FoCH/Chitambo Hospital Health Partnership:

Year established 2010
Sectors NHS
Country Chitambo Hospital, Central Province Zambia

Overall goals

◦ We have had 3 UK government grant-funded projects since 2010. We are currently in round 2 of a Scottish Government Small Grant project on “Embedding and spreading communication and decision support for sustainable emergency medical care: Up-scaling a model developed in Chitambo District, central Zambia”

GOALS

1. FoCH/Chitambo Hospital Health Partnership:
2. FoCH Vision: A healthier Chitambo District
3. Mission statement: Working in partnership to:
4. Advance health in Chitambo District through specific community-driven projects
5. Build links between Chitambo Hospital and Friends of Chitambo elsewhere globally
6. Specific health projects include:
7. Nurse training scholarships (for deprived students)
8. Ambulance maintenance
9. Emergency care communications including information resources/systems; emergency radios; shortcode for health; non-pneumatic anti-shock garments
10. provision of requested office equipment (photocopier/scanner; data projector; wifi)
11. Improvement of under-5 nutrition (in collaboration with Chitambo Nutritionist and Swanson Family SCIO)
12. Infrastructure improvements: obtaining grant funding for a Mothers’ Shelter

Key UK Colleagues and Partners

• THET: 2010-12 (18 month grant-funded project)
• University of Stirling, Highland campus ( 2010-12)
• Scottish Government: 2015-2017; 2017-2019 (2 consecutive 2-year Small Grant Projects)
• NHS Education for Scotland (NES): Programme Lead, Knowledge Services/Decision Support
• Scotland’s International Development Alliance
• FoCH Board members (15 Trustees including 4 in health service roles)

International Partners

Chitambo Hospital/District, Central Province Zambia (since 2003)
• Chitambo School of Nursing, Central Province Zambia (2012-present)
• Zambian Research and Development Technology Academy (ZRDTA), Lusaka (2010 to present)
• Information, and Training Outreach Centre for Africa (ITOCA) , South Africa, (2017 to present)
• University of Zambia, Library/Medical Library (2015 to present)
• United Church of Zambia (2017 to present)

Sustainable development goals

  • SDG 1 - No poverty
  • SDG 2 - Zero hunger
  • SDG 3 - Good health and well-being

Funding source

Friends of Chitambo (FoCH) SCIO:
• Traditional fundraising means (events, stalls, sales talks etc.) targetted to specific funding needs as indicated by Chitambo partners
• Donations (Regular and once off)
• Bequest
• Government grants (3 to date, one from THET, 2 from Scottish Government)

Project origin

The FoCH/Chitambo Hospital Health Partnership originated in a personal link with Chitambo Hospital, as a result of longstanding Church of Scotland involvement there. Chitambo Hospital is a remote, rural hospital in central Zambia. It was founded in memory of Dr. David Livingstone who died nearby and was staffed by Scottish medical missionaries for many years until it became a Zambian Government hospital in the 1970s. A revisit to Chitambo in 2003 re-kindled the connection and led to formation of Scottish-registered charity, Friends of Chitambo (FoCH). FoCH is a grassroots organisation and all our activities respond to stated needs on the ground at Chitambo. In 2003 Chitambo colleagues requested help to improve emergency care, including providing a new ambulance and improving emergency care communications. They also indicated a wish to reopen the Chitambo School of Nursing which had been closed in the 1990s. FoCH has been steadily working towards helping them to meet these expressed needs.
Regular online communications and strategic planning meetings with Chitambo colleagues, as well as needs assessments conducted as part of government-funded grant projects provide ongoing evidence of health needs.

Evidence of need

see above

Project areas

...

Project activities

We have partnered with Chitambo colleagues on:
1. General charity activities:
• re-opening the Chitambo School of Nursing (2012)
• providing Nurse Training Scholarships for underprivileged students (3 at any one time)
• providing some nurse teaching aids (training manikin; teaching models; books)
• providing an ambulance to Chitambo as a centenary gift (2008)
• contributing to maintenance of this and other emergency vehicles
2. Grant project activities:
• improving emergency care communications between hospital, 11 Rural Health Clinics, and the community including
◦ establishing an emergency resource centre at Chitambo Hospital, equipped with books, desktop and tablet pc, smartphones, and emergency care downloads
◦ training Medical Librarians/Information Scientists as Knowledge Brokers to facilitate translation of emergency care information into action, for front-line decisoin-making
◦ linking the resource centre by mobile phone and radio hotline to the clinics
◦ providing tablets and books to clinics as well
◦ providing 4 Very High Frequency (VHF) radios to ‘hardest to reach’ Rural health Clinics which have no mobile phone connectivity
◦ campaigning for access to the Zambian national shortcode for health, to enable community members to call free of charge
• providing requested office equipment (photocopier/scanner; data projector for clinical meetings; wifi enablers)
• identifying contacts to take forward requested help on nutrition improvement in Chitambo District
• lobbying Scottish Government for infrastructure improvements in Chitambo District, resulting in solar power and medical equipment provision

Changes

Reduced mortality and morbidity due to improved local health services, including:
• up-scaling of locally trained nurses
• improved emergency care service
• improved under-5 nutrition services
• improved maternal and child health infrastructure (Mothers’ Shelter)

Next steps

Main achievements:
1. Successfully campaigned on re-opening Chitambo School of Nursing, which has transformed the local community
2. Funding deprived students through training (7 scholarships so far)
3. Helping Chitambo health team to maintain their ambulance fleet
4. Advocated for the Government to pilot the 992 Shortcode for health in Chitambo District, giving community members free access to emergency help/advice
5. Enabling around 150 Chitambo District health staff to access emergency care information, for improved front-line decision-making
6. Training 8 Medical Librarians/Information Scientists (including one from Chitambo) as Knowledge Brokers to help translate emergency care information into front-line action
6. Enabling staff at the remotest Chitambo Rural Health Clinics to call for help, via VHF radios, in case of emergency
7. Identified Chitambo health leads’ perceived priorities for future FoCH support
8. Alerted Scottish Government to infrastructure needs at Chitambo Hospital, resulting in provision of solar power to the hospital and remotest clinics and plans to provide requested medical equipment to the hospital
9. Facilitating provision of a ‘fit for purpose’ anaesthetic machine to Chitambo Hospital, as requested by the health team, through networking with the United Church of Zambia (UCZ)/Churches Health Association of Zambia (CHAZ)
Next Steps: We seek to:
1. Emergency care improvements:
• Improve decision support through spreading the Knowledge Broker network model, initiated at Chitambo, more widely in Africa
• Improve emergency care response through providing quality call handler training to relevant Chitambo District health staff
• Assist Chitambo colleagues to disseminate the 992 shortcode number for health to the community
◦ obtain baseline data on shortcode knowledge
◦ monitor uptake and usage
• Identify NHS volunteers to partner with Chitambo Hospital on emergency care/trauma training
2. Nutrition improvement
• Collaborate with the new Swanson Family SCIO (founded by Scots who also grew up at Chitambo), and Chitambo Nutritionist, on applying for grant funding to improve under-five nutrition in Chitambo District (as requested by Chitambo colleagues at a strategic planning meeting, February 2018)
3. Submit Japanese Government Grassroots Project application for construction of a Mothers Shelter at Chitambo Hospital, in collaboration with Chitambo and other (architect) partners
4. Organisational development: Continue to build our organisational capacity, with the aid of an organisational Consultant

Challenges

Main challenges:
1. Building relationships: This has been a slow process of getting to know and trust each other over the past 15 years that we have been partnered together
2. Cultural differences, e.g. in communication, can be a challenge (UK partners are, perhaps, more direct than Zambian partners)
3. Interesting Scottish partners in supporting Chitambo Hospital, which has profound historical links with Scotland, and is crying out for NHS Scotland institutional links
4. Funding infrastructure improvements: The Beyond Aid agenda is important and discourages ‘unsustainable’ contributions, such as infrastructure improvements. However, Chitambo Hospital/District lacks the very basic infrastructure needed for improved service delivery. Only once this is addressed will other forms of aid be effective. The hospital building is virtually unchanged since it was re-built by Scottish medical missionaries in 1953. In order to be fully ‘fit for purpose’ it desperately needs the same kind of improvements as provided to hospitals in Malawi. In particular, staff have requested help to construct a Mothers’ Shelter, to enable antenatal mothers to lodge at the hospital for 1 month before delivery. Most grant donors do not support such infrastructure developments and yet they are crucial to health improvement.
5. Technical issues: GotoMeetings has proved difficult to use in Zambia, due to the need for a strong internet connection
Mitigation:
1. Relationship building: Continued contact and communication, including via email and WhatsApp, contributes to mutual learning, understanding, and trust
2. Communications: Dialogue on cultural differences contributes to better understanding and we are lucky to have a growing Zambian/Zambian Diaspora membership to facilitate this
3. NHS Scotland Institutional links with Chitambo Hospital:
• A new FoCH Board member is an optician, with extensive experience of volunteering with Vision Aid Overseas. He is applying to become a Global Heath Champion and may be able to facilitate much needed optometry links between NHS Scotland and Chitambo District.
• We would very much like to talk with any health teams (e.g. obstetric, emergency care, trauma, paediatrics, nutrition etc) which might have interest in/capacity for volunteering at Chitambo
• A ‘twinning’ link between Chitambo Hospital and a Scottish equivalent could be the ideal model
4. The Japanese Government Grassroots Projects support such infrastructure work, and FoCH is encouraging Chitambo Hospital to apply for this funding: http://www.zm.emb-japan.go.jp/itpr_en/grassroots.html.
This model of providing infrastructure enabling grantees to make really useful contributions.
5. Used WhatsApp for Knowledge Broker course discussions instead of GotoMeetings

Mitigating challenges

Yes, we would benefit from help with:
1. Developing institutional links between NHS Scotland and Chitambo Hospital
2. Improving health infrastructure in Chitambo District

Partnership principles

  • strategic
  • harmonised
  • effective
  • respectful
  • organised
  • responsible
  • flexible

Project gains

  • leadership
  • teamwork
  • awareness
  • academic
  • resilience
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