The Zambia general elections are scheduled to be held on 20 September to elect a president and representatives to the National Assembly. Civil society organisations in Zambia have identified the elections as an opportunity to ensure key health issues are a priority during the upcoming elections. This has been done successfully in various African countries, most recently in Malawi.
The campaign will target leaders standing for election with the aim of asking them to commit to prioritising equitable and improved access to health-care services. The campaign will reach out to communities across the country to ensure that issues around the delivery of health-care services at the local level, in terms of access and quality, are highlighted. This will be done through community meetings with leaders, case studies, roadshows and other popular mobilisation activities, as well as through lobbying political and community leaders. The campaign is being run by a broad range of organisations under the Civil Society Health Forum and Fair Play for Africa umbrella.
This blog will help give voice to citizens and health-care workers to highlight some of the experiences and challenges with health-care provision in Zambia.
Jacob Kaneya is an environmental health technologist at Lungobe Rural Health Centre.
In theory, Kaneya’s job is to focus on preventing outbreaks of disease such as bilharzia, cholera and malaria. But the reality of working in an under-resourced rural health clinic is that he often has to turn his hand to a range of other medical interventions – including delivering babies.
The health centre has a clinic officer who runs tests on patients and prescribes medicine, as well as a nurse. “We are actually supposed to have two nurses. My house is here on the clinic grounds, but my colleagues live elsewhere, so once they go home I am only trained health worker here.” Kaneya raises an eyebrow and chuckles: “Let’s just say I have delivered lots of babies in the middle of the night.”
Kaneya’s work includes educating the 7,200 people in his area about a range of issues from using bed nets to spraying for mosquitoes and treating water to ensure it is safe to drink. “Prevention is better than cure,” says Kaneya. “If we had the resources to do preventive work properly, we would not need to use so much medicine.”
A key aspect of Kaneya’s work is an outreach programme, travelling on a motorbike to remote rural villages to vaccinate children under five against polio, diphtheria, measles and tuberculosis. But for the past month he has had no petrol to refuel his motorbike. The cooler in which the vaccines are kept is run on kerosene, and they have none of that either. “For the past month we haven’t been vaccinating children. We had to send all our vaccines to Mumbwa [a nearby town] where they have electricity, as we could not keep them at the correct temperature. We are supposed to get fuel from the district health office, but they say they don’t get the money from head office.”
Distances in sparsely populated rural areas often present a major stumbling block. “We can deal with basic cases here, but for serious cases or for patients with complications they have to go to the hospital in Mumbwa. It is about 35km away and they have to provide their own transport, which costs about 14,000 Kwacha each way [R19,80]. Public minibuses are quite scarce in this area so the prices are higher. We have enough drugs to treat flu, coughs and diarrhoea, but we have a problem getting Praziquantel to treat bilharzia. People have to travel to Mumbwa to buy it from the chemist. The medicine costs 10,000 Kwacha [R14.15] and that is after they have paid for transport. That is very expensive and people around here can’t afford it.”
User fees for patients in rural areas have been scrapped in an attempt to ensure poor people can access health services. Unfortunately the revenue lost to clinics is not replaced by the Department of Health, which means health workers often have to make difficult choices.
“We haven’t seen a huge surge in patient numbers since the user fees were scrapped,” explains Kaneya. “We used those fees to buy kerosene for the vaccine fridge and petrol for the motorbike, but now we have to rely on the District Health Office in Mumbwa for those things. They tell us their grants have been reduced since the Global Fund withdrew its money and now they don’t have enough money to run the whole district.
“I feel very sad that corruption has led to hindering progress in providing health services to our communities. Because of a few individuals in government, the poor people who don’t know anything about that corruption case are suffering. This also leads to health workers becoming demotivated, even though we keep trying to do our best.”
Kapula Chindumba is a community volunteer at Lungobe Rural Health Centre.
“I have been a volunteer here since 2006. I am actually retired – I used to work in the Department of Agriculture. I was taken to Chainama for a course on training and counselling and I got a certificate. After training I realised how essential it is to work on HIV issues.
“I do voluntary counselling and testing for HIV, and I can tell you the rates are dropping in this area because of the education around HIV and AIDS. People come here, from age 12 to people in their sixties, because they trust us to be confidential, and because they can talk to us.
“We used to get a small stipend, but now the budgets have been cut after the Global Fund has cut the money, so I don’t know if we will get that money again. But I still come to help because otherwise the clinic staff would be overwhelmed – this clinic is very overpopulated. I have a small farm, and a lovely wife so I am free to make my contribution to society.
“I felt very bad when I heard about the corruption. Our high officials were very careless – that money was really helping us, and they mismanaged money which was supposed to develop this country.”
Ady Moomba is a patient at Lungobe Rural Health Centre.
“I have brought my baby in because he has diarrhoea and is vomiting. I live in Maphoko, which is about 2km away. I rode here on my bicycle. It is better now that we don’t have to pay to come to the clinic because now I can use that K500 [70c] to buy salt, or I can save it in case we have to travel to the hospital in town. The queues are longer now than before because people don’t have to wait to find the money before they come to the clinic for treatment.”