Zambia Prisons Health Systems Strengthening Framework Launched with signing of MOU between Government and CIDRZ

A momentous milestone was achieved on 12th May 2015 at the launch of the Zambia Prisons Health Systems Strengthening (ZaPHSS) Framework when the Memorandum of Understanding between the Government of the Republic of Zambia and CIDRZ was signed by the Permanent Secretary, Ministry of Home Affairs, Dr Chileshe Mulenga, the European Union Ambassador and Head of Delegation to Zambia, Mr Gilles Hervio, and CIDRZ CEO, Dr Charles Holmes. The MOU cements the relationship between CIDRZ and the Ministry of Home Affairs and Zambia Prisons Services to work together to develop and capacitate a prison health system that will plan, manage and implement improved health services in Zambian prisons.  At the signing event, Dr Charles Holmes remarked “that the signing of the MOU today does not represent the beginning of a partnership between the Zambian NGO CIDRZ and the Government of the Republic of Zambia, but represents an important milestone that confirms CIDRZ’s commitment to continue collaborative work with government and other key stakeholders to sustain the implementation of the Health Systems Strengthening task in Zambian Prisons.” The ZaPHSS project is funded by the European Union.

Back row: Members of the CIDRZ ZaPHSS project team, and Dr Chileshe Chisela of Prisons. Fron row: CIDRZ CEO Charles Holmes, EU Ambassador Hervio, PS MoHA Dr Mulenga, and Commissioner of Prisons Percy Chato. Ambassador

Back row: Members of the CIDRZ ZaPHSS project team, and Dr Chileshe Chisela of Prisons Services. Front row: CIDRZ CEO Charles Holmes, EU Ambassador Hervio, PS MoHA Dr Mulenga, and Commissioner of Prisons Percy Chato.


CIDRZ Cervical Cancer Nurse Receives Health Care Giver of the Year Award

Congratulations to CIDRZ Cervical Cancer Screening Nurse and Trainer, Susan Banda, who was named the Health Care Giver of the Year at the 2015 Zambian Women of the Year Awards! She was presented her award by Honourable Vice President Mrs Inonge Wina at a gala dinner in Lusaka recently.

Organising committee chair, Mrs Chilufya Mwaba-Phiri said that the “aim of the inaugural Zambian Women of the Year Awards is to honour women and recognize those that have positively impacted on the lives of their families, workmates, communities and society at large.” Susan was nominated for the award by the many clients that she has served at the CIDRZ Cervical Cancer Prevention Programme of Zambia (CCPPZ). This programme, which is part of the African Centre of Excellence for Women’s Cancer Control at the University Teaching Hospital in Lusaka, provides same day “See and Treat” cervical cancer screening for pre-cancerous lesions. Since inception the programme has screened 200,000 women, has trained nurse screeners, and has set up static and mobile screening services throughout the country. Director of the CIDRZ programme Dr Sharon Kapambwe has recently been seconded to the Ministry of Health to ensure sustainable national scale-up of cervical and breast cancer screening in Zambia.

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CIDRZ Welcomes Dr Richard Mutemwa MSc, MBA, PhD who joins as Deputy Director, Health Systems Strengthening & Primary Health Care

Dr Richard Mutemwa earned his MSc in Medical Statistics (with Epidemiology) from The London School of Hygiene and Tropical Medicine, University of London and his Masters of Business Administration in Health, Population and Nutrition in Developing Countries and PhD in Health Management from Keele University, U.K.

In his immediately previous role he served as Lecturer and Research Fellow teaching research design and analysis; health policy, power and process; reproductive health research; and the Health Services Management component of the Distance Learning Masters of Public Health degree at The London School of Hygiene and Tropical Medicine. Prior to this Dr Mutemwa served as Lecturer and Research Fellow at the University of Southampton, U.K. for nine years teaching health systems and international development, with a specific focus on maternal and child health, and HIV/AIDS research. He has experience in the design, implementation, analysis, and dissemination of both quantitative and qualitative research and has served as Investigator on multi-site international trials as well as published multiple peer-reviewed papers.

Richard has broad experience in Zambia, having served as USAIDCountry Project Manager on the USAID/MOST programme providing technical support to Zambia’s National Vitamin A supplementation programme; as Head of the Nutrition Education Unit of the National Food and Nutrition Commission where he designed and led implementation of the National Nutritional Promotion Strategy in Zambia; and as Head of the Film/Video Unit of the Zambia News and Information Services.

CIDRZ Seconds Dr Sharon Kapambwe to Ministry of Health to Support Sustainable National Scale-up of Women’s Cancer Control Services

CEO Dr Charles Holmes is pleased to announce that CIDRZ Director of Women’s Cancer Control, Dr Sharon Kapambwe, is being seconded to the Ministry of Health (MOH) where she will continue to lead efforts to scale-up high quality cervical and breast cancer services and other key interventions at a National level. To date, with the support of the U.S. Centers of Disease Control and Prevention (CDC) through the U.S. President’s Plan for AIDS Relief (PEPFAR), Pink Ribbon Red Ribbon, Susan J. Komen and other key stakeholders, the CIDRZ Cervical Cancer Screening Programme of Zambia (CCPPZ) has screened almost 200,000 Zambian women, trained over 200 government providers, opened over 33 static screening clinics in government facilities in all ten Zambian provinces, initiated mobile sensitisation and screening clinics, operationalized 21 treatment clinics for complex cervical cancer lesions, and provided web-based consultations with experts for rural centers.

Dr Elizabeth Chizema, MOH Director of Disease Surveillance, Control and Research noted with pleasure that “Dr Kapambwe will be the centre of our efforts to continue expanding women’s cancer services throughout Zambia. We are most appreciative of the CIDRZ secondment of Dr Kapambwe to the MOH, with the support of the CDC, PEPFAR and PRRR. Her presence and CIDRZ’s ongoing support will enable us to transition to a truly sustainable national program of lifesaving cervical and breast cancer screening and treatment for Zambian women.”

Dr Eric Goosby, former U.S. Global Ambassador, now United Nations Special Envoy on Tuberculosis and member of the CIDRZ Board of Directors, stated that “this type of tangible support for the Ministry of Health is central to building capacity and sustainability, and represents the true spirit of CIDRZ in Zambia.”

Dr Kapambwe received her MBChB degree in Medicine and Surgery from the University of Zambia, School of Medicine, and later earned a Master of Public Health degree with a focus on the development of health programmes in developing countries from the Royal Tropical Institute, Vrije University, Netherlands. She joined the CCPPZ in 2008 and for several years has served as Director. In addition to conducting research and contributing to peer-reviewed manuscript publications, she also served as the local Principal Investigator of the Cervical Cancer Research Capacity Training Initiative and co-Chaired the Zambian Human Papilloma Virus (HPV) Vaccination Demonstration project tackling one of the root causes of cervical cancer – infection with HPV. More recently she has been involved in the leadership of the important initiative to incorporate breast cancer screening and diagnosis – the second most common cancer in Zambian women – into the cervical cancer screening facilities.

With continued funding from CDC, PEPFAR, PRRR and other partners, the CIDRZ cervical and breast cancer team will continue to pursue a sustainable program of cervical, breast and other women’s cancer screening and treatment in Zambia. In addition to continued clinical and programmatic contributions, and working with co-investigators in the MOH, CIDRZ investigators are building a vital portfolio of innovative implementation science work in women’s cancer that will feed back into programs and improve women’s health outcomes.

In Zambia, an infectious disease response aims for excellence: “This is what a local organisation looks like”

When Dr. Charles Holmes left the office of the U.S. Global AIDS Coordinator to come to Zambia at the end of 2012, he had a plan that was both modest and ambitious. He was going to use what he had learned as Chief Medical Officer for the world’s largest program dedicated to a single disease, and build the impact of a local program in a resource-challenged country addressing a spectrum of health issues.

Left to right: Dr Charles Holmes, Dr Lottie Hachaambwa of University of Zambia Teaching Hospital, and Dr Roma Chilengi, CIDRZ Chief Scientific Officer.

Left to right: Dr Charles Holmes, Dr Lottie Hachaambwa of University of Zambia Teaching Hospital, and Dr Roma Chilengi, CIDRZ Chief Scientific Officer.

Even before his work for the President’s Emergency Plan for AIDS Relief (PEPFAR), he had been a believer in the combined power of medicine and management. Having witnessed the devastation of Malawi’s AIDS epidemic at a time when treatment was saving lives in the U.S., but not in Africa, he had studied, and helped prove the value of cost-effectiveness analysis both in building health responses, and in building support for them. At PEPFAR, his responsibilities had included not only ARV treatment and PMTCT programs, but programs providing care and support for patients before treatment, and TB programs. He had helped introduce implementation science – the science of analyzing goals, costs, and outcomes – to maximize the reach and effectiveness of PEPFAR programs. He also had headed the program’s first Scientific Advisory Board which provided input on evidence supporting the value of PEPFAR investments.

Now, he wanted to see the principles that had brought life-saving medicine to people around the world at work on the ground every day, and make the difference a lasting one. He wanted – he told the CIDRZ staff when he arrived – “to write the next great chapter in the response to HIV and broader health issues.”

He took the role of Chief Executive Officer of CIDRZ at a turning point. Three years earlier, international organisations providing services through their own programs with PEPFAR support had been given a deadline to turn those programs over to local control, with local boards and management teams that are at least 75 percent local. That deadline had passed when Holmes landed in Lusaka, where CIDRZ is based. CIDRZ had been started a decade earlier by researchers from the University of Alabama. Recently, its in-country leadership had returned to the U.S., to another university. Holmes found a nascent organisation, independent since 2011, and struggling to gain the confidence of donors.

“The first order of business was to build a foundation of stability,” Holmes said recently. With the animation some people show when they talk about art, literature, or popular culture Holmes lights up when he talks about establishing order. CIDRZ went through a series of audits, and with the help of funders, it underwent a governance review to find out what needed to be done. It upgraded its management technology. It recruited board members with proven records, drawing “on the strongest business and medical leadership in the country.” That meant getting referrals, checking references, looking at the performance of organisations for which prospective members had previously served on the boards.

The board now has six local board members, including a leader of the Zambian national pension authority leading the Investment Committee, and three international members, including Dr Eric Goosby, former U.S. Global AIDS Coordinator, and now United Nations Special Envoy on Tuberculosis. Dr Izukanji Sikazwe, a Zambian physician who earned her medical degree in Zambia before going on for internal medicine and infectious diseases training in the U.S. is CIDRZ’s deputy chief executive officer.

“This is what a local organisation looks like,” Holmes said.

Building relationships with the government, to ensure its continued commitment and ongoing investment was critical, Holmes said, but so was clarifying, and diversifying its relationship with external partners, to ensure its autonomy and control over work agreements. “The payoff,” he said, “we have gained the confidence of donors.” CIDRZ has been granted an Equivalency Determination that allows donors to treat it as a U.S. nonprofit, above the level of reporting required of overseas organisations.

In the last year the past and the present came together, with a grant from the Bill and Melinda Gates Foundation to launch the “BetterInfo” study. The study will trace ARV treatment patients, learn their outcomes, and the factors surrounding those outcomes, with a goal of helping programs and facilities understand reasons patients are lost to follow up care, and meet their needs. The idea for the study had its genesis in a PEPFAR Scientific Advisory Board presentation by physician researcher Elvin Geng, who has focused in recent years on finding local reasons for care outcomes.

Word on another grant is pending. In time, Holmes pictures CIDRZ continuing to advance, and eventually without him. “It takes time and energy, but what a great development spillover if you can take the time to do that right,” he said. “If donors and others take the time to appreciate the local environment, you can elevate an organisation.”

Author:  Antigone Barton, Center for Global Health Policy

CIDRZ Receives Equivalency Determination (ED) Status Making it Equal to a U.S. Charity

To earn this recognized status CIDRZ governance, financial controls, and operations have successfully passed rigorous scrutiny from NGOsource ( Earning Equivalency Determination status and being considered equivalent to a U.S. public charity makes it much easier for important potential donors – such as the Bill & Melinda Gates Foundation –  to confidently consider CIDRZ as a grantee, and allows CIDRZ to operate more efficiently with these donors.

Since becoming an independent Zambian NGO in 2011, and restructuring with new executive leadership under Director and CEO Dr Charles Holmes, CIDRZ has intensified focus on increasing the effectiveness of the management of its operations, and especially its financial, governance, and control environment. With the addition of a 5-member strong Internal Audit team, led by an experienced Certified Internal Auditor and Fraud Examiner who reports directly to the Board of Directors Audit Committee Chair, CIDRZ is confident about its accountability and control environment.

An independent Zambian NGO, CIDRZ collaborates with multiple partners so as to leverage diverse resources to assist it in delivering on its mission “To improve access to quality healthcare in Zambia through innovative capacity development, exceptional implementation science and research, and impactful and sustainable public health programmes.” The Bill & Melinda Gates Foundation is one such important donor. The Foundation recently granted CIDRZ a USD$4.76 million award for the Better Information for Health in Zambia study.

CIDRZ Welcomes David Ojok MSc, MPH who joins as Laboratory Quality Control Manager

David earned a BSc degree in Biomedical Science from University of Lincoln, UK; a MSc degree in Immunology and Clinical Microbiology from Makerere University, Kampala Uganda; and is preparing to defend his thesis for a Masters of Public Health degree from Uganda Christian University. He joined CIDRZ in November 2014 as Laboratory Quality Control Manager and also serves as Chair of the Lab Accreditation Committee. In his most previous role David was Team Leader of the Makerere University and Johns Hopkins University Research Collaboration Core Laboratory.

Rural Voices: SCOPE – The Sinazongwe Combination Prevention Evaluation Study

HIV prevention messages don’t always reach deep into rural areas like Sinazongwe District located on the north shore of Lake Kariba in the far south-east corner of Zambia’s Southern province. In fact HIV prevention programmes in remote areas are the most neglected and the least evaluated in Zambia. The Sinazongwe Combination Prevention Evaluation (SCOPE) study, funded by the U.S. Centers for Disease Control and Prevention (CDC) through ICAP at Columbia University, aims to evaluate population-level changes in HIV incidence, prevalence, and disease progression as well as knowledge, perceptions and attitudes in Sinazongwe District before and after implementation of a Development Aid from People-to-People (DAPP) integrated HIV programme called “Total Control of the Epidemic” in conjunction with a GRZ Southern Provincial Health Office and Sinazongwe District Medical Office scale-up of health services.

As part of SCOPE the over 50-member local CIDRZ team is conducting two community-based household surveys before and after the implementation of the DAPP HIV programme and GRZ services scale-up, three healthcare facility clinic record reviews, as well as interviews of up to 40 healthcare workers. It is estimated that up to 9,325 people from 24 Census Supervisory Areas (CSA) in Sinazongwe District will be reached per round during the evaluation exercise that started in July 2014.

Milestones Completed:

–        First round Facility survey data collected from 18 District health facilities

–        Interviews with 29 health care staff members

–        First round Community survey enrolled over 9,000 people from 24 CSAs

–        Ongoing data entry, cleaning and analysis

Sensitisation and Community Relations Create Trust

Undertaking such a large community evaluation cannot take place without the support and approval of local leadership; and the SCOPE study team has always valued interaction with Traditional Chiefs and Village Headmen. During a SCOPE study sensitisation meeting, a Chief requested that testing for malaria be included in the protocol as it was such a big health problem for his people. After discussions with the Southern Province Health Office – a key study partner – malaria testing and treatment was written into the protocol with the majority of test kits and all treatment being provided by the government.

Before study start local Community Health Workers (CHW) were identified by health facility leadership and were briefed on SCOPE by the Community Liaison Officer. The CHW plays an instrumental role by assisting the study team meet local leadership and accompanying them in the field on data collection days. By introducing the CIDRZ SCOPE staff to the community through a known and respected member, the community is assured that the survey team is genuine and working with the full knowledge and partnership of government. In addition, prior to a survey team starting activity in an area they are preceded by a trained Sinazongwe-based drama troupe that informs the audience about the survey and explains that the Ministry of Health is a key partner in this evaluation exercise. Providing regular updates to local stakeholders is also very important during the conduct of a study. SCOPE study coordinator, Henry Muloongo makes quarterly presentations to the Southern Provincial Health Office.

The SCOPE evaluation is planned to be completed by 2017. SCOPE data will be shared with key stakeholders and used to inform government health programming to enhance HIV prevention, treatment and support programmes targeting whole communities as it will provide important information about changes in new HIV cases over time at the population level. It is hoped that SCOPE data will contribute to Zambia, other country governments, and donors benefitting as they decide on the best allocation of resources to achieve reduction in new HIV infections.

It Takes Multiple Partners

A large evaluation such as the SCOPE study requires collaboration of multiple partners. Key entities involved in this study are the: Zambian Ministry of Health, Southern Provincial Health Office, Sinazongwe District Health Management Team, University Teaching Hospital, Centers for Disease Control and Prevention (Zambia and Atlanta U.S. offices), International Center for AIDS Care and Treatment Programs, FHI360, Development Aid People-to-People, University of North Carolina at Chapel Hill, and CIDRZ.

CIDRZ Assists Lusaka District Community Health Office Improve ARV Drug Access to Clinics

Through support provided by CDC/PEPFAR, CIDRZ was able to donate a new, 7-ton, containerized drug delivery truck to the Lusaka District Community Health Office to assist them to deliver life-saving Anti-Retroviral drugs to Lusaka District HIV Treatment and Care Clinics. Previously the District faced logistic challenges as they did not have their own dedicated vehicle for this important activity and so they reached out to CIDRZ to assist.

Since 2003, CIDRZ, with generous support of the CDC/PEPFAR, has contributed to meaningful improvements in the delivery of Zambian paediatric and adult HIV prevention and treatment, including scale-up of counseling and testing, introduction of home-based HIV testing, integration of Couples Counseling and Prevention for Positives, and provision of prevention of mother-to-child HIV transmission (PMTCT) services, as well as improving linkages to care and treatment. During this time CIDRZ assisted Lusaka District with ARV drug delivery by assigning a truck, fuel and driver for this purpose.

But donation of the dedicated ARV drug delivery truck to Lusaka District is one step further in achieving local programme ownership as well as carrying out the CIDRZ mission of “improving access to quality health care” by supporting a sound drug delivery system that assures access of ARV medication to every Zambian that needs it.

Since receiving the truck in late 2014 the Lusaka District drug logistics system has become more efficient and health facilities now receive timely ARV deliveries. District Pharmacist, Mr George Kadima commented “the dedicated truck had tremendously reduced the ARV drug delivery challenges faced by the Lusaka District.”

ACADEMIC ENDLINE Survey Launches to Evaluate Rotavirus Vaccine

From 2011-2014, the Programme for the Awareness and Elimination of childhood Diarrhoea (PAED) at CIDRZ organized and implemented interventions to decrease overall and diarrhoea-related post-neonatal Under 5 child mortality in Lusaka Province.  These interventions included the early roll-out of the rotavirus vaccine in a facility-based study and community-based behaviour change programming to improve child hygiene, feeding and diarrhoea treatment practices.

As PAED began activities, CIDRZ initiated the Baseline of ACADEMIC (A Comprehensive Assessment of Diarrhoea and Enteric Disease Management in Children) to establish the pre-intervention levels of child mortality and diarrhoea-related morbidity. Baseline included a multi-centre facility study to evaluate rotavirus vaccine effectiveness as well as a paper-based community survey reaching over 21,000 households in 220 Census Supervisory Areas to estimate child mortality.

After completion of the ACADEMIC Baseline and all PAED activities, training for the ACADEMIC Endline study commenced in January 2015. A study team of 16 Team Leaders and 46 Team Members were trained to conduct household-based surveys using Nexus 7 handheld tablets and Endline household data collection commenced in late February. In addition to meeting their data collection responsibilities, study staff members have also attended bi-weekly all-team meetings. There, they have received professional development training to increase their knowledge of health topics and enhance their research presentation skills. These efforts have boosted the confidence and morale of all staff to perform to the best of their potential.

The ACADEMIC Endline survey is the first tablet-based CIDRZ research study to successfully use electronic data capture in the field. It also marks the first time Open Data Kit-based survey programming and database generation has been managed in-house. ACADEMIC Endline data collection is projected to complete by mid- July of 2015.