The WHO Representative, Dr. Olusegun Babaniyi visited the Eastern Province Medical Office (PMO) from 12th-15th February 2013. The mission was undertaken to gain a better insight of how health development challenges were being addressed in the province and to identify areas for further collaboration and support through the Technical Cooperation Programme with Government. Dr. Babaniyi was welcomed to the province by the Provincial Minister, Hon. Malozo Sichone (MP), The Permanent Secretary, Mr. Bert Mushala and the Provincial Medical Officer, Dr. Kennedy Malama.

Eastern Province has a total of 9 districts and a total population of 1, 707,731. The free Primary Health Care services policy has been implemented in the province through provision of various promotive, preventive and curative health programmes. The Provincial Medical Office is in charge of 2 2nd level hospitals, 7 1st level hospitals, 8 urban health centres, 156 rural health centres and 53 health posts. There are 8 private surgeries. Despite improvements in the delivery of health services, the province is facing various challenges including a high burden of communicable diseases and an increase in the burden of Non-Communicable Diseases, shortages of essential drugs, inadequate human resources and inadequate infrastructure and equipment.

Major health challenges in the province

• Disease outbreaks are common. Increased cases of measles were reported with a total of 5168 between 2010 and 2011. A total of 521 Anthrax cases and 5 deaths were reported in Chama district in 2011. In 2012 a total of 1316 cases of dysentery were reported, out of the 64 that were investigated, 44 were con-firmed. A total of 7 cases of rabies were confirmed in 2012.
• Eastern Province has a higher incidence of Malaria in the country with 823 in 2010 and 756 in 2011.
• High incidence of HIV/AIDS (10.4%).
• Increased trend in Non-Communicable Diseases (Cancer, Cardiovascular diseases, Chronic Respiratory Diseases and Diabetes Mellitus).
• Maternal Mortality remains high, it was estimated to be 236/100,000 in 2009 and 151/100,000 in 2011.
• Low institutional deliveries (33%).
• Family planning coverage is 162/1000.
• Follow up of mother baby pair in the Prevention of Mother to Child Transmission of HIV is a big challenge.
• Inadequate cold chain facilities at the heath centres.
• Antenatal care attendance remains at 89%, which is below the target of 90% while average antenatal care visits are at 2.8 below the target of 4.
• Erratic vaccine supply especially in the 3rd quarter of 2012.
• Pharmacovigilance remains weak in the province.
• Low operational research levels.

Successes

• Improved human resources for health. Staffing levels have increased from 66% in 2008 to 78% in 2012.
• Improved drug availability from 77% in 2009 to 86% in 2011 due in part to the introduction of the Essential Medicines and Logistics Management Programme
• Increase in ART uptake.
• Reduction in TB notifications from 3171 in 2007 to 2477 in 2012 and increase in TB Cure Rates from 77% to 83% and Treatment Success Rate from 81% to 86% between 2008 and 2011.

Recommendations

• Capacity building for Integrated Disease Surveillance and Response including provision of transport.
• Capacity building for Paediatric ART. 7% of those on ART are children.
• Dissemination of the revised PMTCT guidelines.
• Strengthening integration of TB HIV services to improve initiation of ART of PTB HIV positive patients which is currently at 61%.
• Improved documentation for NCDs and set-ting up of NCDS clinics.
• There is need to scale up male circumcision services.
• Provision of incinerators at health facilities (only 33% coverage) including provision of water testing kits.
• Inclusion of position of the District Surveillance focal person in the establishment.

Dr. Babaniyi was taken on a conducted tour of Chipata General Hospital by Dr. Daniel Makawa, the Acting Hospital Superintendent. Chipata General Hospital caters for a total population of 452,428 for first level ser-vices and 972,648 for second level services. New developments at the Hospital include the establishment of the NCDs Clinics, Intensive Care Unit, Cervical cancer screening and treatment and establishment of a one stop centre for gender-based violence. Dr. Makawa reported a reduction of maternal mortality, reduction of case fatality for malaria and improvement in supplies of essential drugs at the institution. The hospital faces several challenges particularly poor supply of essential drugs by Medical Stores Limited, lack of obstetric and gynaecology theatre in the labour ward, old and obsolete equipment and infrastructure, staff shortages, poor transport facilities and poor water reticulation and sanitation system.

The Provincial Medical Officer, Dr. Malama appealed to WHO for more support to the province. Dr. Babaniyi assured the PMO that WHO remained committed to supporting government particularly in improving immunization programmes; introduction of new vaccines and the expansion of Cold Chain facilities; the scale up of HIV and AIDS prevention and Anti Retroviral Treatment; Voluntary Medical Male Circumcision and Early Infant Male Circumcision, Prevention of Mother To Child Transmission of HIV (PMTCT), the WHO TB Strategy Directly Observed Treatment Short Course (DOTS), Malaria prevention and control, Making Pregnancy Safer, Integrated Management of Childhood Illnesses, and Preparedness, control and response for epidemics and other emergencies. He said that the greatest impact on health could be achieved by strengthening the implementation of these programmes at the district level. Dr. Babaniyi also visited Chipata School of Nursing which was established in 1980. The school provides the enrolled midwifery and registered nurse training programmes since 1987. Recent improvements to the curriculum include paediatric ART, PMTCT and IMCI. Dr. Babaniyi donated a Desktop computer to support Integrated Disease Surveillance and a Blue Trunk Library containing a collection of books on several health topics for reference by health professionals.
 

For More information contact: Nora Mweemba, Health Information and Promotion Officer. GPN Number 37609, Mobile 097873976, WHO Country Office, UN ANNEX BUILDIN Plot 4609, Corner of Andrew Mwenya and Beit Roads, Rhodes Park, P.O. Box 32346, Lusaka, Zambia. E-mail: mweemban [at] zm.afro.who.int (mweemban[at]zm[dot]afro[dot]who[dot]int) Tel No: 00-260-211-255 398 / 255 336 / 255 322 Fax: 00-260-211-252863

Below:

01 The WHO Representative, Dr. Olusegun Babaniyi (centre) with Dr. Kennedy Malama, Provincial Medical Officer, Eastern Province (L) and Dr. Daniel Makawa, Acting Hospi-tal Suprintentent at Chipata General Hospital (R) and WCO and Hospital staff members.

02 (L-R) The Minister For Eastern Province, Hon. Malozo Sichone (MP), The WHO Representative, Dr. Olusegun Babaniyi , Dr. Kennedy Malama, Provincial Medical Officer, Eastern Province and Dr. Peter Songolo, DPC, WHO Country Office.

03 The WHO Representative, Dr. Olusegun Babaniyi donated a desktop computer and a Blue Trunk Library to the Provincial Medical Office.

04 Dr Daniel Makawa, Acting Hospital Superintendent, Chipata General Hospital giving a brief to the Team from WHO.

05 The WHO Representative, Dr. Olusegun Babaniyi with Mrs Joyce Goma, Nurse/Counsellor at the Gender-based violence one stop centre at Chipata General Hospital.

06 Dr. Olusegun Babaniyi at the School of Nursing