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Zambia “SAFE” Strategy Implementation Framework 2013 - 2017

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Zambia “SAFE” Strategy Implementation Framework 2013 - 2017 Ministry of Health Zambia “SAFE” Strategy Implementation Framework 2013 - 2017 Developed and Compiled By the Directorate of Clinical Care and Diagnostic Services National Eye Health Coordination FEBRUARY, 2013 i TABLE OF CONTENTS Statement by the Honourable Minister of Health ..................................................... iv Foreword by the Permanent Secretary ................................................................... vi Message on Trachoma by the Directorate of Clinical Care and Diagnostic Services ... viii Abbreviations and Acronyms ............................................................................... xii PART ONE: ZAMBIA BACKGROUND 1 1.1.0 Country Profile ............................................................................................. 1 1.1.1 Zambian Provinces and Districts .......................................................... 2 1.2.0 Zambia Health System Goals and Priorities ..................................................... 3 1.3.0 Eye Health Services in Zambia ...................................................................... 6 1.4.0 Aims of the “SAFE” strategy implementation framework .................................. 7 PART TWO: TRACHOMA IN ZAMBIA 8 2.1.0 Introduction ............................................................................................... 8 2.2.0 Trachoma Disease Burden in Zambia ............................................................ 9 2.3.0 National Trachoma Survey Results .............................................................. 9 2.4.0 Case for Action ........................................................................................... 12 2.4.1 Impact of trachoma control ............................................................... 13 2.4.2 “SAFE” Strategy ............................................................................... 15 PART THREE: STRATEGIC AND OPERATIONAL FRAMEWORK 17 3.1.0 Stakeholder engagement /roles and responsibilities ....................................... 17 3.1.2 Implementation Structure ............................................................................ 24 PART FOUR: FACTORS FOR SUCCESS 28 4.1.0 Mass Drug Administration (MDA) .................................................................. 32 ii PART FIVE: STRATEGIES AND LOGICAL FRAMEWORK OF “SAFE” STRATEGY IMPLEMENTATION 35 5.1.0 Surgery ...................................................................................................... 35 5.2.0 Antibiotics ................................................................................................... 36 5.3.0 Face and hand washing ............................................................................... 41 5.4.0 Environment .............................................................................................. 43 PART SIX: NATIONAL BUDGET PROJECTIONS FOR FULL “SAFE” STRATEGY SCALE UP 46 6.1.0 Cost estimate for each “SAFE” strategy components ..................................... 46 6.1.1 Surgery Cost Estimate........................................................................ 46 6.1.2 Antibiotics cost estimate......................................................................48 6.1.3 Face and hand washing...................................................................... 50 6.1.4 Environment.......................................................................................52 PART SEVEN: FUNDING FOR THE “SAFE” STRATEGY IMPLEMENTATION 57 7.1.0 Sources of funding ........................................................................... 58 PART EIGHT: GANTT CHART 59 PART NINE: REFERENCES 60 PART TEN: APPENDICES 61 10.1.0 Appendix 1: Schools and surrounding communities visited during ITM survey. 61 10.2.0 Appendix 2: Areas visited during trachoma mapping in fifteen districts using the WHO classical method .......................................................................................... 87 iii Statement by the Honourable Minister of Health Zambia needs a healthy population in order to develop and thrive. The Zambian people are the largest and greatest asset the country has. As a country we still hold to the affirmation and promise to work towards elimination and eradication of all Neglected Tropical Diseases including trachoma. We keep this aspiration and momentum through our mission statement of, “Providing Quality Health Services as close to the family as possible.” This document focuses on the trachoma situation in the country and re-affirms my government's commitment to work with all cooperating partners, civil society, the corporate sector and line Ministries in our pursuit to control, manage and eliminate trachoma in Zambia. It comprehensively highlights the goals, objectives and strategies toward control and elimination of trachoma in Zambia by the year 2020. It also provides an impetus in the reduction of the burden of other infectious diseases like cholera, typhoid, dysentery and other NTDs whose root cause is also related to poor sanitation and hygiene through the “SAFE” strategy components. The challenge in the control of trachoma disease in Zambia has been inadequate resources towards prevention, control and case management coupled with the absence of the institutional framework to fight against trachoma. The inadequate data on the extent of the disease has now been addressed. The prevalence of this disease can be used as an indicator of poverty levels in the country as it mostly affects the poor and marginalized communities. The chronicity of the disease disables and deprives people of their dignity and self esteem. Our priority is to improve the standards of sanitation and hygiene as well as safe water supply as we contribute to the country’s effective response to trachoma. iv I take sincere pleasure in thanking all our “It comprehensively highlights partners and the members of staff at the the goals, objectives and Ministry of Health for their hard work in strategies toward control and bringing to light this major public health elimination of trachoma in challenge in our country. It is my sincere Zambia by the year 2020. It will hope that this partnership will strengthen also provide an impetus in the and that ultimately we can achieve the goal reduction of the burden of other of eliminating trachoma by the year 2020. poor sanitation and hygiene Ministry of Health will endeavour to related infectious diseases such collaborate with other line Ministries in the as cholera, typhoid, dysentery fight against trachoma. and other NTDs through the “SAFE” strategy components.” We welcome any guidance, advice and support from our partners, civil society, line Ministries and all other stakeholders in the fight against trachoma and other Neglected Tropical Diseases. My Government shall remain committed to ensuring that our country achieves the goal of eliminating trachoma by the year 2020. v Foreword by the Permanent Secretary The trachoma survey conducted by MoH and cooperating partners revealed that trachoma is endemic in all provinces of Zambia, with highest prevalence rates found in Southern, Copperbelt, Northern and Muchinga Provinces. Areas affected by trachoma are characterized by perennial water shortages, inadequate sanitation, poor hygiene and poverty. In its trachoma control programme, Zambia has benefitted from various stakeholders. These stakeholders include Ministry of Health, other line Ministries and the eye health co-operating partners such as CBM, Centre for Disease Control (CDC), Colin Glassco Foundation, Geneva Global (GG), International Trachoma Initiative (ITI), Lions Aid Norway (LAN), Operation Eyesight Universal (OEU) and Sightsavers (SS). All 72 districts (as at 2011) were surveyed for trachoma. In fourty six “The WHO “SAFE” strategy is certainly the way to go in (46) districts trachoma was identified responding to the trachoma burden as a Public Health Problem which in the country. This strategy places emphasis on serious structural require the full implementation of the transformation in our delivery of “SAFE” strategy. This translates into water and sanitation services. This certainly provides yet another 70% of the districts being endemic avenue for attainment of the with active trachoma with an average MDGs.” prevalence of 15%. The above findings call for a complete shift in mindset at the community and national levels and change of priorities, especially at the Local Government level. There is need to have a more comprehensive strategy if trachoma is to be eliminated. The WHO “SAFE” strategy is certainly the way to go in responding to the trachoma burden in the country. This strategy places emphasis on serious structural transformation in our delivery of safe water and sanitation services. This certainly provides yet another avenue for attainment of the MDGs. vi The “SAFE” Strategy has been instrumental in developing a framework that will provide a guide in the planning, delivery, and management of “Clean, Caring, Competent and Confidential eye health services at Community, District, Provincial and National levels” in trachoma elimination. The “SAFE” strategy also provides the Ministry of Health with yet another opportunity of synergizing resources in combating all the diseases arising due to poor sanitation and hygiene and lack of safe water. The Ministry of Health and its partners in the trachoma response have found it prudent to apply the most appropriate strategies in the implementation of all activities and programmes pertaining to the “SAFE” strategy in the elimination of trachoma. Accompanying
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