Health support for women, children and youth in Zambia

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.