Monthly Archives: April 2019

COMMUNIQUE FOR TRADITIONAL AND RELIGIOUS LEADERS HEALTH INDABA – LUSAKA

By: C Mwale, G Njikho, L Mphuka, C Shawa, Y Banda

Lusaka Provincial Health, Lusaka, Zambia

Citation Style For This Article: C Mwale, G Njikho, L Mphuka, et.al. Communique For Traditional And Religious Leaders Health Indaba – Lusaka. Health Press Zambia Bull. 2019; 3(3); pp 14-21.

Introduction

Lusaka Provincial Health Office has a mandate to providing quality Primary Health Care to the community of Lusaka province. However, in pursuit to providing this health care, the province has had challenges to do with public health especially those to do with communicable diseases, (DHIS2, 2018). In the recent past emerging issues of non-communicable disease are becoming prominent for example heart related diseases, cancers just to mention a few.

According to Central Statistical Office (2018), the population of Lusaka Province is estimated to be just above 3 million people which is 20% of the estimated national population. If all health systems can be put in place and perform according to the expectation of the health managers, its quality and benefits can only be measured by the type of service the community members are getting, hence requiring vigorous engagement of the traditional and religious leaders in the provision public health services.

Lusaka Provincial Health Office with its partners organised a one-day health indaba aimed at creating awareness of public health issues through the engagement of the traditional and religious leaders, this meeting addressed issues related to communicable and non-communicable diseases, maternal and child health issues, adolescent health issues, TB/HIV/AIDS, mental health, infrastructure development and national health insurance policy issues. The indaba was conducted under the theme, “Raising the Bar for Health Awareness through the Involvement of the Traditional and Religious leaders”. This was in line with the National Development Plan and National Health Strategic Plan for 2017 – 2021 which emphasises the need for community engagement in order to improve the health status of the population (MOH, 2016, MNDP, 2017). Religious and traditional leaders are key in the community as they are visible, important and influential community leaders that make critical decisions pertaining to health. The desire of the ministry is to shift the point of entry into the health system from the health facility to the community at individual household level. Community members should be capacity built and sensitised enough to make their own decisions on wellness.

Main Objective

The main objectives of the Provincial Health Indaba was to create awareness to the Traditional and Religious leaders on how they can be involved in; elimination of Malaria, reduction of Maternal and Child illnesses and deaths, halting and reducing the incidence of Non- Communicable Diseases, achieving HIV epidemic control, reducing new HIV infections from 48 000 to less than 5000, reducing TB Incidences “Towards Elimination” and addressing alcohol and substance abuse.

Materials and Methods

The meeting was attended by ten Chiefs and nine representatives of various religious groups from within Lusaka province, officials from the Ministry of Health Headquarters, Provincial Health Director and his Officers and all the District Health Directors of Lusaka Province and the partners.

Program officers from the Provincial Health Office and Ministry of Health headquarters provided presentations to the audience through power point which was preceded by plenary discussion.

The Provincial Health Indaba Communique

After all the presentations were made, a communique was agreed up to by the members and later read to the whole gathering by Chief Kaputa. Below is the communique;

Preamble

Whereas the Ministry of Health, Lusaka Province Health Office held a one-day meeting for Traditional and Religious Leadership in Lusaka Province at Pamodzi Hotel, on the 14th of March, 2019 under the theme “Raising the bar for health awareness through the involvement of Traditional and Religious leaders”; and,

Whereas the meeting was attended by His Royal Highnesses from all the 7 districts of the province, their two influential Indunas from each chiefdom, and the representatives from the Church mother bodies and the religious groups,

Whereas program officers from the Provincial Health Office made presentations to the house, followed by interactive deliberations after the said presentations; now therefore,

The Traditional and Religious leadership in Lusaka Province do hereby unanimously agreed to the following;

1. Adopt and support the Ministry of Health transformation agenda of promotion of health, prevention of diseases, building of knowledge and skills of communities and re-alignment of health services to suit our cultural setting

2. Call on the Ministry of Health to continue strengthening health systems in line with the 10 legacy goals

3. We shall advocate for partnerships with Ministry of Health to ensure demand creation for health services by religious organization at community, district, provincial and National levels.

4. We shall support moral development of our young people in view of the changing cultural norms

5. We pledge to support the efforts for prevention of HIV/AIDS through efforts such as Voluntary Medical Male Circumcision, behavioural change and condom use.

6. Support the prohibition and control of alcohol abuse in our areas. We pledge to support efforts for preventive measures to control abuse of substances such as; alcohol, methylated spirits, adhesive glue (“solution”) and use of illicit brews such as and kachasu

7. We shall identify and appoint people within our setups to act as confidants for our young people

8. We shall establish and strengthen life skills programs in our congregations and chiefdoms

9. We will promote institutional deliveries and facilitate transportation for all pregnant women in labour; and also ensure that all pregnant women attend Ante Natal Clinic on time.

10. Strongly support the idea that all Traditional and Religious Leaders should become health evangelists- use every opportunity to share key health messages with their subjects and congregations.

11. We will prevent detrimental practices by religious and traditional healers such as stoppage of people from taking drugs such as ARVs/Folic and ferrous

12. Pledge to stop early marriages in our communities and ensure that children of school going age attend school.

13. We will ensure good sanitation with the provision of safe drinking water in our areas. We will support the works of Ministry of Health and other line government departments in our areas by ensuring that we support digging of pit latrines, provision of safe well water, and observance of all other good sanitary practices in our communities.

14. We commit to ensuring that there will be no misuse of mosquito nets in our districts for unauthorized practices, such as use of nets for fishing and as fences for gardens; we will encourage mothers, under five children and families to sleep under treated mosquito nets.

15. Adopt the primary healthcare and community health approach to health care

16. We commit ourselves to disseminate information on the introduction of the comprehensive Health Insurance scheme so as to leave no one behind

17. We pledge to support formation and operationalization of Safe Motherhood Action Groups (SMAGs) in our communities as an effort to combat maternal mortality

18. Call on all Traditional and Religious Leaders to engage their community and congregants to promote health, wellness and prevent diseases

19. We shall strengthen referral systems to the health services including using our sites as collection points for medicines such as ARVs and TB drugs

Conclusion

The objective of the meeting was fully met in that what was discussed and later brought out in the communique covered all the areas that the health systems strengthening aims at achieving. Health promotion and prevention of both communicable and non-communicable diseases was well articulated. Further mechanism for community mobilization were also fully discussed. It is hoped that the religious and traditional leaders will help in the dissemination of the Public Health issues to their subjects so that universal coverage of health for all is released.

List of References

1. CSO, 2018. Zambia in Figures 2018. [Online] Available at:

https://www.zamstats.gov.zm/phocadownload/Dissemination/Zambia%20in%20Figure%202018.pdf

[Accessed 15th March 2019].

2. MNDP, 2017. 7th National Development Plan 2017 – 2017. Lusaka, Zambia: Ministry of National Development and Planning.

3. MOH, 2016. Zambia National Health Strategic Plan 2017 – 2021. Lusaka, Zambia: Ministry of Health.

4. MoH, 2018. Provincial Health Office DHIS2, 2018, Lusaka: Lusaka Provincial Health Office.

HEPATITIS B: VACCINATE. STOP IT IN ITS TRACKS!!!

Addressing The Hepatitis B Prevalence In The Adult Population In Zambia

By: N Nshimbi, A Ngoma

Zambia National Public Health Institute.

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Citation Style For This Article: Nshimbi N , Ngoma A. Hepatitis B: Vaccinate. Stop It In Its Tracks!!! Addressing The Hepatitis B Prevalence In The Adult Population In Zambia. Health Press Zambia Bull. 2019; 3(3); pp 10-13.

Key Messages

• Hepatitis B is highly contagious: it is 50-100 times more infectious than HIV.

• It is a silent killer; most people are only diagnosed after they develop liver damage

• On average, only 5% of people with chronic hepatitis know they are infected; and less than 1% have access to treatment

• 5.6% of the Zambian population aged 15-59 years old have Hepatitis B

• In Zambia, 7% of 15-59-year olds will develop new infections annually.

• Hepatitis B is fully preventable with effective vaccines

Image source: Google

Problem Statement

According to the World Health Organization (WHO, 2017), Hepatitis B is a highly contagious viral infection affecting more than 10 times the number of people infected with HIV. The virus is transmitted through contact with the blood or other body fluids of an infected person. The infection attacks the liver and can cause both acute and chronic disease. Although most people are able to clear the virus, 8 to10% of adults go on to develop chronic infection. In some individuals, especially among those with weak immune systems, the infection may develop into a severe life-threatening form of acute hepatitis. Chronic Hepatitis B infection, lasting longer than 6 months, may lead to liver cirrhosis, liver failure and Liver cancer (WHO, 2017).

In 2017, the global prevalence of Hepatitis B virus (HBV) infection was estimated at 3.5%, with about 325 million persons living with chronic HBV infection and about 1.4 million people dying each year from the disease (WHO 2017). An estimated 337,454 die due to liver cancer, 462,690 due to cirrhosis, and 87,076 due to acute hepatitis. It is estimated that only 5% of people with chronic HBV infection are aware of their infection status, and less than 1% have access to treatment. In most individuals, both acute and chronic infection develops in adulthood, as shown in Figure 1 below.

Figure 1: Age of infection for acute and chronic infections (Source: 1989 CDC Sentinel Surveillance data)

In Zambia, the estimated overall prevalence of Hepatitis B virus is 5.6% among ages 15-59; prevalence among HIV positive individuals is 7.1% whereas in the HIV negatives it stands at 5.4%, (ZAMPHIA 2016). Hepatitis B virus is fully preventable with effective vaccines (WHO, 2017). However, in Zambia, the control strategies have focused on blood bank screening and childhood vaccination. Existing Hepatitis immunization program in Zambia focuses primarily on children six weeks of age, leaving the adult population at risk. the EPI Manual of 2017. Zambia has adopted the WHO goal of eliminating Hepatitis B Virus infection by the year 2030.NHSP 2017. Recent efforts to address the Hepatitis B burden have seen the inclusion of Hepatitis treatment in the HIV treatment guidelines, but no deliberate efforts have been made to address mono-infection and prevention of new infections. occurred in Limulunga, Shangombo, and Senanga districts in Western province in 2018. Furthermore, a recent outbreak in Sesheke district in Western province in January 2019 amassed eight suspected anthrax cases (Table 1, Figure 1). Laboratory samples were not tested from any suspected case in 2018 and 2019 (Table 1).

Figure 2: Hepatitis B prevalence in Zambia by age group (Source ZAMPHIA)

Policy Rationale

In order to achieve HBV infection elimination by the year 2030, Zambia has outlined a number of strategies in the National Health Strategic Plan 2017-2021, to reduce the incidence and mortality due to Hepatitis:

1. Reducing the number of people susceptible to Hepatitis Virus

2. Increasing the proportion of people diagnosed with Hepatitis Virus

Policy Options

In order to reduce the number of people susceptible to Hepatitis B Virus and increase the proportion of people diagnosed as stipulated in the NHSP, the following are possible options:

Option 1: Maintain the Status Quo

• Doing nothing leaves the population at risk, with as many as 7% of 15-59 year olds developing new infections each year (Zamphia 2016).

• If the situation remains unchecked, the prevalence of Hepatitis B could possibly increase to 11.1% by 2030 (incidence calculated).

• Most people remain undiagnosed until they develop serious liver complications which may require either liver transplant, surgical resection or ablation.

• These options on average cost $35,000 [inclusive of airfares for two (patient and companion) and inpatient care] (WHO 2016)

Option 2: Introduce screening and vaccination

• A 3-dose vaccination has been shown to have up to 95% efficacy

• This option recommends vaccination of all persons that test negative for Hepatitis B Virus during screening

• A proportion of people are able to clear the infection and thus have immunity. However, to distinguish those with immunity from those without would require screening for both antigens and antibodies. However, this is not economically feasible.

• An estimated 720,032 cases can be prevented through vaccinations (blood bank 2017)

• This option ultimately results in a reduction in the cost per patient per year of $50,000

• The operational and political feasibility for this option is low to medium

• Introduce awareness campaigns

Option 3: Introduce Screen and treat programme for infected population

• The introduction of a screen and treat program will allow the detection of an estimated 44962 (infected people in the population)

• This option ultimately results in a reduction of new infections per year

• The operational and political feasibility for this option is medium to high

• Introduce awareness campaigns through

Recommendations and next steps

• Implement both interventions options 2 and 3 to achieve maximum impact

• Put in place a media/Short Message Services campaign in order to increase screening uptake/awareness

List of References

1. Ministry of Health et al (2016) Zambia Population based HIV Impact Assessment, MoH, Zambia: phia.icap.columbia.edu/wp…/11/FINAL-
ZAMPHIA-First-Report_11.30.17_CK.pdf

2. WHO (2017) Hepatitis Factsheet, available at www.who.int/mediacentre/factsheets/fs204/en/

3. Central Statistics Office (2014) ZDHS 2013-2014

4. www.cdcpinkbook.com

5. NHSP 2017: National Health Strategic Plan 2017-2021

6. WHO Position Paper on Hepatitis B Vaccines, July 2017 http://www.who.int/immunization/policy/position_papers/who_pp_hepb_2017_
summary.pdf?ua=1

7. Peebles K, Nchimba L, Chilengi R, Bolton Moore C, Mubiana-Mbewe M, Vinikoor MJ. Pediatric HIV–HBV Coinfection in Lusaka, Zambia:
Prevalence and Short-Term Treatment Outcomes. Journal of Tropical Pediatrics. 2015;61(6):464-467. doi:10.1093/tropej/fmv058.

8. Kenneth C Kapembwa, Jason D Goldman, Shabir Lakhi, Yolan Banda, Kasonde Bowa, Sten H Vermund, Joseph Mulenga, David Chama, and
Benjamin H Chi. HIV, Hepatitis B, and Hepatitis C in Zambia (2011) NCBI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162815/

9. Edward Tabor Robert J. Gerety Charles L. Vogel Anne C. Bayley Peter P. AnthonyChao H. Chan Lewellys F. Barker. Hepatitis B Virus Infection
and Primary Hepatocellular Carcinoma (1977) https://doi.org/10.1093/jnci/58.5.1197

An Update On Public Health Security In Zambia

By: B Gianetti, KE Musakanya, C Groeneveld, R Hamoonga, ML Mazaba

Information Systems Unit Zambia National Public Health Institute

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Citation Style For This Article: Gianetti B, Musakanya KE, Groeneveld C, et.al. An update on public health security in Zambia. Health Press Zambia Bull. 2019; 3(3); Pp 7-9.

Zambia is a landlocked country and borders eight nations: Zimbabwe, Botswana, Namibia, Angola, Democratic Republic of the Congo (DRC), Tanzania, Mozambique, and Malawi. In 2018 outbreaks of Ebola virus disease, cholera, measles, poliomyelitis (cVDPV2), monkeypox, and yellow fever were reported in the DRC. Moreover, Zimbabwe reported major outbreaks of cholera and typhoid [1]. Due to Zambia’s expansive and porous borders with countries experiencing multiple ongoing outbreaks, public health security is an issue of utmost national importance.

Introduction

The government of Zambia drafted a five year National Health Strategic Plan (NHSP) in 2017 to provide a framework for building robust health systems across the country. Embedded in the plan are policies that promote security during outbreaks and public health events of importance. At the helm of Zambia’s emergency and outbreak response is the Zambia National Public Health Institute (ZNPHI). ZNPHI was established with a legal mandate in 2015 and serves as a focal point for coordinating public health research, surveillance, workforce capacity strengthening, laboratory systems, information sharing, and emergency preparedness and response activities. This article provides a brief overview of reported outbreaks and outbreak response measures undergone in Zambia in 2018.

Cholera:

In October 2017, ZNPHI was challenged with organizing a response to a large-scale cholera outbreak. By the outbreak’s end in June 2018, 5,582 suspected cholera cases were reported from Cholera Treatment Centres (CTCs) in Lusaka District, 668 of which were laboratory confirmed. In response to the outbreak ZNPHI activated the Public Health Emergency Operations Center (PHEOC) and utilized an Incident Management System (IMS) to help coordinate a multisectoral response. The response included the establishment of seven CTCs in Lusaka District and the development of standard operating procedures for case management. Surveillance was increased and contact tracing and active case finding were performed. Clean supplies of water were provided to affected communities, water supplies were chlorinated, and household water treatment materials were distributed. Additionally, WASH campaigns were held at local schools and community health promotion campaigns were conducted. The government oversaw the emptying of septic tanks, the inspection and emptying of pit latrines, the disinfection of toilets, and the pickup and removal of solid waste. Dedicated call centres were established to receive citizen complaints about sewer blockages and failed trash pickups. The Zambia Defense Forces cleaned up the Central Business District, and legal ordinances were passed banning food street vendors, extending the ban on fishing, and increasing food quality monitoring. Moreover, the Zambian government oversaw oral cholera vaccine (OCV) campaigns in four affected subdistricts.

Figure 1: Map of outbreaks in Zambia (2018)

Table1: Outbreaks in Zambia (2018)

Typhoid

Using the Integrated Disease Surveillance and Response (IDSR) systems, the national surveillance body identified five typhoid outbreaks in Zambia in 2018. A typhoid outbreak is defined as five laboratory confirmed cases of typhoid per 50,000 population. In 2018, typhoid outbreaks occurred in Lusaka, Southern, and Copperbelt provinces. The largest outbreak occurred in January 2018 in Monze District of Southern Province and consisted of 19 suspected cases and seven laboratory confirmed cases. In the response to the outbreak, government officials conducted an investigation that included sending patient and environmental food and water samples for laboratory testing. In addition, tetracycline was procured for the presumptive treatment of quarantined suspected cases, and a door-to-door sensitization campaign was conducted in affected communities.

Measles

Four measles outbreaks were reported in Lusaka, Luapula, North-western, and Copperbelt provinces in 2018. A measles outbreak is defined as three confirmed cases per 100,000 population in a one month period. The largest measles outbreak was recorded in Mansa District of Luapula Province and consisted of 27 suspected cases and six laboratory confirmed cases. In response to the measles outbreaks, government officials launched investigations that included increased surveillance and active case finding. Officials also called for ring vaccination campaigns with the measles containing vaccine (MCV). At the time of the outbreaks there was a shortage of measles IgM ELISA kits necessary for the laboratory confirmation of measles infection and more kits were requested.

Conclusions

Zambia reported ten outbreaks of cholera, typhoid, and measles in 2018. The outbreaks occurred in border areas and in the densely populated Lusaka District, which houses the capital city. Continued national surveillance efforts are required for early detection of outbreaks and increased emergency preparedness activities must be implemented to prevent the cross-border transmission of epidemic prone diseases. ZNPHI has trained over 400 health providers, government officials, members of the defense forces, and employees at point of entries in Ebola Preparedness and Response in Lusaka Province and the provinces bordering the DRC. The institute is currently conducting additional trainings in Eastern, Central, and Western provinces.

List of References

1. World Health Organization. Weekly Bulletin on Outbreaks and Other Emergencies Week 52: 22- 28 December 2018. URL: https://apps.who.int/iris/bitstream/handle/10665/277423/OEW52-2228122018.pdf

UNIVERSAL HEALTH COVERAGE THROUGH ENGANGEMENT OF TRADITIONAL AND RELIGIOUS LEADERS

By: G Njikho, Y Banda, C Mwale

Lusaka Provincial Health Office

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Citation Style For This Article: Njikho G, Banda Y, Mwale C. Universal Health Coverage Through Engangement Of Traditional And Religious Leaders. Health Press Zambia Bull. 2019; 3(3); pp 3-6.

This paper provides a perspective of Universal Health Coverage through community engagement of traditional and religious leaders following the Provincial Health Indaba which was held on 14th March, 2019 under the theme “Raising the Bar for Community Awareness through Traditional and Religious Leaders Involvement”. This theme focused on the need to engage the community on the significance of Universal Health Coverage through health systems strengthening and its importance in achieving health for all in line with the 2030 sustainable development agenda. UHC is technically feasible and attainable and this is one strategy that Zambia has used to accelerate actions towards achievement of UHC using community platforms.

Introduction

Achieving universal health coverage (UHC) and the sustainable development goals (SDGs) requires health systems to shift from an almost exclusively vertical, top-down and curative paradigm to one that places people at the center of health services (Asiya., 2018). According to World Health Organization (WHO) (2019), Universal Health Coverage (UHC) means that all the people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the users to financial hardship.

According to the World Bank (2016) access to health services ensures healthier people; while financial risk protection prevents people from being pushed into poverty. Therefore, universal health coverage through primary health care interventions, is a critical component of sustainable development and poverty reduction, and a key element to reducing social inequities. UHC has three main objectives;

1. Equity in access to health services – everyone who needs services should get them, not only those who can pay for them;

2. The quality of health services should be good enough to improve the health of those receiving services; and

3. People should be protected against financial-risk, ensuring that the cost of using services does not put people at risk of financial harm.

UHC is firmly based on the WHO constitution of 1948 declaring health a fundamental human right and on the Health for All agenda set by the Alma Ata declaration in 1978. UHC cuts across all of the health-related Sustainable Development Goals (SDGs) and brings hope of better health and protection for the world’s poorest.

In the same declaration of Alma Ata in 1978, Member States agreed that community participation was a fundamental component of primary health care. Since then, health researchers, practitioners and policy-makers have worked to develop a meaningful set of practices that contribute to strengthening community participation. The term community engagement, as opposed to participation, emerged from the field of health research and focused on the deliberate integration of communities into the design and implementation of research activities. According to Gregory et al (2008), community engagement also refers to the process of involvement of the community in the planning for health services. For example, community engagement was well applied in the 2013–2016 Ebola virus disease outbreak and recognized the important role of response staff and their ability to engage with communities (Asiya., 2018).

This implies that people and the communities in which they are born, raised, live, work and play, should be at the heart of delivering people-centered and integrated health services. Communities need to be at the center of drivers to improve the quality of health services, access and equity. Focusing on community engagement has become important for global public health, as countries face complex health challenges that stretch and test the capacity and resilience of health systems and the populations they serve. Public health challenges include urbanization, poverty, migration and poor environmental management, alongside man-made and natural crises such as disease outbreaks, floods and armed conflict.

Key strategies for community engagement

Primary health care – Primary health care can cover the majority of a person’s health needs throughout their life including promotive, prevention, treatment, rehabilitation and palliative care. Primary health care is a whole-of-society approach to health and well-being centered on the needs and preferences of individuals, families and communities. Primary health care is rooted in a commitment to social justice and equity and in the recognition of the fundamental right to the highest attainable standard of health, as echoed in Article 25 of the Universal Declaration on Human Rights: “Everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical care and necessary social services” (WHO, 2019). The ministry of health through a transformative agenda, has prioritized the implementation of primary health care to all Zambians through its National Health Strategic Plan and the National Development Plan for 2017 – 2021. This has come in light of ensuring that health facilities are put up everywhere where there are people in order for all to have easy access to health care services. This resonates well with the ministry of health mission of providing equitable access to cost effective, quality healthcare services as close to the family as possible.

Communities have been engaged in the provision of primary health care as they have been in forefront in the identification of services that are of importance to them. These services include; health promotion, disease prevention, curatives services, palliative, rehabilitative, community sensitization/awareness and demand creation services. These services have been made available in all the communities, though access remains a major barrier in many cases.

Universal Health Coverage – One of the targets under the sustainable development goal no. 3: (“ensuring healthy lives and promote well-being for all at all ages”) is to “achieve universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” Since UHC is the overarching target that should facilitate achievement of all the other health targets in SDG 3, it is in line with the key message of the SDGs of “Leaving No One Behind”. Community engagement is a vehicle that can assist in the provision of comprehensive essential health services through UHC. UHC also lays emphasis on addressing the needs of the most vulnerable groups in society particularly women and children, the older persons, refugees and other minority populations (Bakyaita., 2018).

Opportunities available for integration of community engagement with the traditional and religious leader’s platforms

In order to practically achieve Health for all and UHC, there is need to use integrated platforms in a multisectoral approach that effectively contribute to quicker ways of implementing sound health interventions. Therefore, the use of traditional, religious and health systems using the bottom up and up down approaches would enhance achievement of UHC.

Religious system platform

In Zambia the religious set up is firstly made up of individuals who make up families. The families meet in small groupings called sections who later congregate at a church. The churches make up a larger national wide association. It is at each setting that they are opportunities to engage the members and provide sensitization and awareness messages involving health and wellbeing. Therefore, having had the indaba with religious leaders provided opportunities for religious leaders to act as the message carriers and health champions promoters.

Traditional system platform

Another opportunity that the indaba targeted to achieve was the use of the traditional systems. The traditional arrangement is such that they are individuals who live in a given household and belong to a village. A group of villages make up chiefdoms who later make up districts. Similar to the religious system, at each stage they are meetings which are held to discuss various issues. It is at these meetings were we seek to get opportunities to share health matters and create demand for primary health care services. Therefore, equipping the traditional leadership with factual information on health would help in reaching out to a number of people.

Health system platform.

In order to achieve Health for All and UHC the Ministry of Health has set up a well lined structure from the household through to national level. There are firstly households which group up to make neighborhood health committee (NHC) and later health center committee. These health center committees group up into zonal health committee which cover an entire district. In each of the committees the health issues are discussed and these help in spreading the health messages to the entire community. Within the NHCs are community health workers of different expertise like clinical, maternal and public health. These structures are important in the realization of the UHC coverage agenda.

Advantages of Community Engagement with The traditional and religious leaders

Community engagement with the traditional and religious leaders has a mammoth of advantages and benefits which can be used to build up and heighten health systems as we try to attain health for all in the universal health coverage agenda. According to World Health Organization on community engagement (2019) some of the advantages includes the following;

1. Facilitates better health outcomes; sustainability of the health sector is reliant on the full engagement of the community leaders. Traditional and religious leaders are the custodians of the communities and respected community gate keepers. For better outcome of all the health plans the community needs to be engaged from the beginning. Informing them from the beginning provides them with an opportunity to comprehend, own and participate in community health programs including effective use of community assets.

2. Provides information for planning; community engagement produces clear and more valuable input for decision making. The ministry of health gets information from the citizens and the surveillance systems on what is required in the communities. This allows community views to be integrated into the ministry plans and budgets. The traditional and religious leaders have been influential in the implementation of the health services in the community as they have been providing guidance on what specific services are required in a particular community.

3. Identifies health challenges; with the engagement of the traditional and religious leader’s community health challenges are easily resolved. This is because challenges are identified, picked up and reported to the health authorities. The coordination between the ministry of health and the community members is vital in resolving health challenges. For example, traditional leaders have been in the forefront in providing land for construction of health facilities, while religious leaders have embraced implementation of primary health care activities in their settings.

4.Enhances communication between community and health systems;

effective communication involves building relationships through face to face interactions, sharing information to build trust, and creating opportunities where people can interact in order to resolve their health challenges. Ministry of health technical staff highlighted priority public health challenges at the just ended indaba and managed to engage the traditional and religious leaders on specific community health challenges in their respective areas. This provided them with satisfaction on the understanding that they are being engaged and consulted on how to address community health challenges.

Conclusion

Community engagement through existing traditional and religious leaders systems would help in the achievement of UHC. The majority of community members belong to both systems and as such would be used as vehicles for disseminating health messages.

List of References

1. Asiya., O.-K. J. P.-S., 2018. Universal Health Coverage and Community Engagement. [Online]

Available at: https://www.researchgate.net/publication/327264401_Universal_health_coverage_and_community_engagement

[Accessed 24th March 2019].

2. Bakyaita., N. M. N., 2018. Universal Health Coverage: A Perspective of the WHO Country Office in Zambia. The Health Press, 2(4), pp. 5-16.

3. Bank, W., 2016. UHC in Africa: A Framework for Action.. [Online]

Available at: https://openknowledge.worldbank.org/handle/10986/26072

[Accessed 24th March 2019].

4. Chitalu., C., 2018. Zambias National Health Insurance Scheme. The Health Press, 2(4), pp. 5-16.

5. Gregory Janette, W. H.-K., 2008. Using deliberative techniques to engage the community in policy development. [Online]

Available at: https://link.springer.com/article/10.1186/1743-8462-5-16

[Accessed 24th March 2019].

6. MNDP, 2017. 7th National Development Plan 2017 – 2021. Lusaka, Zambia: Ministry of National Development and Planning.

7. MOH, 2016. Zambia National Health Strategic Plan 2017 – 2021. Lusaka, Zambia: Ministry of Health.

8. UN, 2012. Health: Essential for sustainable development. UN Resolution on Universal Health Coverage.. [Online]

Available at: http://www.who.int/universal_health_coverage/un_resolution/en/.

[Accessed 24th March 2019].

9. UN, 2015. Universal Declaration on Human Rights, New York City: United Nations.

10. WHO, 2019. Community engagement for quality, integrated, people-centred and resilient health services. [Online]

Available at: https://www.who.int/servicedeliverysafety/areas/qhc/community-engagement/en/

[Accessed 24th March 2019].

11. WHO, 2019. Health Financing. [Online]

Available at: https://www.who.int/health_financing/universal_coverage_definition/en/

[Accessed 24th March 2019].

12. WHO, 2019. Primary Health Care. [Online] Available at: https://www.who.int/news-room/fact-sheets/detail/primary-health-care

[Accessed 24th March 2019].

Securing Public Health: Everyone Must Play a Role

By: ML Mazaba

Zambia National Public Health Institute ZNPHI

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Citation Style For This Article: Mazaba ML. Securing Public Health: Everyone Must Play a Role . Health Press Zambia Bull. 2019; 3(3); Pp 1-2

Welcome to yet another issue of The Health Press Zambia (THP-Z). The theme for this issue, ‘Securing Public Health: Everyone Must Play a Role’ emphasises the fact that health security is a responsibility for all, be it individuals, communities, institutions, Non-profit organisations, Governments and beyond.

The European Commission’s Global Health Security Initiative defines the term “health security” as one used “to describe preparedness for and response to serious health incidents that are cross-border in nature and that pose a risk to security, destabilize economies, disrupt social cohesion, and affect the critical business of government.” [1].

The World Health Organisation in its constitution emphasises that “the health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States.” [2]. This probably takes into account the fact that health is determined by various factors and so to ensure it is well secured all these factors must be addressed. The health teams alone cannot mitigate all the factors threatening the health security of the populations they are responsible for.

Lessons learnt in previous outbreaks indicate that multisectoral strategies are key to public health and emergency management leading to a secured healthy population and environment. It is important that all stakeholders in the public, policy makers and implementers understand the vital role they play in safeguarding the health of populations; public health emergency, including preparedness, response, and recovery are a responsibility to be shared by all sectors in society.

Figure 1: Multi-sectoral high level support to disease outbreak response

Key to public health security is a collective action supported by all stake holders; from government officials and professional first responders to directors of nongovernmental community organizations, private-sector executives, volunteers, and individual citizens

The Zambian Government recognises the importance every individual, institution and organisation plays in securing health for its populations and as such has reformed its approach in public health and emergency management: The national Action Plan for Health Security, various disease specific epidemic preparedness and response plans are all multisectoral in nature. The epidemic preparedness and response committees and rapid response teams are also multisectoral and multidisciplinary in nature.

Recently a deliberate effort to engage community leaders including religious and traditional leaders is a deliberate effort to ensure all stakeholders are a part of and understand their role in public health security. Read more about this in the editorial entitled ‘Universal health coverage through engagement of traditional and religious leaders’ and the perspective article ‘Communique for traditional and religious leaders health indaba – Lusaka’

Also of interesting read in this issue we publish, a policy brief on hepatitis, an update on the public health security in Zambia.

THP-Z invites all those not yet subscribed to the publication to do so on http://znphi.co.zm/thehealthpress/. We also look forward to your submissions of articles. Read more on public health issues within Zambia and the globe at large on http://znphi.co.zm/thehealthpress/.

List of References

1. Maria Politzar. URL: https://www.devex.com/news/working-toward-global-health-security-strategies-and-challenges-90727

2. World Health Organisation. Health Security. URL: https://www.who.int/health-security/en/