Zambia: Network model improves accessibility and quality of ART (February 2006)

Providing antiretroviral treatment (ART) services in rural areas continues to be a challenge for the Government of Zambia and its international partners. While ART services are more easily managed in the capital of Lusaka and other urban centers, reaching the rural areas requires transportation, cold chain logistics and most importantly, human resources. Even in towns and cities, the long journey from an outlying clinic to a central hospital can be difficult for a referred individual.

With support from the Emergency Plan, the Zambia Prevention Care and Treatment (ZPCT) partnership is responding to the government's request for equity of services for clients in rural and urban areas. In the five northern provinces of Zambia (Central, Copperbelt and the very rural Northern, Northwest and Luapula provinces), ZPCT is providing ART in 24 districts, reaching many rural areas. Even with these more widespread services, the lack of trained doctors to initiate ART beyond provincial or district hospitals remains a barrier. As a result, patients often travel long distances to hospitals on public transportation that they can hardly afford, only to face long waiting lines upon arrival. All of these factors increase the difficulty of accessing ART and, once ART is begun, of adhering to the ART drug regimen.

With USG support, ZPCT has worked closely with the Ministry of Health and the Central, Provincial and District Boards of Health to address these challenges and improve access to ART using the network system. For example, referral hospitals, laboratories and pharmacies have been renovated to accommodate the increased number of patients. In addition, a referral system has been developed to bring CD4 samples from patients to the laboratory, reducing further travel for poor Zambians. These actions have streamlined patient flow within facilities -- and from one facility to another -- thereby improving the overall quality of care that ART patients receive.

In Central and Copperbelt Provinces, ZPCT is assisting District Health Management Teams (DHMTs) and referral hospitals to manage the HIV/ART outreach clinics established at health centers. Doctors from hospitals or the DHMTs travel to the health centers on specific days to organize the clinics. Depending on the capacity of the health center, ARVs are either stored on site or brought in from the referring hospital on specific clinic days. The doctors then initiate ART services and care services, such as treatment for opportunistic infections (OIs), for new clinics and mentor the clinics to manage follow-up visits and to assist patients seeking ART services on days when doctors are not present.

Theresa Chiyaka, Clinician and head of the ART Clinic at the Chipokota Mayamba Health Centre in the Ndola District of the Copperbelt said of the program: "When ART services started in November 2004 at Chipokota Mayamba, patients could only be seen by the doctor once a week, but after ZPCT trained us in ART/OI, clients can now walk into our clinic any time from Monday to Friday to access ART services. This has really improved patient access to services in that they don't have to see the doctor for everything, including OIs that we are now able to manage on our own [and] follow-up of clients on ART."

PEPFAR's partnership with Zambia's public sector through ZPCT has increased access to ART services for rural patients, reduced transportation time and costs, and decreased waiting times. With services being provided to clients in their communities under the network model, ART adherence and follow-up has significantly improved.

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