Help CIDRZ build a healthy Zambia

Welcome to the Centre for Infectious Disease Research in Zambia, known as CIDRZ, and the outstanding work we do on behalf of the people of Zambia.

This vibrant organisation not only performs ground-breaking research to identify more effective ways to prevent and treat deadly infectious diseases in Zambia, CIDRZ is on the front-lines of providing health services to those most in need in public healthcare clinics, while training the next generation of African researchers, healthcare providers and public health leaders.

Since I joined CIDRZ as Director just over 18 months ago, we have launched a new three-year strategic plan, signed robust new Memoranda of Understanding with the Government of the Republic of Zambia, recruited outstanding new Board members, and focused intensely on strengthening our internal systems and governance controls. Our aim is for CIDRZ to be a long-term resource to Zambia, one that will create knowledge, build capacity of future health leaders and save and improve lives.

To assist us reach our vision of a Zambia in which all people have access to quality healthcare
I am excited to announce the launch of a first-ever CIDRZ Fundraising Campaign. Our goal is to raise USD 2.5 million to support our public health work so that we may continue to deliver many more years of high-quality lifesaving work as well as have the needed flexibility to act quickly on promising innovative ideas.

We ask that you join us in improving health in Zambia and the region and make a commitment to support CIDRZ. To learn more about our fundraising campaign, please click here >>>>

Signature Holmes

Charles B. Holmes, MD, MPH
Chief Executive Officer
charles.holmes@cidrz.org

Director’s Letter

It’s a great pleasure to welcome you to CIDRZ, and to our new website. I joined the organisation as Director nearly a year ago, and have enjoyed being welcomed not only into CIDRZ, but also into the vibrant healthcare and research community here in Zambia.

Being part of a mission-driven organisation is special, and I think it drives the dedication that I witness every day among our over 1000 staff, researchers, trainees and volunteers.

This talented community is with us because they want to tangibly improve the health of Zambians. We are collectively able to deliver on that aim through our support for innovative health services delivery within the local public health infrastructure and in close collaboration with the Government and donors, locally relevant research, and training programs for the next generation of researchers, healthcare providers and public health specialists.

During my year with the organisation, we have focused on strengthening our core capacity to function as a newly independent Zambian organisation, while continuing to innovate and deliver on our programmatic and research missions. Through key staff hires, additional training, and investments in business intelligence systems, we’ve grown the effectiveness of our financial and human resources management, internal audit, laboratory services, and numerous other areas.

With broad input from our Government colleagues, clients, staff and donors, we launched a new three-year strategic plan that we think will allow CIDRZ to become even more productive and impactful – all of this is done with the intent of creating a long-term resource to the country of Zambia, that will create knowledge, build capacity of future health leaders and save and improve more lives.

Thank you again for your interest in CIDRZ. We welcome you to be in touch with us – we are always looking for new partnerships and collaborations that will allow us to further our mission here in Zambia.

Signature Holmes2

 

 

 

Charles B. Holmes, MD, MPH

 

Diarrhoea: Tackling a Complex Problem

by Dr Roma Chilengi

In a recent article, as part of the Best Buys in Global Health series, Seth Berkley, the CEO of GAVI Alliance, pointed out that vaccine preventable diseases, diarrhoea included, has a huge negative impact on individuals in the developing world.  Zambia is a perfect example.  Currently, diarrhoea is the third leading cause of death and hospitalizations for Zambian children under the age of 5 years.

This means that Zambia’s 2.4 million children under the age of 5 years will experience millions of diarrhoeal episodes leaving them susceptible to premature death and preventing them from experiencing a healthy childhood. The impact on their families and communities is extensive: caregivers are unable to adequately provide for their families because the time they would spend engaging in paid work or in business is spent caring for sick children; community literacy levels are kept on the low end because children with frequent diarrhoeal episodes are unable to access educational opportunities; families have more children than they can support due to the fear of experiencing multiple child deaths; and affected children struggle with chronic malnutrition, stunted growth and general ill health resulting in poor intellectual development. The resulting effects of diarrhoeal disease entrench poverty in the developing world.

Understanding that the causes and factors that propagate diarrhoea and its complications in Zambia are diverse, we came up with a broad range of solutions to address this complex problem.

Leveraging on our long-standing work and success in strengthening the Zambian public health system, CIDRZ, with support from a UK-based charity – Absolute Return for Kids, and in collaboration with the Zambian government created the Programme for Awareness and Elimination of Diarrhoea or PAED. As the Program Director of PAED, I lead a team of researchers and programme managers to identify and implement high impact initiatives that will address diarrhoeal disease in Zambia. Beginning in 2010, we set out to demonstrate a 15% decrease in diarrhoeal-related deaths among children under the age of 5 in Lusaka Province by introducing a comprehensive diarrhoeal control programme, which includes rotavirus vaccination through the national immunization programme, improved clinical care, and community education. Lusaka Province will serve as our proof-of-concept and our successes and lessons learnt will be applied throughout the rest of the country.

Our second goal, which we have partly accomplished, is to accelerate the country-wide introduction of rotavirus and other high-priority childhood vaccines in Zambia through strategic investments in cold chain, commodities management, in addition to policy and protocol development, planning and advocacy. 

On the 27thof November 2013, the rotavirus vaccine was rolled out nationally at a launch in Mazabuka District by the Minister of Community Development, Mother and Child Health, Dr Joseph Katema.  The result of the roll-out is that any baby can now receive rotavirus and pneumococcal vaccination within any health facility in Zambia.

At the community level, our efforts have resulted in full vaccination of 123,000 babies and training of over 500 frontline health workers in Integrated Management of Childhood Illness. We are also working on a behaviour change campaign that will address attitudes that promote diarrhoeal disease within communities. At the same time, we are conducting both facility and community surveys to determine the impact of our programme.

By working closely with the Zambian government and its partners – and within the public health system in all aspects of implementation – we ensure that our programmes will remain sustainable and will form part of the National Health Strategic Plan for paediatric diarrhoea control.

We will not relent because we know that elimination of diarrhoeal disease is possible. We look forward to the day when no Zambian child, and indeed, no African child dies from severe diarrhoea.

Dr Roma Chilengi is CIDRZ Director of Health Systems and Primary Care

Corporate Social Responsibility: Our Employees Make Us What We Are

by Dr Izukanji Sikazwe
Since I joined CIDRZ in 2013, I am continually amazed by the generosity displayed by CIDRZ employees in their work. I see this in the dedication and selfless service they display in the field and in the office. Our employees are motivated and they see our CIDRZ mission to improve the health outcomes of Zambians by ensuring access to quality healthcare as a personal one. They see a problem and they want to solve it; not just for themselves but for all Zambians.

Marjorie Chileka, our CIDRZ Grants and Contracts Manager, is one such employee. After she experienced difficulty obtaining urgent blood transfusions family members needed due to shortages of blood supply at the Blood Bank, Marjorie thought about how to contribute to correcting the problem.

She did not think only of herself and her family, but of the hundreds, and thousands of Zambians who are at risk of premature death because of scarcity of blood at the blood bank during school breaks. So what did Marjorie do? She took action: she spoke to me and several employees and we joined forces and partnered with the Zambian National Blood Transfusion Service (ZNBTS) to host a blood drive within our premises. On the 31st of January 2014, the blood drive took place at CIDRZ with the ZNBTS Medical Director, Dr Joseph Mulenga, gracing the event. ZNBTS staff was on hand to collect blood as CIDRZ employees, their friends and relatives came in to donate.

One of the donors, Anthony Willombe, a CIDRZ employee, said: “I donate blood because I know that one day I may need it. If not me, then a friend or a family member would need it.” Our employees inspire me.

Corporate social responsibility does not exist in a vacuum. It stems from the worthwhile activities of the people that make up the organisation. Our people at CIDRZ are very responsible and responsive, and they make CIDRZ the same. They care deeply about their work. So together, we at CIDRZ will stand with the Zambian government and our local and international partners to achieve our vision of “a Zambia, and a region, in which all people have access to quality healthcare and enjoy the best possible health, including a life free of AIDS”.

<small></em>Dr Izukanji Sikazwe is CIDRZ Deputy Chief Executive Officer</em></small>

“The Power of Permanence” Mary Fisher

Remarks for CIDRZ Staff & Guests
Lusaka, Zambia – 31 January 2014

It’s so good to see all of you again, and to be with you at a place which is so important to me. I realize that for most of you, coming to CIDRZ means coming to work or engaging in a brief visit. But for me, there is a sense of “coming home” when I’m allowed to be with you. Lusaka was not the first African city where I worked, but I quickly adopted it as my city away from home where I was most at home, most felt as though I belonged, most wanted always to come and never to leave. And it’s worth my saying that as an HIV-positive woman, when I first visited nearly a decade-and-a-half ago, I was a different woman than I am today.

The first time I visited we were just becoming convinced that the anti-retroviral drug therapies were not only going to work – as AZT and other prescriptions had worked – but that it was going to work on a sustained, continual basis. Longitudinal studies and real-life experience were coming together by the late 1990s to say, “Hey, this works! We’re going to be keeping people alive.”

We were still a long way from the sophisticated drugs and combinations which we have today. And we were far, far from moving toward universal access which remains a critical goal today. But for the first time since I and so many others had been diagnosed with the virus that leads certainly to AIDS, there was hope in the air. And hope was new.

And being a woman with AIDS in the United States in 1991, when I was diagnosed, made me a novelty of sorts. Of course there were other women with the virus, but their numbers were low and public awareness was even lower. Being a novelty is not all bad but neither is it all good. And as the years wore on, the novelty wore off. I longed to find others like myself: mothers who wondered how to manage both illness and children, women who had experience with being told we would die, but still needed to live. I did not want to be the exception any longer.

And then I came to Lusaka. What I found here was a community of women very much like myself. We recognized that we are different in race and nationality, language and habits. But those differences paled by comparison to the similarities. We were, and we have remained, literally “blood-relatives.” What binds us is a virus that wants to kill us and a joyful unity that keeps us alive. For the first time in my life with AIDS, here in this city I found myself in the context of others who knew my experience and shared it. And this companionship, this sisterhood, this acceptance which enables us to laugh and sing and dance together – it was new.

And at the core of my life in Lusaka has always been CIDRZ. This is the place of healing that enables me to go home and return, and find my sisters healthy and happy and well. Because CIDRZ welcomed the Abataka Women as they engaged in learning and employment, it has become even more a place in which I feel at home.

And for all this, I thank you. I thank you for taking on the challenges of work within CIDRZ. It is not easy, and sometimes it is not very rewarding. We who are sick can be difficult to serve; we are not always kind, or thankful, or courteous. The hours get long and the pay seems low. The challenges seem never to go away, whether they are scientific barriers, financial limitations or bureaucratic obstacles. It isn’t easy. And yet you come each day, you pour out your energy and your creativity on behalf of all who are sick and dying. And I rise today to offer a sincere “thank you.”

Last Spring I was honored to be with some of you when we dedicated the Max M and Marjorie S Community and Training Centre. We were joined by Charles Holmes, Jessica Grillo and Idah Mukuka and so many others who have made CIDRZ what it is today. And when I was allowed to make a few remarks on that occasion, I recalled that the Rev. Dr. Martin Luther King struggled for his whole life to build what he always called “the beloved community…in which poverty would have no place, racism would have no quarter and violence would have no purpose.”

I said on that occasion that “if I understand King’s dream correctly, what he was calling us to, is nothing more nor less than risking ourselves for one another. The beloved community…will be ushered in when we clearly see our differences and pursue the risk of devotion to one another nonetheless — when I see the pain of your burdens, and risk my comfort to take up your agonies. Dark days have shadowed our history; dark days will come again. And when they come, if we are truly dedicated to the work of community-building, we will be ready.” And here we are again. Once more you have opened your doors and hearts to me; once more you have welcomed me home.

In a world where institutions rise and fall in a span of months, CIDRZ has been committed to the work of learning and healing for years, and now approaching decades. It has taken on work that others see as a project and turned that work into a community commitment that endures. CIDRZ has become, during the years I have known you, a permanent organization committed to sustainable service to the people of Zambia.

We can recall hard times and dark days but, when we do, we need also to see that we have found our way from the darkness to the light. If leadership faltered or funding seemed uncertain, we have emerged from our own fears to see the dawn of a new and better day.

Every day that you work and every night that you labor long, you demonstrate to the people of Zambia that your commitment is not brief or limited; it is not temporary. You are here, and you are here to stay. Permanence is your hallmark.

And as the world of higher education and medical research looks for models, they turn with regularity to you, to see what it is that CIDRZ has done and how you’ve done it. What makes this possible is not only what you have achieved in the past but, more importantly, what you continue to do now. Permanence has brought you this far, but permanence will carry you much further.

And what you mean, as an institution and as individuals, to me is beyond my own description.
I am an American who sometimes despairs of American self-interest; when I am here, and I see what you are accomplishing as an international community drawn from many nations, I take hope for all nations and all humanity.

And I am a woman with AIDS. I am working this week with other women who share with me not only that virus but all that comes with it. And for each of us, CIDRZ stands as proof that aid and comfort is not temporary; it is enduring. When we grow weak, you will be here. If our families need comfort, you will be here. Where others may take their leave, you will take the opportunity to stay, to labor, to heal and to love.

Permanence is more than the accumulation of years and experience. It is the promise that CIDRZ is not only excellent; it is also trustworthy. It will be here long after I leave, and it – you – will be here should I return again. To all of you, and for all of you, I give thanks. Thank you…thank you…thank you!!!

Containing Infection in Zambia Prisons

Developing countries face numerous challenges, with health care and services key among them, and it is often the most vulnerable – such as prison inmates – among an already disadvantaged population who suffer most and have the least access to preventive and curative care. As evidence of this, the landlocked south-central African nation of Zambia, which has the sixth-highest HIV prevalence in the world at 14.3 per cent, has rates of HIV in prisons as high as 33 per cent. Tuberculosis is also endemic, with Lusaka Central Prison having a rate of tuberculosis infection four-and-a-half times that of the surrounding district.

University of Melbourne PhD candidate Stephanie Topp has been working in Lusaka with the Centre for Infectious Disease Research in Zambia (CIDRZ) as a technical adviser and research associate, and has on-the-ground experience of supporting the Zambian Prisons Service to deliver services to this complex population.
“Contrary to popular perception, prison populations are not isolated from the general community, but are in fact highly mobile,” she says, “with people entering, transferring within, and exiting facilities constantly.” Of the nation’s 53 prisons, she says only 17 have access to basic health services. Overcrowding is a huge issue too. “Prisons are at 208 per cent capacity on average, and as bad as 700 per cent in some facilities. The Zambian Prison Service (ZPS) has only 35 health professionals for a system with 17,000 inmates.

“Worryingly, a 2010-11 study of Lusaka Central Prison by CIDRZ showed the rate of HIV infection increased between entry into the prison and exit”. She says factors affecting rate of TB and HIV infection include poor nutrition, stress and limited access to testing and treatment, which speed the progress of the disease, and thus further increase the risk of transmission. “The normalisation of risky behaviours such as interpersonal violence or unprotected sex is also a likely factor in relation to HIV infection.”

Ms Topp says that when prisoners – who have potentially contracted diseases during their incarceration – are released after serving their sentence, this risk of disease spread is transferred from the inmate population to the public at large. “Addressing health and health systems in the prison ‘petrie dish’ is thus critical to any broader attempt to address population health, in Zambia as in any other country,” she says.

Ms Topp has worked to improve health systems in Zambia since 2007 after researching the influences shaping HIV policy in Papua New Guinea as a Rhodes Scholar at the University of Oxford. She is completing her PhD at the University of Melbourne’s Nossal Institute for Global Health, and her thesis is a health systems analysis of primary care centres in Zambia. Her current work is as part of a CIDRZ team that is looking to strengthen the underlying health system in Zambian prisons.
“Currently, the Zambian Prisons Health Directorate lacks a dedicated budget and relies mostly on funds donated for HIV and AIDS interventions, which don’t have a strong focus on health planning and co-ordination. “Dependence on these types of funding makes it almost impossible to improve preventive or curative care in the long term. We needed to address root causes of weak health services in the prisons,” she says.

At the same time, funding for disease-specific activities like tuberculosis screening or safe sex campaigns are more likely to gain the attention of donors and media. Yet, with the extreme political sensitivities, for instance men having sex with men, which remains illegal in Zambia, such activities may be difficult, if not impossible to carry out. “In Zambia there are still many groups – both within government and non-government – unwilling to endorse simple interventions likes condom distribution in prisons. Although there are also many progressive individuals who continue to push the envelope. “Ultimately, our choice to focus our work on basic health infrastructure was driven by our recognition that in order to deliver these disease-specific interventions routinely – not as a one-off campaign – it was absolutely essential to have a functioning, evidence-based system in place. We recognised that without a strong health system in place, improved service delivery and better health outcomes in any area would be difficult to sustain. Through its European Union–funded Zambia Prisons Health Systems Strengthening Project (ZaPHSS), CIDRZ has been working to increase engagement between government ministries and develop systems for coordinated planning and decision-making. “Because the health systems in place to service prison inmates are so weak – we had to start from the top,” she says. “So far, the project has helped the ZPS and health ministries to publish a joint prisons health framework, to address the fact that Zambia’s prison health system has historically worked in isolation from the wider health service and struggled to meet the needs of inmates.”

In the prisons themselves, she says CIDRZ has introduced tuberculosis screening and trained inmates as peer educators who assisted with HIV and tuberculosis screening of 6,436 inmates in 2010-11. In January 2014, the ZPS agreed to the formation of facility-level health committees formed from prison officers and health professionals and with inmate sub-committees who will be trained to deliver preventative information and basic disease surveillance. Prisons Deputy Commissioner Lloyd Chilunkika has described ZaPHSS as helping the prisons service jump start long-needed improvements in prisons health, saying the health directorate had, up to now, been present but not highly functional due to structural and operational challenges.

And in an encouraging development the Ministries of Home Affairs, Health and Community Development will this year commit to collaboration on improved inmate health services. Though such achievements may not have the glamour of traditional health campaigns, Ms Topp says systems-based approaches to health are essential for making health campaigns sustainable. “In the end, the success of vaccine campaigns and treatments activities are rarely sustainable and only partially successful without strong health systems, and our driving rationale is to have a long term-impact on the health services available to this incredibly vulnerable population.”

By Stuart Winthrop
(www.mdhs.unimelb.edu.au)