Zambia: Neighbourhood Health Committees

• Overview
• Target Audience
• Objectives
• Activities
• Outputs
• Impact
• Future Plans

Overview

Zambia faces many challenges to meet the vision of health reform established by its government in 1991: "equity of access to cost-effective quality health care as close to the family as possible." The Zambia Integrated Health Programme (ZIHP) is an ambitious program developed by USAID in partnership with the Government of Zambia to address the main health problems of the people of Zambia and to continue the process of health reform initiated by the government. Part of the process of health reform includes decentralizing health services by strengthening the provision of local services through District Health Management Teams (DHMTs). Zambia's population of 9.8 million people is linguistically and culturally diverse, with 72 recognized ethnolinguistic groups. More than two-thirds of Zambians are under 25. Major factors contributing to high rates of infant and childhood morbidity and mortality nationwide are malaria, diarrheal disease, and malnutrition. High rates of HIV/AIDS transmission and low contraceptive prevalence rates hinder the realization of productive lives for Zambia's adult population. It is estimated that by 2004, AIDS will account for about 210 deaths per day among 15 to 49 year olds.

According to the Zambia Urban Sexual Behavior and Condom Use Survey (1999), about 25% of men and women surveyed had had sexual intercourse by age 15, and about 75% by age 19. Although 98% of married women know of at least one method of modern contraception, only 14% of married Zambian women are currently using a modern method. Zambia's fertility rate is 6.1 (1996 DHS).

Target Audience

NHCs

Objectives

Zambia Integrated Health Programme (ZIHP's) goal is to improve primary health care services for all Zambians by providing technical assistance to local counterparts in the areas of:

• increasing demand for services;
• increased delivery of services at the community level;
• increased delivery of services by the private sector;
• improved quality through improved health worker performance; and
• improved policies and planning and support systems for the delivery of health care interventions.

Of these goals and objectives, CCP contributes to the first two. The remaining three objectives are those of the other ZIHP partners, Abt Associates, John Snow, Inc. (JSI), and Society for Family Health.

Building the capacity of Neighborhood Health Committees (NHCs) to better coordinate population, health, and nutrition (PHN) interventions at the community level is a critical focus area of ZIHPCOMM; it is a participatory process that allows all stake holders at the community level to gain an appreciation of the need to work together. Hence, the more specific goal for community level activities is:

• To improve the skills and capacity of NHC members to be well informed and skilled health promoters in their communities.

Activities

Training of Trainers (TOT) and Roll Out of the NHC Strengthening Package
Participants from select districts and health centers were trained in the PLA approach for community mobilization skills and the Essential Health Care Package (EHCP) to enhance knowledge in disease prevention.

Distance Education Radio Program
The NHC Distance Education Radio Program for service providers was launched in January 2001 after determining the scope, content and details through a design workshop. Looking at the numbers of NHC members across the country that needed to be trained, radio seemed to be the most logical option in terms of cost-effectiveness. The NHC Distance Education Radio Program, seen as the glue for the whole NHC component, supported NHC members as they moved from the training into roles as community mobilizers. The Distance Education Radio Program for NHC members entitled "Our Neighborhood," is a 6-month, 30-minute per week, repeatable course. The program provided technical updates on both health interventions and community mobilization techniques, and provided on-going support and encouragement, filling some of the gap in supportive supervision. A follow-up radio program was launched, entitled "Community Health with Sister Evelina". This program was a follow-up to those NHC members who already completed the formal distance learning course. This 15-minute program gave NHC members additional health and technical updates, community mobilization tips, and information on current health events.

Health Information Cards and booklets
NHC Health Information Cards were developed as a supplement to those NHC members who registered for the distance education course. The cards are print materials that an NHC member can use for technical updates and for providing ideas on community mobilization around a specific health topic. Cards have already been developed on 16 health-related topics. Nine more cards are being developed.

NHC Rapid Assessment
A rapid assessment exercise was conducted to track the achievements of the NHCs in relation to their planned activities. Data is available for 12 districts.

Operations Research
Operations research activities are conducted to guide and inform the NHC strengthening package. The main objective of the research was to determine which approach is most effective in terms of cost and impact for NHC strengthening and community action for the promotion of health and prevention of diseases.

Outputs

• NHCs formed in 72 districts
• 5,394 participants trained in community partnerships building and PLA approach
• 1,460 NHC Action Plans developed
• Catchment populations of about 2.9 million people reached (about 30% of Zambia's population)
• 26 Distance Education Radio Program episodes have aired for 4, 6-month cycles. 5th round in progress. 5,000 NHC members registered to participate in each round.
• Thirteen episodes of "Community Health with Sister Evelina" (follow-up show to the Distance Education Radio Program) aired per quarter, since June 2001.
• NHC Information cards have been printed and distributed to new NHC listeners on HIV/AIDS, STDs, TB, Birth Preparedness, Family Planning, Danger Signs in Pregnancy, Malaria in Pregnancy, Mother to Child Transmission of HIV/AIDS, Community Drama, and Health Care Financing.
• Rapid assessment data available for 12 districts

Impact

The action plans formulated by the NHC were elevated to form part of the health center and district action plans.

Preliminary findings from supervisory/field visits show positive changes have taken place, such as:

Additional NHCs have been formed,

More community members are willing to join,

Neighborhoods are cleaner,

Demand for CLORIN information on the (water purification product promoted by NHCs) has increased.

Future Plans

Expansion of operations outside of ZIHP supported districts. ZIHP is working with Action Computers and the DHMTs to create a database at the district level for compiling community level activities. This will help determine which NHCs are active, what activities they are doing, and what levels of training they have achieved in the Essential Health Care Package and Participatory Learning and Action (PLA) techniques.

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