1. Provide improved and equitable access to healthcare in remote communities
Over the next three years, On Call Africa is looking to build on 11 years of experience of strengthening rural health systems to support the Ministry of Health to achieve its objective of developing model health service packages for rural health services, in partnership with the Community Health Unit. Following a collaborative planning process with MoH, partners and key stakeholders, we have identified what a model health facility might look like, by exploring interventions that:
• Enhance achievement of existing standards that are not being met currently
• Build on and go further than existing standards
• Explore new programmes and initiatives to improve accessibility and quality of health services
Through this pilot we will place volunteer doctors and public health professionals in Rural Health Facilities and embed them in the communities that they are serving during their placement with us. The volunteers carry out structured placements that are based on one of four phases of work: assessment and planning; delivery; monitoring, evaluation and learning; or handover. Volunteers work in partnership with Rural Health Facility staff to facilitate rather than replace existing service provision, and use this direct engagement to inform our programme design and delivery.
During our 12-18 month partnership with each facility we will work with partners and MoH to pilot different interventions and measure their impact to help inform the development of a scalable model health service package for On Call Africa, MoH, and partner organisations.
We are currently piloting the following interventions, alongside our assessments:
• Introduction of solar power through VeroPower
• Working with WaterAid to improve access to Water, Sanitation and Waste Management
• Training health workers on appropriate use of antibiotics to address antibiotic resistance and medicine stock outs
• Trialling an improved outreach kit to improve the level of service offered close to the home through health facility outreach activities
• Supporting improvements to a maternity ward and mother’s shelter to increase uptake of births at the facility (rather than at home)
• Exploring the use of bicycle ambulances to improve transport links to the facility
2. Strengthen rural health systems
Community Health Workers (CHWs) are trained to work within the existing health system to improve access to healthcare and to increase the capacity of Rural Health Facilities. Helping to respond to health needs of sparsely populated catchment areas. We also work with then, and District Health Offices (DHOs), to identify capacity building needs and delivered tailored programmes to respond to these needs with the help of skilled partners. These include access to solar power, improved medical facilities, training of health workers, improved water and sanitation, improved data systems and access to telemedicine.
At national level, we work with the Ministry of Health to support the development of national policies and guidelines that enhance the rural health system at scale.
As a part of our efforts to strengthen rural healthcare systems in Zambia, we are working in partnership with D-tree, AMP Health, and Medic Mobile and the Ministry of Health to develop a standardised CHW package, and looking to pilot the roll out of this, alongside the Community Health Toolkit, across the whole of Livingstone and Kazungula Districts. The toolkit is an open-source digital tool that will support CHWs to carry out their defined roles, by guiding them through patient interactions, and creating an improved mechanism for CHW supervision and support. The toolkit will also create digital patient records at community level and support improved decision making through real-time integration with the national reporting system.
3. WASH in Health Care Facilities (HCFs)
WASH in HCFs is fundamental to the provision of quality healthcare services, particularly for children and pregnant and lactating mothers. Inadequate and inappropriate WASH services lead to an increased risk of infections and disease for users and healthcare workers. The Joint Monitoring Program (2019) revealed that only 1 in 5 rural HCFs in Zambia have access to improved water on premises, improved sanitation, and consistent access to water and soap for handwashing.
In response to the growing international movement for improved WASH in HCFs, WaterAid have worked extensively with MoH to develop national standards for WASH, waste management and accessibility at all rural HCFs. On Call Africa are now working in partnership with WaterAid, over the next three years, to conduct assessments, improve infrastructure and deliver training in line with these new standards in 27 rural HCFs in Western Province. We will work with WaterAid to build evidence of impact on health outcomes and use this as evidence for wider adoption of the standards by MoH, and other NGOs.