · EpiscopalRelief Early Childhood Development Program · Strengthening Early Childhood Development in Zambia c) GBV · Golden Lay Limited (GLL) Workplace HIV Programme · Gender Based Violence (GBV) Project d) HIV/AIDS · HIV Integrated Local Ownership Programme (HILO)- PAEDIATRIC CARE Project · HIV Integrated Local Ownership Programme (HILO)-PMTCT Project · Hope Ndola · New Start HIV Testing and Counselling · Project Mwana - Using mobile technology to improve early infant diagnosis of HIV · Zambia Prevention, Care & Treatment Partnership Project II (ZPCT II) · Church Partnerships for Positive Change (CPPC) Project · Golden Lay Limited (GLL) · Mopani HIV/AIDS program · HIV and SRH Linkages Project e) HSS · Better Health Outcomes through Mentorship and Assessments (BHOMA) Project · Communications Support for Health (CSH) · Partnership for Integrated social Marketing (PRISM) · Zambia Integrated Systems Strengthening Program (ZISSP) f) Malaria · 2014 Zambia NetsforLife Program · Malaria Booster Project (MBP) · Supporting the National Response to Malaria Control Program - UNDP · KCM - Rollback Malaria Programme · Malaria Control and Evaluation Partnership in Africa (MACEPA) · Mopani Malaria Prevention Program g) Maternal & Newborn Health, Child Health · Local to Global Initiative · Stand Up for African Mothers Campaign · Community Safe Motherhood Project h) Nutrition; Nutrition; Nutrition; Nutrition · Accelerating Nutrition Improvements in Sub-Saharan Africa - Surveillance · Child Health and Nutrition Project · Supporting communities in sustainable livelihoods · The Food and Nutrition Technical Assistance III Project (FANTA) i) OVCs · Cecily Eastwood Zambian AIDS Orphans Appeal (Cecilys Fund) j) PMTCT · Maternal and Child HIV and AIDS Health Care and Promotion · Youth Awake PMTCT Project
Mapping of RMNCH & Nutrition Programs/ 43 Projects in Lusaka and Copperbelt Provinces k) SRH · Agents4Change - Reaching Young Women with Integrated Sexual and Reproductive Health and HIV and AIDS information and services · Bwembya Lukutati Memorial Reproductive Health Centre (BLMRHC). · Expanding Reproductive Health Choices for Young People in Zambia · Expanding Young Peoples Access to Comprehensive Sexuality Education and Sexual Reproductive Health Services. · Performance and Accountability Initiative for Better Results (PAIR) · Safe Abortion Project · Safeguard Young People Sexual and Reproductive Health and Rights/HIV (SRHR) programme · The Rachael Lumpa Memorial Reproductive Health Centre – Lusaka (RLMRHC) · The Youth Action Movement · Tikambe! Project-BBC Action Media and Restless Development · Zambia U-Report · Expanding Access to Comprehensive Abortion Care (CAC) Information and Services in Zambia · Scaling Up Family Planning (SUFP) in Zambia
44 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces CONCLUSIONS AND RECOMMENDATIONS
Mapping of RMNCH & Nutrition Programs/ 24 Projects in Lusaka and Copperbelt Provinces 8 The underlying prerequisite to the successful development and roll-out of high quality RMNCH&N interventions is the strengthening of the overall health system in Zambia. A core outcome of this HSS imperative should be strengthened capacity for integration on the part of actors across all sectors dealing with health policy, programming and services delivery. This should all happen within a framework that enables vertical integration, or harmonisation, of processes within programs and horizontal integration across projects. At the health facility level, HSS efforts should be complemented by community systems strengthening (CSS) to stimulate and enable informed demand and accountability for high quality health services.
Key gaps in service delivery begin with the cross-cutting issues undercutting health and health care in Zambia as partially depicted in Figure 17. Harmful societal norms and practices include the challenges posed by child marriage and child sexual abuse, alcohol and substance abuse; and, gender-based violence. These are issues that may not be receiving adequate attention and focus and there is, hence, an opportunity for MDGi to contribute to the scaling up of the necessary interventions in these areas. By way of example, in many peri-urban settings in the 11 selected MDGi districts, as is the case elsewhere in Zambia, the deplorable state of sanitation and the lack of reliable access to safe water supplies poses grave public health challenges with drastic implications for maternal and child health outcomes. Appropriate MDGi support to, or coordination with, water and sanitation interventions affecting these locations is strongly advised.
Interventions under the MDGi project should have features of, both, complementarity and additionality to programmes and projects that have proven to be effective. New interventions should also be contemplated under MDGi to mitigate gaps in the current scope of available services. Apart from staff shortages and other consequences of underfunding, the inaccessibility of health services is a serious constraint on demand for health care, especially in the more remote parts of the country. MDGi resources could be used to increase the scale and scope of transport and outreach services provided by each health facility.
In the above respects, the model adopted by the Better Health Outcomes through Mentoring and Assessment (BHOMA) project is instructive. The BHOMA approach includes various combinations of the elements listed in Table 6 depending on local circumstances:
Table 6: Key elements of the BHOMA project approach
BHOMA element Key Issues Addressed Outcomes a) Providing women with the opportunity to set up their Empowerment of women, Improved family nutrition; own businesses, enabling them to increase their Livelihoods overall improvements in financial independence and their status in the com- health munity. b) Facilitating delivery of health promotion information in Health Education, Family Mitigation of the “Three the community so that women and their partners can Planning Delays”; Better maternal identify warning signs for when they need to access and child health outcomes, different levels of maternal health services. We pro- generally, through improved vide family planning information so women can better spacing of pregnancies space their pregnancies and have control over the number of children they have. c) Assessing transport issues and developing effective Access to Health Facilities More safe deliveries methods of ensuring that women can reach the level of care they need to enable them to give birth safely. d) Training doctors, nurses and midwives so that they HSS through better skills for Better clinical outcomes; can provide high quality, skilled maternal health care medical staff availability of wider range of in the community. health services e) Providing support to upgrade health centre buildings HSS to improve health facil- Increased demand for health and, where needed, medical equipment and medi- ities and availability of medi- services; better clinical cines cations and consumables outcomes
46 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces BIBLIOGRAPHY
Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Arscott-Mills, S., Foreman, M., & Graham, V. (2012). Family Planning Sustainability Checklist: A Project Assessment Tool for Designing and Monitoring Sustainability of Community-based Family Planning Services. Calverton, MD: ICF International.
CIDRZ. (2014, April 2). M.A.C. AIDS Fund Grant Awarded to CIDRZ. Retrieved May 31, 2014, from CIDRZ: http://www.cidrz.org/m-a-c-aids-fund-grant-awarded- to-cidrz/
Countdown to 2015. (2013, May). Countdown to 2015: Maternal, Newborn and Child Survival. Retrieved June 8, 2014, from Zambia Maternal and Child Health Data: http://www.countdown2015mnch.org/country-profiles/zambia
Countdown to 2015. (n.d.). Countdown to 2015: Maternal, Newborn and Child Survival. Retrieved June 8, 2014, from Countdown and the Continuum of Care: http://www.countdown2015mnch.org/about-countdown/continuum-of-care
CSO, MOH, TDRC, UNZA, Macro International Inc. (2009). Zambia Demographic and Health Survey 2007. Calverton, MD: Central Statistical Office (CSO), Ministry of Health (MOH), Tropical Diseases Research Centre (TDRC), University of Zambia (UNZA), and Macro International Inc.
EGPAF. (2013). Zambia Annual Report: Survive and Thrive Project. Lusaka: Elizabeth Glaser Pediatric AIDS Foundation.
Lusaka Times. (2014, March 6). Lusaka Times. Retrieved May 24, 2014, from Reducing teenage pregnancy should be a national agenda-PPAZ: http://www. lusakatimes.com/2014/03/06/reducing-teenage-pregnancy-national-agenda-ppaz/
MOH. (2011). The Zambia Expanded Programme on Immunization: Comprehensive Multi Year Plan (cMYP) 2011-2015. Lusaka: Ministry of Health.
NFNC. (2012). The First 1000 Most Critical Days: Three Year Programme, 2013- 2015. Lusaka: GRZ.
Nkandela, A. (2001). Rapid Assessment of the Incidence of Child Abuse in Zambia. Lusaka: UNICEF, Children In Need Network (CHIN).
PMNCH. (2014). Progress towards MDG s 4 and 5: status and gaps. Retrieved June 28, 2014, from The Partnership for Maternal, Newborn and Child Health: http://www.who.int/pmnch/knowledge/publications/summaries/needs_and_ challenges/en/
48 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces StopAIDS Alliance. (2012). Intensify linkages between HIV and sexual and reproductive health and rights for maximum impact: Stop AIDS Alliance policy position. Washington D.C.: StopAIDS Alliance.
Stringer, J. S., Chisembele-Taylor, A., Chibwesha, C. J., Chi, H. F., Ayles, H., Manda, H., et al. (2013, May 31). Protocol-driven primary care and community linkages to improve population health in rural Zambia: the Better Health Outcomes through Mentoring and Assessment (BHOMA) project. Retrieved June 5, 2014, from BMC Health Services Research: http://www.biomedcentral.com/qc/1472- 6963/13/S2/S7
UKZambians. (2012, April 27). / LATEST / 45,000 Access Mopani VCT Facilities. Retrieved May 29, 2014, from UKZambians: http://ukzambians.co.uk/ home/2012/04/27/45000-access-mopani-vct-facilities/
UNDP & UNAIDS. (2012). Understanding and Acting on Critical Enablers and Development Synergies for Strategic Investments. New York: United Nations Development Programme, Joint United Nations Programme on HIV/AIDS.
UNFPA. (2004). The Glion Call to Action on Family Planning and HIV/AIDS in Women and Children. Retrieved June 20, 2014, from UNFPA: http://www.unfpa. org/webdav/site/global/shared/documents/publications/2004/glion_callaction.pdf
UNFPA. (2004). The New York Call to Commitment on Linking HIV/AIDS and Sexual and Reproductive Health. June 4, 2004 Meeting. New York: Rockefeller Foundation.
UNICEF. (2014). Maternal, Newborn and Child Health. Retrieved May 2, 2014, from Zambia: http://www.unicef.org/zambia/5109_8457.html
United Nations. (1995). Report of the International Conference on Population and Development. New York: United Nations.
United Nations Secretary-General. (2010). The Global Strategy for Women’s and Children’s Health. New York: The Partnership for Maternal, Newborn and Child Health.
WHO. (2012, May). Adolescent pregnancy: Fact sheet N°364. Retrieved May 29, 2014, from World Health Organisation: http://www.who.int/mediacentre/factsheets/ fs364/en/
Mapping of RMNCH & Nutrition Programs/ 49 Projects in Lusaka and Copperbelt Provinces WHO. (n.d.). Country Planning Cycle Database: A World Health Organization Resource. Retrieved March 31, 2014, from http://www.nationalplanningcycles.org/ planning-cycle/ZMB
WHO, PMNCH, UW. (2013). A Global Investment Framework for Women’s and Children’s Health: Advocacy Brochure. Geneva, Switzerland: The World Health Organization, The Partnership for Maternal, Newborn & Child Health and the University of Washington.
WHO, UNFPA, UNAIDS, IPPF. (2005). Sexual and Reproductive Health & HIV/ AIDS: A Framework for Priority Linkages. WHO, UNFPA, UNAIDS, IPPF.
WHO, UNICEF. (2013). Accountability for maternal, newborn and child survival: The 2013 Update. Geneva: WHO, UNICEF.
World Bank. (2014). Project Appraisal Document: Zambia Health Systems Improvement Project. Washington, DC: World Bank.
Wright, N. (2014, April 5). Emerging Voices. Retrieved May 25, 2014, from Welcome to Zambia: http://nataliecwright.wordpress.com/2014/04/05/emerging-voi ces/?blogsub=confirming#subscribe-blog
50 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces APPENDICES
Mapping of RMNCH & Nutrition Programs/ 50 Projects in Lusaka and Copperbelt Provinces Appendix 1 Terms of Reference
Republic of Zambia
Ministry of Community Development, Mother and Child Health
Millennium Development Goals Initiative for Maternal, Neonatal, Child Health & Nutrition
(GRZ-EU-UN MDGi for RMNCH&N)
Terms of Reference
Mapping of RMNCH & Nutrition Programs/Projects in Lusaka and Copperbelt Provinces
To be supported by the
Government of the Republic of Zambia – European Union – United Nations
MDGi Project for Accelerating Progress Towards Maternal, Neonatal & Child Morbidity/Mortality Reduction in Zambia
52 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces A. BACKGROUND
Zambia ranks 164th out of 187 countries on the United Nations Human Development Index. Health indicators remain unacceptably inadequate. Under-five mortality and Maternal Mortality rates are estimated at, respectively, 141 deaths per 1,000 live births and 410 deaths per 100,000 live births. Furthermore, 14.3 percent of the adult population aged between 15-49 lives with HIV. Stunting is estimated at 45% among children under the age of five years. Zambia’s fertility rate of 6.2 percent is amongst the highest within Africa. It is unlikely that Zambia reaches MDGs 4 & 5. The underlying causes of high mortality & morbidity rates are manifold: insufficient human resources and infrastructure, equipment and pharmaceuticals shortages, weak management systems and poor community participation, among others. In 2013, the Ministry of Community Development, Mother & Child Health led the formulation of the national Roadmap for Accelerating Reduction of Maternal, Neonatal and Child Mortality over the period 2013-2015. The Roadmap emphasizes actions to accelerate progress towards high and equitable coverage of priority interventions to provide a continuum of care for Maternal, Neonatal and Child Health & Nutrition along the life cycle: from adolescence and pre-pregnancy to pregnancy, child-birth, the post-natal and neonatal periods, and through the childhood period. As part of national efforts to operationalize the Roadmap, the Ministry of Community Development, Mother and Child Health and UNICEF Zambia, with support from the European Union, will be supporting the implementation of a program for “Accelerating Progress towards Maternal, Neonatal and Child Morbidity and Mortality Reduction in Zambia”. Over a period of 4 years, the program aims at improving availability and quality of Maternal, Neonatal and Child Health & Nutrition services in 11 selected target districts in Copperbelt and Lusaka Provinces, with a total population of approximately 3.8 million people. The program focuses on strengthening service delivery and management at district level, and at building management capacity at the provincial and national levels. Supply-side interventions for improving the availability and quality of services will be complemented by demand-side measures at community and households levels. The program builds on experiences and innovations which have been piloted in Zambia, and aims at combining existing strategies and capacities for specific health & nutrition problems into a comprehensive package of care at district level.
The program will be implemented in 11 selected target districts including 6 predominantly urban districts and 5 predominantly rural districts. The selected target districts are: · Copperbelt Province: Chingola, Kitwe, Luanshya, Mufulira, Ndola and Masaiti. · Lusaka Province: Chongwe, Rufunsa, Kafue, Chilanga and Lusaka district.
The five main Expected Results (ERs) of the MDGi project identified to support the objective of increased utilization of quality health and nutrition services by vulnerable women, adolescents and children are: ER–1: A package of highly effective nutrition services, aligned to the national strategy, is available and used by the most vulnerable populations in all targeted districts. Zambia is an early riser in the Scaling Up Nutrition (SUN) movement, which aims to increase the scale and effectiveness of strategies to tackle under-nutrition. In 2012, the NFNC launched the ‘First 1000 Critical Days’ programme to reduce stunting in children under-2-years of age. Nutrition interventions will be designed and implemented in alignment with the national strategy.
ER–2: Increased availability of a continuum of maternal, neonatal and child health and nutrition services of good quality. Based on district-specific plans, the project will address relevant supply and demand-side factors in line with the six building blocks for health system strengthening as developed by WHO, which underpin the system analysis of the Zambian National Health Strategic Plan.
Mapping of RMNCH & Nutrition Programs/ 53 Projects in Lusaka and Copperbelt Provinces ER–3: Increased knowledge, demand for services and cultural, geographical, and financial access to MNCH care and services. In addition to supply-side factors like non-availability or poor quality of services, economic, social and cultural factors may prevent users from seeking timely and effective care. In line with GRZ’s emphasis on demand-side factors the project will support district health and community services in strengthening their outreach to communities. Communities will be supported to implement nationally-tested approaches such as Safe Motherhood Action Groups, to claim their rights for quality care, and to set up systems to allow for timely referral of patient to service outlets.
ER-4: Improve coverage and accessibility of adolescent and youth friendly services in the targeted districts. The task of improving reproductive health services for young people will receive particular attention. The result will be achieved through supply-side interventions such as making relevant services youth-friendly, inter-sectoral collaboration – for example, with the education sector – and through community interventions to promote views and practices beneficial to the reproductive health of adolescents.
ER-5: The capacity for planning, implementation and co-ordination of MCDMCH, MoH and other stakeholders at national, provincial and district level is improved. The proposed project is one of the first major interventions to be implemented through the new cooperation arrangements as resulting from the recent shift of responsibilities from MoH to MCDMCH. In order to achieve the expected results in the presence of on-going institutional changes, capacity building interventions for better maternal and child health services will need to include support to the relevant institutions at district, provincial and national level to cope with current and future change management tasks.
The program’s implementation plan comprises 3 major phases: 1. Year 1 is the program’s Inception Phase and includes developing a situation analysis for each district through a combination of desk reviews and primary data collection with baseline assessments. This will guide the development of district MDG Acceleration Plans (MAPs) for MNCH&N which will define specific activities, results, and budget. It will also support the set-up of the program’ Monitoring & Evaluation system including quality assurance. 2. Years 2, 3, and 4 are the program’s Implementation Phase. Activities will be implemented according to detailed annual work plans and budgets. Activities will be monitored based on the Monitoring & Evaluation plan including a quality assurance plan for on-going progress assessment towards program’s objectives. 3. The last quarter of Year 4 comprises of a final program evaluation as per Monitoring & Evaluation plan with target indicators.
B. GOAL AND OBJECTIVES
As part of the Inception Phase, a mapping of Maternal, Neonatal, and Child Health & Nutrition programs/projects in the 2 provinces is required.
The goal of the mapping is: i) to ensure alignment of the project with on-going programmes and proactively seek effectiveness and efficiency gains in the 11 selected districts through close collaboration and convergence (geographic and programmatic); and, ii) to document the innovations, lessons learned and best practices to guide the MDGi program.
The specific objectives of the mapping exercise are to: 1. Map and describe all relevant recently completed, on-going and planned RMNCH&N programmes and projects and their contributing partners in each of the 11 selected districts to identify opportunities for synergies, convergence and collaboration with the GRZ-EU-UN MDGi project;
54 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces 2. Identify strategies, input types and outputs (including resources, tools and job-aids) , related to RMNCH service delivery systems strengthening and quality improvement developed under recently completed, on-going and upcoming partner supported RMNCH&N programmes and projects in the 11 selected districts to avoid duplication and facilitate synergies; 3. Analyse lessons learnt in relation to achievements, challenges, and sustainability; 4. Identify innovations and good practices in MNCH& N programming (e.g. innovative delivery strategies, capacity development strategies, incentives, etc); 5. Identify relevant opportunities for programmatic and geographic convergence, integration, and scale-up.
C. SCOPE OF WORK
The Mapping will include all programmes and projects encompassing activities in the area of Reproductive, Maternal, Neonatal and Child Health & Nutrition. It will cover programmes and projects either recently completed, on-going or planned/up-coming in the two provinces of relevance to the scope of work of the GRZ-EU-UN supported MDGi Programme.
The Mapping will include all programs/projects implemented in the 11 selected districts by either the Government of the Republic of Zambia (and its subsidiary departments), development partners, non-governmental organizations, civil society organizations, technical assistance agencies, and any other relevant entity within the scope of this desk review.
The Mapping will adopt a systematic approach to ensure consistency in program/project description and analysis. A standard template will be developed including the below suggested indicative areas: · Program/project title · Implementing organization/agency · Implementation status (whether active, closed, or in pipeline) · Timeframe (total duration, with start and end dates) · Target geographic locations and implementation sites · Goals and Objectives · Main areas of interventions (RMNCH & Nutrition) · Specific activities (within e.g. Family Planning, Sexual & Reproductive Health, Antenatal Care, Delivery Care, Post-Natal Care, Neonatal Care, Immunization, IMCI, Infant & Young Child Feeding and Maternal Nutrition ) · Implementing Partners (public and/or private sector partnerships, with definition of roles & responsibilities within program/project scope) · Resources, tools, systems developed (e.g. strategies, guidelines, protocols, operational plans, job aids, training materials, Planning and Monitoring & Evaluation tools, Information/Education/ Communications & Behavior Change Communications tools, trainers databases, Public-Private Partnerships etc as relevant) · Program/project/activity reviews and/or evaluation reports developed · Assessments, surveys, and/or Research conducted (whether quantitative/qualitative, for operational/formative purposes) · Results (outputs and outcomes) · Challenges and lessons learnt · Sustainability analysis and scale-up/replication plans
Mapping of RMNCH & Nutrition Programs/ 55 Projects in Lusaka and Copperbelt Provinces D. EXPECTED DELIVERABLES AND DUE DATES The Mapping is expected to produce the following deliverables: 1. A standard template for program/project description and analysis; 2. An inventory of all MNCH&N programs/projects in the two selected provinces 3. A report including the below listed areas: · Summary of methodology, description and analysis of main findings · District specific annexes including: - Updated district health profiles - Description of major recently completed, on-going or up-coming RMNCH and Nutrition projects and programmes complete with outputs and outcomes - Analysis of lessons learnt in relation to achievements, challenges, scale and sustainability - Innovations and good practices in RMNCH&N - Recommendations as.
E. DURATION The Mapping is estimated to start by March 25, 2014 and be completed by April 30, 2014.
F. CONTRACT MANAGEMENT The Mapping requires a Lead Researcher/Project Manager with two additional Research Assistants. The Project Manager will report directly to UNICEF for compliance with Terms of Reference, coordination for logistical arrangements, and financial management and he will report directly to the Chief of Health & Nutrition Section, UNICEF Zambia. The Project Manager will work closely for technical & operational coordination with GRZ-UN-EU MNCH&N MDGi team and UNICEF Staff Members.
G. KEY SKILLS, TECHNICAL EXPERTISE, AND EXPERIENCE REQUIREMENTS The following background and skills are expected: · Advanced university degree in Public Health, Medicine, or related field. · At least five years of experience in Maternal, Neonatal and Child Health & Nutrition programs, preferably in Zambia · Proven ability to analyze qualitative and quantitative information · Proven ability to liaise and coordinate with institutional and implementation partners · Fluency in English · Demonstrated ability to write clear and concise reports
H. BASIC CONTRACT POLICIES · Consultants are not entitled to overtime payment · All remuneration and expenses are within total value of signed contract · Expenses incurred before and/or after contract start/end dates are not charged to UNICEF. · Contract becomes effective with signatures of both parties (UNICEF and the Contractor). Contract automatically expires at end-date and as per total contract duration. · All outputs including tools, reports, and datasets shall be the property of the Ministry of Community Development, Mother & Child Health (MCDMCH) and UNICEF. All output master- copies (softcopy and hardcopy versions) shall be handed over to MCDMCH and UNICEF.
56 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Appendix 2 List of Interviewees
Name Title Organisation Type Location
Dr. Caroline Phiri Director, Mother & Child MCDMCH Line Ministry Lusaka
Dr. Penelope Kalesha Child Health Specialist MCDMCH Line Ministry Lusaka
Mr Steven Phiri Registrar, Department of MCDMCH Line Ministry Lusaka Registrar for NGOs
Ms. Grace Mapulanga Community Development MCDMCH Line Ministry Chingola Mutale Officer
Mr. Michael Muyoba District Head, Department of MCDMCH Line Ministry Kitwe Community Development
Mr. Victor Mbumwae Director, Directorate of Policy MGCD Line Ministry Lusaka and Planning
Mr. Nicolas Banda Chief Child Development MGCD Line Ministry Lusaka Officer (Inspections), Department of Child Development
Dr. Christopher Simoonga Director, Directorate of MOH Line Ministry Lusaka Planning & Budget
Dr. Elizabeth Chizema Director, Public Health MOH Line Ministry Lusaka Kawesha
Mr. Mubita Luwabelwa Deputy Director, Directorate of MOH Line Ministry Lusaka Planning & Budget
Mr. Wamunyima Muwana Provincial Permanent Office of the President Line Ministry Lusaka Secretary
Rev Howard J Sikwela Provincial Permanent Office of the President Line Ministry Ndola Secretary
Amb. Anne Mutambo Director Human Resources Office of the President Line Ministry Lusaka
Mr. Kashina Milunda District Commissioner District Commissioner’s Office Line Ministry Chongwe
Dr. Charles Msiska District Medical Officer MCDMCH, District Health Line Ministry Chongwe Management Team
Mr. Siachisa Musole District Administrative Offer District Commissioner’s Office Line Ministry Chongwe
Mr. Elias Kamanga District Commissioner Office of the President Line Ministry Kitwe
Dr Chikafuma Banda District Medical Officer MCDMCH, District Health Line Ministry Kitwe Management Team
Mrs Nsingu J Pasi Kotati Acting Senior Nursing Officer- Kitwe District Medical Office Line Ministry Kitwe PMTCT
Mrs Pauline Kalale Senior Nursing Officer-MCH Kitwe District Medical Office Line Ministry Kitwe Chitenge
Mr. Victor Bowa Clinical Care Officer District Community Medical Office Line Ministry Rufunsa
Ms. Enala Tembo MCH Coordinator District Community Medical Office Line Ministry Rufunsa
Mr. Nicholus Sakala Planner District Community Medical Office Line Ministry Rufunsa
Mr. Elijah Tembo Public Health Officer District Community Medical Office Line Ministry Rufunsa
Mr David Wilima Data Clerk District Medical Office Line Ministry Ndola
Dr M.K Simpungwe District Medical Officer MCDMCH, District Health Line Ministry Ndola Management Team
Ms Chumeli Munyinga Information Officer District Medical Office Line Ministry Ndola
Mapping of RMNCH & Nutrition Programs/ 57 Projects in Lusaka and Copperbelt Provinces Name Title Organisation Type Location
Mrs Racheal Simutwe Senior Nursing Officer-MCH District Medical Office Line Ministry Ndola
Mrs Nyambe Senior Nursing Officer- District Medical Office Line Ministry Ndola Mwanakasale PMTCT
Mr Malao Kabimbe Assistant Accountant District Medical Office Line Ministry Ndola
Dr. Abel Kabalo Provincial medical Officer Lusaka Province Medical Office Government Lusaka Agency
Dr Charles Sakulanda District Medical Officer MCDMCH, District Health Line Ministry Chingola Management Team
Mr Lawrence Mungala Consular Officer Canadian Embassy Cooperating Lusaka Partners
Ms Jennifer Ann Sharpe Assistant to PR & Culture Embassy of Japan Cooperating Lusaka Section Partners
Mr Mwiya Mundia Livelihood Food and Nutrition Irish Embassy Cooperating Lusaka Advisor Partners
Ms Namayuba Chiyota Program Officer Norwegian Embassy Cooperating Lusaka Partners
Ms Lydia Nkole Directors Secretary CDC Cooperating Lusaka Partners
Ms Dorica Nkhona Programme Officer DFID Cooperating Lusaka Partners
Ms Esther Bouma Health Sector Specialist EU Cooperating Lusaka Partners
Dr Paul Kalinda Health Advisor EU Cooperating Lusaka Partners
Mr Kenneth Mwansa Partnership Advisor UNAIDS Cooperating Lusaka Partners
Mr. Ian Milimo Assistant Resident UNDP Cooperating Lusaka Representative (Poverty & Partners MDGs)
Ms. Dellia Yeokum Gender Specialist UNDP Cooperating Lusaka Partners
Dr Mary Otieno Country Representative UNFPA Cooperating Lusaka Partners
Mrs Elizabeth Kalunga Midwifery Advisory UNFPA Cooperating Lusaka Partners
Dr Steven Mupeta National Programm UNFPA Cooperating Lusaka Coordinator Partners
Dr Mary Kapepa Bwalya Child Health Adolescent WHO Cooperating Lusaka Officer Partners
Dr Serai Malumo National Professional Officer WHO Cooperating Lusaka for Making Pregnancy Safe Partners
Ms Karin Perl HIV/AIDS Advisor GIZ Cooperating Lusaka Partners
Mr Ian Membe Senior Program Specialist PEPFA Cooperating Lusaka Partners
Ms Tess Stenseth Executive Assistant PEPFA Cooperating Lusaka Partners
Mrs Audrey Mwenda Health Program - Bilateral SIDA Cooperating Lusaka Pollen Mucemwa Support Officer Partners
Dr Masuka Msumari Family Planning Advisor USAID Cooperating Lusaka Partners
58 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Name Title Organisation Type Location
Mr Peter Chambwela Acting Team Leader for Care Zambia International iNGO Lusaka Scaling up Nutrition
Mrs Mary Simasiku Team Leader for Scaling up Care Zambia International iNGO Lusaka Chibambula Nutrition
Dr Mwangelwa Mubiana- Director, Paediatric HIV Centre For Infectious Disease iNGO Lusaka Mbewe Treatment & Prevention Research in Zambia (CIDRZ)
Dr Benjamin Chi Scientific Director Centre For Infectious Disease iNGO Lusaka Research in Zambia (CIDRZ)
Dr. Roma Chilengi Director of Health Systems Centre For Infectious Disease iNGO Lusaka and Primary Care Research in Zambia (CIDRZ)
Dr. Carolyn Bolton Chief Medical Officer Centre For Infectious Disease iNGO Lusaka Research in Zambia (CIDRZ)
Mrs Beatrice Chiyokoma M&E Officer- PMTCT Centre For Infectious Disease iNGO Lusaka Mwelwa Program Research in Zambia (CIDRZ)
Mr. Crispin Sapele Director Systems and CHAMP - CSH iNGO Lusaka Operations
Mrs Lydia Jumbe Health Advisor Child Fund iNGO Lusaka
Mr. Jack Menke EGPAF iNGO Lusaka
Dr Mike Welsh Country Director FHI360 iNGO Lusaka
Mr. Tamer Kirolos Country Director Save the Children iNGO Lusaka
Ms Saboi Imboela Advocacy and Save the Children iNGO Lusaka Communications Coordinator
Mr. Christopher Mazimba Country Programme Director SUFP iNGO Lusaka
Dr. Godfrey Biemba ZCAHRD iNGO Lusaka
Mr. Godwin Banda Director of Programs ZHECT iNGO Lusaka
Ms. Kathleen Poer Chief of Party ZISSP iNGO Lusaka
Dr. Elijah Sinyinza Deputy Chief of Party ZISSP iNGO Lusaka
Mr. Christopher Ng’andwe Coordinator RMNCH &N ZISSP iNGO Lusaka
Mr. Benson Bwalya M&E team leader ZISSP iNGO Lusaka
Ms. Emily Moonze Planning Manager ZISSP iNGO Lusaka
Mr Charlton Sulwe Provincial Programme FHI360 iNGO Ndola Manager
Ms. Dorothy Sampa Acting Public Relations Kitwe City Council Local Kitwe Manager Authority
Mr. Bornwell Luanga Town Clerk Kitwe City Council Local Kitwe Authority
Ms. Grace Kamaloni Secretary to the Director Kitwe City Council Local Kitwe Administration Authority
Ms. Hildah Kamfwa Secretary to the Mayor Kitwe City Council Local Kitwe Authority
Mr. Julien Mwila Secretary to the Town Clerk Kitwe City Council Local Kitwe Authority
Ms. Gertrude Chibiliti Town Clerk Mufulira Municipal Council Local Mufulira Authority
Mr Mutale Bowa Director of Programmes Afya Mzuri NGO Lusaka
Mrs Rose Zimba Manager Health Program CHAZ NGO Lusaka Manager
Ms. Tina Moyo Program Coordinator Population Council NGO Lusaka
Mapping of RMNCH & Nutrition Programs/ 59 Projects in Lusaka and Copperbelt Provinces Name Title Organisation Type Location
Ms Viviane Sakanga M&E Officer PPAZ NGO Lusaka
Mr Amos Mwale Executive Director Youth Vision Zambia NGO Lusaka
Dr Morrison Zulu Project Director Zambia Defense Forces, NGO Lusaka Prevention Care and Treatment (ZDPCT)
Mr. Richard M Kaoma Chairperson CCZ NGO Chingola
Ms. Florence Mule Chairperson DAPP NGO Chingola
Mr Brian Siyatubi Acting Manager-Community KCM Private Sector Chingola Relations
Miss Lomantzi Mazyopa Community Liaison Officer KCM Private Sector Chingola
Mr Luke Chisanga Community Liaison Officer KCM Private Sector Chingola
Ms Silvia Malichanga Chairperson Kamuchanga Youth Group CBO Mufulira
Mr Maxwell Sisunga Chairperson Murundu Youth Group CBO Mufulira
Ms Shillah Chibemba Treasurer Murundu Youth Group CBO Mufulira
Ms Sandra Mwansa Vice Secretary Murundu Youth Group CBO Mufulira
Mr Concepter Bwalya Secretary Murundu Youth Group CBO Mufulira Mulenga
Mrs Doris Daka Chairperson Twikatane Safe Space Youth CBO Ndola Group
Ms. Esnati Banda Acting In-Charge Bauleni Health Centre Health Facility Lusaka
Ms. Lilian Sichone CNG - Member Bauleni Health Centre CBO Lusaka
Ms. Lilian Chomba Acting Sister In-Charge Chawama Community Health Health Facility Lusaka Centre
Mr. Miyoba Mulonga CNG - Member Chawama Community Health CBO Lusaka Centre
Ms. Grace Moonga SMAG Chairperson Chawama Community Health CBO Lusaka Centre
Ms. Mutinta Chinkuli SMAG member Chawama Community Health CBO Lusaka Centre
Ms Cythia Aikayo In-Charge Chunga Sub Centre Health Facility Lusaka
Mrs Susan Phiri Personal Assistant to the Churches Health Association of Health Facility Lusaka Executive Director Zambia
Mr Jim Mwandia M&E Officer Churches Health Association of Health Facility Lusaka Zambia
Dr. Yekoyesew Worku Technical Advisor Human Clinton Health Access Initiative Health Facility Lusaka Resource for Health Programs
Dr. Masumba Masaninga District Medical Officer MCDMCH, District Health Line Ministry Lusaka Management Team
Dr. Clara Mbwili Muleya Advisor, Planning Lusaka District Health Office Health Facility Lusaka
Mr. Christopher S Mbinji Acting Head-Monitoring and Society for Family Health Health Facility Lusaka Evaluation, Research , M&E Department
Dr Namwinga Chintu Executive Director Society for Family Health Health Facility Lusaka
Dr Mutinta Nalubamba Managing Director Society for Family Health Health Facility Lusaka
Ms Brenda Kabanda Secretary to the ED SFH Society for Family Health Health Facility Lusaka
Dr. Blaise Karibushi Health Specialist UNDP Health Facility Lusaka
Mr. Kampengele Misozi Nutritionist Chilanga Health Centre Health Facility Chilanga
Ms. Elizabeth Chatara Service Coordinator Chilanga Health Centre Health Facility Chilanga
60 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Name Title Organisation Type Location
Dr George Mukupa District Medical Officer MCDMCH, District Health Line Ministry Mufulira Management Team
Mrs Beauty Ndlovu IYCN committee member Chainda Clinic CBO Chongwe
Mrs Betty Chipoba IYCN committee member Chainda Clinic CBO Chongwe
Mrs Betty Mwambo IYCN committee member Chainda Clinic CBO Chongwe
Dr Job Mwanza Medical Officer in Charge Chongwe District Hospital Health Facility Chongwe
Mr. Chopa Choongo Clinical Care Officer Chongwe District Health Office Health Facility Chongwe
Mr. Simbaishala Lubasi Dist. Comm. Dev. Officer Chongwe District Health Office Health Facility Chongwe
Mrs B.M.S Pallu Environmental Health Officer Chongwe District Health Office Health Facility Chongwe
Ms Violet Mwanza Nursing Officer Chongwe District Health Office Health Facility Chongwe
Ms. Janet Magawa Assistant Nurse In-Charge Chongwe Rural Health Centre Health Facility Chongwe
Ms. Emely Muchimba CNG - Member Chongwe Rural Health Centre CBO Chongwe
Ms. Christin Kabanja CNG - Member Chongwe Rural Health Centre CBO Chongwe
Ms. Martha Ndhlovu SMAG member Chongwe Rural Health Centre CBO Chongwe
Ms. Sidoma Mbewe SMAG member Chongwe Rural Health Centre CBO Chongwe
Ms. Leya Ndhlovu SMAG member Chongwe Rural Health Centre CBO Chongwe
Ms. Florence Chakuwa Midwife Kampekete Clinic Health Facility Chongwe
Ms. Martha Katenga Nutrition Group Member Kampekete Clinic CBO Chongwe
Ms. Jean Mwanza Nutrition Group Member Kampekete Clinic CBO Chongwe
Mr. Rabson Chuya CNG - Member Kampekete Rural Health Centre CBO Chongwe
Ms. Malvis Mupela CNG - Member Kampekete Rural Health Centre CBO Chongwe
Ms. Lydia Nchefulu CNG - Member Kampekete Rural Health Centre CBO Chongwe
Mr. Emmanuel Mafulauzi In-Charge: Environmental Kampekete Rural Health Centre Health Facility Chongwe Technologist
Mr. Chrsipin Mafa SMAG member Kampekete Rural Health Centre CBO Chongwe
Ms. Christin Chilinga SMAG member Kampekete Rural Health Centre CBO Chongwe
Ms. Sylvia Nofa SMAG member Kampekete Rural Health Centre CBO Chongwe
Ms. Odria Namukoko Lab Technician Kanakantapa Rural Health Centre Health Facility Chongwe
Ms. Milika Zulu CNG Member Chunga Health Post Health Facility Lusaka
Ms. Oteria Saili CNG Member Chunga Health Post Health Facility Lusaka
Ms. Catherine Mutale CNG Member Chunga Health Post Health Facility Lusaka
Mr. Lazarus Msamba CNG Member Chunga Health Post Health Facility Lusaka
Dr. Whyson Munga District Medical Officer MCDMCH, District Health Line Ministry Kafue Management Team
Ms. Dainess Nkandu CNG Supporter Nangongwe Health Centre Health Facility Kafue
Ms. Beauty Munkombwe CHW Shimabala Health Post Health Facility Kafue
Mrs Lobina Mutafya Registered Midwife In-charge Buchi Main Clinic Health Facility Kitwe Ngosa
Mrs Ephemia Mukuka Chairperson NHC-Ipusukilo Clinic Health Facility Kitwe
Mrs Ruth Mushimbe Health Centre In-charge Zam-tan Clinic Health Facility Kitwe
Ms. Yvone Lubinda Sister In-Charge Chitemalesa Health Post Health Facility Rufunsa
Ms. Beatrice Bwange SMAG member Chitemalesa Health Post Health Facility Rufunsa
Mapping of RMNCH & Nutrition Programs/ 61 Projects in Lusaka and Copperbelt Provinces Name Title Organisation Type Location
Dr. Peter Mulenga District Medical Officer MCDMCH, District Health Line Ministry Luanshya Management Team
Dr. Evaristo Kunka District Medical Officer MCDMCH, District Health Line Ministry Masaiti Management Team
Dr. Mwila Lembalemba District Medical Officer MCDMCH, District Health Line Ministry Chilanga Management Team
Dr. Musanda Siyolwe District Medical Officer MCDMCH, District Health Line Ministry Rufunsa Management Team
Ms. Jane Kabwe Shikabeta Health Post Health Facility Rufunsa
Ms. Violet Mpelo Enrolled Nurse St. Luke Mission Hospital Rufunsa Health Facility Rufunsa
Mrs Lista Nakusula NHC Chairperson Clinic 5 Health Facility Mufulira
Mrs Hilda Sakala Nurse In-charge Clinic 5 Health Facility Mufulira
Mrs Cheelo M Nurse In-charge Kamuchanga Clinic Health Facility Mufulira
Mr Lewis Kunda Chairperson NHC-Kamuchanga Clinic Health Facility Mufulira
Mrs Assumpta Miyanda Nurse In-charge Chipokotamayamba Clinic Health Facility Ndola Kawanda
Mrs Mirriam Phiri Biemba Nurse In-charge Chipulukusu Clinic Health Facility Ndola
Mrs Matilda Kamwale Nutritionist Chipulukusu Clinic Health Facility Ndola
Mr Cornelius Mwanza Clinical Officer-Acting In- Kaniniki Clinic Health Facility Ndola charge
Mrs Beatrice Katebe SMAG Chairperson Kaniniki Clinic CBO Ndola
Mrs Brenda Hamoonga Principal Nursing Officer Mother and Child Health Health Facility Ndola Mwange
Mr Kingsley Kapemfu Acting Senior Health Provincial Health Office Health Facility Ndola Information Officer
Dr Teddy Sokensi Communicable Disease Provincial Health Office Health Facility Ndola Control Specialist
Mrs Mester Nsangwe Provincial Principal Planner Provincial Health Office Health Facility Ndola Shamakamba
Mrs Nalishebo Nyambe Senior Accountant Provincial Health Office Health Facility Ndola Mvula
Mrs Lilian Bwalya Phiri Secretary to the PHO Provincial Health Office Health Facility Ndola
Mrs Lilian Bwalya Phiri Secretary to the PHO Provincial Health Office Health Facility Ndola
62 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Appendix 3 Key Information Questionnaire – District Health Office
INSTRUCTIONS FOR ENUMERATORS NOTE: It is a Requirement to pay a courtesy call on the District Commissioner (DC) prior to your meeting with the DMO.
I. Introduction “Good day. My name is ______. I am part of the research team that is conducting the exercise to map RMNCH&N Programmes in the Lusaka and Copperbelt Provinces. This study was commissioned by UNICEF with authority from MCDMCH.
Our main objectives are to identify recently completed, on-going and planned RMNCH&N programmes and projects in the District and to discuss their implementation issues in terms of effectiveness, coverage and sustainability. Through the DHO, therefore, we would like to obtain an overview of RMNCH&N services provision and uptake in the District. We will then need to visit at least one each from the Levels 1, 2 and 3 health facilities in the District and to conduct interviews with relevant staff there. It may be necessary to complement these interviews with Focus Group Discussions (FGDs) with some members of the community in the catchment area of the health facility. These inquiries will help to inform the design of the GRZ-UN-EU MDGi Project30.
30. MDG initiative for Maternal, Neo- We are required to treat all information and documentation given to us with the utmost natal & Child Health & Nutrition: “Accel- confidentiality and look forward to an open and informative discussion with you. erating progress towards maternal, Thank you. neonatal and child morbidity and mortality reduction J. Guidance for Enumerators in Zambia” 1) Record respondents’ answers in the notebook provided to you for this purpose. 2) Ensure that the formatting and sequencing of the numbering system for your notes of this interview in your notebook exactly match that in this questionnaire. 3) Fulfil all instructions to “obtain information” by documenting clear and complete information in your notes. 4) Codes for unanswered questions: a) NA - Not applicable b) NU - Question not understood by the respondent c) RA - Respondent refused to answer d) DK - Respondent did not know 5) Ensure that you record answers completely to match the data fieldsper the guidance in the question. 6) Ensure that you pose all the questions in this questionnaire. 7) As far as possible, obtain copies of all documentation requested from the respondent in soft copy format. 8) At the conclusion of the interview, ensure that the respondent completes, signs and dates the Interview Record Sheet. 9) Ensure that you have a copy of the letter from PS, MCDMCH, duly endorsed by the DMO, for presentation to at each health facility.
Mapping of RMNCH & Nutrition Programs/ 63 Projects in Lusaka and Copperbelt Provinces INTERVIEW QUESTIONS
SECTION 1: About the Respondent Q1.1. Salutation of respondent (i.e. Dr./Mr./Ms.) Q1.2. Name of the respondent. Q1.3. Job title. Q1.4. Number of years in this role? Q1.5. NOTE TO ENUMERATOR: Do not ask, but note the Gender of the respondent (M/F).
SECTION 2: Staffing of the DHO Q2.1. Obtain copy of the organogram for the DHO and discuss it to obtain an understanding of how the DHO is organised and staffed around RMNCH&N-related functional areas such as: a. Reproductive Health b. Maternal Health c. Child Health d. PMTCT e. Nutrition f. Community Outreach & Partnerships g. Environmental Health Q2.2. Obtain the names and contact details (cellphone and email) for the focal point persons for each of the roles listed in Question Q2.1 above. Q2.3. Has any individual been tasked with the responsibility for Sexual and Reproductive Health (SRH)? (Obtain contact details). Q2.4. Is there a specific responsibility for coordinating/managing the delivery ofAdolescent and Youth Friendly health services in the District? Q2.5. Obtain a copy of documentation detailing filled and vacant positions at the DHO. Q2.6. Obtain information on how long key vacant positions have been open and any related explanations.
SECTION 3: Plans of the DHO Q3.1. Does the DHO have copies of: a. The National Health Strategic Plan, 2011-2015; b. National Food and Nutrition Strategic Plan, 2011-2015 c. The Adolescent Health Strategic Plan, 2011-2015 d. The Adolescent Reproductive Health Strategic Plan, ????-???? Q3.2. Obtain copies of the DHO’s annual plans for 2010, 2011, 2012, 2013 and 2014. Q3.3. Obtain a copy of the District Action Plan, 2014-2016 that was prepared by the DHO as an input into the MDGi project to accelerate the reduction of maternal and child morbidity and mortality. Q3.4. Perform a quick high-level review of the Action Plan and obtain (and document) explanations for any notable issues arising.
SECTION 4: Activities of the DHO Q4.1. Obtain a copy of a statement of recently ended31, on-going and planned DHO’s 31. Closed in calendar years 2013 RMNCH&N activities programmes together with their mapping to the following: or 2014. a. The programmes and projects funding them; b. The funding organisations (i.e. Government Line Ministries, Cooperating Partners, iNGOs, CSOs, Private Sector Companies) for these programmes and projects; c. The thematic and geographic targeting for these activities; d. The actors (Government ministries and agencies, NGOs, CBOs, FBOs) acting in
64 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces partnership to executive these activities; e. Copies of relevant progress and evaluation reports on the implementation of these activities. Q4.2. Obtain the DHOs assessment of the issues enabling or hindering the effective execution of these activities. Q4.3. Discuss the DHO’s involvement, if any, in the design of the programs implemented in the District. Q4.4. Inquire into the level of collaboration between the DHO, the local authority, and the Water and Sewerage Company (Obtain documentary evidence of any such working relationships and arrangements). Inquire into working arrangements with: a. District Development Coordination Committee (DDCC); b. Epidemic Preparedness Committee – Membership, contact persons, minutes, etc. Q4.5. Inquire into (and document) any actions or programmes by the DHO and other health actors in the District to involve men and boys in RMNCH&N issues (with a special focus on SRH issues). Q4.6. Obtain the respondent’s assessment of the alignment of the DHO’s institutional structure with the programmes and projects in the District Q4.7. Discuss this issue (i.e. institutional versus programmatic alignment) with specific reference to the four prongs of PMTCT: PRONG (1) PREVENTING HIV among women of reproductive age BEFORE they get pregnant; PRONG (2) PREVENTING UNINTENDED PREGNANCIES among women living with HIV; PRONG (3) INTEGRATION OF HIV TESTING INTO ANTE-NATAL CARE, provision of ARV treatment to HIV-positive pregnant women and counselling on the best feeding options for their babies; PRONG (4) BETTER INTEGRATION of HIV care, treatment and support for women found to be positive and their families Q4.8. Discuss approaches to, and effectiveness of, outreach to school-going children (e.g. is there any collaboration with the Ministry of Education, etc.). Q4.9. Obtain the respondent’s assessment of the availability and uptake of adolescent friendly health services together with the relevant enabling and inhibiting factors. Q4.10. Discuss approaches to, and effectiveness of, measures to counter societal barriers to male participation in, and support for, RMNCH&N initiatives and activities (including PMTCT) e.g. effectiveness of targeting of community outreach activities by the DHO. Q4.11. Obtain the respondent’s assessment of the adequacy and reliability of data from the Health Information Management System (HIMS). Q4.12. What are the District’s experiences with the implementation the Smartcare system32. Q4.13. Where does the DHO see weaknesses and gaps in the continuum of maternal care?
32. NOTES FOR ENUMERATORS: The SmartCare software was developed to improve continuity of care and provide timely data on maternal and child health, HIV/AIDS, tuberculosis and malaria interventions for public health purposes, including HMIS trend reporting and analysis for health officials and clinicians. SmartCare is now also required for any facility in Zambia desiring accreditation to dispense antiretroviral (ARV) drugs for HIV clients. The SmartCare card is a key part of the electronic health record system. This customized card carries an encrypted copy of a patient’s entire health history. It uses a SIM chip, familiar to those who use cell phones, to store the data. As such, health records travel directly with the patient. A soft copy of the health record is saved in the SmartCare database of every facility the patient visits. These data are later de-identified, and pooled at the district, provincial and national levels for public health monitoring, evaluation and HMIS use. Where cellular reception exists and costs are sustainable, a 3G cellular option can be used between SmartCare and providers, patients, facilities and managers to provide reminders, requests, warnings, updates and reports. SmartCare allows a client to access ARV drugs from anywhere as long as they have a Care Card. The patient’s health data are never lost, even if the client has lost her card. Her data can still be accessed on the facility computer by searching her name, thereby ensuring continuity of care. SmartCare provides continuity of care for patients over time and place, as well as ownership of their personal health record. For clinicians, it provides quick and complete access to patient data, and powerful clinical decision-making support, along with monitoring and evaluation and quality assurance tools.
Mapping of RMNCH & Nutrition Programs/ 65 Projects in Lusaka and Copperbelt Provinces Q4.14. Obtain details of any nutrition components in the DHO’s services and contributing factors to any mismatch between demand for, and supply of, nutrition services to pregnant women, their babies and young children, and to HIV-positive patients on anti-retroviral therapy (ART). Q4.15. What community outreach initiatives are being undertaken to create or leverage partnerships with CBOs and other actors in the community in order to promote awareness and knowledge and reduce stigma while promoting health-seeking behaviours (in particular, with gatekeepers such as traditional and religious leaders, traditional healers, women’s groups, men’s groups, youth groups, etc)?
SECTION 5: Other Observations and Concerns Q5.1. Comment on the incidence of the following and their implications for RMNCH&N as well as the specific measures the DHO is taking to address them from a public health perspective: a. Gender-based violence (against women) – how strong is the collaboration between the DHO and the Zambia Policy Service (Victim Support Unit) b. Alcohol abuse c. Child labour and other forms of child abuse Q5.2. What are the key staffing and skills gaps in the DHO and the health facilities in the District? Q5.3. What are the three biggest concerns facing the DHO in terms of hindraces to the achievement of MDG 1c, MDG 4 and MDG 5 in the District? Q5.4. As the respondent if he/she has any other comments or questions?
End of Interview
Express sincere thanks to the respondent and request a continuing open line of communication with him/her for any further clarifications, information or documentation that may be required by the research team.
Ask the DMO to endorse and sign your copy of the Letter of Permission from PS, MCDMCH, for presentation to the In-Charges at each Health Facility.
66 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Appendix 4 Key Information Questionnaire – District Health Facility
Instructions for Enumerators NOTE: Ensure that you have had prior meetings with relevant officials at the DHO before meeting with any Health Facility personnel. Have a copy of the endorsed/signed letter of permission from PS, MCDMCH to present at each health facility.
Introduction “Good day. My name is ______. I am part of the research team that is conducting the exercise to map RMNCH&N Programmes in the Lusaka and Copperbelt Provinces. This study was commissioned by UNICEF with authority from MCDMCH.
Our main objectives are to identify recently completed, on-going and planned RMNCH&N programmes and projects in the District and to discuss their implementation issues in terms of effectiveness, coverage and sustainability. As part of the study, we are visiting at least one each of the Levels 1, 2 and 3 health facilities in the District to gain an understanding of the RMNCH&N services provided to the community and the challenges faced by the health facilities in providing these services. We will need to interview relevant staff at each health facility and may also conduct Focus Group Discussions with some of the users its services. In this regard, our objective will be to identify the issues enabling, or hindering, the delivery of services while obtaining a sense of the needs in the community and the extent to which they are being met. These inquiries will help to 32. MDG initiative inform the design of the GRZ-UN-EU MDGi Project32. for Maternal, Neonatal & Child Health & Nutrition: “Accelerating We are required to treat all information and documentation given to us with the utmost progress towards confidentiality and look forward to an open and informative discussion with you. maternal, neo- natal and child Thank you. morbidity and mortality reduction in Zambia” Guidance for Enumerators 10) Record respondents’ answers in the notebook provided to you for this purpose. 11) Ensure that the formatting and sequencing of the numbering system for your notes of this interview in your notebook exactly match that in this questionnaire. 12) Ensure that you record respondents’ answers clearly and completely in your notes. 13) Codes for unanswered questions: a) NA - Not applicable b) NU - Question not understood by the respondent c) RA - Respondent refused to answer d) DK - Respondent did not know 14) Ensure that you record answers completely to match the data fieldsper the guidance in the question. 15) Ensure that you pose all the questions in this questionnaire. 16) As far as possible, obtain copies of all documentation requested from the respondent in soft copy format. 17) At the conclusion of the interview, ensure that the respondent completes, signs and dates the Interview Record Sheet.
Mapping of RMNCH & Nutrition Programs/ 67 Projects in Lusaka and Copperbelt Provinces Interview Questions
SECTION 1: About the Respondent Q1.6. Salutation of respondent (i.e. Dr./Mr./Ms.) Q1.7. Name of the respondent. Q1.8. Job title. Q1.9. Number of years in this role? Q1.10. NOTE TO ENUMERATOR: Do not ask, but note the Gender of the respondent (M/F).
SECTION 2: Particulars of the Health Facility Q2.7. Name of the Health Facility. Q2.8. Location of Health Facility. a. Ward (i.e. within the Constituency) b. Address Q2.9. Type or classification of the Health Facility. Q2.10. Ownership of the Health Facility: a. Government b. Mission c. Other (Specify) Q2.11. Particulars of Health Posts overseen by the Health Facility. a. Name b. Location c. Contact details of responsible community volunteer d. Distance from Health Facility e. Services offered. Q2.12. Hours of operation of the facility: a. Days of the week (week days only or seven days a week)? b. 24 hours a day (continuous)? If not, opening time, closing time and lunch break hours. Q2.13. Is there an active SMAG33 in the catchment area of the facility? (Obtain contact information for key members of the group). Describe the working relationship between the 33. Safe Motherhood Action Group SMAG and the health facility. Q2.14. Is there an active Community Nutrition Group (CNG) in the catchment area of the facility? (Obtain contact information for key members of the group). Describe the working relationship between the CNG and the health facility. Q2.15. Number of times (in a month) the facility is open outside normal working hours for emergencies such as deliveries, etc. Q2.16. Catchment population of the facility.
SECTION 2: Health Services and Supporting Activities Q3.1. Ask for information about the programs and projects under which funding for the health facilities services is provided (to the extent the In-Charge has access to this information). Q3.2. Ask about the geographic and demographic coverage of these services. Q3.3. Is the funding envelope for these services sufficient to enable the health facility to meet the needs in the community? Q3.4. What other constraints, if any, are there on the facility’s delivery of RMNCH&N services to the community?
68 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces SECTION 4: Number of Patients and Volume of Services Q5.5. How many patients were seen by the facility during the past month and over the last three months: a. Inpatients b. Outpatients Q5.6. Describe the key services provided for: a. Inpatients b. Outpatients
SECTION 5: Other Observations and Concerns Q5.1. Estimate the percentage of the patient case load that is due to: a. Gender-based violence (against women) – how strong is the collaboration between the DHO and the Zambia Policy Service (Victim Support Unit) b. Alcohol abuse c. Child abuse Q5.2. What are the three biggest concerns facing the health facility in terms of hindrances to the delivery and uptake of RMNCH&N services? Q5.3. As the respondent if he/she has any other comments or questions?
End of Interview Express sincere thanks to the respondent.
Mapping of RMNCH & Nutrition Programs/ 69 Projects in Lusaka and Copperbelt Provinces Appendix 5 Focus Group Discussion Questionnaire
Instructions for Enumerators NOTE: Ensure that you have had prior meetings with relevant officials at the DHO before meeting with any Health Facility personnel or community members.
Introduction “Good day. My name is ______. I am part of the research team that is conducting the exercise to map RMNCH&N Programmes in the Lusaka and Copperbelt Provinces. This study was commissioned by UNICEF with authority from MCDMCH.
As part of the study, we are visiting at least one each of the Levels 1, 2 and 3 health facilities in the District to gain an understanding of the RMNCH&N services provided to the community and the challenges faced by the health facilities in providing these services. We also need to talk to you, the members of the community, to learn about the challenges and problems you are facing in the areas of Reproductive, Maternal, Neonatal and Child Health & Nutrition. We also want to hear what you feel about the prevention, treatment and care services you are receiving from the health facilities and from other providers of health services in your area.
We are required to treat all information and documentation given to us with the utmost confidentiality and look forward to an open and informative discussion with you.
Thank you.
Guidance for Enumerators 1) Identify the CBOs and FBOs that are represented in the group and record their names together with contact information for their representatives and leadership. 2) Arrange separate FGDs for motherhood groups, nutrition groups and youth groups. Ensure representative participation across gender and age under the broad topic categories of (1) MNCH, (2) Nutrition, (3) Sexual and Reproductive Health. 3) Record respondents’ answers in the notebook provided to you for this purpose. 4) Ensure that the formatting and sequencing of the numbering system for your notes of this interview in your notebook exactly match that in this questionnaire. 5) Fulfil all instructions to “obtain information” by documenting clear and complete information in your notes. 6) Codes for unanswered questions: a) NA - Not applicable b) NU - Question not understood by the respondent c) RA - Respondent refused to answer d) DK - Respondent did not know 7) Ensure that you record answers completely to match the data fieldsper the guidance in the question. 8) Ensure that you pose all the questions in this questionnaire. 9) As far as possible, obtain copies of all documentation requested from the respondent in soft copy format.
70 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Interview Questions
SECTION 1: Introductions · Thank the participants for making themselves available for this important discussion. · Introduce yourself, the topic and the objective for the meeting. · Ask the respondents to go through a round of self-introductions. Assure them that theirnames will not be recorded or used beyond the four walls of the meeting.
SECTION 2: Specific Objectives: 1. Examine participant’s experiences and perceptions in relation to pre-pregnancy (family planning), pregnancy, delivery, and post-natal child care services. 2. Examine participant’s experiences and perceptions in relation to nutrition and related services. 3. Examine participant’s experiences and perceptions in relation to sexual and reproductive health services. 4. Identify issues and gaps in access to services along the RMNCH&N continuum.
SECTION 3: Ground Rules Set the ground rules for the FGD as follows: 1. Participants will speak in turn; 2. All contributions are important; 3. Participants will respect each other’s contributions; 4. No speaker will be interrupted by other participants while “on the floor”; 5. Every contribution is valid and important.
SECTION 4: Some Definitions A. REPRODUCTIVE HEALTH: Offer a definition of reproductive health as follows (per UN Programme of Action): “… ‘Health’ is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. ‘Reproductive health’ deals with the reproductive processes, functions and system at all stages of life”. “…Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the rights of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate healthcare services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.”. Discuss the participant’s understanding of reproductive health.
B. RMNCH CONTINUUM OF CARE: “The ‘Continuum of Care’ for maternal, newborn and child health includes integrated service delivery for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and childhood. Such care is provided by families and communities, [and] through outpatient services, clinics and other health facilities.”
Mapping of RMNCH & Nutrition Programs/ 71 Projects in Lusaka and Copperbelt Provinces SECTION 5: General Questions Q3.5. List the providers of the following services in the community? a. Medical b. Educational c. Social Q3.6. What type of services do they provide? Q3.7. Are the services provided in a manner that meets the needs of the community (Quality)? Q3.8. What factors limit the ability of the community to access these services (access)? Q3.9. Are these constraints stronger for certain segments of the local population? (Give reasons) Q3.10. Are adequate measures being taken to ensure the involvement and participation of adolescent, youth and adult males in the prevention aspects of reproductive health? (Give reasons) Q3.11. Are males adequately involved in maternal and child health issues? Are there any men’s groups (e.g. church-based groups) that are actively engaged in reproductive, maternal and other health issues in the community? (Give reasons) Q3.12. Is there an active Safe Motherhood Action Group (SMAG) in the area? (Obtain contact information for key members of the SMAG). Discuss its activities. Q3.13. Is there an active Community Nutrition Group (CNG) in the area? (Obtain contact information for key members of the CNG). Discuss its activities. Q3.14. Are there any active youth groups in the area? (Obtain contact information for their key members). Discuss their activities. Q3.15. Is there a formal process through which these groups provide input into the formulation of RMNCH&N programs targeting the community? Q3.16. Do the health facilities in the area provide a welcoming and safe atmosphere for adolescents and youth? In particular, are “youth friendly” services available at these facilities? (Give reasons). Q3.17. What are the participants’ feelings on the availability, accessibility and quality of psychological support and social services for pregnant women and for nursing mothers in the community? Q3.18. Who are the providers of these psychosocial services (family, health facility, religious groups, traditional birth attendants, traditional healers, etc.)? Q3.19. What are the main issues affecting the health of young children, adolescents and youth in the area? a. Young children b. Adolescents c. Youth
SECTION 6: Other Observations and Concerns Q5.4. What other issues or concerns do you have as individuals and as a community? Q5.5. Ask the participants if they any other comments or questions?
End of Interview
Express sincere thanks to the respondent.
72 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Appendix 6 District-level mapping of RMNCH programs and projects by Key Topic
Programs and Projects Districts Implementation Status (i.e. geographical footprint of programs/ projects)
Groupings of Key Topics Copperbelt Lusaka Active Closed Pipeline No Total Data
Child Health, HSS, CSS Ndola Lusaka; 1 1
Child Health, Maternal and N/A Lusaka; Chilanga; 1 1 Newborn Health Kafue; Chongwe; Rufunsa
Child Health, Nutrition 1 1
Child Health, Sexual & Kitwe 1 1 Reproductive Health (SRH)
Child Health, Tuberculosis Lusaka; Chilanga; 1 1 (TB), HSS
Child Sexual Abuse, Gender- Lusaka; 1 1 Based Violence (GBV)
Child Survival and Health, Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 HIV/AIDS Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
CSS, HIV, Child Health Kitwe Lusaka; 1 1 Chongwe;
Early Childhood Development Lusaka 1 1 (ECD), Child Health, Nutrition, CSS
Early Childhood Development Lusaka; Chilanga; 1 1 (ECD), Water & Sanitation Kafue; Chongwe; (WASH), Gender-Based Rufunsa Violence (GBV), Nutrition
ECD, Reproductive Health, Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Maternal & Child Health, HIV, Luanshya; Masaiti; Kafue; Chongwe; CSS Chilanga Rufunsa
Family Planning Kitwe; Lusaka; 1 1
Family Planning, Maternal Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 and Newborn Health, Sexual Luanshya; Masaiti; Ndola Kafue; Chongwe; & Reproductive Health (SRH), Rufunsa HSS
Gender-Based Violence Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 (GBV) Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
HIV Mufulira; Kitwe 1 1
Chingola; Kitwe 1 1
Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
Kitwe Lusaka 1 1
Masaiti; Ndola 1 1
Ndola 1 1
Lusaka; Chongwe 1 1
1 1
Mapping of RMNCH & Nutrition Programs/ 73 Projects in Lusaka and Copperbelt Provinces Programs and Projects Districts Implementation Status (i.e. geographical footprint of programs/ projects)
HIV, ASA, GBV, CSS ; Luanshya; 1 1
HIV, Child Health, HSS Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
HIV, CSS 1 1
HIV, Family Planning, Malaria, Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Maternal and Newborn Luanshya; Masaiti; Ndola Kafue; Chongwe; Health, HSS, CSS Rufunsa
HIV, Maternal and Newborn Chingola; Mufulira; Kitwe; 1 1 Health Luanshya; Masaiti; Ndola
HIV, Maternal and Newborn Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Health, Child Health Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
HIV, Sexual & Reproductive Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Health (SRH), HSS Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
HIV, Sexual and Reproductive 1 1 Health
HSS Ndola 1 1
Kafue 1 1
HSS, CSS Kafue; Chongwe; 1 1
HSS, HIV Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
HSS, HIV, Malaria, Maternal Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 and Newborn Health, Family Luanshya; Masaiti; Ndola Kafue; Chongwe; Planning Rufunsa
Immunization 1 1
Malaria Mufulira; Kitwe 1 1
Chingola; Kitwe 1 1
Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 2 1 3 Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
Maternal & Child Health Chongwe; 1 1 Rufunsa
Maternal and Newborn Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 2 Health, Child Health Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
Lusaka; Chilanga; 1 Kafue; Chongwe; Rufunsa
Maternal and Newborn Lusaka; 1 1 Health, Child Health, HIV, HSS, CSS
Maternal and Newborn Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Health, Child Health, Sexual Luanshya; Masaiti; Ndola Kafue; Chongwe; & Reproductive Health Rufunsa
Maternal and Newborn 1 1 Health, Child Health, Water & Sanitation (WASH), CSS
Nutrition Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 2 2 Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
74 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Programs and Projects Districts Implementation Status (i.e. geographical footprint of programs/ projects)
Nutrition, HSS Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
Nutrition, Maternal and Kitwe; 1 1 Newborn Health, Child Health, HIV
Nutrition, Maternal and Chingola 1 1 Newborn Health, Early Childhood Development (ECD), Water & Sanitation (WASH), HSS, Gender-Based Violence (GBV)
Sexual & Reproductive Health Kitwe Lusaka 1 1 (SRH)
Lusaka; Chilanga; 1 1 Kafue; Chongwe; Rufunsa
Sexual & Reproductive Health Kitwe Lusaka 1 1 (SRH), Family Planning, HIV
Sexual & Reproductive Health Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 (SRH), HIV Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
PMTCT, ANC, Sexual and Chilanga; 1 1 Reproductive Health Rights (SRHR)
Early Childhood Development Kitwe Chongwe 1 1 (ECD), HSS, Water & Sanitation (WASH)
Family Planning, Sexual & Lusaka; 1 1 Reproductive Health
Family Planning, Sexual & Lusaka Lusaka; 1 1 Reproductive Health (SRH)
Kafue; 1 1
Lusaka; 1 1
Sexual & Reproductive Health Masaiti; 1 1 (SRH), Family Planning
Family Planning, Maternal Kitwe; 1 1 and Newborn Health, HIV
Family Planning, Maternal Masaiti 1 1 and Newborn Health, Sexual & Reproductive Health (SRH)
Child Health, Sexual & Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Reproductive Health (SRH), Luanshya; Masaiti; Ndola Kafue; Chongwe; HIV, Malaria Rufunsa
HSS, CSS, BCC Chingola; Mufulira; Kitwe; Lusaka; Chilanga; 1 1 Luanshya; Masaiti; Ndola Kafue; Chongwe; Rufunsa
Grand Total 44 15 3 6 68
Mapping of RMNCH & Nutrition Programs/ 75 Projects in Lusaka and Copperbelt Provinces Appendix 7 District-level mapping of RMNCH programs and projects by Program/Project
Programs and Projects Districts Count by Implementation Status (i.e. geographical footprint of programs/projects)
Key Topics Addressed Title Copperbelt Lusaka Active Closed No Pipeline Total Data
CSS, HIV, Child Health Integrated Management of Child Ndola Lusaka; 1 1 Illness (IMCI)
Early Childhood Development Programme for Awareness and N/A Lusaka; Chilanga; 1 1 (ECD), Child Health, Nutrition, CSS Elimination of Diarrhoea (PAED) Kafue; Chongwe; Rufunsa
HSS, HIV ColaLife Operational Trial Zambia 1 1 (COTZ)
Child Health, Sexual & Cecily Eastwood Zambian AIDS Kitwe; 1 1 Reproductive Health (SRH), BCC Orphans Appeal (Cecilys Fund)
HSS, CSS, BCC Childhood tuberculosis (TB) Lusaka; Chilanga; 1 1 control project
HIV, ASA, GBV, CSS, BCC Tisunge Ana Athu Akazi Coalition Lusaka; 1 1 (TAAC)
HIV, BCC Project Mwana - Using mobile Chingola; Mufulira; Lusaka; Chilanga; 1 1 technology to improve early infant Kitwe; Luanshya; Kafue; Chongwe; diagnosis of HIV Masaiti; Ndola Rufunsa
HIV, BCC Civil Society`s Community Based Kitwe Lusaka; Chongwe; 1 1 Response to HIV/AIDS Prevention for Children
HIV, CSS Strengthening Early Childhood Lusaka; 1 1 Development in Zambia
Nutrition Zambian Anglican Council-Core Lusaka; Chilanga; 1 1 Program Kafue; Chongwe; Rufunsa
HIV, Maternal and Newborn Health EpiscopalRelief Early Childhood Chingola; Mufulira; Lusaka; Chilanga; 1 1 Development Program Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Chilanga Rufunsa
Maternal and Newborn Health, Expanding Access to Kitwe; Lusaka; 1 1 Child Health, HIV, HSS, CSS, BCC Comprehensive Abortion Care (CAC) Information and Services in Zambia
Maternal and Newborn Health, Scaling Up Family Planning Chingola; Mufulira; Lusaka; Chilanga; 1 1 Child Health (SUFP) in Zambia Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
HSS Gender Based Violence (GBV) Chingola; Mufulira; Lusaka; Chilanga; 1 1 Project Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
HIV, Sexual and Reproductive Family Support to Prisoners and 1 1 Health Ex-Prisoners Children Including Children With HIV
PMTCT, ANC, Sexual and Hope Ndola. Ndola 1 1 Reproductive Health Rights (SRHR)
HSS KCM - HIV/AIDS Programme Chingola; Kitwe; 1 1
HIV Mopani HIV/AIDS program Mufulira; Kitwe; 1 1
Child Sexual Abuse, Gender-Based New Start HIV Testing and Masaiti; Ndola 1 1 Violence (GBV), BCC Counselling
Nutrition, Maternal and Newborn Strengthening Educational Lusaka; Chongwe; 1 1 Health, Child Health, HIV Performance Up (Step-Up) Zambia: Parasocial Training
Maternal & Child Health, BCC Zambia Led Prevention Initiative Chingola; Mufulira; Lusaka; Chilanga; 1 1 (ZPI) Program Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
ECD, Reproductive Health, Zambia U-Report Kitwe Lusaka 1 1 Maternal & Child Health, HIV, CSS, BCC
76 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Programs and Projects Districts Count by Implementation Status (i.e. geographical footprint of programs/projects)
Key Topics Addressed Title Copperbelt Lusaka Active Closed No Pipeline Total Data
Maternal and Newborn Health, Golden Lay Limited (GLL) Luanshya; 1 1 Child Health, BCC
HSS, CSS, BCC HIV Integrated Local Ownership Chingola; Mufulira; Lusaka; Chilanga; 1 1 Programme (HILO)- PAEDIATRIC Kitwe; Luanshya; Kafue; Chongwe; CARE Project Masaiti; Ndola Rufunsa
HIV, Child Health, HSS Church Partnerships for Positive 1 1 Change (CPPC) Project
HIV, Maternal and Newborn Health, Zambia Integrated Systems Chingola; Mufulira; Lusaka; Chilanga; 1 1 Child Health, BCC Strengthening Program (ZISSP) Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
Family Planning, Maternal and Zambia Prevention, Care & Chingola; Mufulira; 1 1 Newborn Health, Sexual & Treatment Partnership Project II Kitwe; Luanshya; Reproductive Health (SRH), HSS, (ZPCT II) Masaiti; Ndola BCC
HIV, BCC HIV Integrated Local Ownership Chingola; Mufulira; Lusaka; Chilanga; 1 1 Programme (HILO)-PMTCT Kitwe; Luanshya; Kafue; Chongwe; Project Masaiti; Ndola Rufunsa
Malaria, BCC HIV and SRH Linkages Project Chingola; Mufulira; Lusaka; Chilanga; 1 1 Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
HIV, BCC HIV and SRH Linkages Project 1 1
Malaria Community Blood Pressure Ndola 1 1 Monitoring in Rural Africa: Detection of Underlying Pre- Eclampsia (CRADLE)
Sexual & Reproductive Health Supporting a Health Assistance Kafue; 1 1 (SRH), BCC Program in Kafue District Hospital
Malaria Better Health Outcomes through Kafue; Chongwe; 1 1 Mentorship and Assessments (BHOMA) Project
Child Survival and Health, HIV/ LiveFree Project Chingola; Mufulira; Lusaka; Chilanga; 1 1 AIDS, BCC Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
Malaria USAID|DELIVER Chingola; Mufulira; Lusaka; Chilanga; 1 1 Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
Gender-Based Violence (GBV), Child Health and Nutrition Project 1 1 BCC
Child Health, Nutrition KCM - Rollback Malaria Chingola; Kitwe; 1 1 Programme
HIV, Sexual & Reproductive Health Malaria Control and Evaluation Chingola; Mufulira; Lusaka; Chilanga; 1 1 (SRH), HSS, BCC Partnership in Africa (MACEPA) Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
Child Health, Maternal and MalariaCare Chingola; Mufulira; Lusaka; Chilanga; 1 1 Newborn Health Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
Sexual & Reproductive Health Mopani Malaria Prevention Mufulira; Kitwe; 1 1 (SRH), HIV, BCC Program
Nutrition Supporting the National Response Chingola; Mufulira; Lusaka; Chilanga; 1 1 to Malaria Control Program – Kitwe; Luanshya; Kafue; Chongwe; UNDP Masaiti; Ndola Rufunsa
Early Childhood Development 2014 Zambia NetsforLife Program ; Chongwe; 1 1 (ECD), Water & Sanitation (WASH), Rufunsa Gender-Based Violence (GBV), Nutrition
Maternal and Newborn Health, Local to Global Initiative Chingola; Mufulira; Lusaka; Chilanga; 1 1 Child Health Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
Nutrition, HSS Malaria Booster Project (MBP) Lusaka; Chilanga; 1 1 Kafue; Chongwe; Rufunsa
Maternal and Newborn Health, Partnership for Maternal, Newborn 1 1 Child Health, Water & Sanitation and Child Health - 2014 Partners’ (WASH), CSS Forum
Child Health, Tuberculosis (TB), Maternal and Child HIV and AIDS Lusaka; 1 1 HSS Health Care and Promotion
Mapping of RMNCH & Nutrition Programs/ 77 Projects in Lusaka and Copperbelt Provinces Programs and Projects Districts Count by Implementation Status (i.e. geographical footprint of programs/projects)
Key Topics Addressed Title Copperbelt Lusaka Active Closed No Pipeline Total Data
Malaria, BCC Stand Up for African Mothers Chingola; Mufulira; Lusaka; Chilanga; 1 1 Campaign Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
HIV, Family Planning, Malaria, Water, Sanitation and Hygiene 1 1 Maternal and Newborn Health, (WASH) for Maternal, Newborn HSS, CSS and Child Health
HSS, HIV, Malaria, Maternal and Pre-school Feeding & Improved 1 1 Newborn Health, Family Planning Household Food
Sexual & Reproductive Health The First 1000 Most Critical Chingola; Mufulira; Lusaka; Chilanga; 1 1 (SRH), BCC Days - Three Year Programme, Kitwe; Luanshya; Kafue; Chongwe; 2013-2015 Masaiti; Ndola Rufunsa
Maternal and Newborn Accelerating Nutrition Chingola; Mufulira; Lusaka; Chilanga; 1 1 Health, Child Health, Sexual & Improvements in Sub-Saharan Kitwe; Luanshya; Kafue; Chongwe; Reproductive Health Africa - Surveillance Masaiti; Ndola Rufunsa
Family Planning, BCC The Food and Nutrition Technical Kitwe; 1 1 Assistance III Project (FANTA)
Early Childhood Development Supporting communities in Chingola 1 1 (ECD), HSS, Water & Sanitation sustainable livelihoods (WASH), BCC
Child Health, HSS, CSS Safe Abortion Project Kitwe Lusaka 1 1
HIV, BCC Tikambe! Project-BBC Action Lusaka; Chilanga; 1 1 Media and Restless Development Kafue; Chongwe; Rufunsa
Nutrition, Maternal and Newborn Performance and Accountability Kitwe Lusaka 1 1 Health, Early Childhood Initiative for Better Results (PAIR) Development (ECD), Water & Sanitation (WASH), HSS, Gender- Based Violence (GBV)
Family Planning, Sexual & Safeguard Young People Sexual Chingola; Mufulira; Lusaka; Chilanga; 1 1 Reproductive Health and Reproductive Health and Kitwe; Luanshya; Kafue; Chongwe; Rights/HIV (SRHR) programme Masaiti; Ndola Rufunsa
Family Planning, Sexual & Youth Awake PMTCT Project Chilanga; 1 1 Reproductive Health (SRH)
Family Planning, Sexual & Child Aid - Integrated Community Kitwe Chongwe 1 1 Reproductive Health (SRH), BCC Development Project Proposal to HITACHI.
Sexual & Reproductive Health The Youth Action Movement Lusaka; 1 1 (SRH), Family Planning
Family Planning, Sexual & Expanding Reproductive Health Lusaka Lusaka; 1 1 Reproductive Health (SRH) Choices for Young People in Zambia
Family Planning, Maternal and Expanding Young Peoples Kafue; 1 1 Newborn Health, HIV Access to Comprehensive Sexuality Education and Sexual Reproductive Health Services.
Family Planning, Maternal and The Rachael Lumpa Memorial Lusaka; 1 1 Newborn Health, Sexual & Reproductive Health Centre – Reproductive Health (SRH) Lusaka (RLMRHC)
HIV Agents4Change - Reaching Young Masaiti; 1 1 Women with Integrated Sexual and Reproductive Health and HIV and AIDS information and services
HIV Bwembya Lukutati Memorial Kitwe; 1 1 Reproductive Health Centre (BLMRHC).
Sexual & Reproductive Health Community Safe Motherhood Masaiti 1 1 (SRH), Family Planning, HIV Project
Immunization Partnership for Intergrated social Chingola; Mufulira; Lusaka; Chilanga; 1 1 Marketing (PRISM) Kitwe; Luanshya; Kafue; Chongwe; Masaiti; Ndola Rufunsa
Child Health, Sexual & Communications Support for Chingola; Mufulira; Lusaka; Chilanga; 1 1 Reproductive Health (SRH), HIV, Health (CSH) Kitwe; Luanshya; Kafue; Chongwe; Malaria Masaiti; Ndola Rufunsa
Grand Total 44 15 6 3 68
78 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Appendix 8 Count of Projects Cross-Classified by RMNCH&N Component Addressed
Province District RMNCH&N Component
Reproductive Maternal Newborn Child Nutrition
Lusaka Lusaka 24 6 6 12 4
Chilanga 15 6 5 7 3
Kafue 15 5 5 6 3
Chongwe 16 6 5 9 3
Rufunsa 14 6 5 7 3
No Data 13 7 7 8 3
Copperbelt Ndola 15 4 4 5 2
Luanshya 15 4 4 4 2
Masaiti 17 5 5 5 2
Kitwe 23 6 6 8 3
Chingola 15 5 5 5 3
Mufulira 15 4 4 4 2
No Data 10 6 4 10 4
Appendix 9 Percentage of Projects Cross-Classified by RMNCH&N Component Addressed
Province District RMNCH&N Component
Reproductive Maternal Newborn Child Nutrition
Lusaka Lusaka 35% 9% 9% 18% 6%
Chilanga 22% 9% 7% 10% 4%
Kafue 22% 7% 7% 9% 4%
Chongwe 24% 9% 7% 13% 4%
Rufunsa 21% 9% 7% 10% 4%
No Data 19% 10% 10% 12% 4%
Copperbelt Ndola 22% 6% 6% 7% 3%
Luanshya 22% 6% 6% 6% 3%
Masaiti 25% 7% 7% 7% 3%
Kitwe 34% 9% 9% 12% 4%
Chingola 22% 7% 7% 7% 4%
Mufulira 22% 6% 6% 6% 3%
No Data 15% 9% 6% 15% 6%
Mapping of RMNCH & Nutrition Programs/ 79 Projects in Lusaka and Copperbelt Provinces Appendix 10 Count of Projects Addressing Malaria, WASH, GBV and Systems Strengthening
Province District Cross-Cutting Issues & Systems Strengthening Components
Malaria WASH GBV HSS CSS
Lusaka Lusaka 6 1 3 12 7
Chilanga 6 1 2 9 3
Kafue 6 1 2 10 4
Chongwe 6 2 2 10 0
Rufunsa 6 1 2 8 0
No Data 2 2 2 2 0
Copperbelt Ndola 6 0 1 10 0
Luanshya 6 0 0 8 0
Masaiti 6 0 1 8 0
Kitwe 8 1 1 9 0
Chingola 7 1 2 9 0
Mufulira 7 0 1 8 0
No Data 2 2 2 5 0
Appendix 11 Percentage of Projects Addressing Malaria, WASH, GBV and Systems Strengthening
Province District Cross-Cutting Issues & Systems Strengthening Components
Malaria WASH GBV HSS CSS
Lusaka Lusaka 9% 1% 4% 18% 10%
Chilanga 9% 1% 3% 13% 4%
Kafue 9% 1% 3% 15% 6%
Chongwe 9% 3% 3% 15% 0%
Rufunsa 9% 1% 3% 12% 0%
No Data 3% 3% 3% 3% 0%
Copperbelt Ndola 9% 0% 1% 15% 0%
Luanshya 9% 0% 0% 12% 0%
Masaiti 9% 0% 1% 12% 0%
Kitwe 12% 1% 1% 13% 0%
Chingola 10% 1% 3% 13% 0%
Mufulira 10% 0% 1% 12% 0%
No Data 3% 3% 3% 7% 0%
80 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Appendix 10 Appendix 12
35. Adapted 35 Count of Projects Addressing Malaria, from (WHO) National Health Planning Cycles and Context The Global Fund Tuberculosis GrantsThe Global Fund Tuberculosis The Global Fund Malaria Grants The Global Fund HIV/AIDS GrantsThe Global Fund HIV/AIDS TetraGAVI DTP Hib Vaccine Support TetraGAVI DTP Hep B Vaccine Support GAVI Measles Vaccine Support Measles GAVI Vaccine Support HumanGAVI Papillomavirus Vaccine Support Fever Yellow GAVI Hib Vaccine SupportGAVI RotavirusGAVI Vaccine Support GAVI PneumococcalGAVI Vaccine Support GAVI Pentavalent Vaccine Support Pentavalent GAVI B Hepatitis Vaccine SupportGAVI GAVI Injection Safety Support Safety Injection GAVI GAVI Civil Society Organisation (CSO) Support GAVI Immunisation Services Support(ISS)Support Services Immunisation GAVI GAVI Health System Strengthening (HSS)Support Strengthening Health System GAVI Human Resources for Health Plan Health Plan and Child Newborn Maternal Health Plan Health Maternal Health Plan Reproductive Mental Health and Plan Substance Abuse Plan Noncommunicable Diseases HIV/AIDS Plan Tuberculosis Plan Tuberculosis Malaria Plan Malaria Multi-Year Plan (cYMP) for Immunization National Development Plan WASH, GBV and Systems Strengthening Plan and Strategy Policy Health National Start 2008 2008 2009 2004 2012 2012 2005 2002 2001 2007 2006 2004 2011 2008 2011 2011 2006 2011 2013 2013 2014 2005 2015 2015 2015 2004 2012 2013 2010 2015 2015 2012 2015 2015 2011 2015 End Dur
2000 xxx 2001 xxx xxx 2002 xxx xxx 2003 xxx xxx xxx xxx 2004 xxx xxx xxx xxx 2005 xxx xxx xxx xxx xxx 2006 xxx xxx xxx xxx xxx xxx 2007 xxx xxx xxx xxx xxx xxx xxx xxx xxx 2008 xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx 2009 xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx 2010 xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx 2011 xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx 2012 xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx 2013 xxx xxx xxx xxx xxx xxx xxx xxx xxx 2014 xxx xxx xxx xxx xxx xxx xxx xxx 2015 2016 2017 2018 2019 2020
Country Documents · National AIDS Strategic Framework 2011-2015 · National Health Strategic Plan, 2011-2015 · Comprehensive multi-year plan for 2011-2015 · National malaria control program strategic plan 2011-2015 · Zambia Tuberculosis Program. Stop TB Strategic Plan Programmatic Planning and Project Timelines 2008-2012
Mapping of RMNCH & Nutrition Programs/ 81 Projects in Lusaka and Copperbelt Provinces Appendix 13 Synergies for Women’s and Children’s Health between the MDGs
The health of women and children, highlighted by MDGs 4 and 5, play a role in all MDGs:
MDG 1 Eradicate extreme poverty Poverty contributes to unintended pregnancies and pregnancy-related and hunger mortality and morbidity in adolescent girls and women, and under- nutrition and other nutrition-related factors contribute to 35% of deaths of children under-five each year, while also affecting women’s health. Charging people less for health services reduces poverty and makes women and children more willing to seek care. Further efforts at the community level must make nutritional interventions (such as exclusive breastfeeding for six months, use of micronutrient supplements and deworming) a routine part of care.
MDG 2 Achieve universal primary Gender parity in education is still to be achieved. It is essential because education educated girls and women improve prospects for the whole family, helping to break the cycle of poverty. In Africa, for example, children whose mothers have been educated for at least five years are 40% more likely to live beyond the age of five. Schools can serve as a point of contact for women and children, allowing health-related information to be shared, services offered and health literacy promoted.
MDG 3 Promote gender equality and Empowerment and gender equality improve the health of women and empower women children by increasing reproductive choices, reducing child marriages and tackling discrimination and gender-based violence. Partners should look for opportunities to coordinate their advocacy and educational programs (including those for men and boys) with organizations focusing on gender equality. Shared programs might include family- planning services, health education services, and systems to identify women at risk of domestic violence.
MDG 6 Combat HIV/AIDS, malaria Many women and children die needlessly from diseases that we have and other diseases the tools to prevent and treat. In Africa, reductions in maternal and childhood mortality have been achieved by effectively treating HIV/ AIDS, preventing mother-to-child transmission (PMTCT) of HIV and preventing and treating malaria. We should coordinate efforts on such interventions by, for example, integrating PMTCT into maternal and child health services and ensuring that mothers who bring children for immunization are offered other essential interventions.
MDG 7 Ensure environmental Dirty water and inadequate sanitation cause diseases such as sustainability - safe drinking Diarrhoea, typhoid, cholera and dysentery, especially among pregnant water and sanitation women, so sustainable access to safe drinking water and adequate sanitation is critical. Community-based health efforts must educate women and children about sanitation and must improve access to safe drinking water.
MDG 8 Develop a global partnership Global partnership and the sufficient and effective provision of aid and for development financing are essential. In addition, collaboration with pharmaceutical companies and the private sector must continue to provide access to affordable, essential drugs as well as to bring the benefits of new technologies and knowledge to those who need them most.
82 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces Appendix 14 Strategic Elements of the Immunisation Vision and Strategy 36 36. (MOH, 2011) Framework
The Immunisation Vision and Strategy framework contains 16 key strategic elements. These elements fall into 4 categories or thematic areas – the pillars of Zambia immunization vision and strategy:
1. Pillar One: Protecting more people 1.1 Strategy 1: Use a combination of approaches to reach everyone targeted for immunization 1.2 Strategy 2: Increase community satisfaction and demand for immunization 1.3 Strategy 3: Vaccinate beyond the traditional target group 1.4 Strategy 4: Improve vaccine, immunization and injection safety 1.5 Strategy 5: Improve and strengthen vaccine management systems 1.6 Strategy 6: Strengthen and evaluate the immunization program
2. Pillar Two: Introducing new vaccines and technologies 2.1 Strategy 7: Prepare for the introduction of Rotavirus vaccine, Pneumococcal vaccines and Measles second dose vaccine.
3. Pillar Three: Integrating immunization, other health interventions and surveillance in the health systems context 3.1 Strategy 8: Strengthen the management, analysis, interpretation, use, and exchange of data at all levels 3.2 Strategy 9: Improve human resources management 3.3 Strategy 10: Sustain and develop appropriate interventions for integration 3.4 Strategy 11: Strengthen surveillance and monitoring 3.5 Strategy 12: Provide access to immunization in emergency and special situations 3.6 Strategy 13: Strengthen linkages with stakeholders (e.g. clinicians, traditional healers, other programs)
4. Pillar Four: Sustainable immunization financing 4.1 Strategy 14: Improve capacity for mobilization of financial and other resources 4.2 Strategy 15: Integrate new vaccines into medium-term expenditure framework (MTEF) and National Health Strategic Plan and Budget 4.3 Strategy 16: Increase partner financial support for immunization
Mapping of RMNCH & Nutrition Programs/ 83 Projects in Lusaka and Copperbelt Provinces Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces