Towards a stronger health system serving the whole community

Mothers turn away from the risks of traditional home births in Zambia

Simon Ingram, UNICEF Communications Consultant
 A hardworking Midwife stands in front of the MDGi plaque at Chaisa clinic in Luanshya
UNICEF/Zambia/2019/Siakachoma
22 August 2019

Chaisa Urban Health Centre occupies a cluster of unassuming single-storey buildings beside a quiet rural road near Luanshya, in Zambia’s Copperbelt Province. A simple brass plaque on the wall acknowledges the extensive refurbishment and equipment the centre received as part of the European Union-funded MDGi programme.

But there is little immediate evidence of a more significant outcome of MDGi support: the improvements behind the scenes to boost healthcare for expectant mothers, babies and young children.

Such is the responsibility of the centre’s Senior Health Officer, Elizabeth Kandolo. Since taking her post in 2016, Sister Kandolo’s aim has been to bring structure, predictability and quality to the services that Chaisa Centre provides— and to make sure that all mothers feel the benefits.

“To take one example, we found that mothers were not coming to the centre for their antenatal check-ups as they are meant to, or indeed to give birth,” says Sister Kandolo. “Maybe because of (a lack of) transport or other problems, or because they didn’t see the benefit.”

As a result, too many expectant mothers were relying on (largely untrained) traditional birth attendants, who were unable to cope whenever complications arose during delivery.

“Too often, women were dying alone, at home,” says Ms Kondola. “That was unacceptable.”
Encouraging expectant mothers to make use of the Health Centre and its enhanced facilities takes various forms. Health volunteers are tasked with identifying and convincing pregnant women in the community. Meanwhile, women visiting the centre who cannot confirm the date of their last period are asked to take pregnancy tests. If positive, they are then signed up for regular check-ups.

“It doesn’t matter if they are coming because of a cough or headache or are bringing in a young child who is sick,” Ms Kondola explains.

“To us, they are all potential mothers and we take them to be tested for pregnancy. If they test positive, then we give them a full check-up and then book them for their antenatal check-ups on the spot.”

This energized approach is yielding encouraging results: In the first quarter of 2019, the number of women signed up by the clinic for their first antenatal visit reached 85, compared to 37 in the same period of 2017.

At the same time, there is strong evidence that the number of women giving birth at home is falling.

“It’s a good start,” says Ms Kondola.

A pregnant woman happily displays her antenatal card while standing outside a clinic in Luanshya
UNICEF ZAMBIA/2019/Siakachoma
Dyness Kapambwe is pregnant and proud to be a beneficiary of the newly constructed MDGi maternity wing at Chaisa Clinic in Luanshya, Copperbelt province of Zambia

Mothers turn away from risks of traditional home births

Dyness Kapambwe is one mother who has decided to take advantage of the services offered by the centre. She came to the centre suffering from fever, before being asked to take a pregnancy test which proved positive.

“I didn’t realise I was expecting again!” says Ms Kapambwe.  She gave birth to two of her previous five children at home. But she is now convinced that the centre can provide her the care she needs for the duration of her pregnancy.

“I know I can get all the help I need before I give birth. They can help me in case there are any problems.”
Community volunteers like Margaret Kasonde are a critical component of the system.

“There are 15 Safe Motherhood Action Group volunteers in this community,” explains Ms Kasonde. “We meet from time to time to see how we can address different issues that come up.”

Part of the challenge is keeping track of a mobile and changing population. Copperbelt Province attracts men coming to find work in the local mines. Many bring their families with them. 

The MDGi-inspired results achieved at Chaisa Centre have not gone unnoticed by government officials in the province. Lenron Mutale, Clinical Care Specialist at the District Health Office in Luanshya, singles out the impact made by better health infrastructure and the improving indicators for fully-immunized children.

“The quality of services being offered has improved so much. It sets a new standard,” says Mr Mutale.

Innovation of a different kind is helping save children’s lives at another facility in Copperbelt Province. An examination of data at the Arthur Davidson Hospital for Children revealed that most child deaths were occurring within 24 hours of their being admitted for treatment.

To tackle the problem, and with the support of MDGi funds, hospital staff started implementing a system known as Emergency Triage Assessment and Treatment (ETAT). As soon as sick children arrive, they are designated as one of three clinical status categories – red, orange or green, corresponding to emergency, priority, or non-urgent. This allows emergency treatment to be prioritized for those children who are in a life-threatening condition.

“With systems strengthened, very sick children are being identified earlier and this has helped us reduce the number of deaths,” says Senior Medical Superintendent, Dr. Mwansa J Kaunda. “We are moving in the right direction and are defining what is the new normal in our Zambian hospitals through implementation of ETAT.”

Beyond new buildings and new equipment, these improvements to health systems, in all their forms. may prove just as impactful for the districts under the MDGi programme.