Health support for women, children and youth in Zambia
Contribution ID : SE-0-SE-6-51190008This website displays open data about Swedish aid, which shows when, to whom and for what purpose Swedish aid is paid out, as well as what results it has produced. This page contains information about one of the contributions financed with Swedish aid.
The intervention will contribute to improving the health of women, children and adolescents by increased access to and demand for quality-assured health services at district level. The activities at district/primary health care level will be complimented by support to strengthen the national health system in order to maximize sustainability.The intervention ha...
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The intervention will contribute to improving the health of women, children and adolescents by increased access to and demand for quality-assured health services at district level. The activities at district/primary health care level will be complimented by support to strengthen the national health system in order to maximize sustainability.The intervention has been developed by Ministry of Health, Ministry of Community Development, Mother and Child Health, Ministry of Finance, civil society, Sida and DFID in consultation with the major health actors in Zambia (UN, USAID, World Bank and EU). The initial plan was that two health ministries would jointly implement the contribution. However, on 18 September 2015, the Government made the unpredictable and abrupt decision that all health issues should again be managed by the Ministry of Health. As of 2012, primary health care including maternal and child health was managed by the Ministry of Community Development, Mother and Child Health. The decision to manage all health issues under the same ministry is most welcome as the separation of primary health care from health system building blocks (policy, medicines and supplies, human resources, information systems, health financing etc.) presented formidable challenges to health development in Zambia. This grant will thus be managed by one (Ministry of Health) instead of two ministries which will greatly facilitate and improve coordination, governance, management, reporting, procurement, supervision, capacity building etc. At the same time, the startup of the implementation is expected to be slowed down due to the administrative changes needed. The appraisal of this contribution was made prior to the Government’s decision to merge all health activities to one ministry. Capacity and risk assessments have been made for both ministries and evaluations show that the Ministry of Health has better governance, management and human resource capacity. As a result, Sida considers that a decision can be made on this contribution despite the significant changes in the Government structure. The intervention follows international and national policies and guidelines for cost-effective and high-impact reproductive, maternal, newborn, child and adolescent health (RMNCAH) and nutrition services. Three out of a total of 10 provinces (central, eastern and southern) have been chosen following analysis of health indicators, socioeconomic data and a mapping of partner organizations work. Sweden will support interventions in eastern and southern provinces and DFID is expected to support the central province.This will be achieved by three outcomes:1. Effective RMNCAH services available in initially two provinces2. Increase community and client demand and uptake of RMNCAH services in initially two provinces3. Health system capacity strengthening to enable effective RMNCAH service delivery at national level and in two target provincesThe strategic interventions that will be supported include:- Capacity building for health care providers, community-based volunteers and managerial staff at central, province and district levels- Recruitment of supplementary human resources- Procurement of health commodities and supplies- Renovation and expansion of health facilities at district level and construction of maternity waiting homes- RMNCAH and nutrition service promotion and health education- Use of quality health information for decision making and management- Effective financial management (at all levels of the health system)- Sector and partner harmonization and coordination for RMNCAH
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Result
The year 2020 basically started off with the COVID pandemic, and has been a challenging year for the RMNCAH/N programme and for MOH as a whole. Zambia's first COVID case was on March 18 and the pandemic affected the entire RMNCAH/N programme in many ways. Most notably, as precautionary measures and travel restrictions were introduced, it meant that implementation of activities had to be postponed and delayed, in particular training sessions, meetings and workshops where many people meet jointly. Procurements were delayed or moved into the future as travel restrictions made it difficult to meet and inspect potential contractors. There was also a delay in completion of several infrastructure projects. A consistent lack of PPEs for health workers meant that several activities, such as outreach, could not be effectively done. Community sensitization meetings could also not take place. Despite COVID and its consequences on service delivery, the RMNCAH/N programme managed to implement quite a considerable number of its planned activities. Actual numbers of trained health workers and community-based volunteers were significantly lower in 2020 due to COVID, but targets were later re-set to realistically reflect the pandemic and its effects. - 212 health workers trained (81 percent of the target) in adolescent SRHR, Reach Every Child, Emergency obstetric and newborn care, nutrition, quality assurance/quality improvement, data use, long term acting methods etc. - 289 community health volunteers trained (exceeding target) across the provinces such as peer educators, SMAGs, and community-based contraceptive distributors. - 67 incinerators at health facilities were completed; 25 staff houses fully renovated, 26 boreholes were drilled, 27 maternity annexes fully completed, 10 youth corners refurbished, 6 labour wards were rehabilitated. In terms of the key performance indicators, 2020 was a year which exacerbated the decline of health indicators that started in 2019. This was a national phenomenon and in fact, the 4 RMNCAH/N provinces faired better than the non-RMNCAH/N provinces in general. It is not possible to determine if the better figures are the result of the efforts of the programme but it is likely that it could have influenced the final outcomes. - Fully immunized children dropped in three provinces; mostly attributed to reduction in outreach due to travel restrictions and inadequate government funding for vaccines and supplies. Eastern province managed however to increase from 80.7 percent to 83 percent. - ANC coverage before 14 weeks dropped in Luapula and Muchinga but increased in Eastern and Southern provinces; in Eastern a rise from 29.8 percent in 2019 to 37.4 percent. This is attributed to intensified community awareness messages, supportive supervision of health workers, provision of mama packs and IEC materials and training of SMAGs. - For skilled deliveries at birth, three provinces noted a drop, whereas Eastern province recorded a 3 percent increase, attributed to deployment of newly trained staff in the province. There were fewer health workers available as some had been allocated to the COVID isolation sites during the peak of the pandemic in mid-2020. - New FP acceptors showed a surprising increase in Eastern and Southern (from 14.5 percent in 2019 up to 16.6 percent in 2020) despite the national shortage of long term methods in 2020. The increase could be attributed to the intensified training of health providers by Marie Stopes and other partners in the two provinces. The supply of contraceptives was erratic throughout the year. - All the provinces recorded a decrease in post-natal care within 6 days; the highest drop in Luapula with almost 20 percent. Again, COVID restrictions and fear to seek services post-partum due to getting infected by COVID are seen as factors behind the drop. - Maternal deaths increased nationally in 2020 compared to 2019. However, three of the four provinces decreased their numbers (not Muchinga), which is likely to be attributed to the RMNCAH/N programme investments in capacity-building and equipment over the past years. - Still birth rate is high in Zambia but it reduced in three of the four provinces (not Muchinga) in 2020. - Neonatal deaths is a huge and static problem in Zambia with few improvements. In 2020, three provinces recorded more neonatal deaths than the preceding year. Southern was the only province that managed to reduce its numbers, partly due to training of staff in EMONC and conducting death reviews regularly.
Determinants for maternal and child health will be measured by four impact indicators: maternal mortality, child and newborn deaths and children under five who are stunted. The impact will be measured through a mini-DHS in 2019-2020 and compared to the 2013-2014 DHS. The following improvements in health outcomes are planned (in the target provinces): - The Maternal Mortality Ratio reduced by 25% from baseline - The Newborn Mortality Rate reduced by 10% from baseline - The Under 5 Mortality Rate reduced by 15% from baseline - The Under 5 Stunting Rate reduced by 3% from baseline The objectives of the intervention are: - Increasing availability and readiness of quality health & nutrition services for mothers, newborns, children and adolescents in two target provinces in Zambia. - Increasing demand and uptake of physically, culturally, and financially accessible services for mothers, newborns, children and adolescents in two target provinces in Zambia. - Strengthening Health Systems at national and sub-national levels as necessary to providing an enabling environment for effective RMNCAH&N service delivery.
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