Lighting the Way for Better Maternal Health Care

Mandombe Clinic

As part of safe motherhood practices, expectant mothers in Zambia are urged to deliver at a health facility so that they will benefit from medical care. But during the night in rural areas without electricity, midwives may have to struggle with a small flashlight torch or improvised kerosene lamp to provide the light they need to monitor labour progress or document clinical procedures.

But this is no longer a problem for Mandombe clinic, a typical poor rural health facility located in the heart of Luangwa District serving over 2000 people. The CIDRZ Better Health Outcomes through Mentoring and Assessment (BHOMA) study funded by the Doris Duke Charitable Foundation, has been implementing structured primary health care improvements in 42 rural centres in Lusaka Province. Mandombe clinic was one of the sites chosen for a 6-month long pilot. BHOMA installed solar panels so that the protocol-directed outpatient care could be implemented and clinical information captured on data servers for assessment and evaluation; part of BHOMA’s aim to improve rural clinical care.

However, after the successful 6-month pilot, the BHOMA study was required to shift out of Mandombe to focus on the other clinics. This presented a moral challenge to the CIDRZ BHOMA team: after assisting with bringing necessary light how could they pull out leaving the health facility, and its laboring patients, in the dark again?

The solution was to reroute the installed solar panels so that they fed into light bulb circuits that would continue to provide some basic lighting. Now laboring women who come to Mandombe clinic in the night find a brightly lit Out Patient Department and maternity room, and a happy midwife able to see what she is doing when she provides necessary care.

New Board Members

Ambassador Eric Goosby

20090825AmbEricGoosby_170_1Ambassador Eric Goosby is Distinguished Professor of Medicine, University of California, San Francisco. He served from 2009 to 2013 as the U.S. Global AIDS Coordinator leading all U.S. Government international HIV/AIDS efforts. In this role, Ambassador Goosby oversaw implementation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), as well as U.S. Government engagement with the Global Fund to Fight AIDS, Tuberculosis and Malaria. He also led the new Office of Global Health Diplomacy at the U.S. Department of State. Ambassador Goosby previously served as CEO and Chief Medical Officer of Pangaea Global AIDS Foundation, and was Professor of Clinical Medicine at the University of California, San Francisco. He has over 25 years of experience with HIV/AIDS, ranging from treating patients at San Francisco General Hospital when AIDS first emerged, to engagement at the highest level of policy leadership. As the first Director of the Ryan White Care Act at the U.S. Department of Health and Human Services, Ambassador Goosby helped develop HIV/AIDS delivery systems in the United States. During the Clinton Administration, he served as Deputy Director of the White House National AIDS Policy Office and Director of the Office of HIV/AIDS Policy of the U.S. Department of Health and Human Services. Ambassador Goosby has longstanding working relationships with leading multilateral organizations including UNAIDS, the Global Fund and the World Health Organization.

Professor Kevin Marsh

Kevin Marsh 2Kevin Marsh is a Professor of Tropical Medicine University of Oxford and has been based for the last twenty five years in Kenya. Qualified in medicine at the University of Liverpool in 1978 he began his research career at the Medical Research Council Unit in the Gambia. From 1985-89, Dr Marsh was at the Institute of Molecular Medicine in Oxford and in 1989 established with colleagues a series of research projects on the clinical epidemiology and immunology of malaria on the Kenyan coast which subsequently developed into an international programme working across a number of east African countries. Dr Marsh has a particular interest in developing and strengthening research capacity and scientific leadership in Africa and has sponsored or supervised over 40 research fellows and doctoral students. He is chair of the World Health Organisation Malaria Policy Advisory Committee and sits on international advisory committees relating to malaria and to global health research. He was elected a fellow of the Academy of Medical Sciences in 2004 and was awarded the Prince Mahidol prize for medicine in 2010.

Annabelle Degroot

Anna webAnnabelle is the Finance Director for the three SABMiller businesses in Zambia managing finances of a $450 million revenue group with multiple complexities. She plays an instrumental role in Strategic, Sales and Operating planning and receives reports from Internal Audit. Previously, Annabelle served for four years as CIDRZ Chief Financial Officer and was responsible for fraud management, and establishing an internal audit department among other key accomplishments. She has broad experience in international financial management and consulting. Annabelle holds a MA in Economics from Cambridge University in the U.K. and an Associate Chartered Accountant degree from the Institute of Chartered Accountants in England and Wales. Annabelle was born in Zambia, and holds a Resident’s permit. She has resided full-time in Zambia since 2001.

Christopher Mubemba

Christopher perfect square1Christopher Mubemba is the Director of Transmission Development ZESCO Ltd, Zambia. Since 1986 Mr Mubemba has served in various senior engineering posts in Zambia ranging from the Zambia Consolidated Copper Mines; within ZESCO in the Department of Electrotechnical Services, Generation and Transmission; the Department of Generation Planning and Design Engineering Development; the Department of Transmission Rehabilitation, Power Rehabilitation Project; to most recently as Project Director executing the USD 2 billion Kafue Gorge Lower Hydroelectric project on behalf of ZESCO Limited. Mr Mubemba holds a Master of Science in Electrical Engineering from the University of Manchester Institute of Science and Technology, U.K. He is a Chartered Engineer of the Institution of Engineering and Technology, U.K., and a Member and Registered Engineer of the Engineering Institution of Zambia.

CIDRZ Celebrates 1 Million New Sanitation Users in Kafue District!

On 24th July a celebration was held in Kafue’s Mupapa Village in Malundu Ward to celebrate the achievement of 1 million new sanitation users in Kafue District! Honourable Deputy Minister of Local Government and Housing, Nicholas Banda, presented a certificate of Open Defecation Free (ODF) status to Headman Shakatwa of Mupapa Village. At the event, 15-year old Catherine Isam expressed her joy at finally having a latrine that provided privacy, and how shameful it was before when she and members of her household practiced open defecation. She encouraged other villages to emulate Mupapa’s achievement.

Mupapa Village Headman (3)

Mupapa Village Headman Shakwata receiving ODF certificate from Deputy Minister Banda – attached
Villagers such as Josephine Aisam and her family constructed a latrine and an effective and easy-to-use soap and water dispenser.

This milestone event is part of the Zambian Ministry of Local Government and Housing, UKAID, UNICEF, WaterAid Zambia and Centre for Infectious Disease Research in Zambia support for the 3 Million People Sanitation Programme that is promoting improvement in community-wide sanitation in rural Zambia. This Community-Led Total Sanitation approach provides awareness to promote the end of open defecation through the action of the community members constructing latrines and handwashing stations supplied with soap or ash to use before eating and after using the toilet. After appropriate sensitisation, the community itself must truly take the lead in this accomplishment to attain Water, Sanitation and Hygiene (WASH) status in order to reduce diarrhoeal disease and improve general well-being of the community.

Mupapa is a small village with 22 households and a population of 231. The effort towards attaining Open Defecation Free (ODF) status was triggered by a community champion in August 2013; the village claimed to be ODF by November 2013; and this was verified in March 2014. Community members were ecstatic to be recognized as a model village and chosen to host the celebrations. It was also an honour for CIDRZ as Mupapa Village is under CIDRZ’s coordination and care.

CIDRZ Awarded Grant from the Bill & Melinda Gates Foundation

CIDRZ has been awarded a USD 4.76 million Bill & Melinda Gates Foundation grant in support of the Better Information for Health in Zambia study. Dr Charles Holmes, CIDRZ Chief Executive Officer and Dr Elvin Geng of the University of California – San Francisco are the overall co-Principal Investigators (PIs), Dr Izukanji Sikazwe, CIDRZ Deputy CEO is the lead local PI, and the study team includes multiple Zambian and other co-investigators.

betterinfo_persons

The purpose of the ‘BetterInfo’ study is to systematically gain a better understanding of why some patients enrolled in antiretroviral treatment (ART) stay in care, while others are ‘lost’ from care. It is estimated that as many as 25-40% of patients in HIV care and treatment programmes are Lost-To-Follow-Up (LTFU). The ‘BetterInfo’ study will trace ART patients, learn of their outcomes, and ask questions about why they have that outcome. This information will enable the study team to more accurately estimate the treatment outcomes of patients who are lost from HIV care thereby gaining a better understanding of the percentage of patients who have chosen to disengage from ART care, those who have chosen to re-engage in ART care at a different facility, and those that have passed away. Understanding this information will allow health programmes and facilities to better meet the needs of ART patients so that they stay in care. The ‘BetterInfo’ study staff will use best practices when tracing ‘lost’ patients to protect privacy and confidentiality, and if a patient has stopped receiving treatment they will encourage them to resume ART care.

The ‘BetterInfo’ study will be conducted in 30 sites in Western, Southern, Lusaka and Eastern Provinces of Zambia over a 29-month period and will be able to provide more accurate estimates of HIV care patient outcomes at both clinic and provincial levels which will help the Zambian Ministry of Health, and Ministry of Community Development Mother and Child Health to make informed decisions about HIV care service provision.

In addition to both Zambian and International research regulatory oversight, the ‘BetterInfo’ study will also be guided by a Zambian and International Advisory Committee of health and HIV experts comprising Dr Carol Phiri, Dr Peter Mwaba, and Dr Albert Mwango of the Government of the Republic of Zambia; Dr Jonas Mwale of the Centers for Disease Control and Prevention – Zambia; Dr Virginia Bond of the London School of Hygiene and Tropical Medicine; Dr David Bangsberg of the Harvard School of Public Health; and Dr Bruce Agins Medical Director of the New York State Department of Health AIDS Institute.

‘BetterInfo’ represents collaboration between multiple investigators from CIDRZ, the University of California – San Francisco, the University of Alabama at Birmingham, and the University of North Carolina – Chapel Hill.

An integral component of the ‘BetterInfo’ study will be an in-depth process evaluation to enable the investigators to identify and understand the best implementation methods, and the resources required for implementation, so that the Ministry or other interested partners could repeat the exercise in a different setting, if desired. As per Gates Foundation grant requirements, ‘BetterInfo’ study results will be shared with the communities involved, the Government of Zambia, and other key stakeholders, as well as be provided as part of the Global Access Commitment.