HIV disclosure in the workplace amongst public service workers in Zambia

Masters of Public Health - see Magister Public HealthWith a prevalence of 14.3% among the 15-49 years age group, HIV/AIDS still constitutes a significant challenge in Zambia. In order to respond to the impact of HIV/AIDS within the workplace, government ministries have developed HIV-focused workplace policies and programmes that provide HIV/AIDS services. However, despite their availability, the number of employees accessing the services, especially those targetting HIV positive workers remains low. The fear (either perceived or real) of disclosing an HIV positive status is one likely reason for the low uptake of services. HIV-positive status disclosure is an important public health goal as it can create opportunities for an individual to access information and social and medical support, and this will affect career and workload related decisions. This exploratory, qualitative study aims to identify and describe the HIV-disclosure experiences of 12 openly HIV-positive Zambian public sector workers living in Lusaka and working in four Zambian Ministries. Both male and female public sector workers were interviewed. The participants’ experiences of disclosing their HIV positive status in the workplace were explored in depth in this study. With the aim of providing those responsible for overseeing and managing the Zambian public sector HIV workplace initiatives with some practical recommendations regarding the disclosure support needed by HIV-positive public sector workers. The study found that whilst participants had an initial fear of disclosing their HIVpositive status in the workplace, their HIV disclosure actually proved to be very beneficial. Not only did it allow their health-related needs (such as accessing medication and visiting a doctor) to be met, but their disclosure also encouraged others to also disclose their status. The recommendations are are aimed at creating a supportive working environment for people living with HIV within the Zambian public service, and offering suggestions to their managers on how best to support the process of disclosure amongst their staff

Sleeping sickness and its relationship with development and biodiversity conservation in the Luangwa valley, Zambia

The Luangwa Valley has a long historical association with Human African trypanosomiasis (HAT) and is a recognised geographical focus of this disease. It is also internationally acclaimed for its high biodiversity and contains many valuable habitats. Local inhabitants of the valley have developed sustainable land use systems in co-existence with wildlife over centuries, based on non-livestock keeping practices largely due to the threat from African Animal Trypanosomiasis. Historical epidemics of human sleeping sickness have influenced how and where communities have settled and have had a profound impact on development in the Valley. Historical attempts to control trypanosomiasis have also had a negative impact on conservation of biodiversity. Centralised control over wildlife utilisation has marginalised local communities from managing the wildlife resource. To some extent this has been reversed by the implementation of community based natural resource management programmes in the latter half of the 20th century and the Luangwa Valley provides some of the earliest examples of such programmes. More recently, there has been significant uncontrolled migration of people into the mid-Luangwa Valley driven by pressure on resources in the eastern plateau region, encouragement from local chiefs and economic development in the tourist centre of Mfuwe. This has brought changing land-use patterns, most notably agricultural development through livestock keeping and cotton production. These changes threaten to alter the endemically stable patterns of HAT transmission and could have significant impacts on ecosystem health and ecosystem services. In this paper we review the history of HAT in the context of conservation and development and consider the impacts current changes may have on this complex social-ecological system. We conclude that improved understanding is required to identify specific circumstances where win-win trade-offs can be achieved between the conservation of biodiversity and the reduction of disease in the human population.Ecosystem Services for Poverty Alleviation (ESPA

Adaptable Lessons Learnt on Procurement from Deployment to a Deadly Emergency Outbreak: The Case of Sierra Leone during Ebola Outbreak 2015

Background: The WHO has standard operating procedures for procurement, travel and logistics for use at country level. Some of the guidance is waived during public health emergencies of international concern. Practical acumen on using the standards for emergency settings is limited at country level. WHO Zambia was one of the countries that responded to the call by WHO HQ to support the 2014 Ebola outbreak in West Africa. This paper aims to document lessons learnt by procurement staffs that were deployed to emergency settings.Methods: Desk review of documents on procurement during emergency settings, terms of reference of the mission, materials on prevention of getting infected by Ebola and general rules governing international deployment were analysed. The staff member was deployed for the duration of eight weeks in 2015 from where experiences gained were reviewed and systematically recorded.Results: Deployment and exposure to an emergency setting was the first such experience to WCO Zambia staff. During the Ebola outbreak in Sierra Leone there was the “no touch person” practice from inherent profound fear of contracting the deadly disease. While the job description was similar with what was prevailing in nonemergency setting in Zambia, the quantities and implementation speed on assignments on average were more than ten times on emergencies. In that environment the procedure for procurement involved Invitation to Bid and Request for Proposal to interested parties occurring at the same time which is done differently from normal situations where there is first a request for quotations and procurement committee deliberate before making selection. In the Ebola set-up, there is a waiver of the competitive bidding requirements.Discussion: The exposure of WCO staff to emergency setting allowed WCO staff to be more knowledgeable about preparation and award contract using additional procurement methods in compliance with WHO policies as adopted for emergencies.Conclusion: Secondment of staff to a setting of emergencies is beneficial to WCO staff in terms of capacity building and handling similar situations in future. Country Offices are encouraged in future to share human resources when situations dictate

Improved Financial Probity in the Health Sector Following the WHO Reforms in Zambia

Background: The World Health Organization (WHO) Reform emphasizes strict adherence to two procedures for disbursements of resources allocated to all the 196 member states as per approval from the World Health Assembly. Direct financial cooperation (DFC) are transactions where funds are transferred to government and concluded in three months after completion of activity. Direct implementation is the procedure when the WHO pays on behalf of the Government of the Republic of Zambia (GRZ) for implementation of processes concluded within 5 months after the activity. The aim of this study is to document financial compliance to WHO reform of WHO Zambia with government.Methods: This was a desk review of financial activities from the WHO country office from January to December 2015. Findings and recommendations from the November 2015 External Audit conducted on the financial operations of the WHO Zambia office in the area of implementation and management of Direct Financial Corporation and Direct Implementation were also analysed.Results: The resource allocations were equally distributed between DFCs and DIs during the year of study. The WHO Zambia conducted fortnightly meetings to review DFC and DI status and, monitoring with all Program officers. Of the 34 DFCs issued only three (8%) were submitted late at the beginning of 2015 with progressive improvement thereafter. WHO Zambia received commendation from the Regional Office, a consideration which was corroborated by the External Audit recommendations.Discussion: One of the reasons for reform was financial accountability challenges in the WHO with donors raising concern. The conformity of the WHO Zambia is an attribute. The WHO Zambia implemented the DFC and DI in accordance with WHO guidelines as evidenced by positive Audit recommendation in this area.Conclusion: The regular WHO Zambia tracking of the status of DFCs and DI is a best practice that the other regional Country offices can emulate. This practice if scaled up to the entire region will increase donor trust and confidence

Using E-Learning for Skills Transfer, Motivation and Retention of Health Workers in Zambia

Background: Health system strengthening continues to be a moving target for developing countries with the human resource factor the most critical bottleneck towards universal health coverage.The human resource management cycle revolves around three interdependent factors: production, recruitment, deployment and retention. The most elusive is retention where both monetary and non-monetary reward systems are equally important. The purpose of this is to document establishment of e-learning as a tool for online skills transfer to address retention of health workers in a cost effectively.Methods: This prospective study analyses the process of establishing an e-learning facility in Central Province of Zambia. Visitations of the site in the PEPFAR (US President Emergency Plan for Aids Relief in Africa) sponsored Chainama College of Health Sciences, Kabwe Campus premises and technical inputs and specifications were documented.Results: The Ministry of Health maximized the prevailing thriving partnership in the health sector by allocating accommodation to e-learning using resources from RMNCH Trust Fund with the WHO dedicating technical support for this concept in close liaison with Ministry of Health officials in Central Province. The facility can accommodate 36 students and is earmarked to be a training facility equipped with appropriate equipment and software to cater for the entire spectrum of diseases and conditions in Zambia. This is an institution which can support the human resource cycle of production, recruitment, deployment and retention, an innovation that be scaled up to address national retention needs.Discussion: E-learning has ushered a sustainable modality of skills transfer to many areas including human resources for health. The government has successfully engaged cooperating partners in Zambia to implement this improvision in the health sector. The WHO has played its part in ensuring that the critical health resource for health pillar of health systems is addressed.Conclusion: Zambia health sector is instituting an intervention that can improve retention of health workers using non-financial motivation through sustainable elearning