Zambia : final country report

SEATS" Zambia program included: expansion of family planning (FP) services in the Lusaka urban district; Lusaka Urban Youth; Zambia Nurses Association (ZNA)/Midwifery Association Partnerships for Sustainability (MAPS); a reproductive health (RH) integration initiative (World Vision/Zamtan); and participation in regional activities. Of particular importance in implementing the program was the extensive collaboration fostered among multiple donors and collaborating agencies. Each SEATS-supported activity maximized the resources of other groups. SEATS collaboration with such entities as the USAID/Zambia-funded Zambia Family Planning Services project, CARE, and the FOCUS project lent greater efficiency and sustainability potential to each of the subprojects and special initiatives. SEATS/Zambia made important contributions. (1) To improve access to services, SEATS supported youth-friendly clinics, and Youth Corners now operate in two pilot clinics; nurses, midwives, and other providers countrywide were trained in delivery of youth-friendly services; 20 youth peer educators were also trained. (2) To improve service quality, SEATS involved communities in identifying needed improvements and developed supervision tools. Waiting time for services has been reduced. (3) In the areas of human resources development and technical competence, providers received new and updated technical training, and trainee follow-up tools reveal as much as 70% learning retention 6 months after training. (4) In the area of institutional strengthening, health centers formed quality teams for problem identification and resolution; and ZNA increased its member services and management. Sustainability plans were developed for each SEATS activity. Nonetheless, health reform continues to present challenges to implementing programs, particularly those that emphasize human resources development. Local and external resources are stretched thin, and the sustainability of donor-supported activities is not assured. Key lessons learned include the following: (1) In settings like Lusaka, the root causes of high-risk behavior may be more due to poverty and difficult social conditions than to lack of access to services. Providing access to contraceptives and information is only one essential step. (2) Expanding quality improvement and data-driven decisionmaking to the community level can successfully build support for youth services, foster youth utilization of services, and help health centers improve service quality. (3) Programs that rely heavily on volunteers who have no other source of income have sustainability threats. Peer educators are an effective means of reaching youth with information and services, but their sustainability is uncertain due to the lack of structures and systems to assure ongoing support. Also, plans and resources are needed to train new peer educators to replace those that "age out" of the program. (4) Involving the community in a broad sense (i.e., parents, youth, and community leaders) in program design, implementation (including training), and evaluation is highly accepted by the communities served and is effective in promoting health and youth-friendly care. (5) Youth liked the peer educator/Youth Corner approach to service provision, and RH utilization increased as a result. Working through the provider professional association offers an established infrastructure to expand and reinforce interventions initiated under the project. Through the development of continuing education, updates at branch meetings, and a reactivated newsletter, ZNA is in a position to help sustain project efforts to promote youth-friendly health services, increase access for youth, and advocate on the part of providers attempting to improve services at their work places. (6) Strengthening partnerships among NGOs, government, and the community improves support for and sustainability of project activities, especially those initiated by NGOs. Linkages with integrated community development programs are needed to tackle problems that lead to negative RH outcomes but are not addressed by FP/RH service providers (e.g., poverty and care for AIDS orphans).