In many of Zambia’s far-flung provinces and villages, access to medical care remains a big challenge, leading to problematic rates of both maternal and infant mortality. As the government aims for an ambitious goal to reduce these fatalities, the question arises of how officials plan to effectively implement their programmes.
Statistically Zambia is doing much better than 20 years ago, but health officials are eager to push the rate down further and are eagerly searching for solutions.
First lady Dr. Christine Kaseba was reported to have said earlier this year that the government needs more effective strategies to increase safety and health of women who are or may become pregnant.
According to the 2010 census, maternal mortality rates were 591 deaths per 100,000 live births, but a vast improvement to the numbers in 1996 of 6,649 deaths per 100,000 live births. Kaseba also said that only 47 per cent of births are attended by a skilled professional in a health institution while home deliveries remain high, up to 53 per cent, in rural areas.
The government has attempted to address these issues through the Ministry of Community Development and Mother and Child Health, which was one of many new ministries established by the Patriotic Front government after winning the 2011 election. Although representatives of this ministry did not respond to interview requests, the Ministry launched its strategy plan for 2013-2016 this past July, highlighting the goal to achieve a reduction of the “disease burden” by 50% in just three years.
The goal of the World Health Organisation is even more ambitious: to reduce the maternal mortality ratio by three quarters by 2015.
The big question, of course, is how to implement the right policies to achieve these goals.
Nkole Chavuma, the acting principal clinical instructor at the Lusaka schools of nursing, says that with this goal in mind, the nursing curriculum at the Lusaka school has expanded to include midwifery and increased focus on community based healthcare for women and children in remote areas.
“What we used to tell people in the communities is to go to (an) acute care setting for (procedures) but they wouldn’t always go,” said Chavuma. “They might have been worried about travel or money. Now we have nurses trained to travel out to the communities. They still give information on family planning and recommend going to the clinic setting or emergency department for certain things, but they are out in communities more.”
But Chavuma said there is still a national nursing shortage and although there are more skilled workers now than a decade ago, Zambia needs more. She also said in order to train more nurses, they need updated equipment: things like moderns patient mannequins, procedure related films, materials and computers. She said they are waiting to hear back on funding from USAid for the upcoming school year to update their mannequins.
“Skilled workers are trained workers,” said Chavuma. “The training encompasses everything from acute and community care to emergency care, but the materials need to be there. Right now we have a small space and our numbesr of students is increasing.”
Levison Chifwaila is medical Nurse and tutor at the Chitambo Hospital Nurse Training School and coordinator of Medical Aid Films, a pilot project that distributes films to rural and low literacy areas. The project offered a training workshop this month on obstetric and neonatal emergencies and safe delivery through the Lusaka School of Nursing.
“The numbers (of maternal deaths) are definitely higher than they need to be,” said Chifwaila.
It’s been difficult to quantify the impact of the media program over the past year, but Chifwaila said it has increased dialogue. He said it’s a good companion to the local-language, educational radio programming introduced more than five years ago through the government.
“We’ve seen (less) deaths, and these issues around (health) are mostly improving because there’s more knowledge around maternal-child health,” he said.
This could also be because of a change in curriculum in nursing schools across the country, adding an increased emphasis on community outreach, said Chavuma. She also said of the updated materials they do possess are powerful teachers, like the graphic, animated movies they recently acquired from Medical Aid Films that they’ve incorporated into their school’s library.
“After watching that, students wouldn’t forget what a post-partum hemorrhage looks like,” said Chavuma. “The films were very illustrative.”
According to the 2000-2010 censuses, the Zambian population had an annual growth rate of 2.8 per cent, increasing from 9,885,591 to 13,092,666 over the 10 years.
Of that population, 60.5 per cent of people resided in rural areas and 39.5 in urban. In 2010, 9.3 per cent of all adult female deaths were maternal related: 11.8 in rural areas and 6.7 in urban areas.
While updating the nursing curriculum and deploying more skilled healthcare workers to areas of Zambia that need the most help is a clear part of the solution, there remains an immense challenge to transform the nation’s vast bureaucratic structure to produce results. For example, according to one report presented by the Ministry of Community Development and Mother and Child Health, no fewer than 23 government agencies split responsibilities on basic healthcare issues. The ministries are frequently separated and re-aligned, leading to a lack of clarity over responsibilities.
With only a few years left in President Sata’s first term, health officials will be under significant pressure to show measurable gains on maternal and infant mortality. The question is whether there is enough time.
Angele Cano is a freelance journalist currently on assignment to Africa. She can be found on Twitter at @angelecano.
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