Fastone Goma

Prevalence of hypertension and its correlates in Lusaka urban district of Zambia: a population based survey

Background Hypertension is a leading cause for ill-health, premature mortality and disability. The objective of the study was to determine the prevalence and associated factors for hypertension in Lusaka, Zambia. Methods A cross sectional study was conducted. Odds ratios and their 95% confidence intervals were calculated to assess relationships between hypertension and explanatory variables. Results A total of 1928 individuals participated in the survey, of which 33.0% were males. About a third of the respondents had attained secondary level education (35.8%), and 20.6% of males and 48.6% of females were overweight or obese. The prevalence for hypertension was 34.8% (38.0% of males and 33.3% of females). In multivariate analysis, factors independently associated with hypertension were: age, sex, body mass index, alcohol consumption, sedentary lifestyle, and fasting blood glucose level. Conclusions Health education and structural interventions to promote healthier lifestyles should be encouraged taking into account the observed associations of the modifiable risk factors.

Pilot-testing service-based planning for health care in rural Zambia

BackgroundHuman resources for health (HRH) planning in Zambia, as in other countries, is often done by comparing current HRH numbers with established posts, without considering whether population health needs are being met. Service-based HRH planning compares the number and type of services required by populations, given their needs, with the capacity of existing HRH to perform those services. The objective of the study was to demonstrate the effectiveness of service-based HRH planning through its adaptation in two rural Zambian districts, Gwembe and Chibombo.MethodsThe health conditions causing the greatest mortality and morbidity in each district were identified using administrative data and consultations with community health committees and health workers. The number and type of health care services required to address these conditions were estimated based on their population sizes, incidence and prevalence of each condition, and desired levels of service. The capacity of each district’s health workers to provide these services was estimated using a survey of health workers (n=44) that assessed the availability of their specific competencies.ResultsThe primary health conditions identified in the two districts were HIV/AIDS in Gwembe and malaria in Chibombo. Although the competencies of the existing health workforces in these two mostly aligned with these conditions, some substantial gaps were found between the services the workforce can provide and the services their populations need. The largest gaps identified in both districts were: performing laboratory testing and interpreting results, performing diagnostic imaging and interpreting results, taking and interpreting a patient’s medical history, performing a physical examination, identifying and diagnosing the illness in question, and assessing eligibility for antiretroviral treatment.ConclusionsAlthough active, productive, and competent, health workers in these districts are too few to meet the leading health care needs of their populations. Given the specific competencies most lacking, on-site training of existing health workers to develop these competencies may be the best approach to addressing the identified gaps. Continued use of the service-based approach in Zambia will enhance the country’s ability to align the training, management, and deployment of its health workforce to meet the needs of its people.RésuméContexteEn Zambie, comme dans d’autres pays, la planification des ressources humaines en santé consiste souvent à comparer les données sur les ressources et le nombre de postes établis, sans égard aux besoins de la population en matière de santé. La planification fondée sur les services consiste à comparer le nombre et le type de services requis par les populations, en fonction de leurs besoins, et la capacité des ressources existantes à fournir ces services. L’étude avait pour but de mettre en oeuvre la planification des ressources humaines en santé fondée sur les services dans deux districts ruraux de la Zambie – Gwembe et Chibombo – afin d’en démontrer l’efficacité.MéthodesAu moyen des données administratives et de la consultation des comités de santé communautaire et des travailleurs de la santé, on a cerné les problèmes de santé qui causent le plus de mortalité et de morbidité dans chaque district. Le nombre et le type de services de santé requis pour traiter ces problèmes ont été estimés en fonction de la taille de la population, de l’incidence et de la prévalence de chaque problème et des niveaux de service souhaités. La capacité des travailleurs de la santé de chaque district à fournir ces services a été estimée grâce à une enquête menée auprès de ces travailleurs (n = 44), qui a évalué leurs compétences particulières.RésultatsLes principaux problèmes de santé relevés étaient le VIH/sida dans le district de Gwembe et le paludisme dans le district de Chibombo. Si les compétences des travailleurs de la santé de ces deux districts cadraient en grande partie avec ces problèmes, d’importants écarts ont été décelés entre les services fournis par ces travailleurs et les services dont ont besoin les populations qu’ils servent. Les écarts les plus importants qui ont été relevés dans les deux districts avaient trait aux éléments suivants : les tests en laboratoire et l’interprétation des résultats, l’imagerie diagnostique et l’interprétation des résultats, la vérification et l’interprétation des antécédents médicaux des patients, l’examen physique, le dépistage et le diagnostic de la maladie et l’évaluation de l’admissibilité au traitement antirétroviral.ConclusionsBien qu’ils soient actifs, productifs et compétents, les travailleurs de la santé de ces districts sont trop peu nombreux pour répondre aux principaux besoins de la population en matière de santé. Compte tenu des compétences particulières où les lacunes sont les plus grandes, offrir une formation en milieu de travail aux travailleurs de la santé actuels afin qu’ils acquièrent ces compétences pourrait être la meilleure approche pour réduire les écarts qui ont été relevés. L’utilisation continue de cette approche fondée sur les services en Zambie améliorera la capacité du pays à penser la formation, la gestion et le déploiement de ses travailleurs en santé en fonction des besoins de sa population.

Task-shifting: experiences and opinions of health workers in Mozambique and Zambia.

BackgroundThis paper describes the task-shifting taking place in health centres and district hospitals in Mozambique and Zambia. The objectives of this study were to identify the perceived causes and factors facilitating or impeding task-shifting, and to determine both the positive and negative consequences of task-shifting for the service users, for the services and for health workers.MethodsData collection involved individual and group interviews and focus group discussions with health workers from the civil service.ResultsIn both the Republic of Mozambique and the Republic of Zambia, health workers have to practice beyond the traditional scope of their professional practice to cope with their daily tasks. They do so to ensure that their patients receive the level of care that they, the health workers, deem due to them, even in the absence of written instructions.The “out of professional scope” activities consume a significant amount of working time. On occasions, health workers are given on-the-job training to assume new roles, but job titles and rewards do not change, and career progression is unheard of. Ancillary staff and nurses are the two cadres assuming a greater diversity of functions as a result of improvised task-shifting.ConclusionsOur observations show that the consequences of staff deficits and poor conditions of work include heavier workloads for those on duty, the closure of some services, the inability to release staff for continuing education, loss of quality, conflicts with patients, risks for patients, unsatisfied staff (with the exception of ancillary staff) and hazards for health workers and managers. Task-shifting is openly acknowledged and widespread, informal and carries risks for patients, staff and management.

Investment incentives and the implementation of the Framework Convention on Tobacco Control: evidence from Zambia

Purpose Policy misalignment across different sectors of government serves as one of the pivotal barriers to WHO Framework Convention on Tobacco Control (FCTC) implementation. This paper examines the logic used by government officials to justify investment incentives to increase tobacco processing and manufacturing in the context of FCTC implementation in Zambia. Methods We conducted qualitative semistructured interviews with key informants from government, civil society and intergovernmental economic organisations (n=23). We supplemented the interview data with an analysis of public documents pertaining to the policy of economic development in Zambia. Results We found gross misalignments between the policies of the economic sector and efforts to implement the provisions of the FCTC. Our interviews uncovered the rationale used by officials in the economic sector to justify providing economic incentives to bolster tobacco processing and manufacturing in Zambia: (1) tobacco is not consumed by Zambians/tobacco is an export commodity, (2) economic benefits outweigh health costs and (3) tobacco consumption is a personal choice. Conclusions Much of the struggle Zambia has experienced in implementing the FCTC can be attributed to misalignments between the economic and health sectors. Zambias development agenda seeks to bolster agricultural processing and manufacturing. Tobacco control proponents must recognise and work within this context in order to foster productive strategies with those working on tobacco supply issues. These findings are broadly applicable to the global context. It is important that the Ministry of Health monitors the tobacco policy of and engages with these sectors to find ways of harmonising FCTC implementation.

Evaluation of recruitment and retention strategies for health workers in rural Zambia

BackgroundIn response to Zambia’s critical human resources for health challenges, a number of strategies have been implemented to recruit and retain health workers in rural and remote areas. Prior to this study, the effectiveness of these strategies had not been investigated. The purpose of this study was to determine the impacts of the various health worker retention strategies on health workers in two rural districts of Zambia.MethodsUsing a modified outcome mapping approach, cross-sectional qualitative and quantitative data were collected from health workers and other stakeholders through focus group discussions and individual interview questionnaires and were supplemented by administrative data. Key themes emerging from qualitative data were identified from transcripts using thematic analysis. Quantitative data were analyzed descriptively as well as by regression modelling. In the latter, the degree to which variation in health workers’ self-reported job satisfaction, likelihood of leaving, and frequency of considering leaving, were modelled as functions of participation in each of several retention strategies while controlling for age, gender, profession, and district.ResultsNineteen health worker recruitment and retention strategies were identified and 45 health care workers interviewed in the two districts; participation in each strategy varied from 0% to 80% of study participants. Although a salary top-up for health workers in rural areas was identified as the most effective incentive, almost none of the recruitment and retention strategies were significant predictors of health workers’ job satisfaction, likelihood of leaving, or frequency of considering leaving, which were in large part explained by individual characteristics such as age, gender, and profession. These quantitative findings were consistent with the qualitative data, which indicated that existing strategies fail to address major problems identified by health workers in these districts, such as poor living and working conditions.ConclusionsAlthough somewhat limited by a small sample size and the cross-sectional nature of the primary data available, the results nonetheless show that the many health worker recruitment and retention strategies implemented in rural Zambia appear to have little or no impact on keeping health workers in rural areas, and highlight key issues for future recruitment and retention efforts.RésuméContexteEn réponse aux problèmes de pénuries des ressources humaines dans le domaine de la santé en Zambie, un certain nombre de stratégies ont été mises en oeuvre pour recruter et maintenir en poste les travailleurs de la santé dans les régions rurales et éloignées. Avant cette étude, l’efficacité de ces stratégies n’avait pas été étudiée. L’objectif de cette étude était donc de déterminer l’incidence de différentes stratégies de maintien en poste de différents corps de métiers de la santé dans deux districts ruraux de la Zambie.MéthodesAu moyen d’une cartographie des incidences modifiée, des données transversales qualitatives et quantitatives ont été recueillies auprès des travailleurs de la santé et d’autres intervenants grâce à des groupes de discussion et des questionnaires individuels auxquels ont été intégrés des données administratives. Les principaux thèmes ont été dégagés des données qualitatives grâce à la transcription des discussions au moyen de l’analyse thématique. Les données quantitatives ont été analysées de façon descriptive ainsi qu’à l’aide d’un modèle de régression. Pour ce dernier, le degré de variation de la satisfaction par rapport à l’emploi, de la probabilité de quitter l’emploi et de la fréquence à laquelle les travailleurs pensaient à quitter leur emploi a été modelé en fonction de leur participation à chacune des différentes stratégies de maintien en poste, tout en considérant des données sur l’âge, le sexe, la profession et le district.RésultatsPas moins de 19 stratégies de recrutement et de maintien en poste ont été dénombrées auprès des 45 travailleurs de la santé interviewés dans les deux districts. La participation à chacune des stratégies variait de 0 à 80 % selon les participants à l’étude. Bien que les suppléments de rémunération pour les travailleurs de la santé dans les régions rurales constituent les mesures incitatives les plus efficaces, presque aucune stratégie de recrutement et de maintien en poste n’était un bon indicateur de la satisfaction face à l’emploi, de la probabilité de le quitter et de la fréquence à laquelle les travailleurs pensaient à quitter leur emploi. Ces facteurs étaient, dans une large part, expliqués par les caractéristiques des travailleurs comme l’âge, le sexe et la profession. Ces résultats quantitatifs étaient conformes aux données qualitatives, qui indiquaient que les stratégies de recrutement et de maintien en poste ne permettaient pas de régler les principaux problèmes déterminés par les travailleurs de la santé de ces districts, notamment des conditions de vie et de travail difficiles.ConclusionsMalgré la taille de l’échantillon limitée et la nature transversale des données primaires disponibles, les résultats montrent néanmoins que les nombreuses stratégies de recrutement et de maintien en poste mises en oeuvre en Zambie rurale n’ont que peu ou pas du tout d’incidence sur le maintien en poste des travailleurs de la santé dans les régions rurales et mettent en lumière des problèmes de recrutement et de maintien en poste clés.

A scoping review of training and deployment policies for human resources for health for maternal, newborn, and child health in rural Africa

BackgroundMost African countries are facing a human resources for health (HRH) crisis, lacking the required workforce to deliver basic health care, including care for mothers and children. This is especially acute in rural areas and has limited countries’ abilities to meet maternal, newborn, and child health (MNCH) targets outlined by Millennium Development Goals 4 and 5. To address the HRH challenges, evidence-based deployment and training policies are required. However, the resources available to country-level policy makers to create such policies are limited. To inform future HRH planning, a scoping review was conducted to identify the type, extent, and quality of evidence that exists on HRH policies for rural MNCH in Africa.MethodsFourteen electronic health and health education databases were searched for peer-reviewed papers specific to training and deployment policies for doctors, nurses, and midwives for rural MNCH in African countries with English, Portuguese, or French as official languages. Non-peer reviewed literature and policy documents were also identified through systematic searches of selected international organizations and government websites. Documents were included based on pre-determined criteria.ResultsThere was an overall paucity of information on training and deployment policies for HRH for MNCH in rural Africa; 37 articles met the inclusion criteria. Of these, the majority of primary research studies employed a variety of qualitative and quantitative methods. Doctors, nurses, and midwives were equally represented in the selected policy literature. Policies focusing exclusively on training or deployment were limited; most documents focused on both training and deployment or were broader with embedded implications for the management of HRH or MNCH. Relevant government websites varied in functionality and in the availability of policy documents.ConclusionsThe lack of available documentation and an apparent bias towards HRH research in developed areas suggest a need for strengthened capacity for HRH policy research in Africa. This will result in enhanced potential for evidence uptake into policy. Enhanced alignment between policy-makers’ information needs and the independent research agenda could further assist knowledge development and uptake. The results of this scoping review informed an in-depth analysis of relevant policies in a sub-set of African countries.

Cigarette Price and Other Factors Associated with Brand Choice and Brand Loyalty in Zambia: Findings from the ITC Zambia Survey

Objectives Little is known about cigarette pricing and brand loyalty in sub-Saharan Africa. This study examines these issues in Zambia, analysing data from the International Tobacco Control (ITC) Zambia Survey. Methods Data from Wave 1 of the ITC Zambia Survey (2012) were analysed for current smokers of factory-made (FM) cigarettes compared with those who smoked both FM and roll-your-own (RYO) cigarettes, using multivariate logistic regression models to identify the predictors of brand loyalty and reasons for brand choice. Results 75% of FM-only smokers and 64% of FM+RYO smokers reported having a regular brand. Compared with FM-only smokers, FM+RYO smokers were, on average, older (28% vs 20% ≥40 years), low income (64% vs 43%) and had lower education (76% vs 44% < secondary). Mean price across FM brands was ZMW0.50 (US

Price, tax and tobacco product substitution in Zambia

0.08) per stick. Smokers were significantly less likely to be brand loyal (>1 year) if they were aged 15–17 years (vs 40–54 years) and if they had moderate (vs low) income. Brand choice was predicted mostly by friends, taste and brand popularity. Price was more likely to be a reason for brand loyalty among FM+RYO smokers, among ≥55-year-old smokers and among those who reported being more addicted to cigarettes. Conclusions These results in Zambia document the high levels of brand loyalty in a market where price variation is fairly small across cigarette brands. Future research is needed on longitudinal trends to evaluate the effect of tobacco control policies in Zambia.

Global tobacco control and economic norms: an analysis of normative commitments in Kenya, Malawi and Zambia

Background In Zambia, the number of cigarette users is growing, and the lack of strong tax policies is likely an important cause. When adjusted for inflation, levels of tobacco tax have not changed since 2007. Moreover, roll-your-own (RYO) tobacco, a less-costly alternative to factory-made (FM) cigarettes, is highly prevalent. Data and methods We modelled the probability of FM and RYO cigarette smoking using individual-level data obtained from the 2012 and 2014 waves of the International Tobacco Control (ITC) Zambia Survey. We used two estimation methods: the standard estimation method involving separate random effects probit models and a method involving a system of equations (incorporating bivariate seemingly unrelated random effects probit) to estimate price elasticities of FM and RYO cigarettes and their cross-price elasticities. Results The estimated price elasticities of smoking prevalence are −0.20 and −0.03 for FM and RYO cigarettes, respectively. FM and RYO are substitutes; that is, when the price of one of the products goes up, some smokers switch to the other product. The effects are stronger for substitution from FM to RYO than vice versa. Conclusions This study affirms that increasing cigarette tax with corresponding price increases could significantly reduce cigarette use in Zambia. Furthermore, reducing between-product price differences would reduce substitution from FM to RYO. Since RYO use is associated with lower socioeconomic status, efforts to decrease RYO use, including through tax/price approaches and cessation assistance, would decrease health inequalities in Zambian society and reduce the negative economic consequences of tobacco use experienced by the poor.

The institutional context of tobacco production in Zambia

Tobacco control norms have gained momentum over the past decade. To date 43 of 47 Sub-Saharan African countries are party to the Framework Convention on Tobacco Control (FCTC). The near universal adoption of the FCTC illustrates the increasing strength of these norms, although the level of commitment to implement the provisions varies widely. However, tobacco control is enmeshed in a web of international norms that has bearing on how governments implement and strengthen tobacco control measures. Given that economic arguments in favor of tobacco production remain a prominent barrier to tobacco control efforts, there is a continued need to examine how economic sectors frame and mobilize their policy commitments to tobacco production. This study explores the proposition that divergence of international norms fosters policy divergence within governments. This study was conducted in three African countries: Kenya, Malawi, and Zambia. These countries represent a continuum of tobacco control policy, whereby Kenya is one of the most advanced countries in Africa in this respect, whereas Malawi is one of the few countries that is not a party to the FCTC and has implemented few measures. We conducted 55 key informant interviews (Zambia = 23; Kenya = 17; Malawi = 15). Data analysis involved deductive coding of interview transcripts and notes to identify reference to international norms (i.e. commitments, agreements, institutions), coupled with an inductive analysis that sought to interpret the meaning participants ascribe to these norms. Our analysis suggests that commitments to tobacco control have yet to penetrate non-health sectors, who perceive tobacco control as largely in conflict with international economic norms. The reasons for this perceived conflict seems to include: (1) an entrenched and narrow conceptualization of economic development norms, (2) the power of economic interests to shape policy discourses, and (3) a structural divide between sectors in the form of bureaucratic silos.