Who is Assisting Women to Deliver Babies within Health Facilities? An Analysis of Deliveries in Four Provinces in Zambia

Skilled birth attendance (SBA) has been shown to reduce maternal mortality and improve birth outcomes. Because skilled professionals are supposed to be present in health facilities, increasing facility deliveries is expected to increase SBA. However, in a country with a critical shortage of skilled health personnel, is this always the case? We present data from three studies conducted in Zambia to understand SBA and delivery practices in health facilities. [from abstract]

Financing Medical Education through the Private Sector

From 2010 through 2013, the SHOPS project implemented a series of pilot activities to explore the feasibility of introducing private sector health education financing mechanisms. SHOPS explored private sector solutions to help meet ambitious targets from the U.S. President’s Emergency Plan for AIDS Relief for training new health care workers. This report shares the project’s work with private pre-service education financing in Malawi, Rwanda, Tanzania, and Zambia.

Unravelling the Quality of HIV Counselling and Testing Services in the Private and Public Sectors in Zambia

Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula. [from abstract]

Hope and Despair: Community Health Assistants’ Experiences of Working in a Rural District in Zambia

In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work.

Differences in Unintended Pregnancy, Contraceptive Use and Abortion by HIV Status Among Women In Nigeria and Zambia

Sub-Saharan Africa is burdened by high rates of unintended pregnancy and HIV. Yet little is known about the relationship between these two health risks in the region. Understanding the associations between HIV status and pregnancy decision making may benefit strategies to reduce unintended pregnancy. [from abstract]

Evaluation of Recruitment and Retention Strategies for Health Workers in Rural Zambia

The purpose of this study was to determine the impacts of the various health worker retention strategies on health workers in two rural districts of Zambia. [from abstract]

Report on the Society for Family Health Gender Assessment

To promote organizational learning and action related to political will and accountability, leadership and management, technical capacity, organizational culture, human resources policies and programs that promote gender equality, non-discrimination, and equal opportunity and treatment with respect to recruitment, hiring, training, remuneration, conditions of work,and programming at Society for Family Health. [from abstract]

Removing Financial Barriers to Access Reproductive, Maternal and Newborn Health Services: The Challenges and Policy Implications for Human Resources for Health

This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health using case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each the authors reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors. [from abstract]

Strong Effects of Home-Based Voluntary HIV Counseling and Testing on Acceptance and Equity: A Cluster Randomized Trial in Zambia

This study investigated the acceptance of home-based counselling and testing by lay counselors, its equity in uptake and the effect of negative life events with a cluster-randomized trial. [adapted from abstract]

Evaluation of a Quality Improvement Intervention to Prevent Mother-to-Child Transmission of HIV (PMTCT) at Zambia Defence Force Facilities

This study evaluates the impact of an intervention that improve the quality of services to prevent mother-to-child transmission of HIV at its health facilities, which included provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, and task shifting of group education to lay workers. [adapted from abstract]

Assessment of Provider Adherence to TB Evidence-based Standards and Guidelines in Zambia

This study was undertaken as part of a multi-country study to determine providers’ adherence with evidence based tuberculosis (TB) standards and guidelines. This particular study assesses adherence with TB guidelines in Zambia at national, provincial/district and facility-based levels. [adapted from summary]

Developing the National Community Health Assistant Strategy in Zambia: A Policy Analysis

The Ministry of Health in Zambia developed a strategy to integrate community health workers into national health plans by creating a new group of community health assistants. The aim of the paper is to analyse the policy development process and the factors that influenced its evolution and content. [adapted from abstract]

Using Verbal Autopsy to Ascertain Perinatal Cause of Death: Are Trained Non-Physicians Adequate?

This initiative’s objective was to develop a standardized verbal autopsy training program and evaluate whether its implementation resulted in comparable knowledge required to classify perinatal cause of death by physicians and non-physicians. [from abstract]

Barriers to Implementation of the HIV Guidelines in the IMCI Algorithm among IMCI Trained Health Workers in Zambia

Since 2004, health workers that have undergone integrated management of childhood illness (IMCI) case management training have also received training in HIV assessment, but follow-up showed that 97% of the health workers assessed did not review or mention the HIV guidelines even though they had received the training. This study aimed to explore reasons for non-adherence to HIV guidelines in the IMCI algorithm and make recommendations on how this can be improved. [adapted from abstract]

Integrating HIV Treatment with Primary Care Outpatient Services: Opportunities and Challenges from a Scaled-Up Model in Zambia

This paper examines the effect of the integrated model for HIV treatment with other primary care services on the organization of clinic services, and explores service providers’ perceptions of the integrated model. [adapted from abstract]

Assessment of Provider Adherence to TB Evidence-Based Standards and Guidelines in Zambia

This study was undertaken to determine providers’ adherence with evidence based TB standards and guidelines in Zambia at national, provincial/district and facility-based levels. [adapted from summary]

Decision Making among Community-Based Volunteers Working in Vulnerable Children Programs

This study was collected data from caregivers who work directly with vulnerable children to explore how care decisions are made by community-based volunteers, and the utility of the Child Status Index at the community level as a job aid. [adapted from summary]

Measuring Health Worker' Motivation in Rural Health Facilities: Baseline Results from Three Study Districts in Zambia

This study assessed health worker motivation as part of the baseline assessment for a health system strengthening intervention in three rural districts in Zambia by examining underlying issues grouped around relevant outcome constructs such as job satisfaction, general motivation, burnout, organization commitment, conscientiousness and timeliness that collectively measure overall levels of motivation. [adapted from abstract]

Retaining Doctors in Rural Zambia: A Policy Issue

This paper creates awareness of the current human resource crisis that Zambia is facing, taking into account the few doctors serving rural communities in the country; and argues that the main driver of doctors’ exodus out of the country is the search for better conditions of service. The paper presents the advantages and disadvantages of various policy options geared toward stemming the tide of doctors leaving the country, primarily through creating greater incentives for doctors to stay. [from author]

Community Discussion Guide for Maternal and Newborn Health Care: A Training Manual for Safe Motherhood Action Groups

This guide contains detailed guidance on how to train safe motherhood action group volunteers in two key areas of their portfolio – maternal and newborn health care.

Health Worker Perspectives on User Fee Removal in Zambia

Health user fees were introduced in Zambia at the beginning of the 1990s with the objective of improving staff motivation. In 2006, they were removed in view of the poverty levels in the country, the high cost for accessing health services, and the desire to provide universal access. This article examines the perspectives of health workers on the change in policy. [adapted from author]

Health Worker Satisfaction and Motivation: An Empirical Study of Incomes, Allowances and Working Conditions in Zambia

In this study the authors examine the relationship between health worker incomes and their satisfaction and motivation. [from abstract]

Human Resources Productivity Improvement in Zambia

This report summarizes key findings of a stakeholder-driven participatory productivity improvement process. The results of the study also shed light on which interventions may be most appropriate and effective for improving productivity within the Zambian context, and could be implemented on a wider scale within the country. [from summary]

In Zambia: Building Sustainable Capacity through Pre-Service Supply Chain Training

This brief describes an intervention on training pre-service trainers that has helped provide graduating biomedical students with supply chain skills and reduce long-term in-service training costs. [adapted from author]

Improving CHW Program Functionality, Performance and Engagement: Operations Research Results from Zambia

The Community Health Worker Assessment and Improvement Matrix (CHW AIM) was designed to help assess communtiy health worker program functionality and to provide benchmarks against which to measure program improvements. This operations research activity was designed as a field intervention study that applied the CHW AIM process. [adapted from summary]

Evaluation of a Task-Shifting Strategy Involving Peer Educators in HIV Care and Treatment Clinics in Lusaka, Zambia

The purpose of this study was to evaluate patient and staff perceptions regarding whether the peer education program as as part of a task-shifting strategy for HIV care relieved the workload on professional health care workers and delivered services of acceptable quality. [adapted from author]

Provider Purchasing and Contracting for Health Services: The Case of Zambia

The objective of this study was to identify and characterize contracting models that have existed in the Zambian health sector and their consequences on access to health care. The study was aimed at assessing the extent to which the identified contracting models have been successful in achieving their intended goals and at determining their potential to be scaled up to the entire health sector, including the private sector. [from summary]

Impact of Organizational Factors on Adherence to Laboratory Testing Protocols in Adult HIV Care in Lusaka, Zambia

This study investigates how physical space, level of staffing, staff burnout, staff absenteeism, staff experience and facilities’ experience with ART provision are associated with levels of adherence to clinical protocol as part of Zambian HIV care and treatment program. [adapted from author]

Searching for Common Ground on Incentive Packages for Community Workers and Volunteers in Zambia

This study reviews experiences and lessons learned regarding monetary and non-monetary incentives for community workers. It includes indicative costings and recommendations for further policy and development with regard to the effective recruitment, training and deployment of community workers in Zambia. [adapted from summary]

Economic Valuations of Community Health Workers' Recompense in Zambia

The objectives of this study were to estimate the economic value of community health workers (CHW), current CHW’s workload and responsibilities, and to obtain a preliminary understanding of CHWs’ opinions of the role they serve in their communities (job satisfaction) and how these services are viewed by members of their communities. [adapted from summary]