In March 2011, Restless Development through the Zambia Governance Foundation started implementing the youth-led health accountability project aimed at increasing access to health services with the support of the local school, clinic, community leaders and community members. The overall objective is to empower young people to take charge of their health and participate in development and decision making by tracking and monitoring the implementation of the National Youth Action Plan policies and holding their local and central government to account for improved youth friendly health service provision. Restless Development’s trained Advocates for Action conducted the initial trainings in ‘community self-assessment’ for 25 in and out of school youths and 5 community leaders. These included the Headman, health staff, teachers and church leaders.
Community members in Matuka (located in Kapiri Mposhi District) then gathered to conduct their own self-assessment of the health services they received at Chankomo Health Centre. One of the issues raised was the lack of transport by the health centre in case of emergencies. The next reliable transport is at Kapiri District Hospital.
One of the major challenges raised by community members was a lack of HIV testing kits at the centre, which ran out three months ago. Community members could not get tested to know their status. With the high cases of teenage pregnancies in the area (located on the transit corridor), the most affected are the pregnant young mothers who do not know their status before and after they deliver. While Zambia has made progress in the prevention of mother to child transmission of HIV and AIDS from a staggering 20% in the 1990s to less than 5% currently, though latest figures are not available, such rural communities still suffer because of lack of adequate services to prevent this transmission. To compound this the maternity wing is not conducive for the young mothers to deliver as the clinic is forced to put ordinary patients with mothers that are in labour in one room due to in adequate space. In some instances, pregnant mothers have been left with no option but to deliver in the nearby bush. This is discouraging many mothers from delivering at the clinic resulting in increased deliveries taking place in the homes with the aid of inexperienced traditional birth attendants (TBA). The TBAs carry out deliveries without adequate protection putting both the mother, baby and traditional birth attendants at risk of contracting the HIV virus and increasing the chances of maternal or child mortality due to other complications. Chankamo Health Centre is also under staffed with only four health workers that cater for a population of over 30,000 people. The clinic has recorded stock outs of essential drugs in the recent past and the community has expressed concern at not receiving quality health services. Long queues are unfortunately the norm and both young and old are put in the same lines. This also means young people with sexually transmitted infections cannot easily get the counselling and treatment they need. If attended to, young people are shouted at by staff and most young people prefer to seek treatment from traditional doctors who may not completely treat the infections leading to further complications.
As a follow up to this assessment process, young people with the support of Restless Development presented the self-assessment report and their demands to the area Member of Parliament, Honourable Friday Malwa and Area Councillor Jean Siwyokusa. A community event was organised at Matuka Basic School to present the case at Chankamo Health Centre where the MP, Local Councillor, Headmen, Indunas and other decision makers. It was resolved that the Kapiri District Health Management Board will be visited so that they could provide the VCT kits and Restless Development was also asked to support in facilitating the provision of VCT kits from other different partners.
A meeting for Decision makers at Matuka Basic School. In the picture is the Area Councillor (far right in yellow top and green, Councillor Jean Siwyokusa) and 3 headmen
In resolving the staffing issues, it was agreed that the area councillor would follow up with Dr Mwiya the District Director of Health in Kapiri, the MP and the provincial health officials to provide at least two additional staff.
Mr Samson Zgambo who is a health worker is happy to have been given the platform to express the gaps existing at the Chankomo health centre to the area counsellor who will table the issues raised with the relevant authorities.
“We have never thought we would meet our area counsellor one on one as this has never happened till now since the Restless Development started this community initiative to meet decision makers. I am happy that Restless Development is helping bring support to the clinic and improve the lives of the young people in the community especially in letting our young friends know about the national youth policy.”
Much work remains to follow up and address the inadequate provision of (youth friendly) health services in the area but a critical and sustainable first step has been made for community members: they have been empowered with the knowledge of their rights contained in national policy and the ability to actively address these with local decision makers (including their local MP) and demand a better health service provision.
This unique form of youth and demand-led accountability is also being piloted across Mindolo (Kitwe), Katondo (Kabwe) and Keembe (Chibombo) communities, with further evidence based case studies to be developed as to the pilot’s progress across August and September 2011.
By Veronique Tembo, Restless Development Advocate4Action and Alumni