Climate variability; enhancing adaptive utilization of browse trees for improved livestock production among agro-pastoralists communities in Southern Zambia

Agro-pastoralists whose sources of livelihood depend on rain-fed agriculture are very vulnerable to ecological disturbance due to increasing climate variability. They are unable to adequately feed their animals in times of extreme weather conditions of floods and droughts thereby causing a disruption in their major source of livelihood. This study analyzed the feeding strategies employed by agro- pastoralists in Southern Zambia and important browse species used in extreme weather conditions, in order to improve their utilization for improved livestock production. The major feeding strategies during droughts include browse utilization, dambo grazing, grazing along streams and supplementary feeding. While during floods, upland grazing and browse grazing were the main strategies. However, most of the agro-pastoralists do not practice pasture management and fodder conservation for their animals. Of the 21 tree browse species identified by the agro-pastoralists, 18 species were found to be important during droughts and 8 during floods. Most of the agro-pastoralists neither knew how to plant these browse species nor how to manage them for better and sustainable use in feeding their animals. Therefore, the agro-pastoralists in the study area need to take up management and feed conservation measures for their animals. Deliberate effort should be made to teach the agro-pastoralists how to plant and manage the important browse species that are suitable in extreme weather conditions. This will enhance productive use of the browse species for improved animal feeding to ensure food security among the pastoralists.Key words: Extreme weather conditions, adaption, browse species, Agro-pastoralists

How HIV/AIDS scale-up has impacted on non- HIV priority services in Zambia

Background: Much of the debate as to whether or not the scaling up of HIV service delivery in Africa benefits non-HIV priority services has focused on the use of nationally aggregated data. This paper analyses and presents routine health facility record data to show trend correlations across priority services. Methods: Review of district office and health facility client records for 39 health facilities in three districts of Zambia, covering four consecutive years (2004-07). Intra-facility analyses were conducted, service and coverage trends assessed and rank correlations between services measured to compare service trends within facilities. Results: VCT, ART and PMTCT client numbers and coverage levels increased rapidly. There were some strong positive correlations in trends within facilities between reproductive health services (family planning and antenatal care) and ART and PMTCT, with Spearman rank correlations ranging from 0.33 to 0.83. Childhood immunisation coverage also increased. Stock-outs of important drugs for non-HIV priority services were significantly more frequent than were stock-outs of antiretroviral drugs. Conclusions: The analysis shows scale-up in reproductive health service numbers in the same facilities where HIV services were scaling up. While district childhood immunisations increased overall, this did not necessarily occur in facility catchment areas where HIV service scale-up occurred. The paper demonstrates an approach for comparing correlation trends across different services, using routine health facility information. Larger samples and explanatory studies are needed to understand the client, facility and health systems factors that contribute to positive and negative synergies between priority services

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

BACKGROUND: Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. METHODS: Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. RESULTS: Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. CONCLUSIONS: This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas

An ethnography of HIV/AIDS care transformation in Zambia

This dissertation adds to the literature on how institutions of care transform. It shows how differently positioned actors, including people with HIV, their friends and families, local health providers and officials, policy makers, local and international NGOs, bilateral, multilateral and transnational organisations, economy and technology interact to shape care practices for people with HIV and AIDS. I argue that it is the interactions and friction between different actors at the different times and spaces that shape both HIV/AIDS care practices and their evolution. The text highlights the friction between actors and their concepts and practices and how these interact with technology to create new forms and practices that are shaped by both the pragmatism and agency of local actors and knowledge of international agencies. To characterise HIV/AIDS care transformation, I provide a thick description of HIV counselling practice in all its main trajectories as currently practiced and attempt to provide a history and evolution of current policies and practices. I highlight the shifts in HIV/AIDS policy and practice as the epidemic matured from the pre-HIV test era through the Pre-HIV treatment era to the treatment era and beyond. I demonstrate the relationship between those shifts, the agency of different actors, the technology and age of the epidemic and show how friction between these actors has shaped HIV/AIDS care transformation in Zambia

The emergence and evolution of HIV counselling in Zambia: a 25-year history

HIV-related counselling practices have evolved since emerging in Zambia in 1987. Whereas, initially, the goal of HIV counselling was to provide psychological support to the dying and their families, as knowledge about HIV grew, counselling objectives expanded to include behavioural change, encouraging safer sexual practices, encouraging disclosure, convincing people to test, treatment adherence and shaping HIV-positive people's sexual and reproductive choices. This paper highlights a number of key shifts in counselling practices in Zambia over the last 25 years, demonstrating the relationship between those shifts, changes in medical technology, (inter)national political will and the epidemiological maturity of the disease. Los métodos de asesoramiento sobre el virus del sida han cambiado desde que se introdujeron en Zambia en 1987. Si bien al principio lo más importante en el asesoramiento sobre el sida era ofrecer apoyo psicológico a los moribundos y sus familias, según se ha ido conociendo mejor esta enfermedad, en el asesoramiento se incluyen ahora cuestiones tales como el cambio de comportamiento, estimular prácticas sexuales más seguras, recomendar la revelación de la enfermedad, convencer a las personas que se hagan la prueba del sida, seguir los tratamientos e influir en las decisiones sexuales y reproductivas de las personas seropositivas. En este artículo destacamos una serie de modificaciones clave en los métodos de asesoramiento en Zambia en los últimos 25 años, demostrando la relación entre estas variaciones, las innovaciones en la tecnología médica, la voluntad política (inter)nacional y la madurez epidemiológica de la enfermedad. Les pratiques du counselling en matière du VIH ont évolué depuis leur apparition en Zambie, en 1987. Si elles avait pour objectif initial d'offrir un soutien psychologique aux mourants et à leur famille, à mesure que les connaissances sur le VIH se sont améliorées, cet objectif s'est élargi pour inclure une approche des changements de comportements; l'encouragement à n'avoir de rapports sexuels que protégés; la promotion du dépistage du VIH auprès du public; l'observance des traitements; et la détermination des choix sexuels et reproductifs pour les personnes séropositives au VIH. Cet article met l'accent sur un nombre de changements clé dans les pratiques de counselling en Zambie ces dernières 25 années, démontrant ainsi le rapport entre ces changements, ceux de la technologie médicale, la volonté politique (inter)nationale et la « maturité épidémiologique » de la maladie