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MAIN REPORT Mapping of Health Links in the Zambian Health

VIEWS: 10 PAGES: 94

									Tropical Health and Education Trust                                            Ministry of Health
UNITED KINGDOM                                                                       ZAMBIA




                                  MAIN REPORT

              Mapping of Health Links
  in the Zambian Health Services and Associated
 Academic Institutions under the Ministry of Health




                                      Submitted to:

                               The Executive Director
                     Tropical Health and Education Trust (THET)
                        210 Euston Road, London NW1 2BE
                                 UNITED KINGDOM

                                          and

                             The Permanent Secretary
                                 Ministry of Health
                         Ndeke House, Haile Selassie Avenue
                               PO Box 30205, Lusaka
                                      ZAMBIA




August 2007                                                           CAN Investments Limited
                                                                      26 Wusakili Crescent, Northmead
                                                                        PO Box 39485, Lusaka, Zambia
                                              Tel/Fax: 260-1-230418, E-mail: can_investments@yahoo.co.uk
                                                                                                                            MAIN REPORT
               The Tropical Health and Education Trust                                      Mapping of Health Links in the Zambian Health
               In conjunction with                                                          Services and Associated Academic Institutions
               The Ministry of Health of Zambia                                                               under the Ministry of Health



 CONTENTS                                                                                                                                        PAGE

 ACRONYMS USED ................................................................................................................................... III
 FOREWORD AND ACKNOWLEDGEMENTS.......................................................................................V
 1       EXECUTIVE SUMMARY..................................................................................................................1
     1.1         INTRODUCTION..............................................................................................................................1
     1.2         METHODOLOGY AND APPROACH ..................................................................................................1
     1.3         EXISTING HEALTH LINKS ..............................................................................................................1
     1.4         POTENTIAL AREAS FOR FUTURE LINKS .........................................................................................2
     1.5         PROPOSED PROCESS FOR IDENTIFYING FUTURE LINKS ..................................................................3
     1.6         CONCLUSION .................................................................................................................................3
 2       CONTEXT............................................................................................................................................4
 3       BACKGROUND ..................................................................................................................................5
     3.1         INTRODUCTION..............................................................................................................................5
     3.2         DEFINITION OF LINKS ....................................................................................................................6
     3.3         THE TROPICAL HEALTH AND EDUCATION TRUST .........................................................................6
     3.4         METHODOLOGY AND APPROACH ..................................................................................................7
     3.5         PROBLEMS ENCOUNTERED ............................................................................................................9
 4       THE HEALTH DELIVERY SYSTEMS IN ZAMBIA...................................................................10
     4.1         DEMOGRAPHIC AND SOCIAL-ECONOMIC CONTEXT .....................................................................10
     4.2         ORGANISATION AND MANAGEMENT ...........................................................................................11
     4.3         MAIN PROBLEMS AND CONSTRAINTS ..........................................................................................16
     4.4         THE HUMAN RESOURCE CRISIS...................................................................................................17
     4.5         SECTOR STRATEGY AND PRIORITIES ...........................................................................................20
     4.6         SECTOR PERFORMANCE ..............................................................................................................21
 5       EXISTING HEALTH LINKS...........................................................................................................23
     5.1         OVERVIEW ..................................................................................................................................23
     5.2         PROVINCIAL HEALTH OFFICES AND DISTRICT HEALTH MANAGEMENT TEAMS ..........................23
     5.3         CENTRAL HOSPITALS (“3RD LEVEL HOSPITALS”).........................................................................24
     5.4         PROVINCIAL AND DISTRICT HOSPITALS (1ST AND 2ND LEVEL HOSPITALS) ...................................32
     5.5         HEALTH CENTRES AND HEALTH POSTS.......................................................................................39
     5.6         HEALTH TRAINING INSTITUTIONS ...............................................................................................39
     5.7         STATUTORY BOARDS AND OTHER UNITS ....................................................................................40
 6       POTENTIAL AREAS FOR FUTURE HEALTH LINKS..............................................................45
     6.1         OVERVIEW ..................................................................................................................................45
     6.2         GENERIC POTENTIAL AREAS FOR FUTURE LINKS ........................................................................45
     6.3         PROVINCIAL AND DISTRICT HEALTH MANAGEMENT LEVEL .......................................................46
     6.4         HOSPITALS AT ALL LEVELS .........................................................................................................46
     6.5         HEALTH CENTRES AND HEALTH POSTS.......................................................................................48
     6.6         HEALTH TRAINING INSTITUTIONS ...............................................................................................48
     6.7         STATUTORY BOARDS ..................................................................................................................49
 7       PROPOSED PROCESS FOR IDENTIFICATION OF FUTURE LINKS ...................................52




August 2007                                                                   i                                           CAN Investments Limited
                                                                                                                                  Lusaka, Zambia
                                                                                                                         MAIN REPORT
               The Tropical Health and Education Trust                                   Mapping of Health Links in the Zambian Health
               In conjunction with                                                       Services and Associated Academic Institutions
               The Ministry of Health of Zambia                                                            under the Ministry of Health




 8      APPENDICES ....................................................................................................................................53
     APPENDIX I: TERMS OF REFERENCE ........................................................................................................1
     APPENDIX II: TRENDS FOR TOP 10 MAJOR DISEASES IN ZAMBIA, 2000-2006 ..........................................1
     APPENDIX III: STAFFING LEVELS AND WORKLOADS.................................................................................3
     APPENDIX IV: DISTRIBUTION OF CORE HEALTH WORKERS BY PROVINCE ...............................................5
     APPENDIX V: CONSOLIDATED LIST OF EXISTING LINKS ..........................................................................1
     APPENDIX VI: LIST OF INSTITUTIONS AND PERSONS INTERVIEWED .........................................................1
     APPENDIX VII: LIST OF DOCUMENTS/LITERATURE CONSULTED ...............................................................1
     APPENDIX VIII: REPORTS/FEEDBACK FROM LINK PARTNERS ....................................................................3




August 2007                                                                ii                                         CAN Investments Limited
                                                                                                                              Lusaka, Zambia
                                                                                              MAIN REPORT
              The Tropical Health and Education Trust         Mapping of Health Links in the Zambian Health
              In conjunction with                             Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                  under the Ministry of Health



 ACRONYMS USED

 Acronym used                           Definition

 AU                                     African Union
 The Consultant                         CAN Investments Limited
 CBOH                                   Central Board of Health
 Chainama                               Chainama Hills Hospital and College for Health Sciences
 CHAZ                                   Churches Health Association of Zambia
 COMESA                                 Common Market for East and Southern Africa
 CPs                                    Cooperating Partners
 DRC                                    Democratic Republic of Congo
 DTSS                                   Director of Technical Support Services
 DHMT                                   District Health Management Board
 DHMBs                                  District Health Management Boards
 DHMTs                                  District Health Management Teams
 FNDP                                   Fifth National Development Plan
 FNDP                                   Fifth National Development Plan
 GNCZ                                   General Nursing Council of Zambia
 Global Fund                            Global Fund against HIV/AIDS, TB and Malaria
 HCs                                    Health Centres
 HMIS                                   Health Management Information System
 HPs                                    Health Posts
 HSSP                                   Health Services Support Program
 HIPC                                   Highly Indebted Poor Countries
 HIPC                                   Highly Indebted Poor Countries
 HMBs                                   Hospital Management Boards
 HMTs                                   Hospital Management Teams
 HIV/AIDS                               Human Immuno-Deficiency Virus/Acquired Immunity
                                        Deficiency Syndrome
 HR                                     Human Resources
 HR Plan                                Human Resources for Health Strategic Plan
 CPs                                    International Cooperating Partners
 JLI                                    Joint Learning Initiative on Human Resources for Health
                                        and Development
 Links                                  Long-term International Health Links
 MMR                                    Maternal Mortality Ratio
 MCZ                                    Medical Council of Zambia
 MTEF                                   Medium Term Expenditure Framework
 MDGs                                   Millennium Development Goals
 MOH or the Ministry                    Ministry of Health
 M&E                                    Monitoring and Evaluation
 NDP                                    National Development Plan
 NHSP                                   National Health Strategic Plan
 NHSP 2006/10                           National Health Strategic Plan 2006/10
August 2007                                             iii                        CAN Investments Limited
                                                                                           Lusaka, Zambia
                                                                                              MAIN REPORT
              The Tropical Health and Education Trust         Mapping of Health Links in the Zambian Health
              In conjunction with                             Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                  under the Ministry of Health

 NHSP                                   National Health Strategic Plan 2006-10
 PRA                                    Pharmaceutical Regulatory Authority
 PRSP                                   Poverty Reduction Strategy Paper
 PRSP                                   Poverty Reduction Strategy Paper
 PHO                                    Provincial Health Office
 STIs                                   Sexually Transmitted Infections
 SADC                                   Southern African Development Community
 SAP                                    Structural Adjustment Programme
 SAP                                    Structural Adjustment Programme
 ToRs                                   Terms of Reference
 Zambia or the Government               The Government of the Republic of Zambia
 TDRC                                   Tropical Disease Research Centre
 THET                                   Tropical Health and Education Trust
 TB                                     Tuberculosis
 UK                                     United Kingdom
 UN                                     United Nations
 USA                                    United States of America
 USA                                    United States of America
 UNZA                                   University of Zambia
 UTH                                    University Teaching Hospital
 UTH                                    University Teaching Hospital
 ZHIP                                   Zambia Integrated Health Programme
 ZNBTS                                  Zambia National Blood Transfusion Service
 ZNFDS                                  Zambia National Flying Doctor Services




August 2007                                             iv                         CAN Investments Limited
                                                                                           Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 FOREWORD AND ACKNOWLEDGEMENTS

 Zambia is currently faced with the challenge of achieving the Millennium Development
 Goals (“MDGs”) by 2015 and national health priorities. Even though the country has
 shown commitment to this aim, there are a number of significant problems and
 constraints, undermining its efforts. These problems are diverse and require concerted
 efforts by all the main stakeholders.

 The country has identified “partnerships” as one of the key strategies for addressing some
 of its problems and constraints, and has embarked on the process of strengthening
 partnerships with all the key stakeholders, including the communities, the private sector,
 the civil society and the international community. In this respect, one type of
 partnerships that has been identified is the establishment of international health links
 (“Links”) between the public health service and training institutions in Zambia, with their
 counterpart institutions in other countries. Even though currently there are just a few
 institutions benefiting from Links, it is generally recognized that Links provide
 significant opportunities for meaningful and sustainable improvements in the health
 sector.

 The mapping of Links is considered as the first step towards the establishment of an
 appropriate strategic framework for the promotion, planning, coordination and
 management of the Links, to ensure that full benefits are derived. It is also considered as
 the beginning of a long-term partnership between the Zambian Ministry of Health
 (“MOH”) and the Tropical Health and Education Trust (“THET”) of the United Kingdom
 (“UK”).

 Even though this assignment was complex and challenging, I am pleased to note that,
 through our joint efforts, it has been successfully completed. In this regard, I wish to take
 this opportunity to acknowledge, with thanks, all the people and institutions that
 contributed to this process. Special thanks go to: Dr. S K Miti, Permanent Secretary,
 MOH, for providing leadership to this process, and Nicholas Chikwenya, for coordinating
 the assignment; members of the counterpart team from THET; and CAN Investments
 Limited, led by Alex Chikwese, who were the consultants on this assignment. Last, but
 not the least, I wish to thank all the Zambian health service and training institutions, and
 the international Links partners which participated in this mapping.

 I thank you all.


 Dr. David Percy
 Director of Health Strategy
 Tropical Health and Education Trust

 August 2007

August 2007                                             v                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 1     EXECUTIVE SUMMARY

 1.1   Introduction

 The Zambian health sector is faced with the challenge of achieving the health related
 MDGs and National Health Priorities. At the same time, the sector is inundated with
 significant problems and constraints, particularly the human resource crisis, which is
 significantly undermining its performance.

 In their efforts to find solutions to some of these problems, some health service and
 training institutions have established Links with counterpart institutions abroad, which
 have provided opportunities for capacity building, staff training, technical exchange
 programmes and material support to these institutions. However, most of these Links are
 not properly coordinated at both the institution and sector levels, and do not therefore
 fully address the sector priorities. In view of the foregoing, MOH has entered into a
 strategic partnership with THET to develop an appropriate strategic framework for the
 promotion, coordination and management of the Links, so as to focus them at sector
 priorities and realize their full potential.

 Given this background, THET, in conjunction with MOH, engaged CAN Investments
 Limited, a Zambian registered management consulting firm, to conduct a mapping of the
 existing Links between the public health service and training institutions in Zambia, and
 their counterpart institutions in other countries. This report presents the findings of the
 mapping and recommendations on the potential areas for future Links.

 1.2   Methodology and Approach

 The methodology and approach adopted for this assignment involved:

      Breaking down the assignment into the following phases: project inception; desk
       review and requirements definition; field visits and feedback from existing Links;
       and reporting;
      Visiting and contacting a large number of health service and training institutions
       throughout the country; and
      Designing and application of an interview tool/questionnaire, which was used for
       structured interviews during the field visits.

 1.3   Existing Health Links

 The mapping established and confirmed the following:

      The concept of Links is not widely understood and applied by most health service
       and training institutions within the public health sector in Zambia;


August 2007                                             1                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



       Some public health service and training institutions in Zambia have successfully
        established Links with international counterpart organizations from various
        countries;
       The Links are mainly concentrated at a few institutions, while majority of the
        institutions do not have any Links. The institutions identified with the highest
        numbers of Links include:
         The University of Zambia (“UNZA”) School of Medicine, together with its
              associated hospital, the University Teaching Hospital (“UTH”);
         The Chainama Hills Hospital and College for Health Sciences (“Chainama”)
              in Lusaka;
         St. Francis Mission Hospital in Katete, Eastern Province;
         Chilonga Mission Hospital in Mpika, Northern Province; and
         Monze Hospital in the Southern Province;
       Most of the hospitals, including Ndola Central Hospital, Kitwe Central Hospital and
        Arthur Davison Children's Hospital, which are among the four largest hospitals in
        the country, have never had any Links; and
       Currently, there is no framework to guide and promote the targeting, establishment,
        coordination, monitoring and evaluation of the Links, particularly at sector level.

 1.4     Potential Areas for Future Links

 All the institutions visited by the mapping team acknowledged the importance of Links
 and expressed interest in developing appropriate Links with counterpart institutions in the
 UK and other countries. On the other hand, most of the major problems faced by these
 institutions are similar, and as such, the potential areas for future Links are mostly
 generic. In this respect, the following have are identified as the potential areas for
 focusing future Links:

      Technical exchange programmes involving staff at various levels, particularly in
       specialized core areas, aimed at providing knowledge and skills transfer;
      Short and long-term secondment of consultants and other experts in specialized areas,
       with emphasis on core service areas at every level, on a gap filling basis;
      Staff training and capacity building for both medical, technical and support staff,
       through short and long-term training programmes, including:
        Short-term training programmes conducted by visiting professors and experts
           from Link partners, in specialized areas; and
        Scholarships for medium and long-term training;
      Collaboration in research and development activities;
      Support to systems development in technical fields, including core health
       programmes, supervision, and monitoring and evaluation;




August 2007                                             2                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



      Support to knowledge sharing and continuing education, through the provision of e-
       learning opportunities and promotion of the use of modern ICTs, including
       facilitation of internet connectivity, internet-based knowledge exchange with the
       British National Formulary and other international sources of essential medical
       journals and publications;
      Specialist support to repairs and maintenance of medical equipment. Currently, there
       are no in-house expertise in this area, resulting into frequent breakdowns and pre-
       mature write-offs of various equipment; and
      Material support in identified priority areas, including infrastructure development,
       equipment and auxiliaries, drugs and medical supplies, and other forms of material
       support, on a gap filling basis.

 Actual scoping of focus areas for each individual institution should be based on the
 priorities and status of the particular institution, and on gap filling basis.

 1.5     Proposed Process for Identifying Future Links

 In order to improve the coordination and management of Links, it is proposed that the
 process of identifying priority areas for Links should be linked to the health sector
 planning process and be aligned to the national health strategic plan. The process should
 form part of the each institution’s medium term expenditure framework (“MTEF”) and
 annual action planning process. Further, implementation of Link activities should be
 managed in a transparent and accountable manner, and captured under the monitoring and
 evaluation arrangements, which are in practice within MOH and the respective
 institutions.

 1.6     Conclusion

 Even though the concept of Links has not been widely understood and applied in the
 Zambian health sector, some institutions have established significant numbers of Links.
 It is generally acknowledged that, if properly planned and managed, Links provide
 significant opportunities for health sector strengthening and capacity building, for long-
 term sustainable development. All the institutions which participated in the mapping
 expressed their interest in developing Links. The mapping provides a sound basis for the
 development of an appropriate strategic framework for planning, coordination and
 management of Links, which is urgently needed for the sector to realize full benefits from
 the Links.




August 2007                                             3                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 2    CONTEXT

 The Zambian health sector is faced with the challenge of achieving the health related
 MDGs and National Health Priorities, aimed at improving the standards of health service
 delivery and health status of the people throughout the country. At the same time, the
 sector is inundated with significant problems and constraints, including: a high and
 complex disease burden; the human resources crisis, with critical shortages of qualified
 health workers at all levels of health service delivery; erratic supply of drugs and medical
 supplies; poor conditions of infrastructure, particularly in rural areas; and shortages of
 transport and communication.

 The country has identified the human resources crisis in the health sector as one of the
 most significant factors undermining its efforts to improve health service delivery, and
 also a major obstacle to achieving the MDGs and national health priorities. In order to
 address this crisis, the Government has developed a five year Human Resources for
 Health Strategic Plan 2006/10 (“HR Plan”). It has also prioritised human resources in the
 National Health Strategic Plan 2006/10 (“NHSP 2006/10”) and the Fifth National
 Development Plan (“FNDP”).

 One of the key strategies identified in the HR Plan is the need to establish and strengthen
 partnerships with key stakeholders, including the need to develop new and strengthen the
 existing long-term Links between the Zambian health service delivery and associated
 training institutions, and their counterpart institutions from other countries, particularly
 the developed countries. Such Links are expected to significantly contribute to the
 mitigation of the impact of the human resources crisis and the other major problems and
 constraints affecting the health sector, through various initiatives, including technical
 exchange programmes, training and capacity building for health personnel, material
 support to individual health service and training institutions, and other means.

 In line with this strategy, in January 2007, the MOH established a strategic partnership
 with THET, the coordinating body for international Links in the United Kingdom
 (“UK”). Under this partnership, THET would facilitate the promotion and establishment
 of appropriate, efficient and effective Links between hospitals and health training
 institutions in the Zambian public health sector, with their counterparts in the UK and
 other developed countries. In this respect, THET, in collaboration with MOH, engaged
 CAN Investments Limited (“Consultant”), to conduct a mapping of existing Links and
 identify potential areas that would require new Links. This exercise is expected to form
 the basis for the development of a strategic framework to guide and facilitate the efficient
 and effective promotion, coordination and management of the Links, in line with the
 priorities set out in the HR Plan, NHSP 2006/10 and FNDP.

 This report presents the findings, observations and recommendations of the mapping
 assignment, conducted between February 2007 and August 2007. The report has been
 prepared in line with the guidelines provided in the terms of reference for this
 assignment.
August 2007                                             4                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 3     BACKGROUND

 3.1     Introduction

 The global community is currently faced with a critical shortage of qualified health
 workers, which is adversely affecting health service delivery and undermining the efforts
 to achieve the MDGs in the developing poor countries. In 2004, the Joint Learning
 Initiative on Human Resources for Health and Development (“JLI”), which is a
 collaborative effort of more than 100 experts, estimated the global shortage of human
 resources for health at 4 million doctors, nurses and midwives (J Ambulatory Care
 Manage, Vol. 29, No. 1, 2006, pp. 98-100). The crisis is reported to have been most
 severe in Sub-Saharan Africa, where shortages of core health workers was estimated at 1
 million, representing approximately two times the core health workers currently in
 posting. While the crisis is attributed to several factors, such as the low outputs from
 health training institutions and the increased mortality levels among health workers due
 to HIV/AIDS, migration of health workers from these countries to richer countries is by
 far the biggest problem. It is estimated that during 2002/2003 alone, more than 3,000
 nurses from Ghana, Kenya, Nigeria, South Africa, Zambia and Zimbabwe were registered
 to practice in the UK (Buchan and Dolvo, 2004).

 In Zambia, the shortage of appropriately qualified health workers has since reached a
 severe crisis and is a serious obstacle to the country’s efforts to implement the MDGs and
 national health priorities, in line with the NHSP 2006/10, the FNDP and Vision 2030.
 This crisis is largely attributed to:

      The poor terms and conditions of service in the public health sector, which have led
       to migration of core health workers from the public health institutions to the private sector
       within the country, and overseas, mostly to the UK, Australia, New Zealand and the United
       States of America (“USA”);
      The high mortality levels among core health workers, due to HIV/AIDS;
      The impact of the HIV/AIDS epidemic on the disease burden, consequently increasing the
       workloads for core health workers; and
      The dwindling outputs at the various health training institutions.

 The most affected facilities are secondary and tertiary level hospitals, which have lost both
 qualified and experienced consultants, doctors, nurses and other paramedics. Training
 institutions have equally been affected, through the migration of lecturers and tutors in
 search of better conditions of service. In its efforts to address the crisis, the Ministry is
 employing various approaches, including the recruitment of doctors from overseas and
 establishment of Links. In this respect, in 2005, approximately 44% of the doctors in
 post were non-Zambians. Further, managers at some health facilities and training
 institutions have established Links between their respective institutions and counterpart
 institutions abroad.


August 2007                                             5                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 Through such Links, medical experts from foreign countries have visited hospitals and
 training institutions to provide services, teaching or service development, material and
 technical support, on a gap filling basis. There have also been some reciprocal teaching
 visits and attachments by Zambian staff overseas. While such Links have resulted in
 transfer of knowledge and skills to health workers in Zambia, and capacity building for
 the affected institutions, there are concerns that such efforts might have resulted in
 fragmentation and duplication of efforts by the parties. In most cases, such Links have
 been through individual efforts and have not fully addressed the priority areas requiring
 capacity building within the respective health institutions.

 Given this background, MOH has identified the need to improve the management,
 coordination, monitoring and evaluation of the Links, through the identification of
 already existing Links and using a holistic approach to identifying areas and institutions
 requiring capacity building, in line with the NHSP 2006/10 and the HR Plan. In this
 respect, MOH in partnership with THET, has identified the need to conduct a mapping of
 Links in the Zambian health service delivery and associated training institutions under the
 Ministry, which would form the basis for the development of the strategic framework to
 facilitate appropriate coordination and management of the Links.

 3.2   Definition of Links

 Links are generally understood as long-term partnerships between health institutions in
 less developed countries and their counterpart institutions overseas. The primary aim of
 the Links is to strengthen health care by supporting the development of skills of health
 care workers, and strengthening health care systems and processes. Health institutions
 involved in Links are initially hospitals, but often also involve their associated academic
 training institutions – medical, nursing and allied health professional schools – to address
 curriculum and faculty needs. Fully developed Links are interdisciplinary, and
 responsive to priorities determined by the partner based in the less developed country.
 This makes them relevant to the local context and sustainable in the long run (Extract
 from: THET, An Introduction to International Health Links).

 3.3   The Tropical Health and Education Trust

 THET is a UK based coordinating body for Links, with over 15 years experience in
 supporting Links. It is an independent charity supported by international partners,
 volunteers, several donors and the UK Government. THET’s vision is to facilitate the
 development of Links between UK health institutions, their associated academic partners,
 such as medical, nursing and allied health professional schools in the UK universities,
 and equivalent health care institutions in other parts of the world (Extract from THET’s
 website, thet.org.uk). Currently, THET’s main support is concentrated in Ethiopia,
 Ghana, Malawi, Uganda and Somalia. They also provide advice and guidance to UK
 Links in other least developed countries [as defined by the UN] and countries with a
 critical shortage of health workers [as defined by the WHO 2006 World Health Report].

August 2007                                             6                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 3.4     Methodology and Approach

 In order to fully address the TORs (See Appendix I) and ensure high quality deliverables,
 the methodology and approach adopted involved breaking down the assignment into the
 following phases:

 3.4.1       Project Inception

 The primary objective of the inception stage was to provide the Consultant with an
 opportunity to clearly understand the assignment, scope the work, develop and agree with
 THET and MOH on the project work plan, methodology/approach and coordination of
 the assignment, and also to complete the administrative formalities for the assignment.
 This phase culminated into the inception report, submitted by the Consultant at the
 commencement of the assignment.

 3.4.2       Desk Review and Requirements Definition

 This phase was intended to help the Consultant to fully appreciate the background and
 context of the assignment, the health sector, the extent of the human resources crisis and
 also to determine the requirements for the assignment. The main tasks included:

 a)      Identification and collection of the relevant data and information. A list of the
         documents collected and consulted is provided at Appendix VII. These included:

           Information on THET and the Links, particularly on its mandate, objectives and
            activities, and the concept of Links and how they operate. This involved
            reviewing the available documentation on THET obtained from MOH and
            through searching on the internet, particularly on the THET website;
          Information on the public health sector and the human resources crisis. Key
            documents collected and reviewed included the 2000 National Census Report,
            FNDP, NHSP 2006/10, HR Plan, Mid-Term Review report, list of health
            facilities in Zambia, Health Facilities Mapping Report 2006, Joint Annual
            Review Reports for 2005 and 2006, and Annual Action Plans and Progress
            Reports for 2006 for MOH head office and the health facilities covered by the
            mapping; and
          Other documents included local and international papers on the human
            resources for health situation in the world and in Zambia, and other relevant
            documents obtained from MOH and other sources;
 b)      Review of these documents to establish the current situation and determine the
         requirements; and
 c)      Identification of critical issues and impediments, and proposing the way forward.




August 2007                                             7                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 3.4.3   Field Visits and Feedback from Existing Links

 Extensive field visits were conducted, covering all the nine provinces of Zambia. In this
 respect, a total of 68 facilities were visited, comprising: 27 hospitals, 21 health training
 institutions, 4 statutory boards and 24 other health related institutions, to collect
 information on the human resource situation, existing Links and the need for new Links.
 A list of facilities surveyed is provided at Appendix VI. The main tasks included the
 following:

    Reviewed the list of hospitals and health training institutions, and identified the
     facilities to be visited and those to be just contacted in writing, including their
     locations and contact details. This was later discussed and agreed with MOH;
    Designed a standard questionnaire for circulation to all the hospitals and health
     training institutions in the public health sector. A letter requesting for appointments
     was sent out to the targeted facilities, with the questionnaire and letter of introduction
     from the Permanent Secretary of MOH;
    Carried out physical site visits to the targeted facilities to discuss the Links and
     collect relevant data. Discussions with these facilities took the form of semi-
     structured interviews. The documents collected included corporate profiles, actions
     plans, progress reports, reports on the past and existing Links and other documents
     relevant to this assignment;
    Sent out a letter, together with the questionnaire and letter of introduction from the
     Permanent Secretary, to the facilities that were not going to be visited, requesting for
     written submissions; and
    Identified foreign institutions involved in the existing Links, the nature of their links
     and their contact details. Wrote to these institutions, via e-mail, requesting feedback
     on their involvement and evaluation of their Links. Also searched the websites of
     some of these Links, to obtain more information.

 3.4.4   Reporting

 During the course of this assignment, three reports were prepared and submitted to MOH
 and THET, as follows:

    Inception report, which was submitted at the beginning of the assignment and
     provided the roadmap for this assignment;
    Draft main mapping report, describing the process, findings and recommendations.
     Submitted for review and comments; and
    This final version of the main mapping report, which has taken into account the
     comments and corrections obtained from all the reviewers.




August 2007                                             8                        CAN Investments Limited
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              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 3.5     Problems Encountered

 During the course of this assignment, a number of challenges were encountered which
 had an impact on the conduct of the assignment. The major ones included:

 3.5.1    Field Visits

 The TORs required the Consultant to contact all the hospitals and health training
 institutions under MOH, in both urban and rural areas. Considering the vastness of the
 country and the accompanying physical barriers, including poor conditions of the roads in
 most of the rural areas, it was not feasible to physically visit all these facilities within the
 duration of this consultancy. In this respect, the Consultant and MOH had to agree on the
 list of facilities to be physically visited, while the rest of the facilities were to be
 contacted in writing and/or by telephone.

 Securing appointments for the visits also presented some difficulties. In some cases, the
 appointments were rescheduled several times, resulting in significant delays. Further, in
 most cases, documentation on the existing Links was not available, particularly regarding
 the scope of activities covered, quantification of the support provided and evaluation of
 the Links.

 3.5.2    Written Feedback from the Facilities

 Feedback from institutions which were not visited was generally poor. Most of them did
 not respond.

 3.5.3    Feedback from the Links

 Contacting those identified to have Links with Zambian health sector institutions also
 presented its own challenges. Whilst some institutions provided us with contact details of
 their Links, others did not have such information. This made it difficult to contact these
 contacts, which made us resort to internet searches. This led to significant delays.
 However, not withstanding these problems a number of Link partners responded. Some
 of these reports are provided at Appendix VIII.




August 2007                                             9                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 4     THE HEALTH DELIVERY SYSTEMS IN ZAMBIA

 4.1    Demographic and Social-Economic Context

 Zambia is a landlocked country located in the southern part of Sub-Saharan Africa. It
 covers approximately 752,614 square kilometres and shares borders with eight countries,
 namely, Tanzania and the Democratic Republic of Congo (DRC) in the north, Malawi
 and Mozambique in the east, Zimbabwe, Botswana and Namibia in the south, and Angola
 in the West. Zambia is a former colony of Great Britain and a member of a number of
 international and regional social-economic groupings, including the Commonwealth,
 United Nations (“UN”), African Union (“AU”), Southern African Development
 Community (“SADC”), and Common Market for East and Southern Africa
 (“COMESA”). The capital city is Lusaka and the official language of communication is
 English.

 The population is currently estimated at 11.7 million people (UNAIDS, 2006) and
 distributed equally at 50% males and 50% females. The average annual population
 growth rate is 2.7% and life expectancy at birth is at 47.5 years for males and 51.7 years
 (CSO, 2000). The country is sparsely populated, with an average population distribution
 rate of 16 people per square Kilometre, and a high dependency ratio, with 47% of the
 total population being under the age of 15 years, and 38% of the population living in
 urban areas. All these factors present significant obstacles and challenges to social-
 service delivery.

 Currently, Zambia is among the Sub-Sahara African countries faced with significant
 social-economic challenges, including a weak economy, high poverty levels and weak
 social service delivery systems, particularly in the rural areas. The country is now listed
 among the least developed countries, with an overall poverty incidence rate of 67% and
 72% of its rural population classified as being in extreme poverty. The health sector is
 challenged by various factors, including a high and complex disease burden, compounded
 by: the high incidence of malaria, HIV/AIDS and other epidemics; critical shortages of
 qualified health workers; erratic supply of essential drugs and medical supplies; under-
 developed infrastructure, particularly transport and communication infrastructure in rural
 areas; and inadequate funding for basic health care services.

 Notwithstanding this difficult situation, the country is committed to significantly improve
 its social-economic condition, including the standards of living and health status of its
 people. In this regard, the country has made commitments to several regional and
 international initiatives focused at social-economic development, including the MDGs,
 the Highly Indebted Poor Countries (“HIPC”) initiative, and the Abuja and Maputo
 Declarations on health. The country, in collaboration with its international cooperating
 partners (“CPs”), has also initiated various local initiatives aimed at ensuring meaningful
 and sustainable social-economic development, which have included: the Structural
 Adjustment Programme (“SAP”); the Poverty Reduction Strategy Paper (“PRSP”); the
 FNDP and Vision 2030 and the NHSP 2006/10.
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              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
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              The Ministry of Health of Zambia                                 under the Ministry of Health



 However, even with all these initiatives and the associated significant achievements, the
 health sector is still faced with significant constraints and challenges, requiring concerted
 efforts and collaborative actions by the Government and other key stakeholders,
 including need to further strengthen collaboration with both local and international
 partners for development.

 4.2     Organisation and Management

 4.2.1    Overview

 Since 1992, the Zambian health sector has been undergoing comprehensive reforms,
 aimed at enhancing the capacity of the sector to significantly improve health service
 delivery and health standards of the people. These reforms included organizational and
 management restructuring, based on the principles of decentralization and partnership,
 aimed at devolving key management responsibilities and resources to district level, and
 strengthening broader participation in the management of public health services. This
 was addressed through the establishment of three important mutually complementary
 organization structures, namely:

      The MOH head office, responsible for policy formulation, supervision, monitoring
       and evaluation of the whole sector;
      A structure providing for popular public participation, responsible for policy
       interpretation, decision-making and control of health service delivery at various
       levels. This structure included: the Central Board of Health (“CBOH”) board, at
       national level; District Health Management Boards (“DHMBs”), at district level;
       Hospital Management Boards (“HMBs”), at hospital level; and Neighbourhood
       Health Committees and Health Centre Committees, at community level; and
      A structure providing for efficient and effective management and technical
       implementation of service delivery. This structure was intended to ensure that health
       services are managed and implemented in a technically competent manner and
       conform to best practices. The structure included: management teams at MOH and
       CBOH, at national level; Provincial Health Offices (“PHOs”), at provincial level;
       District Health Management Teams (“DHMTs”), at district level; and Hospital
       Management Teams (“HMTs”), at hospital level.

 To provide for efficient and effective support and regulatory services to the core health
 service delivery facilities, the Government also established two types of statutory boards,
 the service and statutory boards.

 However, following over 12 years of implementation of these reforms, the government
 identified a number of weaknesses associated with the established organization and
 management system. The main weaknesses and problems included the observed
 duplication of some roles and responsibilities among the MOH and CBOH head offices,


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              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
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              The Ministry of Health of Zambia                                 under the Ministry of Health



 at national level, and the obstacles related to the huge financial outlays required for
 separation of employees transferred from the civil service to the new structures, as they
 were expected to enter into direct employment contracts with their respective boards.

 In this respect, since 2005, the public health sector has been undergoing another major
 restructuring, which has led to the dissolution of the CBoH, together with the hospital and
 district health management boards. Under this new arrangement, the functions of MOH
 and CBOH at the top, have been merged and the management and control of all state-
 owned health facilities and services is now directly under MOH, through the Provincial
 Health Offices. However, in order to ensure continued popular public participation in the
 management of health services, the hospital and district management boards are being
 replaced with advisory councils, while the hospital and district management teams have
 been maintained. The restructuring process has now reached its final stages.

 4.2.2   Health Sector Structure

 The health sector in Zambia is liberalized and comprises of three types of service
 providers, namely, state-owned health facilities, faith-based health facilities, under the
 coordination of the Churches Health Association of Zambia (“CHAZ”), and the private
 sector.

 4.2.2.1 State-Owned Health Facilities

 The public health sector combines state-owned and faith-based health facilities.
 However, the organization and management of faith-based health facilities is discussed
 separately in Section 4.2.1.2 below.

 Most state-owned facilities are owned and controlled by MOH, with a few falling under
 the Ministry of Defence and Ministry of Home Affairs. The Ministry of Defence has
 only one hospital, the Maina Soko Military Hospital in Lusaka, and a few clinics located
 at the various military locations around the country. On the other hand, the Ministry of
 Home Affairs does not operate any hospitals, but has some clinics at their police and
 prison service stations. State-owned health facilities under MOH are located in all the 72
 districts of the country and include 3rd Level hospitals, 2nd Level hospitals, 1st Level
 hospitals, health centres (“HCs”) and health posts (“HPs”).

 4.2.2.2 Faith-Based Health Sector

 Faith-based health facilities are owned by various religious organisations, predominantly
 Christian organizations from different denominations and countries. These facilities are
 spread across Zambia, mainly in rural areas, and include 31 hospitals, 69 rural health
 centres and 25 community-based organisations. Administratively, these facilities are
 independently managed by their respective sponsors.


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              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 However, in order to provide for appropriate technical support and coordination, they are
 organized under the Churches Health Association of Zambia (“CHAZ”), which is an
 inter-denominational non-governmental umbrella organisation for Christian church health
 facilities in Zambia. It is the second largest provider of health care services in Zambia,
 after the Government, and currently contributes 30% of the overall health care services in
 Zambia, and 60% in rural health areas.

 Although these facilities are owned and managed by their respective sponsoring faith-
 based organizations, they provide free medical care services to the general public, and
 supplement the Government’s efforts. These facilities are officially recognized as public
 facilities and are therefore provided with Government grants for staff salaries and
 operations. They also have a strong linkage with the District Health Management Teams
 (“DHMTs”), which are responsible for coordinating all public and faith-based health
 service delivery institutions within the respective districts. In addition, they also receive
 financial and technical support from their respective sponsoring faith-based
 organizations, and other well wishers and Links.

 4.2.2.3 Private Health Sector

 The private health sector includes hospitals and health centres/clinics owned by private
 investors, the privatized mining companies and the civil society/non-governmental
 organizations (“NGOs”). Private health facilities provide basic health care services at
 health centre level, and general medical and specialized services at hospital level. The
 contribution of this sub-sector could be estimated in the range of 10% to 15%. These
 facilities are predominantly concentrated in the mining and other urban areas, with
 minimal presence in rural areas. Private health facilities are registered corporate entities
 and managed as private businesses. Currently, the supervision, monitoring and
 evaluation of the performance of this sector by MOH is weak and needs further
 strengthening.

 4.2.2.4 Traditional Health Practitioners

 Alongside modern medical facilities, traditional health therapy is also offered by various
 individuals and registered entities. They mainly offer herbal remedies and spiritual
 healing services. Whilst these services are managed as private businesses, they are
 coordinated by the Traditional Health Practitioners of Zambia (“THPAZ”), an association
 formed and registered to promote and advocate for traditional health therapy. Currently,
 there are increasing claims by various traditional health practitioners that they have
 discovered herbs to cure HIV/AIDS, which claims are still being subjected to scientific
 verifications and trials.




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              The Tropical Health and Education Trust           Mapping of Health Links in the Zambian Health
              In conjunction with                               Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                    under the Ministry of Health



 4.2.3    Existing Health Facilities

 Health service facilities include: the core facilities, such as hospitals, health centres and
 health posts; statutory boards; and health training institutions; all operating at different
 levels of service delivery.

 4.2.3.1 Core Health Service Delivery Facilities

 Table 1 below presents a summarised analysis of the existing core health service delivery
 facilities in Zambia:

 Table 1: Summary of Existing Health Facilities in Zambia
                                                      Health
                                    Hospitals        Centres                   Health Posts         Total
  Type of Provider                   Number          Number                       Number          Number
  Public/Government                         58         1,052                            19          1,129
  Faith-based/CHAZ                          39            69                            25            133
  Private                                   17            97                              1           115
  Total                                   114          1,218                            45          1,377
  Source: Ministry of Health and Churches Health Association of Zambia, 2007


 Below are the summarized descriptions of these facilities, starting from the health posts,
 at community level, to central hospitals, which are the highest and most sophisticated
 referral facilities:

    Health Posts (“HPs”): Are intended to serve small communities with populations of
     approximately 500 households (3,500 people) in the rural areas, and 1,000 households
     (7,000 people) in the urban areas, and are supposed to be established within 5Km
     radius for sparsely populated areas. The number of HPs required throughout Zambia
     is 3,000, however only 45 are currently available, including 1 private facility;
    Health Centres (“HCs”): These include Urban Health Centres, intended to serve
     urban communities with catchment populations of between 30,000 and 50,000 people,
     and Rural Health Centres, servicing catchment areas of 29 Km radius or population of
     10,000 people. The national target for HCs is 1,385, but currently 1,218 are
     available, including Government, faith-based and private HCs;
    1st Level Referral Hospitals: These are hospitals at district level, intended to
     provide referral services in medical, surgical, obstetric and diagnostic services,
     including all clinical services to support HC referrals. Such facilities are found in
     most of the 72 districts and are intended to serve catchment populations of between
     80,000 and 200,000 people. Currently, there are a total of 89 such facilities,
     comprising 72 government/Faith-based facilities and 17 private facilities;




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              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



    2nd Level Hospitals: These are provincial general hospitals, intended to provide sub-
     specialised referral services in internal medicine, general surgery, paediatrics,
     obstetrics and gynaecology, dental, psychiatry and intensive care services. They are
     also intended to act as referral centres and provide technical back-up for 1st level
     hospitals, and offer training services. These facilities are intended to cover catchment
     populations of between 200,000 to 800,000 people. Currently there are a total of 20
     second level hospitals. Two provinces, namely Southern and Copperbelt, have 5 and
     3 second level hospitals respectively. MOH has observed the need to rationalize the
     distribution of these facilities through right-sizing; and
    3rd Level Hospitals: These are also known as central hospitals and are meant to
     provide specialised services in internal medicine, surgery, paediatrics, obstetrics,
     gynaecology, intensive care, psychiatry, training and research, and also act as referral
     centres for 2nd level hospitals. The scope of coverage for such facilities is a
     catchment population of 800,000 people and above. Currently there are only 5 such
     facilities in the country, including the UTH and Chainama in Lusaka and 3 others on
     the Copperbelt Province, namely, Ndola Central Hospital, Kitwe Central Hospital and
     Arthur Davison Children’s Hospital in Ndola.

 4.2.3.2 Health Statutory Boards

 Two types of statutory boards, regulatory and service, have also been established to
 provide support to the Ministry and the health delivery system. Statutory boards play an
 important role in the implementation of the overall Government health policy and
 regulation of the health sector. Regulatory boards are responsible for enforcing specific
 Government Laws and policies, while service statutory boards provide support services to
 the core health service delivery facilities. Administratively, statutory boards are managed
 by boards of directors appointed by the Minister of Health, in accordance with the
 relevant statutes, and are technically responsible to MOH, through the office of the
 Director of Technical Support Services (“DTSS”).

 Regulatory boards currently include the Medical Council of Zambia (“MCZ”), General
 Nursing Council (“GNCZ”), Pharmaceutical Regulatory Authority (“PRA”), Food Safety
 and Food Quality Control Services Unit, Environmental Health and Epidemiological
 Trends Unit, Radiation Protection Board, Radiology and Medical Devices Control Unit
 and the Medical Laboratory Regulatory Services Unit. On the other hand, service
 statutory boards are responsible for providing specific services in support of the health
 delivery system and include the National Food and Nutrition Commission (which is
 partially regulatory and partially service), Zambia National Flying Doctor Services
 (“ZNFDS”), Zambia National Blood Transfusion Service (“ZNBTS”) and the Tropical
 Disease Research Centre (“TDRC”).




August 2007                                             15                        CAN Investments Limited
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              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 4.2.3.3 Health Training Institutions

 The public health sector also includes a number of health training institutions providing
 various types of pre- and in-service training for health workers. These institutions play a
 pivotal role in the production of appropriately trained health workers, including medical
 doctors, nurses, clinical officers and paramedical staff for the Zambian health sector.
 These institutions include:

      UNZA School of Medicine, Lusaka. This is the only medical school in the country
       for producing medical doctors. The school also offers training at lower levels in
       various health disciplines, including BSc. Degree Bio-Medical Sciences, Degree in
       Post-Basic Nursing, Degree in Anaestasia, and others;
      Chainama Hills College of Health Sciences, Lusaka. Chainama College commenced
       its operations in 1936 and is the oldest health training institution in Zambia. It
       produces medical cadre in various disciplines, at diploma and advanced diploma
       levels, including environmental health, clinical medicine (general), clinical medicine
       (mental health), clinical medicine (medical licentiate), nursing (various
       specializations), counseling and other fields;
      Nursing training schools for registered and enrolled nurses, located throughout the
       country. Currently, there are a total of 19 nursing schools in the country. During
       2007, MOH is committed to renovating and re-opening 3 nursing schools;
      2 colleges for training of medical laboratory technologists, which include the Evelyn
       Hone College in Lusaka, the Ndola School for Bio-Medical Sciences on the
       Copperbelt; and
      Other training institutions for other health cadres, paramedics, including the UTH
       School of anaestasia and the Lusaka Dental School.

 4.3     Main Problems and Constraints

 MOH is committed to the successful implementation of the NHSP 2006/10, whose vision
 is to ensure “Equity of access to assured affordable health care services, as close to the
 family as possible”. However, there are a number of constraints and challenges which
 are adversely affecting the health sector.

 These include:

      High and complex disease burden, compounded by the effects of HIV/AIDS and
       malaria. According to the Health Management Information System (“HMIS”) report
       for 2006, the top five leading causes of morbidity and mortality included: malaria,
       respiratory infections (non-pneumonia), diarrhea (non-blood), trauma (accidents,
       injuries, wounds, burns) and eye infections. Even though HIV/AIDS is not included
       in this list, it is responsible for a larger portion of morbidities and mortalities.
       HIV/AIDS has seriously devastated the health sector and overstretched the limited
       human, financial and material resources available;

August 2007                                             16                        CAN Investments Limited
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              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



      Critical shortages of appropriately qualified core health workers and teaching staff in
       training institutions;
      Inadequate funding to the health sector. The Government has made a commitment to
       increase funding to the health sector to 14% of the national budget, however, this has
       not been achieved yet and funding is now about 12% of the budget. However, the
       Government and its international cooperating partners are making significant efforts
       to continue improving funding to the sector;
      Erratic supply of essential drugs and medical supplies, and poor logistics
       management. This problem has significantly undermined health service delivery,
       specially in the rural areas, which are difficult to reach;
      Inadequate and poor state of essential health infrastructure and equipment, including
       mothers’ shelters, basic equipment and tools;
      Poor transport and communication facilities to facilitate efficient and effective
       communication and transportation in support of health services. This is due to a
       combination of factors, including poor geographical access, poor state of public
       transport and communication infrastructure and lack of reliable motor vehicles and
       communication systems; and
      Inadequate facilities and systems to support efficient and effective information,
       education and communication of health programmes and messages to the public.
       This includes the inadequate investment in appropriate modern ICT, which has made
       it difficult for the health sector to benefit from the new technological innovations,
       with potential to significantly improve health service delivery.

 4.4     The Human Resource Crisis

 Zambia is among the Sub-Saharan African countries that are most affected by the critical
 shortages of human resources for health, with severe shortages of appropriately qualified
 health workers at all levels of the health service delivery system and training institutions.
 Over the past three to four decades, the number of doctors has actually declined from
 1,283 in 1975 to 646 in 2005, whilst the population has continued to grow at over 2.7%.
 In 2005, staffing levels in the health sector were estimated at 23,176, representing 47% of
 the recommended staff establishment of 49,360 (HR Plan, MOH, Zambia, 2005).
 Consequently, the workloads for health workers have drastically worsened, as evidenced
 by the Doctor to Population ratio, which has continued to deteriorate and is currently
 estimated at 17,589:1, against the recommended 4,940:1. Table 2 presents a summarised
 analysis of staffing levels and staff workloads in the Zambian health sector. A more
 detailed analysis is presented at Appendix III.




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 Table 2: Health Sector: Staffing Levels and Workloads (Summary), Zambia
                                     STAFFING LEVELS                         STAFF/POPULATION RATIOS
                             Recommended                                      Recommended Existing Staff/
                             Establishment  Existing                         Staff/Population  Population
  Staff Category                     (2005)    Staff Variance                       Ratios, 1:  Ratios, 1:
  Medical Doctors                      2,300             646      1,654                 4,940            17,589
  Nurses                              16,732           6,096     10,636                   679             1,864
  Mid Wives                            5,600           2,273      3,327                 2,029             4,999
  Clinical Officers                    4,000           1,161      2,839                 2,841             9,787
  Other Health
  Workers                             20,728          13,000      7,728                   548                  874
  Total                               49,360          23,176     26,184                   230                  490
  Source: MOH HRIS database / NHSP 2006/30, MOH, Zambia


 The situation is compounded by the inequitable distribution of the available health
 workers, which has continued to favour urban areas at the expense of rural areas.
 Currently, it is estimated that approximately 23% of rural health centres in Zambia are
 operating without any qualified health worker, while 50% of them operate with only one
 qualified health worker (Joint Annual Review 2006 Report, MOH, Zambia). Health
 training institutions have equally suffered severe shortages of teaching staff and in the
 current state do not have the required capacities to expand their outputs in line with the
 demands of the HR Plan. The distribution of clinical and nursing staff in Zambia is as
 analysed in Table 3 and Appendix IV.

 Table 3: Distribution of Clinical and Nursing Staff per 100,000 Populations by Province,
 Zambia
                                                                       Zambia                       Zambia
                                        Clinical        Registered    Enrolled      Registere      Enrolled
  Province                 Doctors      Officers         Midwives     Midwives      d Nurses         Nurses      Total
  1) Urban
  Regions:
  Lusaka Province              12.0            14.7            6.6          19.5          26.0          62.9         142
  Copperbelt
  Province                      7.8             9.8            6.2          22.2          24.2          56.5         127
  2) Rural Regions:
  Southern Province             2.8            13.1            3.5          28.6           9.9          50.8         109
  North Western
  Province                      1.8             8.3            2.1           6.9           6.3          48.4          74
  Western Province              1.8             9.3            1.6          10.1           6.7          33.6          63
  Central Province              0.7             8.8            2.5          13.0           6.1          24.6          56
  Eastern Province              1.0             6.7            0.9          11.6           6.6          28.3          55
  Luapula Province              2.1             6.6            0.6           6.6           7.3          30.9          54
  Northern Province             0.9             6.1            0.9            8.9          8.0          20.5          45
  Source: Joint Annual Review Report for 2006, Ministry of Health, April 2007, Zambia




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              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 The human resource crisis in Zambia is not only severe but also complex. It includes
 actual shortages of the required numbers of essential health workers, shortages of the
 right skills and skills mix, poor geographical distribution and a high and complicated
 disease burden. The crisis has been largely caused by a combination of factors,
 including: high staff attrition levels; inadequate staff training capacities; and impact of
 HIV/AIDS.

 4.4.1   High Staff Attrition Levels

 Despite the fact that there are no reliable sources of data on the attrition levels for health
 workers in Zambia, it is generally acknowledged that the prevailing levels are high. An
 analysis of the human resources crisis in the Zambian health sector estimated the annual
 attrition rates for 2003 at 9.8% for medical doctors, 5.3% for nurses, 4.2% for
 pharmacists, 3.5% for laboratory technologists, and an overall average of 5.4% for the
 year (G Kombe et.al, Human Resources Crisis in the Zambian Health System: A Call for
 Urgent Action, Abt Associates Inc., 2005).

 One of the main contributing factors to staff attritions in Zambia is the brain-drain or
 migration of core health workers from the public health institutions to either the private
 sector within the country or to overseas countries, mostly to the United Kingdom (“UK”),
 Australia, New Zealand and the United States of America (“USA”), in search of better
 remuneration and conditions of service. The available data indicates that, in 2004, the
 number of Zambian doctors practicing in the USA and Canada alone was more than 10%
 of those who were practicing in Zambia (Hagopian et al., 2004). Similarly, the number of
 nurses leaving the country has kept on increasing.

 Training institutions have equally been affected through migration of lecturers and tutors
 in search of better conditions of service overseas. According to the Nursing and
 Midwifery Council of the UK, between 1998 and 2003, a total of 461 Zambian nurses
 were recruited to work in the UK. Currently, it is believed that approximately 300
 Zambian doctors are practicing abroad (HR Plan, MOH, Zambia). The other major factor
 contributing to high staff attritions in the health sector is the increase in mortality levels
 among the core health workers due to HIV/AIDS. The most affected are the secondary
 and tertiary level hospitals, which have continued to loose significant numbers of
 qualified and experienced clinicians, nurses and other paramedics.

 4.4.2   Inadequate Staff Training Capacities

 The capacities at the various health training institutions, making it difficult for these
 institutions to expand their outputs and meet the ever increasing demand for health
 workers. Currently, Zambia has only one medical school, at the University of Zambia
 (“UNZA”), the Chainama College of Health Sciences, 19 nursing schools and three
 technical colleges for laboratory technologists and pharmacists.


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              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 However, in 2004, all these training facilities only produced 49 doctors, 540 nurses, 38
 laboratory technologists and 20 pharmacists, which were far below the outputs required
 to maintain staff levels (G Kombe et.al, Human Resources Crisis in the Zambian Health
 System: A Call for Urgent Action, Abt Associates Inc., 2005).

 4.4.3    Impact of HIV/AIDS

 Zambia is among the Sub-Saharan African countries that are most affected by the
 HIV/AIDS epidemic, with an average HIV prevalence rate of 16% among the adult
 population and 27% in urban areas (Zambia Demographic Health Survey 2001/2002).
 The impact of HIV/AIDS on the staff crisis is in two ways, namely: the direct impact on
 the mortality levels for core health workers; and the increase in the disease burden, which
 in turn increases the workloads for health workers. In this respect, the fight against
 HIV/AIDS is among the areas that have been prioritised in the NHSP and FNDP.

 4.5     Sector Strategy and Priorities

 The current health sector strategy is outlined in the NHSP 2006/10 and the health chapter
 of the FNDP. It is based on a set of national health priorities, which take into account the
 commitments to regional and international initiatives in health, particularly the MDGs,
 and the Abuja and Maputo Declarations on health. Below is the summarized framework.

 4.5.1    Vision, Goal, Principles and Priorities

 The vision, goal, key principles and national health priorities identified for the period
 from 2006 to 2010 are as follows:

 Vision:                   To ensure equity of access to assured quality, cost-effective and
                           affordable health care services as close to the family as possible, and
                           significantly contribute to the human and socio-economic
                           development of the nation.

 Overall Goal:             To establish a society in which Zambians create environments
                           conducive to health, learn the art of being well and provide basic
                           level health care to all.

 Key Principles:           Equity of access; Affordability; Cost-effectiveness; Accountability;
                           Partnerships; Decentralisation and Leadership.

 Theme:                    Towards the attainment of the Millennium Development Goals and
                           National Health Priorities.

 National Health Human resource crisis; Integrated Reproductive Health (“IRH”);
 Priorities:     Child Health; HIV/AIDS; malaria; tuberculosis; epidemics control
                 and public health; and environmental health and food safety.
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              The Tropical Health and Education Trust                Mapping of Health Links in the Zambian Health
              In conjunction with                                    Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                         under the Ministry of Health



 4.5.2    Main Objectives

 The main objectives include:

      To provide a well motivated, committed and skilled professional workforce;
      To reduce the under 5 Mortality Rate (“>5MR”) by 20%, from 168 per 1,000 live
       births in 2005, to 134 by 2010;
      To reduce the Maternal Mortality Ratio (“MMR”) by one quarter, from 729 per
       100,000 live births in 2005, to 547 by 2010;
      To halt and begin to reduce the spread of HIV/AIDS and Sexually Transmitted
       Infections (“STIs”);
      To halt and begin to reduce the spread of Tuberculosis (“TB”), through effective
       interventions;
      To halt and reduce the incidence of malaria by 75% and malaria related under 5
       mortality by 20%;
      To ensure availability of adequate, quality, efficacious, safe and affordable essential
       drugs and medical supplies at all levels; and
      To significantly improve the availability, distribution and condition of essential
       infrastructure and equipment, so as to provide for equity of access to essential health
       services.

 4.6     Sector Performance

 The performance of the health sector is being seriously undermined by the various
 constraints and challenges highlighted earlier. Despite this situation, over the past 5 years
 ended 2006, the performance of the health sector has shown some improvements. Most
 of the selected healthcare delivery indicators have improved. The healthcare OPD per
 capita attendance increased from 0.73 in 2002 to 0.86 in 2006, first antenatal attendance
 coverage improved from 89% to 92%, supervised deliveries increased from 49% to 61%,
 and the fully immunized coverage under 1 year increased from 76% to 87%. Table 4
 below, presents more details on the performance.

 Table 4: Trends of Selected Healthcare Delivery Indicators, 2002 -2006
 Indicators                                                  2002         2003        2004       2005        2006
 Health Centre OPD per Capita Attendance                      0.73         0.86        0.76       0.78        0.86
 First Antenatal Coverage (%)                                   89           95          97         93          92
 Average Antenatal visits                                      3.4          3.3         3.1        3.0         2.9
 Supervised Deliveries (%)                                      49           55          61         62          61
 Fully Immunised Coverage under 1 year (%)                      76           74          80         82          87
 Under Weight Prevalence (%)                                    22           21          17         16          14
 New Family planning accepters rate                           111          123         127        138         140
 Health Centre Staff Load Contacts                              16           17          17         17        18.2
 Drug Kits opened per 1,000 patients                          0.69         0.73        0.93       1.08        0.99
 Source: Ministry of Health HMIS/JAR 2006

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 On the other hand, despite the significant commitment and resources invested in the
 sector by the Government and its partners and the subsequent improvements in the key
 health service delivery indicators, the disease burden has remained high and is not
 improving. According to the HMIS report for 2006, over the past 7 years, most of the top
 leading causes of morbidity and mortality have continued to deteriorate.

 Malaria has continued to head the list of the 10 leading causes of morbidity and mortality,
 with the incidence rate increasing from 316 cases per 1,000 population in 2000 to 410
 cases in 2006 and the number of malaria cases increasing from 3.6 million in 2000 to 4.9
 million in 2006. However, number of deaths due to malaria declined from the 8,952 in
 2000 to 6,471 in 2006. The incidence rate for respiratory infections (non-pneumonia)
 increased from 119 per 1,000 population to 192, while the cases increased from 1.3
 million to 2.3 million. An analysis of the trends for the top ten causes of morbidity and
 mortality is presented at Appendix II.




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                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 5     EXISTING HEALTH LINKS

 5.1     Overview

 In Zambia, the concept of Links is not widely understood and appreciated. However, in
 trying to address the staffing problems and capacity limitations that are being experienced
 in the health sector, some health service facilities and training institutions have
 established Links with counterpart institutions in foreign countries. Through such Links,
 medical experts from foreign countries have visited these institutions to provide services,
 teaching or service development, on a gap filling basis. In some cases, these institutions
 have also received significant technical, material and financial support, through the same
 Links. There have also been reciprocal professional attachments and teaching visits by
 Zambian staff. Such Links are largely concentrated in Lusaka and are most common at
 the UTH, the UNZA School of Medicine and at Chainama hospital and college. Outside
 Lusaka province, only a small number of health facilities and training institutions
 indicated that they have Links, with St. Francis Hospital, a Catholic owned facility in the
 town of Katete, Eastern Province, standing out with the highest number of Links among
 the institutions outside Lusaka.

 Even though it is acknowledged that Links have added value to the beneficiary
 institutions and that they have led to significant transfers of knowledge and skills to
 health workers and institutions in Zambia, the lack of a framework for management and
 coordination of the Links in the country has led to fragmentation and duplication of
 efforts of the Link parties. In view of this situation, some of the Links do not address the
 institutional and sector priorities requiring capacity building and in most cases, such
 Links are established through individual efforts and therefore do not fully address the
 capacity needs of the respective institutions. Given this background, MOH has identified
 the need to establish an appropriate framework for promotion, management, coordination,
 monitoring and evaluation of the Links in the Zambian health sector.

 This part of the report discusses the existing Links, identified during the mapping
 exercise. The section is structured to analyse the Links by the types and levels of health
 institution, in the following order: provincial health offices, district health management
 teams, hospitals, health centres/health posts, training institutions and statutory boards.

 5.2     Provincial Health Offices and District Health Management Teams

 5.2.1    Brief Profile

 Provincial health offices (“PHOs”) are responsible for providing technical support and
 supervision to all public health institutions in their respective provinces. This is done
 through the direct supervision of District Health Management Teams (“DHMTs”),
 hospitals and health statutory boards, which are in turn, responsible for providing
 technical support and supervision of the health facilities and training institutions at
 district level.
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 The main roles and responsibilities of PHOs include, interpretation and dissemination of
 health sector policies to DHMTs and other health institutions within their jurisdiction,
 coordinating the planning process at provincial level, supervising the implementation of
 sector policies, monitoring and evaluation of the performance of the DHMTs, hospitals,
 health centres, health posts, statutory boards and training institutions within their
 respective provinces. Each PHO is headed by a Provincial Health Director (“PHD”), who
 is answerable to the Permanent Secretary of MOH, with technical oversight from the
 Director of Technical Support Services (“DTSS”). Each PHD is supported by a team of
 managers and specialists in core health and support service areas. On the other hand,
 DHMTs are responsible for the management, coordination, supervision, monitoring and
 evaluation of health facilities at district level, including district hospitals, health centres
 and health posts in their respective districts. DHMTs are headed by District Health
 Directors, supported by complements of managers and specialists in core health and
 support service areas.

 5.2.2    Existing Links

 Except for the Livingstone DHMT, none of the PHOs and DHMTs reported to have
 established any Links. The Livingstone DHMT has established a Link with NORDKAPP
 –KOMMUNE of the Norway, who are providing technical and financial support to the
 mental rehabilitation programme. The main activities under this Link include:

      A staff exchange programme, restricted to staff below the age of 35 years; and
      A community based rehabilitation programme for mental patients. This includes
       training and capacity building for members of staff and the communities involved in
       the rehabilitation of mental patients.

 5.3     Central Hospitals (“3rd Level Hospitals”)

 Central Hospitals are also known as 3rd Level hospitals. These are the largest and most
 sophisticated hospitals in Zambia, intended to provide specialised services in internal
 medicine, surgery, paediatrics, obstetrics, gynaecology, intensive care, psychiatry,
 training and research, and also to act as referral centres for Provincial General Hospitals
 (2nd Level hospitals). Currently, there are only 5 such facilities in the country, namely,
 the UTH and Chainama Hospital in Lusaka, Ndola Central Hospital (“NCH”) and Arthur
 Davison Children’s Hospital (“ADH”) in Ndola, and Kitwe Central Hospital in Kitwe.
 The main constraints and challenges faced by these facilities are more or less similar and
 include:

      Critical shortages of health workers. These facilities are currently operating at below
       50% of the staff establishment, with the attendant effects;




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              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
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    Shortages of specialist consultants and doctors, in the required numbers and specialist
     areas, has significantly undermined the delivery of specialised services expected from
     such facilities. For example:
      Ndola Central Hospital only has 9 consultants, against the establishment of 25,
         and even though the intensive care unit exists, there are no trained expertise to
         manage the unit; and
      ADH does not have enough doctors and mainly depends on interns, who only
         come on temporal deployments. Currently there is only 1 paediatrician, who is
         also the Executive Director, 2 surgeons, 1 dentist and 2 paediatric surgeons, which
         are far below the establishment levels;
    Erratic supply of essential drugs and medical supplies, especially at lower hospitals
     and health centres, combined with the poor adherence to referral procedures at lower
     levels, has resulted into over congestions at these facilities. This increases staff
     workloads and overstretches the available health workers;
    The poor state of essential infrastructure and equipment, including basic tools and
     accessories, has significantly restricted the capacities of these institutions to offer
     specialised services and negatively affects the quality standards of services rendered;
     and
    Poor transport and communication, particularly ambulances and radio message
     systems, is making it difficult to attend to emergency evacuation services. Moreover,
     even the few available ambulances are not equipped with appropriate basic life-saving
     equipment.

 The mapping of Links revealed that, out of the 4 central hospitals, only the UTH/UNZA
 School of Medicine have established Links. The other 3 facilities, which are all based on
 the Copperbelt, reported that they have not established any Links. Below are summarised
 reports by facility.

 5.3.1   The University Teaching Hospital /UNZA School of Medicine

 5.3.1.1 Brief Profile

 The UNZA School of Medicine is one of the schools of the University of Zambia
 (“UNZA”) and the only national medical school in Zambia. It was established in 1965
 and became an independent school of UNZA in 1970. The school, together with the
 UTH, which is the accredited hospital, are located in Lusaka. The pre-clinical and other
 departments of the school are located at the Ridgeway campus, while the clinical
 departments and the dean’s administrative offices are located within the premises of the
 UTH. The school currently offers graduate and post-graduate programmes in the
 following fields of study: joint Bachelor of Medicine and Bachelor of Surgery Degrees;
 Master of Medicine in surgery, obstetrics and gynaecology, paediatrics and child health,
 medicine and orthopaedic surgery; and Master of public health.



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 It also offers Bachelor Degrees and high level training and education in nursing,
 pharmacy, physiotherapy and biomedical sciences. Since its opening, the school has
 produced more than 1,200 medical doctors.

 UTH is the hospital accredited to the School, even though it operates under MOH. It is a
 specialised hospital and the largest hospital in the country, with bed capacity of 1,800.
 Through the established working relationships between the school and UTH, the joint
 functions of these two institutions are threefold, namely: medical training, research and
 clinical care.

 5.3.1.2 Existing Links

 UTH and the School of Medicine have established a significant number of Links, and
 local and international collaboration programmes covering research, and student and staff
 exchange programmes. The existing Links at UTH/UNZA School of Medicine are
 provided in Table 5 below.

 Table 5: Existing Links at UTH/UNZA School of Medicine
 S/N    Link Partner                  Nature of Link
 1.     University College,           A long-term collaboration has been established between this
        London Medical                university and UZA/UTH under the ZAMBART project, a 10
        School, UK.                   year collaboration project in TB research. Under this project, a
                                      building has been constructed at the UNZA Ridgeway campus, to
                                      support the activities of this project.
 2.     Kent State University,        Under this link, some staff members of UTH have been sponsored
        UK.                           for PhD studies. Currently, one member of staff is pursuing a
                                      PhD in Nursing.
 3.     Sussex and Brighton           This Link includes exchange programmes for nursing staff and
        Medical School and            students, and comprehensive capacity building support to
        Teaching Hospital,            UNZA/UTH.
        and Brighton
        University, UK.
 4.     University of                 Under this programme, the University of Bradford has been
        Bradford, UK.                 providing physiotherapy equipment to UTH/UNZA.
 5.     Institute of Child            This Link includes collaboration in research, exchange visits
        Health University             involving research staff, infrastructure support and scholarships in
        College, London, UK.          Public Health.
 6.     Harvard University,           Harvard University and UNZA/UTH are involved in a number of
        USA.                          collaborations in research including, Sickle cell diagnostic
                                      (screening of sickle cell disease and establishing the levels of
                                      sickle cell in Zambia) and capacity building in diagnosis of sickle
                                      cell in rural areas.
 7.     University of Emory,          Collaboration in research and scholarships for master’s degree in
        USA.                          Public Health.



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 8.     Kent State University,        Staff exchange, capacity building and research. One member of
        USA.                          staff has been awarded a scholarship and is still pursuing a PhD
                                      programme at the Kent State University.
 9.     University of                 The link with this university was established through a former
        Nebraska, USA.                member of staff of the UNZA department of pediatrics. This link
                                      is in the area of research in cancer, HIV/AIDS and Malignant for
                                      post graduate students. The contact person at the University of
                                      Nebraska is Charles Wood.
 10.    University of                 Through this Link, a center of excellence building has been
        Alabama, USA.                 constructed at the UTH. Other activities include the
                                      CIRDZ/University of Alabama- Research activities, MPH
                                      scholarships and institutional strengthening.
 11.    University of Miami,          This project has come to an end, but Links with the school in the
        USA.                          area of capacity building are still open, even though not active.

 12.    Yale University               Under this Link, UNZA and the University of Yale have been
        School of medicine,           carrying out research in Malaria at Macha hospital in Choma.
        USA.
 13.    Mehari University             Link between Mehari University and UNZA School of Medicine
                                      on research collaboration, and student and staff collaboration on
                                      microbicides. Under this arrangement, UNZA shares resources
                                      with UTH.
 14.    Kalorinska Institute,         Institutional collaboration project funded by SIDA.           The
        Sweden                        department of Post Basic Nursing at UNZA has benefited from
                                      technical support and exchange visits. Two professors have been
                                      appointed as visiting professors. Under the nursing and staff
                                      exchange programme, both institutions are supposed to do the
                                      following:
                                       send up to two exchange students each year during the duration
                                         of the agreement, unless the number is varied by mutual
                                         agreement; and
                                       share information on a regular basis; and recognise that the
                                         academic credit of the studies abroad is the responsibility of
                                         the degree granting institution.
 15.    Helsinki Polytechnic          Staff and student exchange programmes, and implementation of
        Stadia, Finland.              the Malawi –Zambia health care project during the spring of 2005
                                      and academic year 2005-2006. This included short term staff and
                                      student exchange programmes.
 16.    MIE University of             Exchange programme between the two institutions. However the
        Japan.                        Zambian counterparts have not been able to get sponsorship for
                                      this programme.
 17.    University of Bergen,         Collaboration with this university was through the NUFU Project
        Norway.                       20002 to 2006. This project was designed to strengthen UTH and
                                      UNZA in HIV/AIDS related interventions and capacity building.
                                      Under this project, two students where sponsored for PhD
                                      programmes at the University of Bergen.



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 18.    Copenhagen                    Partnership and collaboration in research.
        University’s Center
        for Medical
        Parasitology (CMP),
        Denmark:
 19.    Yamananshi                    This research project came to an end in 2006. Under this project
        University, Japan.            a research laboratory was constructed and two UTH members of
                                      staff were trained up to PhD level and one up to Masters level.
 11.    Marie Master                  Collaboration on sickle cell management.
        University.
 12.    Communication for             The Dreyfus Health Foundation of New York, USA, is the
        Better Health                 sponsor of this programme. The main activities under this
        (“CBH”).                      collaboration include support to the medical library and helping
                                      out in dissemination of health information to front line health
                                      professionals in the rural areas of Zambia.
 13.    International Atomic          This agency has been supporting the following projects: Tumor
        Energy Agency                 market project; Tissue culture project; and The newborn
        (“IAEA”).                     screening and nuclear project.
 14.    Other Links:                   University of Queensland, Australia: Collaboration in
                                          schizophrenia research).
                                       University of Ain Shams, Cairo, Egypt.
                                       University of Malawi, Malawi.
                                       University of Bergen, Norway.
                                       University of Bergen, Norway.
                                       University of Pretoria, South Africa.
                                       University of Nottingham, UK: Collaboration in
                                          communication research.
                                       Institute of Psychiatry, London, UK.
                                       University College, London Medical School, UK.
                                       Bradford University, UK.
                                       Gordon University, UK.
                                       The London School of Tropical Medicine-UK.
                                       Medical Research Council, UK.
                                       Leeds University, UK.
                                       Michigan State University, USA: Collaboration in epilepsy
                                          and stigma research, and in neurological.
                                       State University, Nebraska, USA: Collaboration in
                                          telemedicine.
                                       University of Nairobi, Kenya.
                                       University of Miami, USA.
                                       University of Nebraska-USA.
                                       Massachusetts Institute of Technology-USA.




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 15.     Other collaborating              The World Federation for Medical Education (“WFME”);
         partners include:                The Foundation for Advancement in MEDICAL Education
                                           and Research (“FAIMER”);
                                          The Society for Directors of Research in Medical Education
                                           (“SDRME”).
                                          Prevention of Maternal Mortality in Africa (“PMM”)
                                          The Surgical Society of Zambia. Collaboration in surgery.
                                          College of Surgeons of East, Central and Southern Africa.
                                          World Orthopaedic Concern (“WOC”).
                                          Pharmaceutical Society of Zambia.

 5.3.2    Chainama Hills Hospital and College for Health Sciences

 5.3.2.1 Brief Profile

 Chainama is a government facility located in Lusaka and comprises of a 3rd level referral
 hospital and a college for health sciences. The hospital is the only facility in the country
 offering specialist referral services in mental health. Apart from specialist referral
 services in mental health, the hospital also offers other clinical services. The Chainama
 College is the second largest health training institution, after the UNZA medical school,
 to which it is also affiliated. It is also the oldest health training institution in Zambia,
 opened in 1936. The college claims that it produces approximately 70 to 80% of frontline
 health workers in Zambia.

 Chainama offers a wide range of training programmes at diploma and advanced diploma
 levels. These include: diploma in environmental health, diploma in clinical medicine
 (general), diploma in clinical medicine (mental health), diploma in orthomic nursing
 (post-basic programme), diploma in counselling, advanced diploma in medicine (medical
 licentiate programme in various specialisations), registered mental nursing course, and
 the centre for continuing education, providing a wide range of courses.

 5.3.2.2 Existing Links

 Chainama is among the few health institutions that are benefiting from Links with
 international institutions. The following Links were reported:

 Table 6: Existing Links at Chainama Hospital and College
 S/N     Link Partner                     Nature of Link
 1.      Leeds Metropolitan               Training support, through Degree Programs’ and scholarships.
         University, UK                   Leads Metropolitan University is currently running Masters in
                                          Public Health; and Doctor of Philosophy in public health
                                          programs at Chainama Hills College. Sends lecturers to support
                                          these programmes which are quarterly/modular based. A new
                                          intake of 3 started in March 2007.


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 2.      The University of              Training support, MPH and PHD in Public Health scholarships
         Manchester, UK.                for members of staff. From 2000 to 2002, Manchester
                                        University conducted a Masters of Education in Primary Health
                                        programme at Chainama College.
 3.      Michigan University,           Health Care support.
         USA.
 4.      University of Mehari           Training support, Masters in Nero Psychiatry.
         (Medical School.
 5.      Mental Health Trust,           Providing support in form of teaching at the college. Also
         UK.                            supporting the hospital in health service provision and staff
                                        training.
 6.      Sight Savers                   Technical and material support to the orthomology programme.
         International, UK.
 7.      Operation Eyesight,            Has pledged to support the college in infrastructure
         Canada.                        development.
 8.      Beit Trust, UK.                Has pledged to provide financial support to construct a lecture
                                        theatre. Project awaiting finalization of building plans by the
                                        Ministry of Works and Supply.
 9.      Lothian Health Board,          Providing support in form of providing specialists.
         Scotland.
 10.     VVOB, Belgium.                 Collaboration in teaching. Providing technical advisors and
                                        supporting workshops. Support to the computer laboratory.
 11.     Prime – UK NGO                 Training support, Medical School.
 12.     HSSP/JPIGHO, USA               Support to curriculum development.
 13.     University of Zambia.          Support to Palliative Care.
 14.     National Malaria               Institutional collaboration.
         Center , Zambia.

 5.3.3   Ndola Central Hospital

 5.3.3.1 Brief Profile

 The Ndola Central Hospital (“NCH”) is the second largest hospital in Zambia. It is a
 specialised hospital catering for the Ndola and Masaiti districts, with a combined
 population of approximately 600,000 people. The hospital also serves as a referral
 facility for the Northern, Luapula, Central and North-Western provinces, and other towns
 of the Copperbelt Province. NCH was established in 1972 and has a bed capacity of 851
 beds and 97 cots. The hospital consists of 26 wards, one school of nursing and
 midwifery, and one biomedical sciences college. It is designed to provide secondary and
 tertiary care services to adults in the following fields: Medicine, general surgery,
 obstetrics and gynaecology, psychiatry, ophthalmology, skin and STIs, dentistry,
 pathology, laboratory support services, radiology, orthopaedics, physiotherapy, urology
 and anti-retral viral treatment (“ART”). However, due to lack of a district hospital in
 Ndola, NCH is compelled to also offer first level services, in addition to its normal
 services.


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 5.3.3.2 Existing Links

 The hospital does not have any existing Links, except for some institutional support
 arrangements with:

    The Zambia Prevention, Care and Treatment (“ZPCT”) is a 6 year collaboration
     project between Zambia and the United States of America aimed at strengthening and
     expanding existing HIV/AIDS services in five selected provinces. ZPCT is working
     closely with the hospital on the HIV/AIDS programme, with emphasis on ART; and
    ORET programme, which is about to commence the rehabilitation of the operating
     theatre and provide new X-ray and ultra-sound machines.

 5.3.4   Kitwe Central Hospital

 5.3.4.1 Brief Profile

 Kitwe Central Hospital (“KCH”) is the third largest general hospital in Zambia and is
 located in the city of Kitwe on the Copperbelt province and comprises of the hospital
 itself and the nursing and midwifery school. KCH provides specialised services to the
 adult population. The services offered include secondary and tertiary care to adults in the
 following of fields: Medicine, general surgery, obstetrics and gynaecology, psychiatry,
 ophthalmology, skin and STI, dentistry, pathology, laboratory support services,
 radiology, orthopaedics, physiotherapy, urology and ART.

 5.3.4.2 Existing Links

 KCH does not have and has never had any Links with any international counterpart
 institutions.

 5.3.5   Arthur Davison Children’s Hospital

 5.3.5.1 Brief Profile

 The Arthur Davison Children’s Hospital (“ADH”) is situated in the city of Ndola, on the
 Copperbelt province, and is the only specialized children’s hospital in Zambia. It is a
 third level referral institution with an official bed capacity of 250, which at peak periods
 from September to June, increases to nearly 300. Due to high demand, ADH is also
 compelled to provide second level services. Most of its clients are drawn from the
 districts of Ndola, Luanshya, Masaiti, Mpongwe and Lufwanyama on the Copperbelt.
 Other provinces sending patients for specialist treatment at ADH include Luapula,
 Northern, North-Western and Central provinces. The clients of the hospital are mainly
 children up to the age of 14 years.



August 2007                                             31                        CAN Investments Limited
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              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 The services provided by ADH include both curative and rehabilitative health care
 services, which include: outpatients, medicine, surgery, dentistry, radiology, pathology,
 neonatology,      otolaryngology,   physiotherapy,     orthopedics,     ultrasound    and
 echocardiography, ophamology, ART services, psychosocial, PMCT, VCT, mortuary and
 pharmaceutical services. It also provides teaching to a variety of students from medical
 and nursing schools, paramedical and technical colleges. There are several factors
 affecting the performance of ADH.

 In addition to the generic problems being experienced by the hospitals, ADH is
 experiencing the following problems:

      Shortages of pediatric formulation in efavirenz, lack of coordination between the
       public and private health sectors in terms of commencements of ARVs in order to
       avoid early placement of children on second line treatment, and inconsistent supply of
       adequate drugs to treat opportunistic infections;
      Inadequate space, for example, the ART clinic is always crowded due to the increased
       numbers of children accessing ART services. This calls for construction of an ART
       family centre for both children and their guardians to access ART services;
      No appropriate equipment to carry out ARV drug resistance profiles, especially with
       children exposed through PMTCT;
      No PMTCT referral system to detect the neonates who were exposed to ARVs; and
      Shortages of appropriate equipment and reagents to detect creptococcal meningitis,
       toxoplasmosis and tuberculosis in children.

 5.3.5.2 Existing Links

 Currently, ADH does not have any Links. However, in 2006, they received 5 student
 volunteers from the USA, who only came for one week. The Northrise University of
 Ndola also brought in some experts on a one-off visit basis.

 5.4     Provincial and District Hospitals (1st and 2nd Level Hospitals)

 5.4.1    Brief Profile

 Provincial and District Hospitals (1st and 2nd Level hospitals) are also faced with similar
 constraints and challenges as the other health service delivery institutions. The most
 critical ones include:

      Critical shortages of human resources;
      Erratic supply of essential drugs and medical supplies;
      Poor transport, logistics and communication infrastructure; and
      Poor condition of essential infrastructure.



August 2007                                             32                        CAN Investments Limited
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                                                                                                MAIN REPORT
              The Tropical Health and Education Trust           Mapping of Health Links in the Zambian Health
              In conjunction with                               Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                    under the Ministry of Health



 However, at this level, the situation is more severe than at the Central Hospitals (3rd Level
 hospitals), especially that a large number of provincial and district hospitals are located in
 rural areas. In this respect, Provincial and District Hospitals need various forms of
 support, including the establishment of Links, to enable them improve the standards of
 service delivery.

 5.4.2   Existing Links

 Out of a total of 74 District (1st Level) Hospitals and 19 Provincial (2nd Level) Hospitals
 in the country, 17 reported to have established some Links of some kind. However, only
 4 of these had significant numbers of Links to talk about, namely: Chainama Hills
 Hospital/Health Training College in Lusaka; St. Francis Mission Hospital in Katete,
 Eastern Province; Chilonga Mission Hospital in Mpika, Northern Province; and Monze
 Hospital in the Southern Province.

 Whilst a list summarizing the existing Links, by institution, is provided at Appendix V,
 we present below, as an example, descriptions of Links existing at St. Francis Hospital,
 Chilonga Hospital and a summary list for the other Provincial and District level hospitals.

 5.4.2.1 St. Francis Hospital, Katete

 St. Francis hospital is a mission hospital located in the town of Katete in the Eastern
 province of Zambia. The mapping revealed that St. Francis is probably has the highest
 number of Links compared to other provincial and district hospitals. St. Francis is a good
 example of how Links could benefit health facilities in improving the standards of health
 service delivery. In view of the established Links, even though St. Francis is classified as
 a 2nd Level hospital, it attends to referrals from all over the country. The hospital’s
 success in establishing and maintaining Links is largely attributed to the existing and past
 expatriate volunteer managers and specialists, who have continued to be very committed
 to supporting this hospital. The following Links were reported at St. Francis Hospital:

 Table 7: Existing Links at St. Francis Hospital
 S/N     Link Partner                   Nature of Link
 1.      Zambia Society Trust,          The society has been supporting the AIDS Orphans programme,
         UK.                            through the AIDS project.
 2.      Hands Around The               This organization was founded by Dr. David Steiner, who used
         World (“HATW”), UK.            to work at the hospital as a doctor in the early 1990’s. The aim
                                        of this organization is to assist by sending skilled volunteers for
                                        short periods to share their skills. A number of volunteers have
                                        visited and assisted in the pharmacy, maternity and ultrasound
                                        sections.




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              The Ministry of Health of Zambia                                    under the Ministry of Health



 3.     Friends of St Francis’, Friends of St. Francis Hospital is an organization that keeps
        UK.                     former members of staff of the hospital in touch with each other
                                and up to date with news from the hospital. It also raises a
                                substantial amount of funding for the hospital. The funds come
                                in all various forms, including personal donations from former
                                staff and other friends of the hospital, church groups, special
                                fundraising events, such as marathons, birthdays (whereby
                                birthday gifts are donated to the hospital) and stalls at
                                exhibitions. They also assist with recruitment of volunteers,
                                mainly doctors, from the UK. A donation of £10,000 was made
                                a few years ago and the bank interest on this amount has been
                                used to fund staff training. Most of the funds raised go towards
                                procurement of drugs and medical supplies, which are sent
                                annually by container, supplementary salaries for senior doctors
                                and other key staff, and support to staff training.
 4.     Lothian Health Board,   A team from Lothian Health Board visited the hospital in 2004,
        Scotland.               comprising of clinical staff and a health information specialist,
                                on a fact-finding mission to identify areas of support and
                                collaboration. The information specialist also spent some time
                                working with hospital records staff.
 5.     Scottish Borders Africa The Group has been supporting the hospital’s AIDS project,
        AIDS Support Group.     through fundraising.

 6.     United Society for the          USPG was formed by merging two mission societies, namely
        Propagation of the              the Universities Mission to Central Africa (“UMCA”) and the
        Gospel (“USPG”).                Society for the Propagation of the Gospel (“SPG”). The link
                                        with UMCA dates back to the founding of the hospital in 1948
                                        by Fr. Francis Trefusis, a missionary with UMCA. Many of the
                                        early members of staff at the hospital were UMCA
                                        missionaries. UMCA/USPG support to the hospital has
                                        continued, through provision of medical doctors and other
                                        qualified health workers and financial and material support. In
                                        this respect, the current Executive Director and Pediatrician, Dr.
                                        Shelagh Parkinson and the Manager Administration, Ian
                                        Parkinson are USPG missionaries. They have also taken
                                        particular interest in supporting HIV programmes and, for a
                                        number of years, have been sending HIV infection prevention
                                        kits, containing HIV test kits, gloves, syringes, needles,
                                        disinfectants and sharps boxes, and have also been piloting a
                                        post exposure prophylaxis policy, aimed at reducing the risks of
                                        staff getting infected by HIV upon being accidentally pricked
                                        by contaminated needles.
 7.     Summer Concert,                 The summer concert event was introduced nine years ago. This
        Netherlands.                    is an outdoor summer music concert held in Laren, the
                                        Netherlands, every year to provide entertainment to the general
                                        public and raise funds for St. Francis hospital. Funds raised at
                                        these concerts are often supplemented by the Netherlands
                                        Government and sent to St. Francis hospital.

August 2007                                             34                           CAN Investments Limited
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                                                                                                MAIN REPORT
              The Tropical Health and Education Trust           Mapping of Health Links in the Zambian Health
              In conjunction with                               Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                    under the Ministry of Health




 8.     Medical Support                 The Medical Support Group (“MSG”) was founded by former
        Group, Netherlands.             members of staff of St Francis’ Hospital, living in the
                                        Netherlands. The main aim of MSG is to provide support to the
                                        hospital, which is being done in a number of ways, including
                                        fundraising, material support and establishing linkages between
                                        the hospital and various donors. MSG has also been providing
                                        support to capital projects and the workshop. In this respect, on
                                        several occasions, they have been sending senior members to St
                                        Francis to physically assist with building projects and provide
                                        support to the workshop. Over the years, the MSG has also
                                        been providing material support in form of drugs and
                                        equipment donated to the hospital.
 9.     Bed Sponsorship                 A bed sponsorship scheme has been introduced as a fundraising
        Scheme, Netherlands:            activity for the hospital. Under this scheme, organizations and
                                        individuals sponsor specific beds in the hospital at $1,500 per
                                        bed per year. The hospital provides the sponsors quarterly
                                        reports on the performance of the sponsored beds. Most of the
                                        money raised by this scheme is used on the procurement of
                                        drugs for the hospital.
 10.    Gooi Noord Hospital,            For some years there has been a relationship with this hospital.
        Netherlands.                    This relationship was strengthened by Dr. Jan Croft, Chirug
                                        (Surgeon) when he retired from Gooi Noord. Dr. Croft had also
                                        used to work at St. Francis’. The support has varied, ranging
                                        from sending short term personnel to assist in the laboratory,
                                        equipment and financial support through Bed Sponsorship
                                        Scheme. It is hoped that the relationship could be developed
                                        further.
 11.    Cordaid, Netherlands:           Cordaid has been supporting the hospital’s HIV/AIDS project
                                        for many years. They have since taken over the role of lead
                                        donor, helping to co-ordinate communications with the other
                                        donors to the programme. Cordaid have in the past assisted with
                                        staffing, particularly doctors.
 12.    Simavi, Netherlands.              Simavi is a Dutch Organisation currently supporting the
                                        project aimed at improving water supply at the hospital. They
                                        have also previously funded the procurement of an x-ray
                                        machine for the hospital.
 13.    Episcopal Relief and            Recently started to support the AIDS project. It was with their
        Development (“ERD”),            support that the new vehicle for the AIDS project was
        USA.                            purchased in 2004.
 14.    Catholic     Medical            CMMB are part of the AIDS Relief Consortium and were very
        Missions        Board           instrumental in St. Francis being selected as one of the first five
        (“CMMB”), USA.                  AIDS Relief sites in Zambia. CMMB have also recruited a
                                        doctor from USA to work at the hospital.
 15.    Catholic Relief                 CRS is the lead organization in the AIDS Relief consortium.
        Services (“CRS”),
        USA.


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                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 16.    Jersey Overseas Aid    Over the years, JOA has supported the hospital through sending
        (“JOA”), USA.          of workgroups, funding of building projects, such as the recent
                               housing project, and procurement of drugs and medical
                               supplies.
 17.    Direct Relief          DRI has been supporting the hospital with donations of drugs
        International (“DRI”), and medical supplies and medical equipment. The first
        USA.                   container of drugs, medical supplies and equipment from DRI
                               was received by the hospital in 2004.
 18.    Katho College,         This Link started in 2003, largely through the initiative of Dirk
        Belgium.               Monbaliu. The college trains nurses and midwives, among
                               many other professions. The training support programme
                               focuses at providing students with opportunities to spend part of
                               their time in a different environment. As a result of this support,
                               a group of nursing and midwifery students came and spent 12
                               weeks at the hospital, gaining experience on the wards as well
                               as theoretical learning. Two of their tutors also spent some time
                               at the hospital, both with their own students and also the
                               hospital’s own nursing students. Katho College has also
                               provided financial support to the hospital, particularly to
                               support the school library. The programme will continue.
 19.    Christian Aid.         Supported the hospital’s AIDS project for many years. They
                               have also previously made other donations, such as the upgrade
                               of the Special Care Baby Unit.
 20.    Guernsey Overseas Aid GOA has funded the construction of 4 staff houses for the
        (“GOA”).               hospital. They have also been providing financial support
                               through MSG.
 21.    Lions International    The Lions have supported the hospital’s eye work for a number
        (The Lions).           of years. In 2005, they donated a vehicle for eye outreach
                               activities. They have also provided funds for motor vehicle
                               repairs, funded eye camping sessions and sponsored staff
                               training programmes.
 22.    Missio Austria.        Mission has been supporting the HIV/AIDS project for ten
                               years.
 23.    Old Catholics, Bonn, Supports the hospital AIDS project.
        Germany.
 24.    Sandy Logie Fund.      Support for treatment of HIV patients.
 25.    Zambia Anglican        Has been providing financial grants to the hospital. Through the
        Council (“ZAC”,        Administrator Revd Rogers Banda, they also assist with
        Zambia.                processing immigration and medical council papers for
                               expatriate staff and clearing through customs and Ministry of
                               Finance of all items coming from overseas.




August 2007                                             36                        CAN Investments Limited
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              The Tropical Health and Education Trust           Mapping of Health Links in the Zambian Health
              In conjunction with                               Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                    under the Ministry of Health



 5.4.2.2 Chilonga Hospital, Mpika

 Chilonga is a mission hospital operated by the Catholics. The hospital is a level 2 facility
 based in the town of Mpika, Northern Province. The following are some of the Links that
 were identified at Chilonga Hospital:

 Table 8: Existing Links at Chilonga Hospital
  S/N    Link Partner                                        Nature of Link
  1.     Action Medior, Germany                              Drugs, once in a while
  2.     BD, USA                                             Laboratory technology
  3.     Bridge of Friendship, Germany                       Second hand equipment
  4.     Bridge of Friendship. Germany                       Dr. Muller, visiting Gynaecologist
  5.     CORDAID, The Netherlands                            Small Projects, HR recently infrastructure
  6.     Development Cooperation Ireland (DCI)               Infrastructure-Midwifery School
         Friends of Chilonga Foundation,
  7.     Netherlands                                         Former Doctors who worked at Chilonga
  8.     MISEREOR, Germany                                   Funds and Equipment
  9.     Streekziekenhuis Midden Twente, Hengelo             Based on proposals
  10.    The Beit Trust, UK                                  Infrastructure –building
  11.    Trace, Tanzania                                     Human Resources Development

 5.4.2.3 Monze Hospital, Southern Province

 Monze Hospital is a Level 1 hospital based in Monze, Southern Province. The following
 Links were reported:

 Table 9: Existing Links at Monze Hospital
 S/N    Existing Links                            Nature of Link
 1.     AIDS Health Care Foundation.              Support to HIV/AIDS and ART activities.
 2.     VSO, UK.                                  Volunteer staff from overseas.
 3.     Hands Around the World.                   Extension of the Children's ward, male ward and
                                                  completion of the ICU. Also provides support to staff
                                                  development.
 4.     Misereor –Germany.                        Support to HAART Project.
 5.     Other Links:                               Michigan State University, USA
                                                   Canadian Food for Children
                                                   Catholic Mission Board




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              In conjunction with                               Services and Associated Academic Institutions
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 5.4.2.4 Existing Links - Other Provincial and District (1st and 2nd Level) Hospitals

 A number of Links were also identified at some provincial and district level hospitals.
 However, again it appeared that such Links are mainly concentrated at a few facilities.
 Further, some of the Links were not described. Below are the Links identified at the
 other 1st and 2nd Level hospitals:

 Table 10: Existing Links at other Provincial and District Hospitals
 S/N    Institution/ Hospital         Existing Links                 Nature of Link

 1.     Chikankata Mission            Boston University, USA.        Research Program on Malaria
        Hospital, Southern                                           Management in rural areas (2 year
        Province.                                                    program).
                                      Michigan State University,     Joint Research (2 year renewable)
                                      USA.                           on adherence to ART in rural
                                                                     setting.
                                      Swedish Rotary Doctor,         Visiting Swedish doctors.
                                      Sweden.
 2.     Kabwe General                 Massachusetts General          Research on Maternal and Infant
        Hospital, Central             Hospital, USA.                 Health Improvement
        Province
 3.     Kabwe Mine                    Massachusetts General          Systems strengthening and staff
        Hospital, Central             Hospital, USA.                 training.
        Province.
 4.     Lewanika General              University of Moto        in Surgery, Infrastructure, Equipment
        Hospital, Western             Czech Republic.              & Training.
        Province.
 5.     Livingstone General           Center for Disease Control     Support to counseling services,
        Hospital, Southern            (CDC), USA.                    laboratory services, equipment,
        Province                                                     infrastructure development.
                                      Johnson and Johnson Yale       Post     graduate     doctors  for
                                      University, USA.               experience and research
                                      Rapids –World vision           Psycho-Social support program for
                                                                     children living with HIV/AIDS,
                                                                     Orphans and Vulnerable Children
                                                                     (will run up to 2010).
                                      Zambezi – Physiotherapy        Student exchange program
 6.     Mansa General                 Indirect link through Rotary   Provision of equipment and drugs.
        Hospital, Luapula             Club of Mansa Direct
        Province.                     Relief International.
 7.     Kaoma DHMT/                   FMC (Former Dutch Doctors)     Help out in new hospital construction
        Hospital
                                      Orange Babies of Netherlands    Construction of maternity Ward
                                      Touch of Ireland               Short term /Construction of children’s
                                                                     Ward




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              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 5.5     Health Centres and Health Posts

 Health Centres (“HCs”) and Health Posts (“HPs”) are distributed throughout the country
 in both urban and rural areas. They are the first points of access for health services by the
 general public. These facilities are the most affected by the various problems and
 constraints currently being experienced by the health sector. Currently, a large number of
 the HCs and HPs, especially those in rural areas are severely affected by the critical
 shortages of qualified health workers and are, in some cases, forced to depend on
 untrained personnel, they are also more exposed, when it comes to the erratic distribution
 of drugs and medical supplies, and are significantly affected by the poor state of
 infrastructure, transport and communication.

 During the process of this assignment, we did not find any HCs or HPs with established
 Links. This probably could be due to the fact that the focus for this mapping was on
 hospitals and training institutions.

 5.6     Health Training Institutions

 Health training institutions play an important role in providing the health sector with
 appropriately trained health workers. The institutions providing training for health
 workers in Zambia include: the UNZA School of Medicine; Chainama College of Health
 Sciences; Nursing and Midwifery Schools; Science Laboratory Training Colleges; and
 training schools for other paramedics. Currently, these institutions are faced with
 significant challenges, including the critical shortages of teaching staff, shortages of
 teaching materials and aids, inadequate capacities and general dilapidation of
 infrastructure. Scaling up of training and development is one of the main strategies
 proposed in the HRH Strategic Plan for resolving the human resource crisis.

 5.6.1    Existing Links

 During the mapping of Links, a total of 21 health training facilities were identified
 throughout the country, including the UNZA School of Medicine. Out of these, a total of
 9 were found to have established Links. The Links for UNZA School of Medicine have
 already been discussed together with the UTH, under the section on Level 3 Hospitals.
 Provided in Table 11 are the Links identified at the other training institutions.

 Table 11: Existing Links at Health Training Institutions
 S/N     Training Institution    Existing Links              Nature of Link
 1.      Ndola College of Bio- Irish Aid (Dublin in Infrastructure, Staff
         Medical Science, Ndola. Institute of Technology) up development, 18 staff members
                                 2006.                       have been trained.
 2.      UTH - Nursing School    Johnson & Johnson           Capacity building.
                                 Karolin’s, Sweden           Staff and student exchange.



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                                           CIMO – Finland                 Staff and student exchange.
                                           (www.stadia.fi )
 3.      Kasama School of                  University of Ireland,         Training and capacity building.
         Nursing, Northern                 Galway.
         Province.
 4.      Chikankata College of Plans to link with the                     Research purposes.
         Bio-Medical     Sciences, University of Boston. Not
         Southern Province.        yet finalized.
                                   University of Michigan                 Staff     Development       and
                                   through UNZA.                          exchange programme.
                                   University of Michigan,                Research at the College and
                                   through UNZA.                          clinical, diagnostic laboratory,
                                                                          and staff development and
                                                                          exchange.
 5.      Livingstone School of             Kristianstad University –      Tutor and Student exchange
         Nursing, Southern                 Department of Health           programme.
         Province.                         Science (Sweden)
                                           Norway –SOGN OQ                Tutor and Student           annual
                                           FJORDANE University –          exchange programme.
                                           Faculty of Health Studies

 5.7     Statutory Boards and Other Units

 There are two types of statutory boards in the Zambian health sector, namely, regulatory
 and service boards. Regulatory boards are mainly responsible for enforcing specific
 pieces of the legislation governing the health sector, for and on behalf of MOH, whilst
 service statutory boards are responsible for providing specific support services to the core
 health service delivery systems. The findings revealed that the following Links existed at
 this level.

 5.7.1    The Medical Council of Zambia

 5.7.1.1 Brief Profile

 MCZ was established under the Medical Council Act of Zambia and is the institution
 responsible for regulating the medical profession in the country. To practice in Zambia,
 medical professionals are required to register and continue meeting the professional and
 ethical requirements of MCZ. Currently, MCZ only operates one office, in Lusaka, but
 plans are underway to decentralise the operations by setting up branches at provincial
 level throughout the country.




August 2007                                             40                           CAN Investments Limited
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              The Tropical Health and Education Trust          Mapping of Health Links in the Zambian Health
              In conjunction with                              Services and Associated Academic Institutions
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 5.7.1.2 Existing Links

 MCZ has no established any Links, except for the collaboration in information sharing
 with the Association of Medical Council of Southern Africa (14) countries, and the
 General Medical Council (GMC), UK. However, with the help of THET, they are in the
 process of developing a Link with the UK Regulatory Authorities, focusing on the
 following areas:

      Supporting the MCZ restructuring process by providing a consultant to provide
       appropriate technical advisory to the restructuring process;
      Information and knowledge sharing; and
      Professional collaboration.

 5.7.2     The General Nursing Council

 5.7.2.1 Brief Profile

 The GNCZ was established under the Nurses and Midwives Act of 1970. This Act was
 later revised and replaced with the Nurses and Midwives Act of 1997, which redefined
 the functions of the GNCZ and expanded the scope of practice for nurses and midwives.
 GNCZ is the only institution mandated by MOH to set, enforce, monitor and evaluate
 performance standards for nursing and midwifery training, clinical practice, management
 and research in Zambia. Currently, GNCZ is faced with significant challenges, including
 the shortages of staff, inadequate capacity to efficiently and effectively fulfil its mandate,
 and inadequate financial support.

 5.7.2.2      Existing Links

 GNCZ has in the past established and benefited from a number of Links, on a project
 basis. However, most of the projects supported by these Links have been completed,
 leaving significant gaps, which still require filling. A number of past and existing Links
 were identified at the GNCZ, which are briefly described in Table 12.

 Table 12: Existing Links at the General Nursing Council
 S/N     Link Partner                 Nature of Link
 1.      Swedish International        Institutional collaboration. This Link was established 1997. The
         Development                  key technical partner was Karolinska Institutet, a Medical
         Cooperation Agency           University based in Stockholm, Sweden (“Karolinska”). College
         (“Sida”).                    of Health Sciences (“CCHS”), Evelyn Hone College, Zambia
                                      Integrated Health Project (“ZIHP”), World Health Organisation
                                      (“WHO”), the Central Board of Health (“CBOH”) and MOH.
                                      Implementation of the activities under this Link also involved the
                                      participation of other Zambian institutions, namely, UNZA
                                      School of Post-Basic Nursing, UNZA School of Medicine, UTH
                                      School of Nursing and Midwifery, Chainama.

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                                      Programme focused at needs assessment and capacity building for
                                      all health training institutions in Zambia. The assessment
                                      revealed critical shortages of staff, especially teaching staff,
                                      shortages of teaching materials and teaching aids and significant
                                      deteriorations in essential infrastructure.        Following these
                                      findings, a number of activities were conducted, which included:
                                       The Problem-Based Learning Group: Through the work of
                                           this group, the problem based learning approach was
                                           introduced in health training institutions;
                                       The Research Group: Tasked to carry out capacity building
                                           in research for tutors. Significant capacity building and
                                           training of tutors in research was conducted. As a result, a
                                           number of research activities were undertaken and a number
                                           of books were produced by the tutors;
                                       The Books and Libraries Group: Tasked to take inventory of
                                           books available in all training institutions. Following this
                                           assessment, in 2006, significant quantities of appropriate
                                           books and study materials were procured in bulk and
                                           distributed to the various training institutions. Procuring of
                                           the remaining 50% of the allocation has already started;
                                       The Training Assessment and Curriculum Development
                                           Group (“TNACD”): Key activities of this group included the
                                           review of existing curricula, development of new curricula
                                           and training materials, and providing updates for students
                                           and teaching staff. The group also produced a handbook on
                                           malaria for nurses and midwives; and
                                       The Writers Group: This group was tasked to develop a plan
                                           on the future long-term sustainability of the activities
                                           supported by the Link, once this arrangement has come to an
                                           end. The main aim is to identify the key constraints and
                                           make appropriate recommendations.
 2.     John Hopkins                  This Link focused at the review and development of the
        University’s Capacity         curriculum for midwifery training. Even though the project came
        Building Programme,           to an end in 2004, the following planned activities were not
        with support from             completed and are still relevant: Sensitization activities for the
        JHPIEGO/USAID.                newly developed curriculum; and staff training in continuous
                                      assessment.
 3.     ZHIP/USAID                    The Zambia Integrated Health Programme (“ZHIP”), with
        Support.                      support from the USAID, provided financial and technical
                                      support towards curriculum review for nurses and midwives.
                                      Also provided one motor vehicle for M&E. This project has
                                      since come to an end.
 3.     Health Services               The Health Services Support Program (“HSSP”) is a USAID
        Support Program               sponsored programme. HSSP has been providing financial and
        (HSSP), Zambia.               technical support to some programmes on specific activity basis.



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              The Ministry of Health of Zambia                                 under the Ministry of Health



 5.7.3    The Tropical Disease Research Centre

 The Tropical Disease Research Centre (“TDRC”) is located in Ndola. It is a statutory
 board mandated to support the health sector with research and development services in
 tropical diseases. During the mapping visit, it was reported that TDRC has established
 several Links. However, management offered to make a written submission, which until
 the time of finalizing this report had not been submitted.

 5.7.4    The Zambia National Flying Doctor Service

 5.7.4.1 Brief Profile

 The Zambia National Flying Doctor Service (“ZNFDS”) was established in 1965 as a
 service statutory board responsible for providing outreach health care services to most
 remote areas of the country. The ZNFDS head office is based in Ndola, on the
 Copperbelt province, and its main services include preventive, curative and general health
 care services, and emergency evacuation services. ZNFDS flies medical doctors from
 urban areas to provide outreach medical care services in the remote, difficult to reach
 rural areas, and also facilitates referral services by flying patients from remote areas to
 urban hospitals. Currently, the operations of ZNFDS are significant constrained by the
 following problems and challenges:

        Only 2 small aeroplanes available, which do to meet the needs. Previously, had 4
         aeroplanes;
        The available aeroplanes are not pressurized and do not have life-saving equipment
         and therefore not appropriate for this purpose;
        Transport problems. Have only one old ambulance for emergency evacuations
         between the hospital and the airport in Ndola;
        While a clinic at their base in Ndola, the facility lacks basic equipment;
        Poor state of communication facilities and equipment. Largely dependent on an old
         and unreliable radio messaging system;
        Lacks the necessary ICT equipment and software. Currently, the entire institution
         has only 6 stand alone desktop computers, and only one of these is connected to the
         internet; and
        Inadequate funding, aggravated by the high costs of repairs and maintenance for the
         aeroplanes.

 5.7.4.2 Existing Links

 Currently, ZNFDS does not have any Links. However, in the past they had a Link with
 Oxfarm. This Link, which has since come to an end, focused on providing material
 support to ZNFDS, in form of boats for transportation of patients to the ZNFDS
 established points and clinics.


August 2007                                             43                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 5.7.5   Other Statutory Boards

 The other statutory boards are equally experiencing significant constraints and
 challenges, including critical shortages of appropriate staff, and inadequate funding to the
 core programmes. Existing Links at the remaining statutory boards have not been
 identified. However, some of statutory boards receive technical and financial support
 from bilateral and multilateral donors, on project basis, which may not be classified as
 Links.




August 2007                                             44                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 6     POTENTIAL AREAS FOR FUTURE HEALTH LINKS

 6.1     Overview

 During the mapping exercise, potential areas for future Links were discussed. The areas
 identified are summarized below, under the following categories: generic, provincial and
 district management offices, central hospitals, provincial and district hospitals, health
 centres and health posts, training institutions and statutory boards.

 6.2     Generic Potential Areas for Future Links

 The problems and constraints being experienced by health service institutions at different
 levels are to a large extent similar, except for a few which are specific to some
 institutions. In this respect, most of the potential areas proposed for future Links are
 generic and could benefit most of the health sector institutions. The areas include:

      Technical exchange programmes involving staff at various levels, particularly in
       specialized areas, to provide for knowledge and skills transfer;
      Short and long-term secondment of consultants and other experts in all specialized
       areas, with emphasis on core service areas at every level, on a gap filling basis;
      Staff training and capacity building for both medical, technical and support staff,
       through short and long-term training programmes:
        Short-term training programmes conducted by visiting professors and experts
           from Link partners, in specialized areas, targeting various levels;
        Development of standard operating procedures; and
        Long-term training could be in form of scholarships;
      Collaboration in research and development activities;
      Support to systems development in technical fields including core health
       programmes, supervision, and monitoring and evaluation;
      Support to knowledge sharing, through provision of e-learning opportunities and
       promotion of the use of modern ICTs, including facilitation of internet connectivity,
       internet-based knowledge exchange with the British National Formulary and other
       sources of essential medical journals and publications;;
      Specialist support to repairs and maintenance of medical equipment. Currently, there
       are no in-house expertise in this area, resulting into frequent breakdowns and pre-
       mature write-off of various equipment; and
      Material support in identified priority areas, including infrastructure development,
       provision of equipment and auxiliaries, drugs and medical supplies, and other forms
       of material support, on a gap filling basis.




August 2007                                             45                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 6.3     Provincial and District Health Management Level

 In addition to the generic potential areas for Links, PHOs and DHMTs would require
 support aimed at addressing their specific needs, including:

      Capacity building and skills strengthening in supervision skills, monitoring and
       evaluation; and
      Transport and communication to strengthen routine and adhoc supervision, and
       monitoring and evaluation.

 6.4     Hospitals at all Levels

 The following are the additional potential areas for future Links for the hospitals, based
 each facility’s specific needs:

 6.4.1    UTH/UNZA School of Medicine

 The UTH/UNZA School of Medicine have already developed a significant number of
 Links with various international counterpart institutions. However, these Links appear to
 be fragmented by departments and sections, and are not coordinated both at the institution
 and sector levels. In view of the foregoing, what would be required is to analyse these
 Links in detail, align them to institutional and sector objectives and priorities, identify the
 gaps and develop an appropriate framework for coordination, monitoring and evaluation.

 6.4.2    Ndola Central Hospital

 Through performance assessments and other studies, the Copperbelt PHO and the Ndola
 central hospital management team have identified the following as some of the specific
 areas requiring Links at the Hospital:

      A Link with an obstetrics unit of a major teaching hospital to provide continuous
       technical support to the doctors at the hospital; and
      Secondment of consultants in:
        Maternal care, to provide support in the establishment of an obstetrics and
           gynaecology post-graduate training school;
        Neonatal care, including the introduction of latest guidelines on neonatal
           resuscitation and kangaroo care method; and
        Training of biomedical engineers.

 In Ndola district, Maternal Mortality Ratio (“MMR”) is currently estimated at 230-330
 per 100,000 live births. A review of maternal deaths for 2006 attributed most of the
 maternal deaths to lack of supervision of the intern doctors, due to the critical shortage of
 obstetricians and gynaecologists at the hospital.


August 2007                                             46                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 Establishment of a Link with an obstetrics unit of a major teaching hospital would
 therefore be of great benefit as it would mitigate the current shortages of these specialists.
 The benefits to the UK doctors would be to gain experience in attending to women in the
 Tropical African environment, surgical repairs of fistulas, advanced cervical cancer and
 treatment of acute septic abortions that are not commonly found in the UK. This could
 take the form of exchange visits of about 3-6 months or longer, if an obstetrician could be
 'posted' to the hospital to train the intern doctors and those specializing in obstetrics and
 gynaecology. If possible, establishment of a permanent training centre for Obstetrics and
 Gynaecology in Ndola would make a major contribution.

 Neonatal care is another challenge for the Ndola Central Hospital. There is need to
 establish a Link with a neonatal/paediatrics unit of a major teaching hospital. Neonatal
 mortality is extremely high, and yet staff shortages do not allow for dedicated nurses to
 be in attendance of neonates at all times. The use of kangaroo care or “skin to skin”
 method of caring for the neonates is not practiced. Further, oxygen and suction are used
 in resuscitation, instead of ambu bags. Introduction of the “skin to skin” method of
 caring for neonates, as practiced at Monse hospital in Zambia, would be ideal. Also
 required are skills updates and adherence to the American Association of Neonatal
 resuscitation guidelines. Such a Link would be of significant benefits to both parties.

 Maintenance and repair of medical equipment is a challenge. There is no training
 programme for biomedical engineers, although a local college and UNZA provide
 training for technicians and degrees in electrical and electronic engineering, respectively.
 The Netherlands has made commitments to support the establishment of an ongoing
 training programme to supplement the graduates from these colleges to become medical
 equipment technicians and medical engineers.

 6.4.3   Kitwe Central Hospital

 KCH’s needs for future Links are, to a large extent, similar to those outlined under
 generic potential areas of future Links and those for Ndola Central Hospital. In addition,
 KCH needs to establish an obstetric unit, including theatre and equipment, to replace
 the smaller unit that now exists. The hospital serves 31 health centres for complicated
 cases and several districts for 3rd level referrals.

 6.4.4   Arthur Davison Children’s Hospital

 Due to its specialised nature, in addition to the list of generic potential areas for future
 Links, ADH also requires long-term secondment of consultants and other experts in all
 the specializations, especially in neonatal and child health care, HIV/AIDS, malaria and
 tuberculosis, which all rank high on the major cases at ADH.




August 2007                                             47                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 6.4.5    Provincial and District Hospitals (Level 1 and 2 Hospitals)

 In addition to the generic needs for Links, these categories of hospitals would require
 Links in support to:

      Support to maternal and child health, including expertise, infrastructure and transport
       support. Most of the district hospitals are located in rural areas and face significant
       challenges in the management of expectant mothers and children, due critical
       shortages of staff, poor state of infrastructure and shortages of transport and
       communication facilities for Emergency Obstetrics Care (“IMOC”); and
      Support to HIV/AIDS programmes, including prevention and treatment, particularly
       in rural areas. Rural areas are significantly disadvantaged as far as distribution of
       experts and capacities to manage ART programmes.

 Specific priorities for each facility could be identified from their Strategic Plans and
 Annual Action Plans.

 6.5     Health Centres and Health Posts

 HCs and HPs are probably the most affected in terms of shortages of qualified staff,
 essential drugs and medical supplies, communication, transport, logistics and poor state
 of infrastructure. HCs and HPs could benefit from Links focused at:

      Support to service delivery in form of secondment of personnel, including doctors,
       nurses, clinical officers, probably to the DHMTs, so that they form a pool of
       qualified staff who could be covering all the HCs and HPs in the particular district, on
       a gap filling basis;
      Staff training and capacity building in core programme areas and maintenance of
       medical equipment. Again, such training could combine staff from various HCs and
       HPs;
      Institutional capacity building, including support to infrastructure, communication
       and transport.

 6.6     Health Training Institutions

 One of the main strategies proposed in the Human Resource Plan is the need to expand
 training outputs of health training institutions. This requires significant strengthening of
 capacities at training institutions, including renovations and expansions of infrastructure,
 improving on the availability of teaching staff and teaching aids. In this respect, this area
 has significant potential for establishment and strengthening of partnerships with
 international health training institutions, through Links. In addition to the list of generic
 needs for Links, training institutions would require Links in the following areas:

      Long-term secondment of teaching and other experts from the Links;

August 2007                                             48                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health

      Continuous curriculum reviews and introduction of modern teaching methods;
      Material support in identified priority areas, requiring gap filling. These include the
       provision of teaching aids, study materials and text books, both electronic and hard
       copies, upgrading the standards of the libraries and laboratories; and
      Support to infrastructure development, including classrooms and hostels.

 6.7     Statutory Boards

 6.7.1    The Medical Council of Zambia

 MCZ requires Links to develop appropriate capacity to regulate the medical profession in
 a more efficient and effective manner. In addition to the generic areas for potential
 Links, MCZ has identified the following areas:

      Technical support in organization and management, preferably in form of a long-term
       technical advisor;
      Systems development in technical fields including supervision, monitoring and
       evaluation; and
      Technical collaboration with similar institutions abroad.

 6.7.2    The General Nursing Council

 GNCZ has continued to face significant challenges, particularly in respect of shortages of
 staff, inadequate financial and technical support to its core programmes, transport and
 logistics. Whilst the previous Links have proved very useful, they have left gaps that
 need to be filled. GNCZ has identified the following as the specific areas requiring future
 Links:

        Technical expertise and financial support towards the following activities:
        Curriculum reviews;
        Development and procurement of study materials and text books;
        Information, education and communication of core activities;
        Programme supervision, monitoring and evaluation, including provision of
         transport;
        Exchange programmes and attachments for staff from GNCZ and nurse and
         midwifery training institutions on an exchange basis; and
        Research and development programmes;
        Support to the development and enhancement of the use of ICTs at GNCZ and in
         nursing and midwifery training institutions; and
        Support towards infrastructure development. GNCZ would like to construct an
         office block for their operations, a centre of excellence and a resource centre.




August 2007                                             49                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 6.7.3    The Tropical Disease Research Centre

 The mapping of health Links established that TDRC has a number of Links.
 Management offered to make a written submission on the existing and required Links.
 However, the same had not been received by the time of finalizing this report.

 6.7.4    The Zambia National Flying Doctor Service

        The following were identified as the priority areas for future Links:

        Technical and financial support towards:
        pressurizing and equipping the available aeroplanes with emergency life-saving
         equipment;
        equipping the clinic with the necessary basic equipment and
        provision of additional appropriately equipped ambulances;
        Staff training, especially for core staff, i.e. doctors and nurses, in handling of
         emergencies;
        Improvements in communication systems. Replacement of the old radio messaging
         system with modern radio communication systems; and
        Improving the availability and access to modern ICTs, including provision of
         hardware, software, networking and improved access to the internet.

 6.7.5    Medical Imaging and Radiology

 In Zambia, radiology was introduced in the early 1930s, initially providing conventional
 x-ray services. Over the years, other forms of imaging services such as ultrasound,
 nuclear medicine and, later, computerized tomography, have gradually been introduced.
 Medical Imaging is important in the provision of the Basic Health Care Package (BHCP),
 as it provides essential diagnostic services for clinical policy decisions making. It is
 estimated that, currently, approximately 70% of cases in Zambian hospitals are referred
 to radiology at some stage of case management.

 Even though significant progress has been achieved in the development of medical
 imaging in Zambia, there are still significant problems and constraints in this area. The
 major ones include shortages of appropriately qualified staff, obsolete equipment, poor
 infrastructure, shortages of essential consumables, no clear policy and standard operating
 procedures, lack of educational facilities for advancement in education, and poor public
 awareness on hazards of radiation.




August 2007                                             50                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 Medical imaging is one area which could significantly benefit from establishment of
 appropriate Links with counterpart institutions in the UK and other developed countries.
 In June 2007, a team of experts from the Zambian Ministry of Health, led by the Director
 of Clinical Care and Diagnostic Services, conducted a study tour of the United Kingdom,
 under the THET programme. The main objective of this tour was to discuss development
 of medical imaging services, through education and training.

 The Zambian team also held discussions with officials from the South Bank University
 and the Society and College of Radiographers, where issues of education and training
 were widely deliberated. Through this process, the following were identified as potential
 areas for future Links:

        Development of a Link in form of twinning of the Radiography Department at
         South Bank University with the Department of Radiography at the University of
         Zambia;
        South Bank University to provide Continued Professional Development through
         Lecturer upgrade in various fields under the leadership of Professor Mary
         Lovegrove. Some funds have already been set aside for the initial part;
        Collaboration with the College of Radiographers in area of Teaching Aid Materials
         and Journals;
        Training of some Zambia Radiographers beyond first-degree qualification, with
         advanced practice as front line practitioners in radiology;
        South Bank University interested in reviewing the Zambian BSc. Radiography
         Curriculum before validation and adoption by the University of Zambia Senate; and
        Seeking UK Lecturers to kick start the BSc Degree Programme whilst Zambian
         lecturers undergo upgrade training.

 It was also agreed that the South Bank University should conduct a Situation Analysis of
 Medical Imaging Services Education and Training in Zambia, which could form a basis
 to identification of needs.

 6.7.6    Other Statutory Boards

 Most of the statutory boards could greatly benefit from Links covering the following
 areas:

        Technical support, including secondment of technical advisors to support core
         programme areas;
        Staff training and technical exchange programmes in core business areas; and
        Material support, on a gap filling basis, in identified priority areas.




August 2007                                             51                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 7    PROPOSED PROCESS FOR IDENTIFICATION OF FUTURE LINKS

 As earlier discussed in the background and also observed from the findings, even though
 the concept of Links is not widely understood and applied in Zambia, there are a number
 of health institutions that have taken initiative to establish Links. However, these Links
 lack an appropriate framework for effective organisation, management, and monitoring
 and evaluation. As a result, they are not properly coordinated and in some cases not
 linked to the sector and institutional priorities.

 In order to improve on this situation and ensure that the Links are properly coordinated
 and targeted at the right priorities, it is recommended that the process of identifying
 priority areas should be linked to the planning process. The areas for Links should be
 identified from the sector and institutional priorities outlined in the national health
 strategic plans, medium term expenditure framework and annual action plans. In the same
 spirit, implementation of Link activities should be managed in a transparent and
 accountable manner, and be clearly reflected in the plans and progress reports, and
 captured under the monitoring and evaluation arrangements in practice within the
 Ministry and the relevant institutions.




August 2007                                             52                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                             MAIN REPORT
              The Tropical Health and Education Trust        Mapping of Health Links in the Zambian Health
              In conjunction with                            Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                 under the Ministry of Health



 8       APPENDICES


 S/N                    Description/Title
 Appendix I             Terms of Reference
 Appendix II            Trends for Top 10 Major Diseases in Zambia, 2000-2006
 Appendix III           Staffing Levels and Workloads
 Appendix IV            Distribution of Core Health Workers By Province
 Appendix V             Consolidated List of Existing Links
 Appendix VI            List of Institutions and Persons Interviewed
 Appendix VII           List of Documents/Literature Consulted
 Appendix VIII          Reports Links Partners




August 2007                                             53                        CAN Investments Limited
                                                                                          Lusaka, Zambia
                                                                                               MAIN REPORT
              The Tropical Health and Education Trust          Mapping of Health Links in the Zambian Health
              In conjunction with                              Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                   under the Ministry of Health




                            Appendix I:                 Terms of Reference




August 2007                                                                         CAN Investments Limited
                                                                                            Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 Terms of Reference for Mapping Health Links in the Zambia Health
 Services and Associated Academic Institutions

 Background
 The health sector in Zambia is faced with a human resources crisis due to migration of core health
 workers from the public health institutions to the private sector within the country and overseas,
 mostly to the UK, Australia, New Zealand and the USA. The root cause of attrition is poor
 conditions of service in the public health system. Death among core health workers due to
 HIV/AIDS is another cause of attrition.

 The most affected facilities are secondary and tertiary level hospitals which have lost both
 qualified and experienced consultants, nurses and other paramedics. Training institutions have
 equally been affected through migration of lecturers and tutors in search of better conditions of
 service overseas. In order to address the staffing problems faced by health facilities and training
 institutions, managers within these facilities have established Health Links [hereafter referred to
 as Links] with partner institutions in foreign countries. Through such Links, medical experts in
 foreign countries have visited hospitals and training institutions to provide services, teaching or
 service development on a gap filling basis. There have sometimes been reciprocal teaching visits
 by Zambia staff overseas. Such Links are very common at the University Teaching Hospital and
 the School of Medicine at the University of Zambia. While such Links have resulted in a transfer
 of knowledge and skill to health workers in Zambia, there are concerns that such efforts might
 have resulted in fragmentation and duplication of effort by the parties. In certain instances, such
 Links have not addressed the key priority areas that require capacity building in the health
 institution. In most cases, such Links have been through individual efforts and did not fully
 address the capacity needs of respective institutions. The Ministry of Health [MOH] has
 acknowledged that there is need to better co-ordinate Links between the health facilities in
 Zambia and overseas institutions through identification of already existing Links and using a
 holistic approach to identifying areas and institutions that require capacity building through such
 efforts, in line with MOH’s strategic plans.

 In order for the MOH to establish Links that will address the capacity needs of the country it,
 together with the Tropical Health and Education Trust [THET], intends to undertake a mapping
 exercise of existing Links and to identify areas that will require Links in future in collaboration
 with THET and similar organisations in other countries. Through this effort it is expected that the
 MOH will better co-ordinate its capacity building efforts through Links with foreign institutions.

 Definitions
 Links are developmental partnerships which build capacity in Zambia’s health staff and the
 health care delivery system at primary, secondary and tertiary levels including in medical, nursing
 and other health related colleges or schools. They also have advantages for the non-Zambia
 partner/s through the acquisition of new knowledge, skills, and awareness. In Links one partner
 must be in Zambia and the other/s from another country. Some partnerships will have more than
 two partners and may involve several countries. Partnerships can involve individuals,
 departments, whole institutions, districts, professional associations or networks.
 Note; during the research and in the Zambia context this definition may need refining and this
 should be done in agreement with THET and the MOH Planning Department.




August 2007                                             1                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                            MAIN REPORT
              The Tropical Health and Education Trust       Mapping of Health Links in the Zambian Health
              In conjunction with                           Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                under the Ministry of Health



 Purpose
 The outcomes of the research will be used:

      By the MOH to identify areas and institutions that require capacity building through Links.
       This will enable the MOH to prioritise better institutions that will require capacity building
       through Links
      By the MOH to strategically influence future Links with all overseas partners
      By THET to facilitate the creation of Links with the UK within the MOH’s strategy
      By other researchers to identify field sites to assess the impact of Links on the Zambia
       Health Services and on the other partners.

 Accountability
 The consultant will be in contract to THET who will work with the Zambia MOH Planning
 Department to manage the contract. The outcomes should be made available to the MOH and
 THET.

 Context
 The Zambia Ministry of Health has already mapped existing health services/facilities in Zambia
 and they have also mapped large donors. THET has agreed with the MOH that for the purpose
 outlined above mapping is needed of Links.

 Specification
 The consultant should:

 1.    Contact all Zambia Health Facilities and “map” existing Links including the name of the
       partners, the focus of the partnership and the frequency and type of activities.
 2.    This will include such information as the number of people involved, numbers trained,
       exchanges and activity plans.
 3.    Identify the sources and level of resources [human and financial] supporting the Link.
 4.    Collect from Links copies of their evaluations or of evidence and stories which fall short of
       evaluations but give useful indications of the impact of their activities.
 5.    Produce a report which should include the following outcomes:
        A brief description of the methods used to collect the information.
        A description of Links in Zambia including their location, name of the partners, the
           focus or foci of the partnership and the frequency and type of activities.
        A description of the sources and level of resources [financial and human] available to
           support the Link.
        A collation of evaluations already undertaken of the Links.
        An analysis of trends and themes emerging from Link activities that would inform
           future policy on Links by MOH and THET.
        A description of health service processes and institutions that could benefit from
           capacity building through Links, particularly those that are highlighted in MOH plans.




August 2007                                             2                        CAN Investments Limited
                                                                                         Lusaka, Zambia
                                                                                        MAIN REPORT
              The Tropical Health and Education Trust   Mapping of Health Links in the Zambian Health
              In conjunction with                       Services and Associated Academic Institutions
              The Ministry of Health of Zambia                            under the Ministry of Health




     Appendix II:               Trends for Top 10 Major Diseases in Zambia,
                                         2000-2006




August 2007                                                                  CAN Investments Limited
                                                                                     Lusaka, Zambia
                                                                                                MAIN REPORT
              The Tropical Health and Education Trust           Mapping of Health Links in the Zambian Health
              In conjunction with                               Services and Associated Academic Institutions
              The Ministry of Health of Zambia                                    under the Ministry of Health



  Trends for Top 10 Major Diseases in Zambia, 2000-2006
  S/N   Disease Name         Indicator                2000        2002        2004           2005        2006
  1.    Malaria              Incidence/1,000           316         388         383            373         410
                             Cases               3,591,621   4,101,169   4,328,485      4,361,436   4,947,096
                             Deaths                  8,952       9,021       8,289          7,737       6,471
  2.    Respiratory          Incidence/1,000           119         148         153            161         192
        Infection: Non-      Cases               1,340,283   1,565,430   1,726,597      1,883,618   2,322,362
        pneumonia
                             Deaths                  1,269       1,057       1,436            911         687
  3.    Diarrhoea: Non-      Incidence/1,000            65          80          75             75          81
        blood                Cases                 739,055     846,336     843,423        875,077     977,138
                             Deaths                  2,795       2,996       2,725          2,931       2,427
  4.    Trauma:              Incidence/1,000            34          42          46             46          48
        Accidents,           Cases                 390,869     447,278     525,039        538,359     576,495
        injuries,
                             Deaths                    646         787         833            829         806
        wounds, burns
  5.    Eye Infections       Incidence/1,000            47         43           40            40          41
                             Cases                 471,743    451,346      448,280       461,881     498,884
                             Deaths                     72          8            5             -           1
  6.    Skin Infections      Incidence/1,000            28         37           42            42          41
                             Cases                 309,758    393,384      472,746       491,858     493,864
                             Deaths                    135        126          125            88         103
  7.    Respiratory          Incidence/1,000            35         45           44            42          39
        Infection:           Cases                 402,643    475,389      494,040       493,765     474,996
        Pneumonia
                             Deaths                  4,254      4,484        4,186         4,273       3,425
  8.    Ear/Nose/Throat      Incidence/1,000            21         25           23            24          26
        Infections           Cases                 238,403    260,058      259,877       277,421     314,470
                             Deaths                     49         31           34            79          31
  9.    Intestinal           Incidence/1,000            20         22           17            16          16
        Worms                Cases                 217,142    227,856      197,639       188,733     197,701
                             Deaths                     49         14            6            10           3
  10.   Anaemia              Incidence/1,000            13         16           15            13          13
                             Cases                 155,149    166,241      170,846       148,948     158,544
                             Deaths                  2,761      2,612        2,381         2,474       2,507
  Source: Health Management Information System (HMIS) Report 2006, Ministry of Health




August 2007                                                                          CAN Investments Limited
                                                                                             Lusaka, Zambia
                                                                                        MAIN REPORT
              The Tropical Health and Education Trust   Mapping of Health Links in the Zambian Health
              In conjunction with                       Services and Associated Academic Institutions
              The Ministry of Health of Zambia                            under the Ministry of Health




                   Appendix III:            Staffing Levels and Workloads




August 2007                                                                  CAN Investments Limited
                                                                                     Lusaka, Zambia
                                                                                           MAIN REPORT
              The Tropical Health and Education Trust      Mapping of Health Links in the Zambian Health
              In conjunction with                          Services and Associated Academic Institutions
              The Ministry of Health of Zambia                               under the Ministry of Health



                                    STAFFING LEVELS                       STAFF/POPULATION RATIOS
                                      Recommended                               Existing Staff/ Recommended
                      Existing         Establishment               Existing Population Ratios, Staff/Population
  Staff Category         Staff                 (2005) Variance        Staff                 1:        Ratios, 1:
  Doctors                  646                  2,300    1,654         646              17,589            4,940
  Nurses                6,096                  16,732   10,636       6,096               1,864              679
  Mid Wives             2,273                   5,600    3,327       2,273               4,999            2,029
  Clinical Officers     1,161                   4,000    2,839       1,161               9,787            2,841
  Pharmacists               24                     42       18           24            473,450          270,543
  Pharmacy Tech             84                    120       36           84            135,271           94,690
  Lab. Scientists           25                     50       25           25            454,512          227,256
  Lab. Technologists       100                    210      110         100             113,628           54,109
  Lab. Technician          292                  1,300    1,008         292              38,914            8,741
  EHO                       53                    120       67           53            214,393           94,690
  EH Technologist           32                    220      188           32            355,088           51,649
  EH Technicians           718                  1,300      582         718              15,826            8,741
  Dental Surgeon            14                     33       19           14            811,629          344,327
  Dental
  Technologist              40               300           260           40               284,070            37,876
  Dental Therapist           2               300           298            2             5,681,402            37,876
  Physiotherapist
  (Degree level)             0                50            50            0                       -         227,256
  Physiotherapist
  (Diploma level)           86               250           164          86                132,126            45,451
  Radiologists               3                33            30           3              3,787,601           344,327
  Radiographers            139               200            61         139                 81,747            56,814
  Paramedics               320             6,000         5,680         320                 35,509             1,894
  Nutritionist              65               200           135          65                174,812            56,814
  Support Staff        11,003            10,000         -1,003      11,003                  1,033             1,136
  Total                23,176            49,360         26,184      23,176                    490               230
  Source: Ministry of Health HRIS database/NHSP




August 2007                                                                     CAN Investments Limited
                                                                                        Lusaka, Zambia
                                                                                        MAIN REPORT
              The Tropical Health and Education Trust   Mapping of Health Links in the Zambian Health
              In conjunction with                       Services and Associated Academic Institutions
              The Ministry of Health of Zambia                            under the Ministry of Health




  Appendix IV:               Distribution of Core Health Workers By Province




August 2007                                                                  CAN Investments Limited
                                                                                     Lusaka, Zambia
                                                                                                                                             MAIN REPORT
 The Tropical Health and Education Trust (THET)                  Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
 In conjunction with                                                                                                             under the Ministry of Health
 The Ministry of Health of Zambia




 Table 1: Distribution of Core Health Workers by Province
                                                              Zambia     Zambia                                             Environmental
                              Clinical Registered Registered Enrolled   Enrolled Pharmacy           Lab. Paramedical               Health
  Province     Doctors        Officer Midwives        Nurse Midwives      Nurse      Staff          Staff      Staff         Technologists         Total
 Central            35            132          60         84      242        388        9             37         46                    93          1,126
 Copperbelt       202             187         126        357      505      1,160       33            110        140                    79          2,899
 Eastern            29            138          15        103      159        506        8             28         38                    95          1,119
 Luapula            15              65         10         36       39        274        5             25         21                    55            545
 Lusaka           256             212         129        421      305      1,014        5            103        162                    58          2,665
 North Western      21              55          5         38       41        281        7             18         20                    73            559
 Northern           22            107          18         94      149        320        5             30         35                    90            870
 Southern           38            174          31        117      359        663       16             48         53                   126          1,625
 Western            28              91         16         38       64        350        4             18         30                    81            720
 Total            646           1,161         410      1,288    1,863      4,956       92            417        545                   750         12,128
 Source: HRHSP 2006/10, MOH, Zambia




August 2007                                                                                                                         CAN Investments Limited
                                                                                                                                            Lusaka, Zambia
                                                                                          MAIN REPORT
 The Tropical Health and Education Trust (THET)   Mapping of Health Links in the Zambian Health Services
 In conjunction with                                               and Associated Academic Institutions
 The Ministry of Health of Zambia                                             under the Ministry of Health




              Appendix V:              Consolidated List of Existing Links




August 2007                                                                     CAN Investments Limited
                                                                                        Lusaka, Zambia
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The Tropical Health and Education Trust (THET)                          Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                     under the Ministry of Health
The Ministry of Health of Zambia



Consolidated List of Existing Links

 Province        Institution                     Link Partner                            Type of Link
 Central         Kabwe General Hospital,         Massachusetts General Hospital,         Research on Maternal and Infant Health Improvement
                 Kabwe                           USA
 Central         Kabwe Mine Hospital, Kabwe      Massachusetts General Hospital,         Systems strengthening and staff training.
                                                 USA
 Copperbelt      Ndola College of Bio-Medical    Irish Aid (Dublin in Institute of       Infrastructure, Staff development, 18 staff members have been trained.
                 Science, Ndola                  Technology) up 2006.
 Eastern         St. Francis Hospital, Katete    Summer Concert, Netherlands.            The summer concert event was introduced nine years ago. This is an
                                                                                         outdoor summer music concert held in Laren, the Netherlands, every
                                                                                         year to provide entertainment to the general public and raise funds for
                                                                                         St. Francis hospital. Funds raised at these concerts are often
                                                                                         supplemented by the Netherlands Government and sent to St. Francis
                                                                                         hospital.
 Eastern         St. Francis Mission Hospital    Simavi, Netherlands.                    Simavi is a Dutch Organisation currently supporting the project aimed
                                                                                         at improving water supply at the hospital. They have also previously
                                                                                         funded the procurement of an x-ray machine for the hospital.

 Eastern         St. Francis Mission Hospital,   Bed Sponsorship Scheme,                 A bed sponsorship scheme has been introduced as a fundraising
                 Katete                          Netherlands:                            activity for the hospital. Under this scheme, organizations and
                                                                                         individuals sponsor specific beds in the hospital at $1,500 per bed per
                                                                                         year. The hospital provides the sponsors quarterly reports on the
                                                                                         performance of the sponsored beds. Most of the money raised by this
                                                                                         scheme is used on the procurement of drugs for the hospital.
 Eastern         St. Francis Mission Hospital,   Catholic Medical Missions Board         CMMB are part of the AIDS Relief Consortium and were very
                 Katete                          (“CMMB”), USA.                          instrumental in St. Francis being selected as one of the first five AIDS
                                                                                         Relief sites in Zambia. CMMB have also recruited a doctor from USA
                                                                                         to work at the hospital.
 Eastern         St. Francis Mission Hospital,   Catholic Relief Services (“CRS”),       CRS is the lead organization in the AIDS Relief consortium.
                 Katete                          USA.
 Eastern         St. Francis Mission Hospital,   Christian Aid.                          Supported the hospital’s AIDS project for many years. They have also
                 Katete                                                                  previously made other donations, such as the upgrade of the Special
                                                                                         Care Baby Unit.



August 2007                                                                     1                                                          CAN Investments Limited
                                                                                                                                                   Lusaka, Zambia
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The Tropical Health and Education Trust (THET)                        Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                   under the Ministry of Health
The Ministry of Health of Zambia

 Eastern         St. Francis Mission Hospital,   Cordaid, Netherlands:                 Cordaid has been supporting the hospital’s HIV/AIDS project for
                 Katete                                                                many years. They have since taken over the role of lead donor, helping
                                                                                       to co-ordinate communications with the other donors to the
                                                                                       programme. Cordaid have in the past assisted with staffing,
                                                                                       particularly doctors.
 Eastern         St. Francis Mission Hospital,   Direct Relief International           DRI has been supporting the hospital with donations of drugs and
                 Katete                          (“DRI”), USA.                         medical supplies and medical equipment. The first container of drugs,
                                                                                       medical supplies and equipment from DRI was received by the hospital
                                                                                       in 2004.
 Eastern         St. Francis Mission Hospital,   Episcopal Relief and Development      Recently started to support the AIDS project. It was with their support
                 Katete                          (“ERD”), USA.                         that the new vehicle for the AIDS project was purchased in 2004.

 Eastern         St. Francis Mission Hospital,   Friends of St Francis’, UK.           Friends of St. Francis Hospital is an organization that keeps former
                 Katete                                                                members of staff of the hospital in touch with each other and up to date
                                                                                       with news from the hospital. It also raises a substantial amount of
                                                                                       funding for the hospital. The funds come in all various forms,
                                                                                       including personal donations from former staff and other friends of the
                                                                                       hospital, church groups, special fundraising events, such as marathons,
                                                                                       birthdays (whereby birthday gifts are donated to the hospital) and stalls
                                                                                       at exhibitions. They also assist with recruitment of volunteers, mainly
                                                                                       doctors, from the UK. A donation of £10,000 was made a few years
                                                                                       ago and the bank interest on this amount has been used to fund staff
                                                                                       training. Most of the funds raised go towards procurement of drugs
                                                                                       and medical supplies, which are sent annually by container,
                                                                                       supplementary salaries for senior doctors and other key staff, and
                                                                                       support to staff training.
 Eastern         St. Francis Mission Hospital,   Gooi Noord Hospital, Netherlands.     For some years there has been a relationship with this hospital. This
                 Katete                                                                relationship was strengthened by Dr. Jan Croft, Chirug (Surgeon) when
                                                                                       he retired from Gooi Noord. Dr. Croft had also used to work at St.
                                                                                       Francis’. The support has varied, ranging from sending short term
                                                                                       personnel to assist in the laboratory, equipment and financial support
                                                                                       through Bed Sponsorship Scheme. It is hoped that the relationship
                                                                                       could be developed further.
 Eastern         St. Francis Mission Hospital,   Guernsey Overseas Aid (“GOA”).        GOA has funded the construction of 4 staff houses for the hospital.
                 Katete                                                                They have also been providing financial support through MSG.




August 2007                                                                    2                                                         CAN Investments Limited
                                                                                                                                                 Lusaka, Zambia
                                                                                                                                                  MAIN REPORT
The Tropical Health and Education Trust (THET)                        Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                   under the Ministry of Health
The Ministry of Health of Zambia

 Eastern         St. Francis Mission Hospital,   Hands Around The World                This organization was founded by Dr. David Steiner, who used to work
                 Katete                          (“HATW”), UK.                         at the hospital as a doctor in the early 1990’s. The aim of this
                                                                                       organization is to assist by sending skilled volunteers for short periods
                                                                                       to share their skills. A number of volunteers have visited and assisted
                                                                                       in the pharmacy, maternity and ultrasound sections.
 Eastern         St. Francis Mission Hospital,   Jersey Overseas Aid (“JOA”),          Over the years, JOA has supported the hospital through sending of
                 Katete                          USA.                                  workgroups, funding of building projects, such as the recent housing
                                                                                       project, and procurement of drugs and medical supplies.
 Eastern         St. Francis Mission Hospital,   Katho College, Belgium.               This Link started in 2003, largely through the initiative of Dirk
                 Katete                                                                Monbaliu. The college trains nurses and midwives, among many other
                                                                                       professions. The training support programme focuses at providing
                                                                                       students with opportunities to spend part of their time in a different
                                                                                       environment. As a result of this support, a group of nursing and
                                                                                       midwifery students came and spent 12 weeks at the hospital, gaining
                                                                                       experience on the wards as well as theoretical learning. Two of their
                                                                                       tutors also spent some time at the hospital, both with their own
                                                                                       students and also the hospital’s own nursing students. Katho College
                                                                                       has also provided financial support to the hospital, particularly to
                                                                                       support the school library. The programme will continue.
 Eastern         St. Francis Mission Hospital,   Lions International (The Lions).      The Lions have supported the hospital’s eye work for a number of
                 Katete                                                                years. In 2005, they donated a vehicle for eye outreach activities. They
                                                                                       have also provided funds for motor vehicle repairs, funded eye
                                                                                       camping sessions and sponsored staff training programmes.
 Eastern         St. Francis Mission Hospital,   Lothian Health Board, Scotland.       A team from Lothian Health Board visited the hospital in 2004,
                 Katete                                                                comprising of clinical staff and a health information specialist, on a
                                                                                       fact-finding mission to identify areas of support and collaboration.
                                                                                       The information specialist also spent some time working with hospital
                                                                                       records staff.




August 2007                                                                   3                                                          CAN Investments Limited
                                                                                                                                                 Lusaka, Zambia
                                                                                                                                                   MAIN REPORT
The Tropical Health and Education Trust (THET)                         Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                    under the Ministry of Health
The Ministry of Health of Zambia

 Eastern         St. Francis Mission Hospital,     Medical Support Group,               The Medical Support Group (“MSG”) was founded by former
                 Katete                            Netherlands.                         members of staff of St Francis’ Hospital, living in the Netherlands.
                                                                                        The main aim of MSG is to provide support to the hospital, which is
                                                                                        being done in a number of ways, including fundraising, material
                                                                                        support and establishing linkages between the hospital and various
                                                                                        donors. MSG has also been providing support to capital projects and
                                                                                        the workshop. In this respect, on several occasions, they have been
                                                                                        sending senior members to St Francis to physically assist with building
                                                                                        projects and provide support to the workshop. Over the years, the MSG
                                                                                        has also been providing material support in form of drugs and
                                                                                        equipment donated to the hospital.
 Eastern         St. Francis Mission   Hospital,   Missio Austria.                      Mission has been supporting the HIV/AIDS project for ten years.
                 Katete
 Eastern         St. Francis Mission   Hospital,   Old Catholics, Bonn, Germany.        Supports the hospital AIDS project.
                 Katete
 Eastern         St. Francis Mission   Hospital,   Sandy Logie Fund.                    Support for treatment of HIV patients.
                 Katete
 Eastern         St. Francis Mission   Hospital,   Scottish Borders Africa AIDS         The Group has been supporting the hospital’s AIDS project, through
                 Katete                            Support Group.                       fundraising.
 Eastern         St. Francis Mission   Hospital,   United Society for the Propagation   USPG was formed by merging two mission societies, namely the
                 Katete                            of the Gospel (“USPG”).              Universities Mission to Central Africa (“UMCA”) and the Society for
                                                                                        the Propagation of the Gospel (“SPG”). The link with UMCA dates
                                                                                        back to the founding of the hospital in 1948 by Fr. Francis Trefusis, a
                                                                                        missionary with UMCA. Many of the early members of staff at the
                                                                                        hospital were UMCA missionaries. UMCA/USPG support to the
                                                                                        hospital has continued, through provision of medical doctors and other
                                                                                        qualified health workers and financial and material support. In this
                                                                                        respect, the current Executive Director and Pediatrician, Dr. Shelagh
                                                                                        Parkinson and the Manager Administration, Ian Parkinson are USPG
                                                                                        missionaries. They have also taken particular interest in supporting
                                                                                        HIV programmes and, for a number of years, have been sending HIV
                                                                                        infection prevention kits, containing HIV test kits, gloves, syringes,
                                                                                        needles, disinfectants and sharps boxes, and have also been piloting a
                                                                                        post exposure prophylaxis policy, aimed at reducing the risks of staff
                                                                                        getting infected by HIV upon being accidentally pricked by
                                                                                        contaminated needles.




August 2007                                                                    4                                                          CAN Investments Limited
                                                                                                                                                  Lusaka, Zambia
                                                                                                                                                 MAIN REPORT
The Tropical Health and Education Trust (THET)                       Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                  under the Ministry of Health
The Ministry of Health of Zambia

 Eastern         St. Francis Mission Hospital,   Zambia Anglican Council (“ZAC”,      Has been providing financial grants to the hospital. Through the
                 Katete                          Zambia.                              Administrator Revd Rogers Banda, they also assist with processing
                                                                                      immigration and medical council papers for expatriate staff and
                                                                                      clearing through customs and Ministry of Finance of all items coming
                                                                                      from overseas.

 Eastern         St. Francis Mission Hospital,   Zambia Society Trust, UK.            The society has been supporting the AIDS Orphans programme,
                 Katete                                                               through the AIDS project.
 Luapula         Mansa General Hospital,         Indirect link through Rotary Club    Provision of equipment and drugs.
                 Mansa                           of Mansa Direct Relief
                                                 International
 Lusaka          Chainama Hills Hospital and     Beit Trust, UK.                      Has pledged to provide financial support to construct a lecture theatre.
                 College                                                              Project awaiting finalization of building plans by the Ministry of
                                                                                      Works and Supply.
 Lusaka          Chainama Hills Hospital and     Lothian Health Board, Scotland.      Providing support in form of providing specialists.
                 College
 Lusaka          Chainama Hills Hospital and     Mental Health Trust, UK              Providing support in form of teaching at the college. Also supporting
                 College                                                              the hospital in health service provision and staff training.
 Lusaka          Chainama Hills Hospital and     HSSP/JPIGHO, USA                     Support to curriculum development.
                 College, Lusaka
                 Chainama Hills Hospital and                                          Training support, through Degree Programs’ and scholarships. Leads
                 College, Lusaka                                                      Metropolitan University is currently running Masters in Public Health;
                                                 Leeds Metropolitan University,
 Lusaka                                                                               and Doctor of Philosophy in public health programs at Chainama Hills
                                                 UK
                                                                                      College. Sends lecturers to support these programmes which are
                                                                                      quarterly/modular based. A new intake of 3 started in March 2007.
 Lusaka          Chainama Hills Hospital and     Michigan University, USA             Health Care support.
                 College, Lusaka
 Lusaka          Chainama Hills Hospital and     National Malaria Control Center,     Institutional collaboration.
                 College, Lusaka                 Zambia
 Lusaka          Chainama Hills Hospital and     Operation Eyesight, Canada           Has pledged to support the college in infrastructure development.
                 College, Lusaka
 Lusaka          Chainama Hills Hospital and     Prime – UK NGO                       Training support, Medical School.
                 College, Lusaka
 Lusaka          Chainama Hills Hospital and     Sight Savers International, UK.      Technical and material support to the orthomology programme.
                 College, Lusaka



August 2007                                                                   5                                                         CAN Investments Limited
                                                                                                                                                Lusaka, Zambia
                                                                                                                                                MAIN REPORT
The Tropical Health and Education Trust (THET)                      Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                 under the Ministry of Health
The Ministry of Health of Zambia

 Lusaka          Chainama Hills Hospital and     The University of Manchester, UK    Training support, MPH and PHD in Public Health scholarships for
                 College, Lusaka                                                     members of staff. From 2000 to 2002, Manchester University
                                                                                     conducted a Masters of Education in Primary Health programme at
                                                                                     Chainama College.
 Lusaka          Chainama Hills Hospital and     University of Mehari (Medical       Training support, Masters in Nero Psychiatry.
                 College, Lusaka                 School
 Lusaka          Chainama Hills Hospital and     University of Zambia (UNZA),        Support to Palliative Care. Affiliation to INZA
                 College, Lusaka                 Zambia
 Lusaka          Chainama Hills Hospital and     VVOB, Belgium.                      Collaboration in teaching. Providing technical advisors and supporting
                 College, Lusaka                                                     workshops. Support to the computer laboratory.

 Lusaka          General Nursing Council         WHO                                  Various areas, including capacity building
 Lusaka          General Nursing Council of      Health Services Support Program     The Health Services Support Program (“HSSP”) is a USAID
                 Zambia (“GNCZ”)                 (HSSP), Zambia.                     sponsored programme. HSSP has been providing financial and
                                                                                     technical support to some programmes on specific activity basis.
 Lusaka          General Nursing Council of      John Hopkins University’s           This Link focused at the review and development of the curriculum for
                 Zambia (“GNCZ”)                 Capacity Building Programme,        midwifery training. Even though the project came to an end in 2004,
                                                 with support from                   the following planned activities were not completed and are still
                                                 JHPAIEGO/ZHIP/USAID.                relevant: Sensitization activities for the newly developed curriculum;
                                                                                     and staff training in continuous assessment.
 Lusaka          General Nursing Council of      Swedish International               Institutional collaboration. This Link was established 1997. The key
                 Zambia (“GNCZ”)                 Development Cooperation Agency      technical partner was Karolinska Institutet, a Medical University based
                                                 (“Sida”), Sweden                    in Stockholm, Sweden (“Karolinska”). College of Health Sciences
                                                                                     (“CCHS”), Evelyn Hone College, Zambia Integrated Health Project
                                                                                     (“ZIHP”), World Health Organisation (“WHO”), the Central Board of
                                                                                     Health (“CBOH”) and MOH. Implementation of the activities under
                                                                                     this Link also involved the participation of other Zambian institutions,
                                                                                     namely, UNZA School of Post-Basic Nursing, UNZA School of
                                                                                     Medicine, UTH School of Nursing and Midwifery, Chainama.

                                                                                     Programme focused at needs assessment and capacity building for all
                                                                                     health training institutions in Zambia. The assessment revealed critical
                                                                                     shortages of staff, especially teaching staff, shortages of teaching
                                                                                     materials and teaching aids and significant deteriorations in essential
                                                                                     infrastructure. Following these findings, a number of activities were
                                                                                     conducted, which included:
                                                                                             The Problem-Based Learning Group: Through the work of this



August 2007                                                                 6                                                          CAN Investments Limited
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                                                                                                                                                 MAIN REPORT
The Tropical Health and Education Trust (THET)                       Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                  under the Ministry of Health
The Ministry of Health of Zambia

                                                                                      group, the problem based learning approach was introduced in health
                                                                                      training institutions;
                                                                                              The Research Group: Tasked to carry out capacity building in
                                                                                      research for tutors. Significant capacity building and training of tutors
                                                                                      in research was conducted. As a result, a number of research activities
                                                                                      were undertaken and a number of books were produced by the tutors;
                                                                                               The Books and Libraries Group: Tasked to take inventory of
                                                                                      books available in all training institutions. Following this assessment,
                                                                                      in 2006, significant quantities of appropriate books and study materials
                                                                                      were procured in bulk and distributed to the various training
                                                                                      institutions. Procuring of the remaining 50% of the allocation has
                                                                                      already started;
                                                                                              The Training Assessment and Curriculum Development Group
                                                                                      (“TNACD”): Key activities of this group included the review of
                                                                                      existing curricula, development of new curricula and training
                                                                                      materials, and providing updates for students and teaching staff. The
                                                                                      group also produced a handbook on malaria for nurses and midwives;
                                                                                      and
                                                                                               The Writers Group: This group was tasked to develop a plan
                                                                                      on the future long-term sustainability of the activities supported by the
                                                                                      Link, once this arrangement has come to an end. The main aim is to
                                                                                      identify the key constraints and make appropriate recommendations.
 Lusaka          General Nursing Council of      ZHIP/USAID Support.                  The Zambia Integrated Health Programme (“ZHIP”), with support
                 Zambia (“GNCZ”)                                                      from the USAID, provided financial and technical support towards
                                                                                      curriculum review for nurses and midwives. Also provided one motor
                                                                                      vehicle for M&E. This project has since come to an end.
                                                 Association of Medical Council of
 Lusaka          Medical Council of Zambia       Southern Africa (14) countries        Information Sharing on professionals (Collaboration)
                                                 General Medical Council (GMC),
 Lusaka          Medical Council of Zambia       UK;                                  Information sharing (long term)
                 UTH - Department of             Child Advocacy International
 Lusaka          Pediatric                       (CAI)                                Student Exchange, Research
                 UTH - Department of
 Lusaka          Pediatric                       Copenhagen / Denmark                 Research Collaboration
                                                 London School of Tropical Health
                                                 ( International Federation of
 Lusaka          UTH - EYE Unit                  opthmology- CANON Education           Capacity building /Staff Training


August 2007                                                                  7                                                          CAN Investments Limited
                                                                                                                                                Lusaka, Zambia
                                                                                                                                                  MAIN REPORT
The Tropical Health and Education Trust (THET)                        Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                   under the Ministry of Health
The Ministry of Health of Zambia

                                                 Trust
                                                 Operation Eyesight University/
 Lusaka          UTH - EYE Unit                  Irish Aid                             Human Resources Development , Clinical, Instrument Technician,
                                                 Operation Eyesight University/
 Lusaka          UTH - EYE Unit                  Irish Aid                             Infrastructure Development
                                                 Operation Eyesight University/
 Lusaka          UTH - EYE Unit                  Irish Aid                             Program administration
 Lusaka          UTH - EYE Unit                  Vision Aid Overseas                   Human Resources Development , Clinical, Instrument Technician,
                                                 London School of Tropical
 Lusaka          UTH - Labs                      Hygiene (ZAMBART)                     TB Research
                                                 University College of London
 Lusaka          UTH -   Labs                    Middlesex                              Pediatrics 4 yrs
 Lusaka          UTH -   Labs                    University of Alabama Birmigham       Research , CIDARZ
 Lusaka          UTH -   Labs                    University of Alabama Birmigham       Placenta transmission of HIV/AIDs (research finished
 Lusaka          UTH -   Nursing School          Johnson & Johnson                     Capacity building
 Lusaka          UTH -   Nursing School          Karolin’s, Sweden                     Staff and student exchange programmes
 Lusaka          UTH - Nursing School            CIMO – Finland (www.stadia.fi )       Staff and student exchange
                                                 World Federation of
 Lusaka          UTH - Anesthesia School         Anesthesiologist                      Supply of Literature
                 UTH - Department of
 Lusaka          Pediatric                       Harvard University                    Area of Sickle Cell, Screening, Capacity building
                 UTH - Department of
 Lusaka          Pediatric                       Marie Master University               Research Capacity building
                 UTH - Department of
 Lusaka          Pediatric                       Medical Research Council (MRC)        Measure of drugs
                 UTH - Department of
 Lusaka          Pediatric                       Mehari University                     Student Exchange
                 UTH - Department of
 Lusaka          Pediatric                       MIE University Japan                  Research on ROTA virus ( vaccine)
                 UTH - Department of             National Atomic Energy 2001 for
 Lusaka          Pediatric                       3 yrs & renewed 2004                  Technical Co-operation
                 UTH - Department of
 Lusaka          Pediatric                       Pharmaco- Kinetics (prof Chintu)      ARV – for children – Metabolism; fixed dose,
                 UTH - Department of
 Lusaka          Pediatric                       University of Yale (USA)              Research Collaboration
 Lusaka          UTH - Department of             WHO                                   Sickle Cell management


August 2007                                                                   8                                                          CAN Investments Limited
                                                                                                                                                 Lusaka, Zambia
                                                                                                                                                   MAIN REPORT
The Tropical Health and Education Trust (THET)                         Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                    under the Ministry of Health
The Ministry of Health of Zambia

                 Pediatric
                 UTH - Department of
 Lusaka          Pediatric                       WHO-TDRC                               Multi-lateral Malaria Research and ICT communication infrastructure
                                                 Brighton Sussex University
 Lusaka          UTH - EYE Unit                  Hospital                               Provide Spectacles
 Lusaka          UTH - EYE Unit                  Sight Server International &           Human Resources Development , Clinical, Instrument Technician,
                                                 JICA (Yamanashi University (5yrs
 Lusaka          UTH - Labs                      has ended)                             Setup Lab, Provided staff, Trainined, PHD, Msc
 Lusaka          UTH - Nursing School            Brighton University                    Departmental Training for nurses
                 UTH - Obstetrics &                                                     Academic exchange program –lecturers- Curriculum & Teaching
 Lusaka          Gynecology Department           Brighton University                    method
                 UTH - Obstetrics &
 Lusaka          Gynecology Department           CIDARZ                                 Clinical care on PMTC
                 UTH - Obstetrics &              DFID through MRC UK Medical
 Lusaka          Gynecology Department           Research Center                        Multiple site trials in Mazabuka Microbicides
                 UTH - Obstetrics &
 Lusaka          Gynecology Department           Harvard University                     Collaboration (MOU in place to setup School of midwifery
                 UTH - Obstetrics &
 Lusaka          Gynecology Department           HSSP                                   Post Abortion Care Training Center for PAC
                 UTH - Obstetrics &
 Lusaka          Gynecology Department           JHPIEGO                                Malaria Program –injection safety
                 UTH - Obstetrics &              London School of hygiene and
 Lusaka          Gynecology Department           Tropical Medicine                      Active Research Infant feeding & health
                 UTH - Obstetrics &
 Lusaka          Gynecology Department           NISIR                                  Collaboration
                 UTH - Obstetrics &
 Lusaka          Gynecology Department           TDRC                                   Collaboration
                 UTH - Obstetrics &
 Lusaka          Gynecology Department           UNFP                                   family Planning- setup center of excellence
                 UTH - Obstetrics &
 Lusaka          Gynecology Department           University of Alabama                  CIDARZ, Research on Cervices Cancer
                 UTH - Obstetrics &
 Lusaka          Gynecology Department           WHO                                    Various Research
                 UTH - UNZA School of
                 Medicine Department of
 Lusaka          Surgery                         Anthony Matani (Individual)            Has been donating spinal and surgical implants for the past 5years



August 2007                                                                    9                                                          CAN Investments Limited
                                                                                                                                                  Lusaka, Zambia
                                                                                                                                                 MAIN REPORT
The Tropical Health and Education Trust (THET)                       Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                  under the Ministry of Health
The Ministry of Health of Zambia

                 UTH - UNZA School of
                 Medicine Department of          Eurolink – Based in the United
 Lusaka          Surgery                         Kingdom                              They have been donating Urology equipment
                 UTH - UNZA School of
                 Medicine Department of          European Urology Association –
 Lusaka          Surgery                         based in Paris                        They donate Urology and microscopic equipment
                 UTH - UNZA School of
                 Medicine Department of          Lusaka orthopedics and Research      Has been supplying Orthopedic Implants and Training. They have
 Lusaka          Surgery                         Trust (LORET)                        been supporting the department for over 6 years
                 UTH - UNZA School of
                 Medicine Department of          Midland Region Ent Unit Tullmort
 Lusaka          Surgery                         (Ireland)                            Experts visits twice a year. They come to teach and operate
                 UTH - UNZA School of
                 Medicine Department of
 Lusaka          Surgery                         Rotary Club of Lusaka                Weekly donation of food and has adopted a ward
                 UTH - UNZA School of
                 Medicine Department of          Surgical College of Surgeons for     Build skills laboratory for post graduates. The skills laboratory is
 Lusaka          Surgery                         East, Central and Southern Africa    based at the Department of Surgery
                 UTH - UNZA School of
                 Medicine Department of
 Lusaka          Surgery                         Surgical Society of Zambia           The Surgical Society of Zambia conduct for post graduates
                 UTH - UNZA School of
                 Medicine Department of                                                Infrastructure Development of Orthopedic Department. (building and
 Lusaka          Surgery                         Vision 2020                          equipment
 Lusaka          UTH / UNZA School of            Communication for Better Health      The Dreyfus Health Foundation of New York, USA, is the sponsor of
                 Medicine                        (“CBH”)                              this programme. The main activities under this collaboration include
                                                                                      support to the medical library and helping out in dissemination of
                                                                                      health information to front line health professionals in the rural areas
                                                                                      of Zambia.
 Lusaka          UTH / UNZA School of            Copenhagen University’s Center       Partnership and collaboration in research.
                 Medicine                        for Medical Parasitology (CMP),
                                                 Denmark
 Lusaka          UTH / UNZA School of            Harvard University, USA.             Harvard University and UNZA/UTH are involved in a number of
                 Medicine                                                             collaborations in research including, Sickle cell diagnostic (screening
                                                                                      of sickle cell disease and establishing the levels of sickle cell in
                                                                                      Zambia) and capacity building in diagnosis of sickle cell in rural areas.




August 2007                                                                   10                                                        CAN Investments Limited
                                                                                                                                                Lusaka, Zambia
                                                                                                                                                 MAIN REPORT
The Tropical Health and Education Trust (THET)                       Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                  under the Ministry of Health
The Ministry of Health of Zambia

 Lusaka          UTH / UNZA School of            Helsinki Polytechnic Stadia,         Staff and student exchange programmes, and implementation of the
                 Medicine                        Finland                              Malawi –Zambia health care project during the spring of 2005 and
                                                                                      academic year 2005-2006. This included short term staff and student
                                                                                      exchange programmes.
 Lusaka          UTH / UNZA School of            Institute of Child Health            This Link includes collaboration in research, exchange visits involving
                 Medicine                        University College, London, UK.      research staff, infrastructure support and scholarships in Public Health.
 Lusaka          UTH / UNZA School of            International Atomic Energy          This agency has been supporting the following projects: Tumor
                 Medicine                        Agency (“IAEA”).                     market project; Tissue culture project; and The newborn screening and
                                                                                      nuclear project.
 Lusaka          UTH / UNZA School of            Kalorinska Institute, Sweden         Institutional collaboration project funded by SIDA. The department of
                 Medicine                                                             Post Basic Nursing at UNZA has benefited from technical support and
                                                                                      exchange visits. Two professors have been appointed as visiting
                                                                                      professors. Under the n ursing and staff exchange programme, both
                                                                                      institutions are supposed to do the following:
                                                                                       send up to two exchange students each year during the duration of
                                                                                          the agreement, unless the number is varied by mutual agreement;
                                                                                          and
                                                                                       share information on a regular basis; and recognise that the
                                                                                          academic credit of the studies abroad is the responsibility of the
                                                                                          degree granting institution.
 Lusaka          UTH / UNZA School of            Kent State University, UK.           Under this link, some staff members of UTH have been sponsored for
                 Medicine                                                             PhD studies. Currently, one member of staff is pursuing a PhD in
                                                                                      Nursing.
 Lusaka          UTH / UNZA School of            Kent State University, USA.          Staff exchange, capacity building and research. One member of staff
                 Medicine                                                             has been awarded a scholarship and is still pursuing a PhD programme
                                                                                      at the Kent State University.
 Lusaka          UTH / UNZA School of            Marie Master University              Collaboration on sickle cell management.
                 Medicine
 Lusaka          UTH / UNZA School of            Mehari University                    Link between Mehari University and UNZA School of Medicine on
                 Medicine                                                             research collaboration, and student and staff collaboration on
                                                                                      microbicides. Under this arrangement, UNZA shares resources with
                                                                                      UTH.
 Lusaka          UTH / UNZA School of            MIE University of Japan              Exchange programme between the two institutions. However the
                 Medicine                                                             Zambian counterparts have not been able to get sponsorship for this
                                                                                      programme.




August 2007                                                                     11                                                      CAN Investments Limited
                                                                                                                                                Lusaka, Zambia
                                                                                                                                                 MAIN REPORT
The Tropical Health and Education Trust (THET)                       Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                  under the Ministry of Health
The Ministry of Health of Zambia

 Lusaka          UTH / UNZA School of            Other Links/Collaborating Partners   These include:
                 Medicine                                                                 University of Queensland, Australia: Collaboration in
                                                                                           schizophrenia research).
                                                                                          University of Ain Shams, Cairo, Egypt
                                                                                          University of Malawi, Malawi
                                                                                          University of Bergen, Norway
                                                                                          University of Bergen, Norway
                                                                                          University of Pretoria, South Africa
                                                                                          Institute of Psychiatry, London, UK
                                                                                          University College, London Medical School, UK.
                                                                                          University of Nottingham, UK: Collaboration in communication
                                                                                           research.
                                                                                          Bradford University, UK
                                                                                          Gordon University, UK.
                                                                                          The London School of Tropical Medicine-UK.
                                                                                          Medical Research Council, UK
                                                                                          Leeds University, UK.
                                                                                          Michigan State University, USA: Collaboration in epilepsy and
                                                                                           stigma research, and in neurological.
                                                                                          State University, Nebraska, USA: Collaboration in telemedicine
                                                                                          University of Nairobi, Kenya
                                                                                          University of Miami, USA
                                                                                          University of Nebraska-USA
                                                                                          Massachusetts Institute of Technology-USA
                                                                                          The World Federation for Medical Education (“WFME”)
                                                                                          The Foundation for Advancement in MEDICAL Education and
                                                                                           Research (“FAIMER”);
                                                                                          The Society for Directors of Research in Medical Education
                                                                                           (“SDRME”).
                                                                                          Prevention of Maternal Mortality in Africa (“PMM”)
                                                                                          The Surgical Society of Zambia. Collaboration in surgery
                                                                                          College of Surgeons of East, Central and Southern Africa
                                                                                          World Orthopaedic Concern (“WOC”).
                                                                                          Pharmaceutical Society of Zambia




August 2007                                                                 12                                                          CAN Investments Limited
                                                                                                                                                Lusaka, Zambia
                                                                                                                                                 MAIN REPORT
The Tropical Health and Education Trust (THET)                       Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                  under the Ministry of Health
The Ministry of Health of Zambia

 Lusaka          UTH / UNZA School of            Sussex and Brighton Medical          This Link includes exchange programmes for nursing staff and
                 Medicine                        School and Teaching Hospital, and    students, and comprehensive capacity building support to UNZA/UTH.
                                                 Brighton University, UK.
 Lusaka          UTH / UNZA School of            University of Alabama, USA.          Through this Link, a center of excellence building has been
                 Medicine                                                             constructed at the UTH. Other activities include the CIRDZ/University
                                                                                      of Alabama- Research activities, MPH scholarships and institutional
                                                                                      strengthening.
 Lusaka          UTH / UNZA School of            University of Bergen, Norway         Collaboration with this university was through the NUFU Project
                 Medicine                                                             20002 to 2006. This project was designed to strengthen UTH and
                                                                                      UNZA in HIV/AIDS related interventions and capacity building.
                                                                                      Under this project, two students where sponsored for PhD programmes
                                                                                      at the University of Bergen.
 Lusaka          UTH / UNZA School of            University of Bradford, UK.          Under this programme, the University of Bradford has been providing
                 Medicine                                                             physiotherapy equipment to UTH/UNZA.
 Lusaka          UTH / UNZA School of            University of Emory, USA.            Collaboration in research and scholarships for master’s degree in
                 Medicine                                                             Public Health.
 Lusaka          UTH / UNZA School of            University of Miami, USA.            This project has come to an end, but Links with the school in the area
                 Medicine                                                             of capacity building are still open, even though not active.

 Lusaka          UTH / UNZA School of            University of Nebraska, USA.         The link with this university was established through a former member
                 Medicine                                                             of staff of the UNZA department of pediatrics. This link is in the area
                                                                                      of research in cancer, HIV/AIDS and Malignant for post graduate
                                                                                      students. The contact person at the University of Nebraska is Charles
                                                                                      Wood.
 Lusaka          UTH / UNZA School of            Yale University School of            Under this Link, UNZA and the University of Yale have been carrying
                 Medicine                        medicine, USA.                       out research in Malaria at Macha hospital in Choma.
 Lusaka          UTH / UNZA School of            Yamananshi University, Japan         This research project came to an end in 2006. Under this project a
                 Medicine                                                             research laboratory was constructed and two UTH members of staff
                                                                                      were trained up to PhD level and one up to Masters level.
                 UTH / UNZA School of
                 Medicine Department of
 Lusaka          Surgery                         World Orthopedic Concern (WOC)       Donate orthopedic implants and conduct Orthopedic courses
 Lusaka          UTH / UNZA School of            University College, London           A long-term collaboration has been established between this university
                 Medicine, Lusaka                Medical School, UK.                  and UZA/UTH under the ZAMBART project, a 10 year collaboration
                                                                                      project in TB research. Under this project, a building has been
                                                                                      constructed at the UNZA Ridgeway campus, to support the activities



August 2007                                                                    13                                                       CAN Investments Limited
                                                                                                                                                Lusaka, Zambia
                                                                                                                                                  MAIN REPORT
The Tropical Health and Education Trust (THET)                        Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                   under the Ministry of Health
The Ministry of Health of Zambia

                                                                                       of this project.



                                                 Operation Eyesight University/
 Lusaka          UTH EYE Unit                    Irish Aid                              Eye equipment procurement
                 UTH -Obstetrics &
 Lusaka          Gynecology Department           Break through Cancer Trust            Have adopted B21 ward
 Northen         Kasama School of Nursing,       University of Ireland, Galway.        Training and capacity building.
                 Northern Province.
                 Chilonga Mission Hospital,
 Northern        Mpika                           Action Medior, Germany                Drugs, once in a while
                 Chilonga Mission Hospital,
 Northern        Mpika                           BD, USA                               Laboratory technology
                 Chilonga Mission Hospital,
 Northern        Mpika                           Bridge of Friendship, Germany         Second hand equipment. Dr. Muller, visiting Gynaecologist.
                 Chilonga Mission Hospital,
 Northern        Mpika                           CORDAID, The Netherlands              Small Projects, HR, and recently, infrastructure
                 Chilonga Mission Hospital,      Development Cooperation Ireland
 Northern        Mpika                           (DCI)                                 Infrastructure-Midwifery School
                 Chilonga Mission Hospital,      Friends of Chilonga Foundation,
 Northern        Mpika                           Netherlands                           Former Doctors who worked at Chilonga
                 Chilonga Mission Hospital,
 Northern        Mpika                           MISEREOR, Germany                     Funds and Equipment
                 Chilonga Mission Hospital,      Streekziekenhuis Midden Twente,
 Northern        Mpika                           Hengelo                               Based on proposals
                 Chilonga Mission Hospital,
 Northern        mpika                           The Beit Trust, UK                    Infrastructure –building
                 Chilonga Mission Hospital,
 Northern        Mpika                           Trace, Tanzania                       Human Resources Development
 Northern        Kasama school of Nursing        University of Ireland , Galway        Capacity building
                 Mungwi District Health          Limbelzel International of
 Northern        Management Team                 Germany                                Capacity building




August 2007                                                                  14                                                           CAN Investments Limited
                                                                                                                                                  Lusaka, Zambia
                                                                                                                                                 MAIN REPORT
The Tropical Health and Education Trust (THET)                       Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                  under the Ministry of Health
The Ministry of Health of Zambia

 Southern        Chikankata College for Bio-     University of Michigan, through      Support to research at the College and to the diagnostic laboratory, and
                 Medical Sciences, Southern      UNZA.                                staff development and exchange.
                 Province.
                 Chikankata College of Bio-                                           Plans to link with University of Boston for research purposes. Not yet
 Southern        Medical Sciences                University of Boston, USA            finalized
 Southern        Chikankata Mission Hospital,    Boston University, USA.              Research Program on Malaria Management in rural areas (2 year
                 Southern Province.                                                   program).
 Southern        Chikankata Mission Hospital,    Michigan State University, USA.      Joint Research (2 year renewable) on adherence to ART            in rural
                 Southern Province.                                                   setting.
 Southern        Chikankata Mission Hospital,    Swedish Rotary Doctor, Sweden.       Visiting Swedish doctors.
                 Southern Province.
                 Livingstone District Health
 Southern        Management Team                 Africa Impact                        Volunteers come to assist in rural centers
                                                                                      Mental Rehabilitation program – exchange program only restricted to
                 Livingstone District Health                                          35 yrs and below. Community Based Rehabilitation Program
 Southern        Management Team                 NORDKAPP –KOMMUNE                    (training) in mental health.
 Southern        Livingstone General Hospital,   Center for Disease Control (CDC),    Support to counseling services, laboratory services, equipment,
                 Southern Province               USA.                                 infrastructure development.
 Southern        Livingstone General Hospital,   Johnson and Johnson Yale             Post graduate doctors for experience and research
                 Southern Province               University, USA.
 Southern        Livingstone General Hospital,   Rapids –World vision                 Psycho-Social support program for children living with HIV/AIDS,
                 Southern Province                                                    Orphans and Vulnerable Children (will run up to 2010).
 Southern        Livingstone General Hospital,   Zambezi – Physiotherapy              Student exchange program
                 Southern Province
 Southern        Livingstone School of           Kristianstad University –            Tutor and Student exchange programme.
                 Nursing, Southern Province.     Department of Health Science
                                                 (Sweden)
 Southern        Livingstone School of           Norway –SOGN OQ FJORDANE             Tutor and Student annual exchange programme.
                 Nursing, Southern Province.     University – Faculty of Health
                                                 Studies
 Southern        Monze Mission Hospital          AIDS Health Care Foundation.         Support to HIV/AIDS and ART activities.
 Southern        Monze Mission Hospital          Canadian Food for Children
 Southern        Monze Mission Hospital          Catholic Mission Board


August 2007                                                                  15                                                         CAN Investments Limited
                                                                                                                                                Lusaka, Zambia
                                                                                                                                                MAIN REPORT
The Tropical Health and Education Trust (THET)                      Mapping of Health Links in the Zambian Health Services and Associated Academic Institutions
In conjunction with                                                                                                                 under the Ministry of Health
The Ministry of Health of Zambia

 Southern        Monze Mission Hospital          Hands Around the World.             Extension of the Children's ward, male ward and completion of the
                                                                                     ICU. Also provides support to staff development.
 Southern        Monze Mission Hospital          Michigan State University
 Southern        Monze Mission Hospital          Misereor –Germany.                  Support to HAART Project.
 Southern        Monze Mission Hospital          Other Links                         These include:
                                                                                      Michigan State University, USA
                                                                                      Canadian Food for Children
                                                                                      Catholic Mission Board
 Southern        Monze Mission Hospital          VSO, UK.                            Volunteer staff from overseas.
 Western         Kaoma DHMT                      FMC (Former Dutch Doctors)          Help out in new hospital construction
 Western         Kaoma DHMT                      Orange Babies of Netherlands        Construction of maternity Ward
 Western         Kaoma DHMT                      Touch of Ireland                    Short term /Construction of children’s Ward
 Western         Lewanika General Hospital,      University of Moto in Czech         Surgery, Infrastructure, Equipment & Training.
                 Western Province.               Republic.

 Western         Lewanika Hospital               Project Educate                     Capacity building
                                                 University of Moto in Czech
 Western         Lewanika Hospital               Republic                            Surgery ,Infrastructure, Equipment & Training




August 2007                                                                  16                                                        CAN Investments Limited
                                                                                                                                               Lusaka, Zambia
                                                                                                 MAIN REPORT
The Tropical Health and Education Trust (THET)       Mapping of Health Links in the Zambian Health Services and
In conjunction with                                                            Associated Academic Institutions
The Ministry of Health of Zambia                                                     under the Ministry of Health




        Appendix VI:               List of Institutions and Persons Interviewed




August 2007                                      1                                     CAN Investments Limited
                                                                                               Lusaka, Zambia
                                                                                                         MAIN REPORT
The Tropical Health and Education Trust (THET)               Mapping of Health Links in the Zambian Health Services and
In conjunction with                                                                    Associated Academic Institutions
The Ministry of Health of Zambia                                                             under the Ministry of Health



List of Institutions Visited, Officials Interviewed and Contact Addresses
 PROVINCE        DISTRICT        INSTITUTION/ CONTACT               STAFF INTERVIEWED             POSITION
                                 DETAILS
 Central         Chibombo        Chibombo District Hospital         1. Mrs Veronica Mwape         1. Manager
                                 (Liteta)                                                         Administration
 Central         Kabwe           Kabwe General Hospital             1. Dr K Malama                1. Executive Director
                                                                    2. Mr. Elias K Sililo         2. Senior Personnel
                                                                                                  officer
 Central         Kabwe           Kabwe Mine Hospital                1. Dr K Malama                1. Executive Director
                                                                    2. Mr. Elias K Sililo         2. Senior Personnel
                                                                                                  officer
 Central         Kabwe           Kabwe School of Midwifery          1. Dr K Malama                1. Executive Director
                                                                    2. Mr. Elias K Sililo         2. Senior Personnel
                                                                                                  officer
 Central         Kapiri          Kapiri Mposhi Distric              1. Dr Charles Mwinuna         1. Executive Director
                 Mposhi          Hospital
 Central         Mkushi          Mkushi District Hospital           1. Dr. Mwanza                 1. Executive Director
 Central         Serenje         Serenje District Hospital          Hospital Administration       Doctors
                                                                    Team consisting of the        1. Matron
                                                                    following:                    2. Acting Principal
                                                                    1. Dr. Ngozi Igbasi           Clinical Officer
                                                                    2. JK. Hamir                  3. Acting Nursing Officer
                                                                    3. Mr John W. Nchelenje       4. Acting Hospital
                                                                    4. Harrison Chilufya          Administrator
                                                                    5. Mr. Raymond K.             5. Radiographer
                                                                    Mukupa                        6. Senior Environmental
                                                                    6. Mr Royd Simuchembu         Technologist
                                                                    7. Mr Mutale Alexander
 Copperbelt      Kitwe           Kitwe Central Hospital,            1. Dr. Anthony Mutiti         1. Acting Director ,
                                 Telefax 02-228604 Email:                                         Clinical Services
                                 Anthony_mutiti@yahoo.com
 Copperbelt      Kitwe           Kitwe District Health              1. Dr C. John Banda           1. Director
                                 Management Team
 Copperbelt      Ndola           Arthur Davison Hospital            1. Mr. CCG Mulinda            1. Acting Human
                                                                                                  Resources Manager
 Copperbelt      Ndola           Ndola Central Hospital             1. Dr Malawo                  1. Director
                                 Telephone : 612590, Fax:
                                 612204, Email:
                                 nch@zamnet.zm
 Copperbelt      Ndola           Ndola College of Bio-Medical       1. Mr Nguluta                 1. Principal/Director
                                 Science                            2. Mr Mulenga                 2. Assistant Director
 Copperbelt      Ndola           Ndola District Health              1. Dr. Kakungu                1. Director
                                 Management Team Email:             Simpungwe                     2. Manager Planning
                                 mkakungusimpungwe@yahoo            2. Dr Nyendwa                 3. Administrative Officer
                                 .co.uk                             3. Mr A.K. Musaba             4. Human Resources
                                                                    4. Mr S. Ngandwe              Officer
 Copperbelt      Ndola           Ndola School of Nursing            1. Mrs Kakungu                1. Nursing Education
                                                                                                  Manager
 Copperbelt      Ndola           Provincial Health Office c/o       1. Florence Kashita           1. Human Resources
                                 Data Management                                                  Specialist
                                 Specialist,Email:
                                 eggwai@gmail.com

August 2007                                              2                                     CAN Investments Limited
                                                                                                       Lusaka, Zambia
                                                                                                         MAIN REPORT
The Tropical Health and Education Trust (THET)               Mapping of Health Links in the Zambian Health Services and
In conjunction with                                                                    Associated Academic Institutions
The Ministry of Health of Zambia                                                             under the Ministry of Health

 Eastern         Chipata         Chipata General Hospital           1. Dr Charles Fanata          1. Acting Executive
                                 P.O Box 510119                                                   Director
                                 Telefax 221427, Mobile
                                 0977480095, 0955545355
 Eastern         Chipata         Chipata School of Nursing          1. Dorothy HS Banda           1. Acting Principal Tutor
                                 P.O Box 510119
                                 Telephone 06-222808
                                 Fax: 06-223638
                                 Email:
                                 dorabanda2005@yahoo.com
 Eastern         Katete          Private bag 11, Katete             1. Dr. Parkinson              1. Executive Director
                                 Telephone: 06-252344
                                 Fax        : 06-25278 email:
                                 saintfrancis@zamtel.zm
 Eastern         Lundazi         Lundazi District Hospital          1. Mr Evaristo Chikwanka      1. Acting Hospital
                                 P.O Box 530013, Lundazi                                          Administrator
                                 Telephone :06-480055
                                 Fax         :06-480055
 Eastern         Nyimba          Nyimba District Hospital           1. Dr. Simwaba Davies         1. Executive Director
                                 (DHMT)
                                 P.O Box 570013
                                 Telephone: 06-374271
                                 Fax        : 06-374271
                                 Mobile     : 0977414826
 Eastern         Petauke         Petauke District Hospital          1. Mr. Jere G                 1. Principal Clinical
                                 (DHMT)                                                           Officer
                                 P.O Box 56008
                                 Telephone : 06-371075
                                 Fax         : 06-371029
                                 Email:
                                 ednamundelela@yahoo.co.uk
 Luapula         Mansa           Luapula Province Health            1. Dr. E Bwalya               1. Director
                                 Office,Telefax 02-821235,          2. Mr Mpofu                   2. Clinical Specialist
                                 Email: ebwalya@zamtel.zm
 Luapula         Mansa           Mansa General Hospital             1. Dr. Francis Bwalya         1. Director
                                 Tele/fax; 02-821188/821635         2. Justin Kapenda             2. Hospital Administrator
                                 Email:
                                 bwalyachiza@yahoo.com
 Luapula         Mansa           Mansa Nursing School,              1. Mr. AM Luboya              1. Principal
                                 Mobile 09789778                    2. Mr. Mulenga                2. Tutor
                                                                    3. Mr. Mwila                  3. Tutor
                                                                    4 Mr. Kanswata                4. Tutor
 Lusaka          Lusaka          Anaesthesia School                 1. Mr. Banda T.               1. Head of Department
 Lusaka          Lusaka          Chainama Hospital                  1. Dr. Welani Chilengwe       1. Executive Director
                                                                    2. Dr. Mudenda                2. Director Training
                                                                    3. Mr. Nsama                  3. Registrar
 Lusaka          Lusaka          CHAZ                               1. Dr Simon Mphuka            1. Executive Director
 Lusaka          Lusaka          Chest Diseases Laboratory




August 2007                                             3                                      CAN Investments Limited
                                                                                                       Lusaka, Zambia
                                                                                                           MAIN REPORT
The Tropical Health and Education Trust (THET)                 Mapping of Health Links in the Zambian Health Services and
In conjunction with                                                                      Associated Academic Institutions
The Ministry of Health of Zambia                                                               under the Ministry of Health

 Lusaka          Lusaka          Department of Pediatric              1. Dr Evans Mpabalwan1
                                 ( we need to make follow ups         2. James Chipeta              2. Lecturer school of
                                 with staff members in this           3. Dr Tendai Msoka            pedratics
                                 dept)                                4. Dr Somwe                   3.
                                                                      5. Professor Chintu           4. Head of Department
                                                                      6. Dr Kankasa
 Lusaka          Lusaka          Dept of Obstetric &                  1. Dr. Kasonka                1. Head of Dept
                                 Gynaecology                          2. Dr. Maureen                2. Consultant Obstetrician
                                                                      Chisembele
 Lusaka          Lusaka          Eye Unit                             1. Dr. Grace Mutati           1. Head of Department
 Lusaka          Lusaka          General Nursing Council of           1. Mrs Chipepo                1. Acting Registrar (Edu
                                 Zambia                               2. Mrs Dorcas Phiri           & Train.Mg)
                                                                      3. Mrs Stella Chisuuka        2. Standards &
                                                                      4. Mrs Theresa Sikaleyo       Compliance Manager
                                                                      5. Mrs Judith Chileshe        3. M&E Specialist
                                                                                                    4. Examination &
                                                                                                    Education Specialist
                                                                                                    5. Accountant
 Lusaka          Lusaka          Lusaka Dental School                 1. Dr Muteba                  1. Principal
                                 P.O Box 33987,                       2. Dr Nalumino Sayela         2. Dental Surgeon
                                 Telefax 01-239789
                                 Email:
                                 itone_muteba@yahoo.ca
 Lusaka          Lusaka          Medical Council of Zambia            1. Mr. Malijani Alfred        1. Inspection Officer
                                 P.O Box 32554,                       2. Mr. B.B. Bwalya            2. Registration Officer
                                 Telephone 01 236241
                                 Fax: 01- 239317
                                 Email: mcz@zamtel.zm
 Lusaka          Lusaka          UNZA Department of                   1. Professor Mullah           1. Head of Department
                                 Medicine
 Lusaka          Lusaka          UNZA Department of Surgery           1. Professor Desai            1. Head Department of
                                                                                                    Surgery
 Lusaka          Lusaka          UTH Administration                   Dr. Peter Mwaba               Managing Director
 Lusaka          Lusaka          UTH Laboratory Department            1. Dr. Mudenda                2. LAB Manager
 Lusaka          Lusaka          UTH School of Nursing                1. Beatrice Zulu              1. Acting Principal
                                                                      2. Josephine Himoonga         2. Principal Tutor
                                                                      3. Honestor Banda             3. Acting principal Tutor
 North           Solwezi         NW Provincial Health Office          1. Mr Enock Kalambo           1. Clinical Care Specialist
 Western                         08-821997                            2. Ms Lukonde Jennifer        2. Office Administrator
                                                                      3. Mr Ngoma Robert            3. Human Resources
                                                                                                    Specialist
                                                                                                    4. Environmental
                                                                                                    Specialist

 North           Solwezi         Solwezi District Health              1. Mr Dawson Kabwita          1. District Health
 Western                         Management Team                      2. Mr Mutesi Elliott          Information Officer
                                                                                                    2. Manager
                                                                                                    Administration
 North           Solwezi         Solwezi General Hospital             1. Job Moonga                 1. Hospital Manager
 Western
 North           Solwezi         Solwezi School of Nursing            1. Florence Mukupa            1. Senior Tutor
 Western


August 2007                                                4                                     CAN Investments Limited
                                                                                                         Lusaka, Zambia
                                                                                                          MAIN REPORT
The Tropical Health and Education Trust (THET)                Mapping of Health Links in the Zambian Health Services and
In conjunction with                                                                     Associated Academic Institutions
The Ministry of Health of Zambia                                                              under the Ministry of Health

 Northern        Kasama          Kasama General Hospital             1. Dr. Simon Mukosa           1. Director
                                 Mobile: 097848960                   2. Mrs D. Mwape               2 Nursing Officer
                                 Tele/fax: 04-221304, Email:         3. Mr. Sandala                3.Acting Hospital
                                 smukosa@yahoo.com                                                 Administrator
 Northern        Kasama          Kasama School of Nursing            1. Mr. Elson muulu            1. Principal Tutor
                                 P.O Box 410056
                                 Telefax 04-221024
                                 Email: kasam@zamtel.zm
 Northern        Kasama          Provincial Health Office, P.O       1. Dr Fabian Kabulubulu       1. Director
                                 Box 410026, Kasama,                 2. Mrs. Mugala                2. Clinical Officer
                                 Telefax: 04-221501, Email:          3. Mrs. Elizabeth Mvula       3. Human Resources
                                 fredah56@yahoo.co.uk                                              Officer
 Northern        Luwingu         Luwingu District Health             1. Dg Ilunga                  1. Director
                                 Management Team (Hospital)
                                 Mobile : 097713504
 Northern        Mpika           Chilonga Mission Hospital           1. Sister Mutamba             1 Administration Manager
                                 P.O Box 450030                      Elizabeth
                                 Mpika
                                 Zambia
                                 Email:
                                 chilongahospital@diompika.or
                                 g
                                 Manageradmin.art.chilonga@
                                 gmail.com
                                 Mobile: 096355163
                                 096645548
                                         099742838
                                 Fax: 04-370112

 Northern        Mpika           Mpika District Heath                1. Mr. Mwansa Bernard         1. Director
                                 Management Team                     2. Mr. Martin Mbao            2. Human Resources
                                 P.o Box 450046                      3. Mrs. Mwaba                 Officer
                                 Mpika                                                             3. Manager
                                 Email:                                                            Administration
                                 inongemwanje@yahoo.com
                                 Mobile :097210673
 Northern        Mpika           Mpika General Hospital              1. Dr. Mulindwa               1. Medical Officer
                                 P.O Box 450011, Mpika               2. Mr. Victor Chimbala        Incharge
                                 Mobile: 097756337                   3. Mr. John Mwelwa            2. Hospital Administrator
                                         099376036                   4. Mr. Charles W. Mumba       3. Senior Nursing Officer
                                         097853805                   5. Mrs Dorothy                4. Nursing Officer
                                         095439139                   Siambelele
                                 Email: mulindwah@yahoo.fr
 Northern        Mungwi          Mungwi District Health              1. Grace Nanyiza              1. Director
                                 Management Team
                                 Telefax: 04-230035
                                 Mobile : 099402930
 Southern        Choma           Choma District Helath               1. Dr. Mkandawire             1. District Health Director
                                 Management Team
 Southern        Kalomo          Kalomo District Health              1. Mr Sakala                  1. Acting Manager
                                 Management Team                                                   Planning



August 2007                                               5                                     CAN Investments Limited
                                                                                                        Lusaka, Zambia
                                                                                                         MAIN REPORT
The Tropical Health and Education Trust (THET)               Mapping of Health Links in the Zambian Health Services and
In conjunction with                                                                    Associated Academic Institutions
The Ministry of Health of Zambia                                                             under the Ministry of Health

 Southern        Livingstone     Livingstone Central Hospital       1. Dr. Phiri                  1. Executive Director
                                                                    2. Mrs Nchengamwe             2. Senior Nursing Officer
                                                                    3. Mr. D. Makando             3. Manager
                                                                    4. Dr. Robert Fubisha         Administration
                                                                                                  4. Manager Clinical Care
 Southern        Livingstone     Livingstone District Health        1. Mrs C. Sikazwe             1. Manager Planning and
                                 Management Team                    2. Clarence Musumo            Development
                                                                    3. Rose Banda                 2. District Health
                                                                                                  Information Officer
                                                                                                  3. Acting Environmental
                                                                                                  Health officer
 Southern        Livingstone     Livingstone School of Nursing      1. Mrs. H. Simaubi            1. Acting Senior Nurse
                                                                                                  Tutor
 Southern        Livingstone     Provincial Health Office           1. Dr Alisheke Lutangu        1. Provincial Health
                                                                                                  Director
 Southern        Mazabuka        Chikankata College of Bio-         1. Jane Banda Chisenga        1. Lecturer
                                 Medical Sciences                   2. Wilner Chiyota             2. Clinical Instructor
                                                                    3. Linda Mabumba              3. Lecturer
                                                                    4. Mr. Potipher Pilingana     4. College Manager

 Southern        Mazabuka        Chikankata Mission Hospital        1. Richard Bradbury           1. Manager
                                                                                                  Administration
 Southern        Mazabuka        Chikankata School of Nursing       1. Mr. Mhango                 1. Principal Tutor
                                 and Midwifery
 Southern        Monze           Monze Mission Hospital             1. Dr John Y. Mvula           1. Executive Director
                                                                    2. Joshua Maimo               2. Human Resources
                                                                                                  Officer
 Southern                        Choma General Hospital             1. Mr. Munyanya               1. Human Resources
                                                                    Mubiana                       Officer
 Southern                        Mazabuka District Hospital         1. Mrs Chilima                1. Matron
                                                                    Haboombe
 Western         Kaoma           Kaoma District Hospital            1. Mr. E. Phiri               1. Manager Planning &
                                 P.O Box 94009, Kaoma               2 Mr M. Muyunda               Development
                                 Fax 360227, Tele 360093            3. Mr M. Pumulo               2. Manager
                                 Email: chombana@yahoo.com                                        Administration
                                                                                                  3. TB/ Leprosy Officer
 Western         Mongu           Lewanika General Hospital          1. Dr. Andrew Silumessii      1. Executive Director
                                 P.O Box 910147, Fax 221233         2. Mr Munsanje Paul           2. Information Officer
                                 Telephone: 221012
                                 Email: asilumessi@yahoo.com

 Western         Mongu           Lewanika School of Nursing         1. Biemba Maliti              1. Acting Principal
                                 P.O Box 910147, Fax 22347
                                 Telephone: 221468
                                 Email: bkahalu@yahoo.ie




August 2007                                              6                                      CAN Investments Limited
                                                                                                        Lusaka, Zambia
                                                                                             MAIN REPORT
The Tropical Health and Education Trust (THET)   Mapping of Health Links in the Zambian Health Services and
In conjunction with                                                        Associated Academic Institutions
The Ministry of Health of Zambia                                                 under the Ministry of Health




              Appendix VII: List of Documents/Literature Consulted




August 2007                                                                        CAN Investments Limited
                                                                                           Lusaka, Zambia
                                                                                              MAIN REPORT
The Tropical Health and Education Trust (THET)    Mapping of Health Links in the Zambian Health Services and
In conjunction with                                                         Associated Academic Institutions
The Ministry of Health of Zambia                                                  under the Ministry of Health



List of Literature Consulted
S/N      Document Title/Description
1.       Annual Action Plans from institutions visited
2.       Economic Report for 2005 and 2006
3.       Fifth National Development Plan (NDP 2006-10) – Health Chapter
4.       Health Sector Joint Annual Review Reports – 2005, 2006
5.       HMIS Annual Bulletins for 2005, 2006
6.       Institutional and Organisational Appraisal Report (MOH/CBoH), 2004
7.       Mid-Term Expenditure Framework (MTEF) Plans for MOH
8.       MOH Action Plan – 2006 (Narrative/ABB) for 2006, 2007
9.       MOH Annual Reports – 2005, 2006
10.      MOH HIV/AIDS and STIs Action Plan 2006 and Progress Reports
11.      MOH Human Resource Strategic Plan 2006-2010 and Action Plan for 2006
12.      MOH Institutional Strategic Plan, 2005 – 2009
13.      MOH Progress Report on ART
14.      MOH Progress Reports and Accounts to the SAG and Minutes
15.      NAC Mid-Term Review Report
16.      NAC Progress Report 2006
17.      National Budget (Yellow Books) – 2006, 2007
18.      National Budget (Yellow Books) – 2007
19.      National Budget Speeches – 2006, 2007
20.      National Health Strategic Plan (NHSP 2006-2010)
21.      Poverty Reduction Strategy Paper (PRSP)
22.      Recent Review/Surveys on HR Issues
23.      Several research papers on human resources for health
24.      THET Publications and Website
25.      Zambia Health Demographic Survey 2001/02 (and Status for 2006)
26.      Zambian Health Sector Support – Mapping Report, DFID, 2006




August 2007                                                                         CAN Investments Limited
                                                                                            Lusaka, Zambia
                                                                                                    MAIN REPORT
The Tropical Health and Education Trust (THET)          Mapping of Health Links in the Zambian Health Services and
In conjunction with                                                               Associated Academic Institutions
The Ministry of Health of Zambia                                                        under the Ministry of Health




              Appendix VIII: Reports/Feedback from Link Partners

                                            (Submitted Separately)




August 2007                                                                               CAN Investments Limited
                                                                                                  Lusaka, Zambia

								
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