Improving access to care in Zambia

Emergencies occur everywhere, and each day, they consume resources regardless of whether there are systems capable of achieving good outcomes. (WHO Bulletin)

The above emphasises the essence of developing emergency medicine by improving access to emergency care.

I am honoured to have been involved in a project to develop the emergency care capacity in Zambia. Recently I was invited to do an assessment on the progress and pilot phase of the program.

Zambia

The Zambian population is estimated to be 14.3 million and 61% of the population lives in rural areas. Zambia is a lower middle income country. The 2013 WHO statistics shows the life expectancy at birth to be 55 years. There is 0.5 hospitals per 100 000 population with 20 hospital beds per 10 000 population. Zambia has the second lowest doctor to patient ratio globally with 0.2 doctors per 100 people. Out of pocket expenditure is high.

Since a large part of the Zambian healthcare budget comes from non-governmental organisations and private funders, the focus of healthcare data reporting is based on the millennium development goals (MDG’s) and it only highlights a selective distribution of disease burden. As I’ve mentioned in a previous blog, the MDG’s exclude trauma and/ or developing emergency care systems. So there is limited data about the true extent of emergencies and as such the need remains largely undefined.

What is known is that the death rate from traumatic injury in Zambia is about ten times that of the UK. Referring to 2014 WHO burden of road injury report; road injuries in Sub-Saharan Africa (SSA) accounts for one-fifth of the global road injury death rate. The rate of road injuries is 40% higher than the global average. This figure is based on mortuary statistics in main centres of SSA and it’s believed to be underreported. Statistically the three least safe regions (road injury) in the world are Western, Central and Eastern SSA. Zambia is part of Eastern SSA. I was confronted with this reality when on the way to our location; we passed ten road traffic accidents. At most of these accidents there were no emergency services (traffic, police or medical) and the incidents was managed by civilians.

Zambia currently has no emergency care infrastructure; there is no organized ambulance service, no universal emergency care number, and few vehicles suitable for patient transport and no formal prehospital training program.

The Zambian Defence force and the Zambian Ministry of Health recognize these issues and as such have called for the strengthening of Zambia’s emergency care system.  The Health Systems Action Network defines health system strengthening as initiatives and strategies that improves access, coverage, quality and efficiency of health care.

In one of the previous facilitation sessions, a ZDF representative stated that their aim is to create a movement that will save lives and that have an impact on the ordinary person in a village. After the assessment, they are certainly on track to achieve that goal.

How they are strengthening their system:

As a resource poor country, it was decided to start at the grassroots. The rural areas are perceived to experience the greatest need and will be reached first through the existing ZDF infrastructure in these areas. The Zambians feel strongly about it being an inclusive project and are working closely with various stakeholders to achieve the objectives. I was impressed with the cooperation and high level involvement.

The plan is to conduct Emergency First Aid Responder (EFAR) training over 5 days for approximately to a mixed group of participants including influential members from villages and defence force members. I assessed the pilot project and it’s my opinion that this approach allows for a fast and effective way to create core emergency care competencies within the community.

Summary

Sustainability is a key concept of development and this project seems to be economically and socially sustainable. I look forward to remaining involved in this project.

Storytelling is a vital component to create change, whether it’s organizational or societal and I’d like to end this blog paraphrasing the statement that one of the facilitators made during his opening.

From today, our (Zambian) story is changing and the story that we should be telling from this training onwards is that everybody deserves good emergency care.

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