Kalabo District Hospital KDH Western Province Zambia Name

Kalabo District Hospital (KDH) Western Province, Zambia. Name: Stanford Munampamba Programme: MA Development Studies S/N: 1606167548

Introduction • Kalabo District is located in the western part of Zambia. The district is generally rural. • The District Hospital is the only Government facility covering a very big population. • Stretching through the Liuwa National Park and covering Makoma land, Tapo areas up through to beyond Lukona areas and Sihole areas.

Back ground analysis at Kalabo District Hospital (KDH) in Western Province (Zambia) • Most of the patients that are admitted at the Hospital come from far away places and find a little difficulties to find other meals and that most of the drugs are out of stock hence they need to buy from pharmacies. • Our survey focused on cleanness, nurse and doctor`s help with other professional workers and services provided and evaluation as well as a close look at the prevalence of communicable and non communicable diseases such malaria, HIV/ AIDS, diabetes other STIs such as syphilis and the rate of abortions at the hospital. • Patients rating of the services provided. • Objectives and assessment of SNDP indicators.

Entry point at KDH

Congestion at KDH OPD

OPD-KDH • • • During our survey, we found substantial evidence of over crowding that could have been caused by registration staffs at OPD. This is because most staffs come late for work and delay in starting work, they also spend too much time charting with friends when patients a waiting in pain. We also discovered that, members of staff spend a lot of time having meetings at the expense of patients. However, our survey also revealed that essential workers do extra jobs other than what the job offer letters stipulate. Hence essential departments/sections suffer from such shocks of unplanned work loads. This contributes to other members of stuff delay in starting work because of there supervisors' absence during meetings. The over clouding during registration is also caused by lack of space hence patients standing in the corridors during registration. The hospital (OPD) doesn't have enough sitting space for patients. The OPD area is not well ventilated.

Quality care analysis of data at Kalabo District Hospital Quality of care received 70 63 60 47 50 40 Quality of care received 30 20 10 0 YES NO

Quality care analysis • People in rural areas have very little options in terms of income generating activities since most of them are involved in farming and fishing which gives them meaningful income once a year. • As seen in the graph above, people in rural areas have no any other option of health care hence, an increase in service utilization. • However, the interviews revealed that most of the patients were happy that services were brought closer to the people. • However, the disease burden remain high.

Quality analysis at KDH • During our survey we found an increase in total utilization of public health services and an increase in drug consumption. • Utilization of public health was estimated to have increased among the rural population. • The graph below shows patients response, 81% were happy while 19% were not satisfied with the service. • Promotion of Health Education in the prevention, control of diseases, expand access to HIV prevention, treatment services, including sexually transmitted infections and blood safety.

PATIENTS HAPPY WITH SERVICES OFFERED 90. 00% 80. 00% 70. 00% 60. 00% 50. 00% 40. 00% 30. 00% 20. 00% 10. 00% YES NO

Evaluation of services offered • Patients under rated the service they received because of the following: • The health workers do not explain the procedures and risks associated to during or any related health process. • They do not explain to the patient who to contact when any symptoms or risk occur. • The health workers do not explain to patients how the medication works and possible side effects. • The health facility does not provide a discharge or follow up instruction in case symptoms appeared.

Evaluation of services offered • Our survey further revealed that, during night time the OPD and the surrounding hospital lacked proper lighting system that could have been caused due to non availability of proper electrification in spite of the facility being electrified. • We further discovered that during night, medical officers on duty are always not available. • They are on `call` stay home officers. • The survey further revealed that patients complained over medicals officers who only treat those of their interest or if they are told he or she has a social status. For example a district commissioner (DC). • This only come to light when a patients from Lukona, Kashitu and Libonda areas complained.

An advert at the entry of female maternal ward

• • Challenges and disappointments at Kalabo District Hospital (KDH) Funding cuts: in most cases this is because of poor decision making than scarcity of funds. The biggest cuts are experienced in drugs, community activities and flexible emergence cash: precisely these inputs – in additional to human resource – required to cope with the increasing number of patients. Drug stock outs: it is a common place for patients to leave facility with prescription instead of medicines, directly undermining the free care policy. ‘Many people can not afford to buy drugs for themselves hence they resort to using traditional drugs which are not very effective. Patients let down: what was good and welcome police for free care turned into a missed opportunity for nation especially the rural. Quality of health care suffered at times and patients often forced longer waiting times fewer drugs and over worked stuff. Luck of government implementation meant that the most vulnerable suffered the most. This simply meant that the facility is not able to cope up with the continued increase in utilization. Poor communication and implementation: a large part of reason for uneven and incomplete implementation of policy was down to insufficient planning time. This contributed to poor consultation especially with the stuff responsible for implementing the reform at facility level.

Evaluation of the services offered at Kalabo District Hospital (KDH) in western province 30 26 25 20 15 14 Patients satisfactions 10 5 0 yes no

Patients' rating of the services received • Health care issue is not satisfactory • Our survey reviewed that, most of the patients would not encourage there relatives for any treatment at the hospital. • But, they are compelled to because it is the only nearest facility. • One of the reasons that caused this reaction is the state of sanitation at the facility that is below standards and the absence of the most need drugs. • From the picture below, you must be able to tell that from a crowed female ward with patients on the ground, these buckets are not enough. • The female ward is has no enough bed space as same of the patients are made to use the floor as their bed space.

Female toilets with few buckets used for water

Evaluation of patients satisfaction with the services offered at Kalabo District Hospital 35 32 31 29 30 25 20 18 15 10 5 0 v-effective q-effective non

A Researcher at one of the Utility Vans parked KDH during a survey

Male ward at KDH

SNDP INDICATORS • According to the graph below, the facility recorded a reduction in maternal and child mortality. • The maternal death declined due to high percentage of skilled health personnel. • The facility implemented ant-malaria interventions, which included mass screen and test and community based campaigns on surveillance system however, the incidences of malaria still remain relatively high because inadequate of transport and resource to cover large areas • The disease burden at the facility remain high. • The facility continued to face challenges due to inadequate medical staff and weak logistics management in supply of drugs and medical supplies.

ASSEMENT OF SNDP INDICATORS 100 90 80 70 60 ASSESMENT OF SNDP INDICTORS 50 40 30 20 10 0 V/HIGH MEDIUM LOW V/LOW

General responses from patients at Kalabo District Hospital. • Overall quality of services was quiet effective • The helpfulness of registration at OPD is also quiet effective. • The overall quality care of nurses at OPD is also quiet effective. • The overall quality care of Doctors is also quiet effective. • The overall quality of emergency satisfactory is also quiet effective.

HEALTH PROMOTION (PREVALENCES DISEASES) HEALTH PROMOTION (PREVALENCE DISEASES) V/HIGH MODERATE LOW V/LOW

Health promotion • Kalabo District Hospital (KDH) continues to make progress in the health promotion, the facility faces a double burden of diseases – communicable and non-communicable. • HIV and AIDs, malaria and TB remain major drivers of disease burden and an increase in non-communicable diseases such as diabetes is increasing is being reported. • Due to inadequate integration, there has been an overlap in the flow of information; inadequacy/incompleteness of information that is collected; and poor analysis and use of the information. • This has in turn led to gaps in knowledge on the impact of interventions; duplication of efforts; and huge transaction costs in terms of time spent to produce reports.

ASSEMENT OF THE SNDP OBJECTIVES V/EFFECTIVE Q/EFFECTIVE N/AVAILABLE

ASSEMENT OF THE SNDP OBJECTIVES • • • For many facilities, achieving the SNDP will require breaking out of vicious circles to enter virtuous circles. The link between economic growth and human development operates through two channels. First, there is the ‘macro’ link whereby growth increases a country’s tax base and therefore makes it possible for the government to spend more on the key public services of health and education. The second channel between growth and human development is a ‘micro’ link, whereby growth raises the incomes of poor people and thereby increases their ability to pay for activities and goods that improve their health and education. In general, a growing economy tends to provide greater job opportunities. These lead in turn to increased demand for education as people expect higher returns for them and their children from the investment of time and money in acquiring skills. The link works equally in the opposite direction. Increased government spending on health and education tends to boost growth in the future, and households reap the benefits from increased investments in health and education through higher future incomes. This generates a virtuous circle of development. But while growth can have strongly positive effects, it is not sufficient for making more rapid advances in health development. For example, both Angola and Georgia have per capita incomes of $2, 200, but while Georgia’s levels of health and education are almost as high as those in OECD countries, Angola’s are among the worst in the world.

What should be done at KDH • The rural citizens have the right to decent quality health care accessible to all. • The government should increase the budget to at least 15% in accordance with Abuja declaration. • Ensure access to medicines and eliminate drug shortages at all levels of the health care system. • Ensure that KDH entrenches practice of transparency and accountability in planning and spending of the health budget. • Ensure an increase in health facility to reduce pressure in waiting time. • Ensure an increase in water supply at heath facility to avoid out breaks of diseases such as dysentery and others. • While the initiatives are welcome, overall health worker shortages remains critical and the facility should quickly look into this through the human resource manager at the facility.

Kalabo District Hospital (KDH)

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