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The Southern African nation of Zambia is home to nearly 16 million people — 66 percent of whom are under the age of 25. The country’s health system faces many challenges, including a very high risk of infectious diseases. Although
Zambia has made some impressive reductions in maternal and child mortality over the past two decades, rates are still high, with 280 women out of 1,000 dying as a result pregnancy complications and 262 out of 1,000 children dying before they reach the age of five.
Zambia has an HIV prevalence rate of 12.5 percent among people between the ages of 15 and 49, making it the seventh most affected country in the world, according to UNAIDS. Prevalence rates vary considerably within the country from a high of 18 percent in Copperbelt Province to a low of 6 percent in Muchinga. Infection rates are highest in cities and towns along major transportation routes, with young women, military personnel, commercial sex workers, truck drivers, and people who work in fisheries among the populations at greatest risk of contracting HIV.
The country’s health system is severely overstretched and has a physician density of just 0.17 per 1,000 people.
Consequently, strengthening Zambia’s health system — in part by developing sustainable local capacity to train health workers and finding ways to streamline care and prevention services — are of critical importance.
With support from PEPFAR and the US Government team in country, AIHA currently manages four partnerships to strengthen health system capacity in Zambia through our HRSA-supported HIV/AIDS Twinning Center Program, having successfully graduated two long-standing partnerships — one focused on palliative care and another on HIV prevention through the mass media — from this technical assistance program in late 2014.
In addition, AIHA is part of the USAID-funded Zambia Rising consortium led by Save the Children. Under Zambia Rising, we are spearheading efforts to strengthen the country’s social welfare workforce by implementing a training program for community-based psychosocial caregivers known as Para Social Workers and by strengthening the institutional capacity of the national professional social work association.
Click here for a printable overview of our work in Zambia.
Building Capacity in Biomedical Technology to Improve Quality of Care
Drawing on our experience implementing projects designed to strengthen local capacity in biomedical engineering and technology in Ethiopia, Kenya, and Uganda, AIHA began supporting efforts to ensure Zambia’s public health laboratories achieve accreditation in 2016.
In collaboration with the Kenyan company, Biologics, we implemented a preliminary training on routine maintenance, repair, and calibration of non-automated laboratory equipment for 26 biomeds. AIHA procured and distributed toolkits to the 17 Ministry of Health labs seeking accreditation and conducted a study tour that brought three key biomedical personnel to our partner sites in Ethiopia as a way to expose them to more advanced biomedical engineering programs.
This was an important learning experience that is supporting the development of strategies that will move the project forward. In the coming year, partners will continue training activities and work to create two calibration centers with the overarching goal of increasing the Ministry’s capacity to maintain and repair laboratory equipment critical for HIV testing, diagnosis, and treatment as the country works to attain global 90-90-90 targets. CDC/Zambia supports this project.
Zambian Defense Forces Learning Resource Center Initiative
2005 – Present
Building on an existing relationship between the Zambian Defense Force and the US Department of Defense, this AIHA initiative is working to improve HIV treatment and care for military personnel and their families by improving access to evidence-based medical resources through information and communication technologies and telemedicine.
AIHA has been collaborating with Zambian Defense Forces (ZDF) military medical personnel since 2005 and has been providing direct technical assistance since 2007 through our Knowledge Management Initiative and pre- and in-service medical training in targeted fields such as emergency medicine, injection safety, and infection control at the Defense School of Health Sciences.
The project is designed to improve provider access to evidence-based clinical resources as a means of enhancing care management for PLHIV and other military and civilian patients treated at ZDF clinical sites throughout the country.
AIHA has to date established 21 Knowledge Management Centers (KMCs) at ZDF clinical sites and we are continuing to train medical personnel in effective research and implementation techniques to improve quality and efficacy of patient care. At these KMCs, healthcare personnel can easily tap into a wealth of up-to-date clinical research, texts, case studies, treatment protocols, and other evidenced-based resources that can guide their practice and improve quality of care and HIV/AIDS treatment outcomes.
AIHA supports effective use and scale up of KMCs by providing targeted training on evidence-based medicine, emergency medicine, proper research protocols, online resources, and other relevant topics both through workshops and distance learning courses. From October 2014 to March 2015 alone, ZDF KMCs logged nearly 250 visits from users looking to access clinical resources. During that same timeframe, local KMC coordinators trained 114 individuals in the use of evidence-based clinical tools and research, clearly demonstrating ZDF’s commitment to supporting the ongoing professional development of military medical personnel.
AIHA, the Georgia-based Global Partnership for Telehealth, and ZDF began collaborating on a groundbreaking locally driven, locally owned telemedicine program in March 2014. Telemedicine uses telecommunications technology to enhance, expedite, or even directly provide healthcare services by accessing offsite databases, linking clinics or care providers to central hospitals, or transmitting x-rays or other diagnostic images for examination by experts at another site.
Slated to launch in August 2015, the ZDF telemedicine program will link experts at Maina Soko Military Hospital in Lusaka with health staff at five pilot sites across the country to improve the quality of diagnostics and treatment services at these military clinics.
In rural parts of Zambia, telemedicine can greatly improve access to care.
ZDF oversees more than 50 clinical health sites, many situated in rural areas far from referral hospitals where specialized care can be accessed, so it is well-positioned to take the lead on this cutting-edge health initiative. In these rural areas, telemedicine can greatly improve access to care, reduce morbidity and mortality rates, and improve quality of life for both the military and local civilian populations that ZDF clinics serve.
In addition, AIHA has been working closely with the Defense School of Health Sciences and Zambia’s Ministry of Health on the development of a National Curriculum for Emergency Services and has already begun training faculty in the use of this curriculum. Similarly, AIHA has supported the School’s efforts to draft curricula for injection safety and infection prevention, which are currently being implemented by faculty.
University Teaching Hospitals, Lusaka and Livingstone / Center for International Health
2006 – Present
Partners are working to improve ART and related care for children living with HIV by training pharmacists at two Pediatric HIV/AIDS Centers of Excellence and better integrating them into HIV care teams. They are also building local capacity to implement ongoing professional development and training opportunities.
With support from CDC/Zambia, AIHA began working with the University Teaching Hospital (UTH) in Lusaka and Livingstone Central Hospital (LCH) in 2006, linking them with the Milwaukee-based Center for International Health (CIH) to improve the quality of services provided by pharmacists at the Pediatric ART Centers of Excellence at both Zambian institutions. In 2014, AIHA graduated CIH upon successful completion of their technical assistance objectives and has since been providing direct support to UTH and LCH through our HIV/AIDS Twinning Center Program.
From day one, a key objective of this project has been to develop in-country training capacity that enables pharmacists to more effectively organize and manage pharmacy services as a way to better ensure high quality HIV-related treatment and care to mothers, infants, and children.
In support of this objective, partners have been continually working to better integrate pharmacists into multidisciplinary HIV/AIDS care teams at both hospitals. To this end, partners have established six satellite pharmacies — including a
Pediatric ART Satellite Pharmacy at UTH — to improve access to both medications and expert advice in selected wards.
AIHA established Knowledge Management Centers (KMCs) at both institutions and facilitated training for pharmacists on evidence-based medicine, online resources, and searching techniques. We’ve also provided targeted training on the use of Lexicomp, an online database that provides clinical information, including drug usage guidelines that help health professionals make safer, faster care decisions.
In 2016, AIHA supported UTH and LCH as they shifted their focus to clinical mentorship, with both institutions serving as centers of excellence in delivering HIV/AIDS pharmaceutical care. Local experts trained in partnership with CIH
continued to roll out training and mentorship activities for pharmacists and pharmacy assistants working at provincial level health sites throughout Zambia. Currently, partners are working to launch an adolescent disclosure project, as well as a therapeutic drug monitoring project with both pharmacies.
In response to local needs, LCH’s pharmacy team is also providing clinical pharmacy training and mentorships in all correctional facilities situated in Southern Province as a way to ensure the high-risk inmate populations have access to quality HIV and TB care and treatment. In particular, partners are working to develop the capacity of selected prison wardens and CHWs to act as trainers and mentors fully capable of assisting others with uptake of the system. They are also training a peer support network among specific inmate patient groups to strengthen treatment uptake and adherence, as well as working to assure continuity of care for prisoners who are on treatment and released.
Chreso Ministries / University of South Carolina
2015 – Present
Partners are working together to strengthen the capacity of Chreso Ministries to mitigate the impact of HIV/AIDS on key populations, including men who have sex with men (MSM); commercial sex workers (CSWs); people who inject drugs (PWID); and lesbian, gay, bisexual, and transgender (LGBT) individuals. Key objectives are to increase awareness and understanding among health and allied care providers as a way of improving access to health and social services and to reduce the stigma and discrimination experienced by these high-risk groups.
Chreso Ministries is a faith-based organization in Zambia dedicated to providing life-changing education and training programs, as well as healthcare services, to individuals and families in the poorest communities across the country, including members of key populations (KPs) at high risk of contracting HIV such as MSM, CSWs, PWID, and the LGBT community.
According to the UNAIDS Gap Report 2014, between 40-50 percent of all new HIV infections among adults worldwide occur among KPs and their immediate partners. In low-income countries, KPs often face the additional burden of widespread stigma and discrimination in healthcare settings and criminalization of substance use, sex work, and same-sex sexual behaviors. These social and structural realities create high-risk environments that undermine public health goals, violate human rights, and limit safe and effective provision of HIV prevention, care, and treatment services.
With support from CDC/Zambia, AIHA is working to change this through an institutional twinning partnership that links Chreso Ministries with the University of South Carolina (USC). Together, partners kicked off their collaboration by conducting a comprehensive needs assessment of KP health services at Chreso Ministries clinical sites. They also met with KP support groups and members of KP communities to gain a better understanding of their needs, as well as critical gaps in services they face on a day-to-day basis.
Partners conducted two preliminary sensitivity training workshops for Chreso healthcare workers to strengthen their capacity to provide client-centered medical and psycho-social support services to KPs. A team from Chreso Ministries also traveled to USC, where they learned about some of the model psycho-social support services and HIV prevention, care, and treatment interventions in place to meet the unique needs of KPs.
In the coming year, partners plan to develop a sensitivity training package specific to the Zambian context and implement a comprehensive schedule of training sessions based on Chreso’s needs. They also plan to conduct onsite mentoring in the provision of quality, comprehensive, and client-centered care for KPs and will work to enhance responsiveness to the needs of KPs at Chreso Ministries sites through the creation and support of consumer advisory boards (CABs). Other efforts will focus on the development of bi-monthly support groups designed to engage, empower, and support a broader base of KPs and building the capacity of Chreso Ministries to monitor and evaluate KP services at their brick-and-mortar and mobile healthcare sites.
Certificate Program in Laboratory Leadership & Management
2016 – Present
AIHA is collaborating with the International Training and Education Center for Health (I-TECH) and the University of Washington (UW) to implement a 9-month project to strengthen the leadership and management skills of Zambian laboratory staff in management positions as a way to empower them to make meaningful improvements to their laboratory’s operations.
The 16 individuals who each earned a Certificate in Laboratory Leadership and Management from the University of Washington in November 2016 were drawn from Ministry of Health public health laboratories earmarked for international accreditation. They enrolled in the course in March 2016 and spent nine months strengthening their skills in quality assurance practices; application of diagnostic technologies; data analyzation and interpretation; and communication of results and impacts. Developed and conducted by I-TECH, this program features a blend of distance learning and face-to-face training activities, along with targeted mentorship to foster professional growth. In the coming year, AIHA and I-TECH will implement another round of training targeting other lab workers from the same public health laboratories, with the 16 lab managers trained last year serving as mentors.
2013 – 2017
AIHA was part of the USAID-supported Zambia Rising Project led by Save the Children. Zambia Rising worked in coordination with two other USAID projects (Data Rising and Community Rising); all three were designed to strengthen local systems and capacity to improve the quality of life for orphans and vulnerable children (OVC) living in Zambia.
Lack of full access to health services, proper nutrition, and education, paired with high unemployment rates have threatened Zambia’s stability, putting far too many children at risk. UNAIDS estimated that there are 95,000 children in Zambia who are living with HIV.
AIHA supported the institutionalization of the social work profession in Zambia by strengthening the Social Workers Association of Zambia (SWAZ). We worked closely with SWAZ staff to determine requirements for establishing a national office, engaging a Board of Directors, setting up a schedule of regular meetings, and other organizational capacity development activities. We also worked with SWAZ and the University of Zambia on educational requirements, continuing education, and other matters related to professional standards and accreditation. Collectively, these efforts supported SWAZ’s goal to build membership, advocate for the social work profession, and become a self-sufficient, self-sustaining association.
Zambia Institute of Mass Communication Educational Trust / University of Kentucky School of Journalism
2008 – 2014
Partners are working to build ZAMCOM’s capacity as a media training institution with the objective of increasing public awareness about HIV/AIDS through improved media coverage of the epidemic.
AIHA first started working with the Zambia Institute of Mass Communication Educational Trust (ZAMCOM) in 2005, piloting training courses to improve local media coverage of HIV/AIDS-related topics.
In 2008, we partnered ZAMCOM with the University of Kentucky School of Journalism and Telecommunications with the goal of strengthening its organizational capacity to train journalists on HIV/AIDS reporting, as well as on reporting techniques and print and broadcast production.
Partners worked to improve training programs based on ZAMCOM’s strategic goals, training some 200 Zambian journalists on accurate HIV/AIDS reporting. They conducted a series of workshops in Chipata, Kitwe, and Livingstone to train community members to produce radio programs on HIV and other critical public health issues and provided training for staff at community radio stations throughout the country, along with targeted prevention messages that were translated into local languages.
In October 2011, the partners launched the “Newspaper in Education” project in close cooperation with Zambia’s Ministry of Education and the Zambia Daily Mail to improve classroom access to reading material and teaching resources — in particular on health topics and gender-based violence.
This partnership worked closely with another AIHA twinning partnership that linked ZAMCOM with the Media Institute of Southern Africa (MISA) in Botswana to implement a pan-African public HIV/AIDS awareness campaign called “Hearts & Minds.”
Palliative Care Alliance of Zambia / African Palliative Care Association
2005 – 2014
This south-south partnership worked to develop institutional and human resource capacity at PCAZ and position the organization as a leading advocate for national palliative care policies and standards throughout Zambia. In September 2010, PCAZ began receiving direct funding from AIHA’s Twinning Center to continue their efforts to strengthen palliative care throughout Zambia.
Partners at the Palliative Care Alliance of Zambia (PCAZ) have emerged as a leading advocate for promoting national palliative care standards and policies in Zambia, thanks in part to an AIHA Twinning Center partnership with the Uganda-based African Palliative Care Association (APCA) that was funded from 2005 to 2010.
In September of 2010, AIHA began providing direct funding to PCAZ to support their efforts to strengthen palliative care throughout Zambia. To this end, we established a Knowledge Management Center (KMC) at PCAZ in 2011 to provide staff and other parties with access to a wide range of evidence-based resources, research, and other material that can help strengthen palliative care throughout Zambia.
The main objectives of this highly successful twinning partnership were to:
- Develop organizational and human resource capacity of PCAZ and its staff;
- Promote best practices in palliative care; and
- Create broader awareness through expanded advocacy and information dissemination efforts.
Over the years, PCAZ ushered in many positive changes in the country. Key accomplishments include the development of a morphine fact book for Zambia and resource material on morphine use, as well as a chapter on pain management for the NAC Care Treatment and Prevention guidelines.
PCAZ spearheaded the development of the Palliative Care National Strategic Plan and co-authored an article on palliative care that appeared in both the Zambia Daily Mail and Times of Zambia, which coincided with the 10th African Growth and Opportunity Act.
In addition, PCAZ developed the country’s first draft Pediatric Palliative Care Curriculum, which was piloted through a training-of-trainers course for 15 health professionals. They also developed data quality management tools to strengthen their services to hospices, facilitated palliative care sensitization workshops for hospice and clinic workers, and finalized the Palliative Care National Strategic Plan.
In the final years of their participation in AIHA’s technical assistance program, PCAZ focused on providing strategic planning and development trainings to enhance hospice capacities, as well as their own visibility through clearly documented plans. Another priority during their sustainability phase was economic strengthening through a pilot project that sought to ensure better recognition of palliative care providers, who are the unsung heroes of the health system.
Zambia HIV/AIDS Media Initiative
2005 – 2006
In partnership with the Zambia Institute of Mass Communication Educational Trust, this innovative initiative focused on improving the accuracy, quality, and scope of HIV/AIDS-related coverage in mass media outlets throughout Zambia and other PEPFAR-supported countries by training journalists and editorial staff.
HIV/AIDS media coverage in Zambia has long lacked the depth and innovation the subject matter demands. Many working reporters have no formal journalism training. Most reporters are unfamiliar with even basic information about HIV and its far-reaching implications for every sector of society.
In 2005-2006, with the support of PEPFAR and the US Embassy in Lusaka, AIHA collaborated with the Zambia Institute of Mass Communication Educational Trust (ZAMCOM) to build mass media capacity by training both print and broadcast journalists.
In July and August 2005, ZAMCOM brought 60 Zambian journalists to Lusaka for skills-based trainings facilitated by two experienced American journalists. The trainings were conducted in two 11-day sessions, each attended by 30 media professionals. This was the first time a media training of this type was held in Zambia.
These trainings consisted of presentations by physicians, policymakers, statisticians, economists, educators, civic leaders, and PLHIV. They also provided time in the field for gathering information and conducting interviews in two high-burden towns — Kafue and Kapiri-Mposhi — before returning to ZAMCOM campus to produce stories about the impact of HIV/AIDS in communities throughout Zambia.
Training materials and additional technical assistance for this project were provided by the Kaiser Family Foundation.
More than 80 stories were produced during the two workshops and published or broadcast. Some 30 more were subsequently produced. Various media outlets created HIV/AIDS desks and initiated new columns or programs as a result of this initiative and two participants received national recognition for producing the best HIV-related stories of 2005.
The way you feel charged up today is the way you must be every day. You must treat every day like World AIDS Day.”
— Chilufya Mwamba-Phiri, a long-time AIDS activist in Zambia, challenging journalists and editors to take their coverage of the epidemic more seriously during her presentation at ZAMCOM’s Editorial Leadership in HIV/AIDS Reporting for PEPFAR Countries workshop, in Lusaka, December 1, 2006.
Through the initial trainings and a follow-up meeting conducted in January 2006, a number of challenges that impede accurate and effective coverage of Zambia’s HIV/AIDS epidemic were identified, including:
- Limited access to information, expert sources, and PLHIV who are willing to speak on the record about their situation;
- Financial constraints and lack of necessary resources; and
- Editors and other supervisors who claim the public has no interest in stories about HIV/AIDS.
As a result, people in Zambia do not always have access to potentially life-saving information about HIV-related prevention, treatment, and support services.
AIDS is a story that touches all sectors of society and must be covered as such. Mass media can — and should — work to shine a spotlight on the epidemic’s impact on society. Targeted training, professional development, and access to key information sources play a critical role in improving the quality and scope of HIV coverage by the mass media.
Combining journalism theory, practice, production, and ethics with expert sessions on HIV-related topics can build capacity among reporters and awareness among editors, thereby improving public access to accurate and useful information.
In addition, government officials, along with healthcare policymakers and providers, need to understand the value of the mass media for getting information about HIV prevention and treatment options disseminated to the public and forge mutually beneficial working relationships.
The training model used by ZAMCOM proved to be highly effective with both national and regional implications for improving media coverage of HIV/AIDS and other health-related stories.
The following two posters based on AIHA’s Zambia HIV/AIDS Media Initiative were accepted for presentation at the XVI International AIDS Conference held in August 2006 in Toronto, Canada:
- Telling Stories of Life and HIV/AIDS in Zambia: National Training for Journalists Helps Improve Quality and Scope of Media Coverage
- Using Broadcast Media to Shine a Spotlight on the Realities of Zambia’s HIV/AIDS Epidemic