PAN AFRICAN CONFERENCE OF MINISTERS FOR LOCAL GOVERNMENT: LEADERSHIP CAPACITY BUILDING FOR DECENTRALIZED GOVERNANCE AND POVERTY REDUCTION IN AFRICA

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1 PAN AFRICAN CONFERENCE OF MINISTERS FOR LOCAL GOVERNMENT: LEADERSHIP CAPACITY BUILDING FOR DECENTRALIZED GOVERNANCE AND POVERTY REDUCTION IN AFRICA (Manthabiseng Convention Center, Maseru, Kingdom of Lesotho, 30 August 1 September 2006) COMMUNITY PARTICIPATION IN THE DELIVERY OF HEALTH SERVICES: THE EXPERIENCE OF MASAITI DISTRICT HEALTH MANAGEMENT BOARD (ZAMBIA) Presentation by: MR BENARD MASWANA DISTRICT DIRECTOR OF HEALTH MASAITI DISTRICT, ZAMBIA

2 Ministry of Health Masaiti District Health Department PRESENTATION OF PAPER ON COMMUNITY PARTICIPATION IN THE DELIVERY OF HEALTH SERVICES: THE EXPERIENCE OF MASAITI DISTRICT HEALTH MANAGEMENT BOARD (ZAMBIA) TO BE PRESENTED AT THE PAN AFRICAN CONFERENCE FOR MINISTERS OF LOCAL GOVERNMENT TO BE HELD IN THE KINGDOM OF LESOTHO FROM 30TH AUGUST 1ST SEPTEMBER 2006 BY: MR BENARD MASWANA DISTRICT DIRECTOR OF HEALTH MASAITI DISTRICT ZAMBIA

3 1.0. PREAMBLE In this presentation, focus will be on the Community members directly involved in the Health Service Delivery. We will further discuss how they relate to the following:- Planning Financing Service Delivery Monitoring and Evaluation Partnership at community level 1

4 Further the document will also highlight the general overview of the district as follows: 1.1. Masaiti District Health Map showing the location of the Health Facilities 2

5 NOTES: Masaiti is a Rural District The population is 113,900 with a 2.6 percent annual growth rate. There are twenty (20) health facilities. 3

6 1.2. HEALTH STATUS The following table shows common cause of illness for 2004 and HIV/ AIDS is not indicated but it is a serious health problem in the district.. All along it was difficult to capture it at our health facilities due to logistics problems. Table showing Top 10 Causes of Morbidity (all ages) by year No Disease Incidence Disease Incidence Malaria R/I Non Pneumonia Diarrhoea Non bloody Eye Infection Trauma accidents Skin infection R/I Pneumonia Ear/ Nose Throat Muscular Skeletal Intestinal worms Malaria R/I Non Pneumonia Diarrhoea Non Bloody Trauma/ Acc. Eye Infection Skin infection Pneumonia Ear/ Nose Muscular Intestinal worm Source: HMIS Analysis: incidences for many infections reduced in 2005 as compared to

7 1.3. SOCIO-ECONOMIC PROFILE Social Status The main ethnic groups are Lamba people. The family structure is based on monogamous, matrilocal marriages. There are three Chiefs in the district They are other ethnic groups that have migrated Economic Status: The main agricultural activities: The District has no commercial industries The agricultural Sector which is composed of 90% of subsistence farmers 10% of medium and commercial farmers The activities are crop production, fish farming, livestock scale production and vegetable production. 5

8 Commercial activities mainly retail businesses Formal employment sector accounts for 5% employed by Government departments, District Council, Non- Governmental Organisations 6

9 2.0. Community Health Providers and what they do. The following table shows the community health providers who are directly involved in the health delivery. Table 2.1. showing Health Providers CATEGORY Trained Traditional Birth Attendants (TBAs) Community Based Distributors (CBDs) Community Health Workers Peer Educators NUMBER FUNCTION Conduct clean deliveries at community level Involved in IEC in Health Issues Participate in Child Health Services Distribute condoms Health Education Treat minor diseases i.e. malaria, diarrhoea Conduct Health Education to Peers TB Support Health Neighborhood Give support to TB patients on DOTs Responsible for provision of Health Education at community level 7

10 WHAT WAS THE AIM? - To improve the Health Status of Zambians through ensuring of Equity of Access to Cost Effective, Quality Health Services as close to the family as possible. WHAT WAS THE PRINCIPLE? To provide Health Service through the District Health System, where Bottom up Planning and Implementation takes place 8

11 2.2. COOPERATING PARTNERS AT DISTRICT LEVEL There are 21 cooperating partners working at the District level. These consists of government departments and non governmental organisations. There main role in health is dissemination of information on HIV/ AIDS, some are involved in primary health programmes, family planning and also food security. For details refer to Annex INVOLVEMENT OF COMMUNITY In 1991, the Zambian Government embarked on the Health Reforms as articulated in the National Health Policies and Strategies NHPS of 1992 to which Masaiti District Health Board became a beneficiary. 9

12 COMMUNITY INVOLVEMENT IN PLANNING There are two basic planning approaches thus:- (i) Preparation of Annual Action Plans This involves community meetings to make priorities for Health Activities to be undertaken by the Community (ii) Zambia Social Investment Fund (ZAMSIF) This was a Government Programme funded by the World Bank and Masaiti Health Board accessed this fund for Infrastructural Development 10

13 Masaiti Health Management Board through Community Involvement constructed many new centres The Community identified their own need after community sensitization by the District Sub committee under the District Development Coordinating Committee (DDCC) The community together with the District drew the Action Plan to identify what activities will be undertaken and who will carry out the works among the partners The cooperating partners in this context were ZAMSIF, Masaiti Health Management Board and the Community 11

14 The Table below shows what the Board achieved under this Project Notes: ZAMSIF Zambia Social Investment Fund. This was a Government Project Fund which required Fifteen percent (15%) community contributions as a condition for projects to be undertaken. PRP Poverty Reduction Programme of the Government. This requires identification of Projects by the communities themselves for funding to be accessed. Name of New Centre Kashitu Kaloko Trust Masaiti Boma Mukolwe Kamifungo Njelemani Maternity Lupiya TOTAL Year construct ed Total Amount (ZMK) 315,491, ,786, ,491,000 70,000,000 70,000,000 94,000, ,500,000 1,499,268,000 NB: Refer to Annex 2 which shows pictures of these centres which were built jointly with the Board and the community. Source of Funding ZAMSIF ZAMSIF ZAMSIF PRP GRZ PRP GRZ PRP GRZ PRP GRZ 12

15 COMMUNITY PARTICIPATION IN FINANCING One of the principles in the health reforms is to enhance partnership in the community. This was to empower the community in terms of ownership of the health delivery system. It also entailed that individual families could fully realise the need to participate in solving of their health problems By Cost sharing This is done through payment of user fees or medical fees 13

16 Notes: The cost sharing enhance ownership of the health facilities by the community Provided financial resources for purposes of rehabilitating health facilities The community effort accounts for 10% of the income 40,000,000 30,000,000 20,000,000 10,000, Estimated 30,000,0 31,764,0 35,000,0 35,000,0 Actual 31,886,6 37,218,3 31,856,2 29,585,1 Source: FAMS 14

17 2.4. COMMUNITY PARTICIPATION IN SERVICE DELIVERY EXAMPLE OF TRADITIONAL BIRTH ATTENDANTS (TBAs) Thirty (30) Traditional Birth Attendants were trained in 2003 in a bid to lower maternal and new born mortality through provision of safe and clean deliveries and the following graph shows the performance of TBAs after training comparing to Health Providers:- NB: For more details on the achievements made jointly by the Board and participation of the community is indicated in Annex 1. 15

18 Notes: Coverage in % % Coverage in % by TBAs - 53% Coverage in % by RHC - 47% In addition the following Health Providers have been trained:- Community Based Distributors (CBDs), Community Health Workers (CHWs), Peer Educators, and Microscopists, Malaria Agents, TB Supporters and Home Based Care Providers have been trained. Graph shows community participation in service delivery TBAs RHC TBAs RHC Source: HMIS 16

19 2.5. COMMUNITY PARTICIPATION IN MONITORING AND EVALUATION The 208 Health Neighbourhood Committees hold meetings to discuss important Health Issues. The community discussions are:- Various Health thrusts more especially Water and Sanitation. Their access to clean and safe water as well as ventilated pit latrines They receive Reports from Secretaries on improvement been made regarding various health issues Receive reports from various Community Health Providers Through their Rural Health Centre Committee composed of:- -Chairman General chosen by all the neighbourhood committees in the catchment area of each centre - In charge of Health facility as Secretary - 5 other community members from Health Neighbourhood committees 17

20 Community Participation cont/d. Through this approach programmes and projects are evaluated and monitored. Lastly when projects are implemented, there is always a project committee responsible for construction works. The Foreman is always from the Community PARTNERSHIP AT COMMUNITY LEVEL The Community health Providers rely on other partners to enhance service delivery. The common partners involved in the sensitization programmes are:- Schools Authorities Church Leaders Chiefs and their Advisors Traditional Healers Social Workers Agriculture Officers 18

21 3.0. CONCLUSION The major contributing factors to enhanced Health Service Delivery can be cited as follows:- Community Participation The investment to Capacity Build the community is bearing fruit. Involvement of the communities in Health Reforms is in itself a form of Decentralization because it promotes participatory governance for effective service delivery. This should be encouraged. 19

22 STRONG DISTRICT HEALTH MANAGEMENT The Ministry of Health in Zambia had trained District Health Managers in the area of Strategic Planning, Research, Financial and Human Resource Management This enabled the District to provide Technical as well as Audit Performance assessment using the Selected Health Indicators. The District Health Management Team is further answerable to well informed and dedicated Provincial Health leadership at levels who in turn report to the Ministry of Health at National level. 20

23 ATTITUDE TOWARDS WORK The Masaiti District Health Management has been a dedicated and committed team with the positive attitude towards work and will remain a model for generations to come. The aspect of team work, the spirit to work in a coordinated and focused manner has been the nucleus for success. This team spirit has also spilled into the community in the area of their jurisdiction. 21

24 SHARING OF EXPERIENCES Masaiti District Health Management has been visited by various organisations in and outside Zambia. They met the District Health Management team as well as the Health Neighborhood Committees to look at the implementation of the Health Reforms. We have sampled some of the organisations which visited Masaiti and indicated their views regarding the community participation in the delivery of health services in our district. Refer to Annex 3. 22

25 It is important to encourage partnership by providing enabling environment to would be Investors in the area of Health. This is a strong tool Masaiti Health Board had used to achieve high levels of performance confirmed by the winning of the 2006 United Nations Public Service Award in the Category of Improved Service Delivery. Lastly, allow me to pay tribute to the organisers of this important conference. This exposure has been a great inspiration to me as well as members of the Masaiti District Health Management Board. Occasions like this will linger in our memories for many years to come and the information we have been able to access will assist us to improve upon our performance in the area of poverty reduction through improved health services. Thank You. 23

26 The following Annex 1 shows pictures for the newly constructed rural health facilities Fig. 1. Kashitu RHC Source: HMIS Notes:- The total cost for the new construction was K315,491,000. Of this total community contribution was 15%.

27 Fig. 2. Picture showing old Kashitu RHC Source: HMIS

28 Fig. 3 showing Kaloko Rural Health Centre Source: HMIS

29 Fig. 4 Picture showing Mukolwe Rural Health Centre under construction Source: HMIS 34

30 Fig. 5. Picture below showing Newly constructed Masaiti Boma Health Centre Source: HMIS 35

31 Fig. 6. Picture showing Njelemani Rural Health Centre Source: HMIS 36

32 Annex 2 shows Improved health service indicators in which the community have been directly involved. Graph 1 shows utilisation of health facilities (OPD attendances) for 2003 and 2004 Notes: There is notable increase in the health facility utilisation in 2004 compared to 2003 reasons being that more health facilities were built to improve physical accessibility by the community. Capacity building has been undertaken extensively for the health providers in all the health thrusts Logistics such as drugs and other medical supplies has improved

33 Graph 2 showing Child Mortality Reduction for the years 2003, 2004 and 2005 Notes: Child Mortality has reduced tremendously due to improved case management as well as improved logistical support Improved referral systems between various levels of health care Successful immunisation campaign has helped to reduce child mortality especially in the area of immunisable diseases Due to increased awareness amongst the communities

34 Notes: The graph shows the fully immunised under 1 for the district in 2003 to 2004 compared with the national level. It is noted that there was better coverage at District level than at National level the reason being the Increased awareness of the community on the need to have the under ones immunised Availability of logistics and supplies required to undertake the immunisation programme The increased technical support from the district level to the health facility providers 100% Graph 3 shows Under 1 fully immunised children compared with the national level for the years 2003 and % 80% 70% 60% 50% 40% 30% 20% 10% 0% 87% 76% 96% % 39

35 Notes The HIV prevalence was lower in 2004 and has increased in 2005 reasons being:- Improved access to quality PMTCT and VCT services Establishment of ART programmes and more centres introduced Drugs are available and free of charge Graph 4 shows HIV/ AIDS prevalence for the years 2004 and

36 Notes Improvement in terms of cure rate has been as a result due to the availability of drugs (under DOTS programme) Improved diagnostic skills Establishment of the TB Supporters within the community Knowledge has improved among the health providers Due to strong political will within the nation and also the involvement of many stake holders involved in the fight against TB Graph 5 showing TB Cure rates for the years 2004 and % 70% 65% 60% 55% 64% 67% District 64% 74% National 67% 73% 74% 73% 41

37 Graph 6 showing Family Planning Acceptors for 2003, 2004 and 2005 Notes: There is a general increase in the number of new acceptors due to the following: Community Sensitization Programme Increased community awareness on the importance of family planning Available contraceptive choice Improved Referral systems

38 Annex 3: Quotes reflecting the visitors views DATE 14/11/ /08/ /01/ /04/ /11/ /04/1996 VISITORS Group of South African Middle Management PDM School Wits University Two Angolan Ministry of Health officials and one official from W.B Washington office Ministry of Health, Zimbabwe officials and UNICEF Zimbabwe Ndola Urban District Health Management Board Chililabombwe District Health Management Mufulira District Health Management Team COMMENTS We saw Neighbourhood Health Committees as well as self help projects. We were very impressed what we saw and the extent, depth of community involvement. The visit included interviews with the Neighbourhood Committees was very impressive- we learnt numerous experiences Team members held discussions on Health Reforms which helped map our way forward. Keep up with the good work. Well organised Health Neighbourhood Committees, please keep it up. The relationship of people and institution was found to be very cordial and encouraging. A lot was learnt from the tour. The district has a strong spirit of team work. We learnt a lot from meeting the leaders of health Neighbourhood. Source: Visitors Book 43

39 Annex 4: Table showing Partners and include government departments and non-governmental organizations in the health sector by program focus and catchment area Organization Ministry of Education Ministry of Agriculture Northern Baptist Association of Zambia (NBAZ) Planned Parenthood Association of Zambia (PPAZ) Catchment Area In all Schools The Whole district Fiwale and Kafulafuta Mission rural health centres The whole district Programme Focus and Activities Child to Child School health education to prevent AIDS and STIS HIV/ AIDS prevention Household Food Security Curative PHC at static and outreach activities Home care under HIV/ AIDS programme Family Planning services/ nutrition and parasite control Training of TBAs, CBDs Provision of logistics to TBAs and CBDs ATTOM

40 Cont. Society for Family Health Zambia Social Investment Fund (ZAMSIF) Public Service Capacity Building Project (PSCAP) Chiefs Mayo-Mwana HODI The whole district The whole district The whole district The whole district Silangwa Part of the district i.e. Mishikishi and Kaf. GRZ Family planning services Supply of chlorine Control of malaria (ITNs) Infrastructure Development Support to TBA training Facilitated recapture Nutrition Rehabilitation Centre PHC Activities Provision of farming inputs to vulnerable groups affected by HIV/AIDS

41 Cont. Seventh Day Adventist Church (SDA) District Aids Task Force (DATF) Masaiti District Council Ndola Catholic Diocese Mupapa The whole district The whole district Part of Masaiti Curative preventive and promotive services HIV/ AIDS activities Approves plans Allocates land for development Provides 1 st referral services under St Theresa s Hospital Provides primary health care, water and agricultural activities and training of TBAs and CHWs under Unione Medico Missionary Italiana (UMMI)

42 Cont. Ndola Central Hospital Arthur Davison Hosp. St. Theresa s Mission SCOPE-OVC Kaloko Trust Foundation for Cross Cultural Education (FCE) Masaiti Orphan Support Whole district Whole district Whole district Whole district Luansobe area Part of Masaiti Chilulu and Shimibanga ward Provide 1 st referral services Provide 1 st referral services Provide 1 st referral services Support to organization involved in HIV/AIDS programme Provide HIV/ ADIS sensitization programmes Primary health care services such as malaria control, child health and reproductive health Farming, knitting, sewing and HIV counselling

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