2016 - 2 MD's mission

Progetto: N&EPF-VPM 009/16/ANC - Kafue District ANC HCs

2° MissionZambia - August 2016

  • Dr.Carlo Vittorio Resti MD - AOSCF

Nando & Elsa Peretti Foundation co-funded Project 009/2016
Title :  Antenatal care upgrade in the Kafue District, Zambia
Team leader: Ngo VPM - Rome - Italy 
Partner : AOSCF - Azienda Ospedaliera S.Camillo Forlanini -Health Cooperation office - Rome - Italy
Local Partner : KDHMT - Kafue District Health Management Team - Zambia 

Report:  The present mission has been carried out under the Regional Law n. 2/2004, Art. 71, as a training expert in the above mentioned project at Kafue District Hospital (KDH) and in 3 Rural Health Center (RHC) August, 1st-15th 2016.

Specific objectives:

a) To plan and implement a training course (refresher course) for health workers, mainly midwives, on "Mother and child health district's situation: how to improve ANC service in the RHCs." for n. 20 participants from different part of Kafue District.
b) To carry out a field rapid needs assessment in n. 3 selected RHC of the Kafue District, to develop a list of needed items and intervention to upgrade the facilities.
c) To perform administrative and banking practices in order to pay allowances for health personnel, project management local staff and the project's driver from 1st to 14th August 2016 and purchase of stationery and coffee breaks at the training venue.

In the 1st week of mission n. 3 RHC selected by the KDHMT have been visited and assessed.
Travel by car for a total of 435 Km. mainly on asphalt roads has been accomplished. Two trips in Lusaka and return for other 225 Km. transport and assistance to the Gynecologist Dr. Ketty M. Lubeya.

Chisankane RHC is 47 km far from Kafue District Hospital and shows some structural problems with latrines and renovation and lay out of Maternity Ward and labour Ward. The staff consists of 4 health workers of which only 1 midwife and out of 535 expected deliveries, about 200/year are attended at RHC.
Chanyanya RHC is 29 km. Far from Kafue District Hospital heading west on a gravel road. There are problems of internal renovation of MCH rooms and of shortage of surgical instruments, drugs and furniture. The staff consists of 5 health workers of which only 1 midwife  and out of 620 expected deliveries only about 220 are attended at RHC.
Kambale RHC is located 103 Km far from Kafue district hospital, heading south on a good tarmac road up to Chirundu and only 13 km apart from Chirundu mission Mtendere Hospital, its natural referral hospital. There are problems of lack of adequate furniture and equipment for the labour ward and with water supply that is from the river Zambesi. The staff consists of 4 health workers of which only 1 midwife. Out of 307 expected deliveries, only about 100 are attended at RHC facility.

Selected Rural Referral Health Centre / Maternity profiles (RHC)

Chisankane: 9904 pop. 535 exp. Deliv. 4 staff/ 1 MW
Chanyanya: 11618 pop. 620 exp. Deliv. 5 staff/ 1 MW
Kambale: 6207 pop. 307 exp. Deliv. 4 staff/ 1 MW

The supervision and assessment results have been discussed during the training session in order to review and jointly finalize the three lists of priority needs to upgrade the three RHCs (All.1).
In the second week of mission, in addition to the administrative meetings and collection of documentation for the accountancy, a  Refresher Course on the upgrade of ANC services in Kafue District, of 14 hours duration (2 days) for n. 20 participants, mainly midwives, has been organized, accomplished and evaluated.
The training was successful and answered to most of the expectations of trainees. However, some drawbacks in logistics have been evidenced as it is showed in the final questionnaire (All. 2).
Particularly the allocated budget for allowances(different exchange rates) was not adequate to cover travel and accommodation expenditures. Here is an abstract of the current revised Government per capita rates:

Food only (one day no travel) =75 ZMK
Out of Pocket (for overnight stay only) = da 153 a 162 ZMK
Per Diem (all inclusive) = da 500 a 600 ZMK (da 650 a 800 ZMK  for Lusaka).

Ms. Cathy Kabeta (Anest. Tech.) was in charge of the organization and administration. The undersigned expert MD, played the role of meeting leader, lecturer, facilitator e supervisor, as planned. The refresher course has been shrinked in 2 days of 7 hours classroom instead of 3 half days, due to budget  constraints, travel and logistics of most of the participants and due to the imminent political elections of August 11th of the Country President.

The mission was successful in pursuing all the objectives, without difficulties.
Worth of note the complaints about the amount of training allowances (30 ZMK per diem), not in line with Government standards. For instance, while the budgeted per diem was 30 ZMK, the Government standard is from 500 to 600 ZMK. (almost 3 USD vs. almost 50 USD per day).
To improve the quality of a basic emergency obstetric and newborn care at ANC clinic level and in the prompt referral of at risk pregnancies were also mentioned and widely discussed:
- ambulance with driver and fuel;
- vouchers for private transport of mothers in labour;
- supply and training for midwives on ultrasound portable scan diagnostic use in ANC.
These are items beyond the budget capacity of the present project. Another local priority in addressing the maternal mortality and stillbirth rates are mothers education campaigns, supported by voluntary organizations (SMAGs), that may be useful for a behavioural change to contrast the tendency of more than half of the women to deliver at home without skilled assistance.

Rome/Kafue, August 14 - 2016 
Carlo V. Resti MD

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