Sunday, April 19, 2015

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Zambia's Mobile Hospitals

For a health care system in need of drastic structural reforms, the introduction of "mobile hospitals" could prove to be only a superficial improvement.
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President Rupiah Banda at the opening ceremony of the mobile hospitals in Chongwe District, Zambia, on April 2 2011.

Zambia, which occupies the 157th place in the list of 169 countries on the Human Development Index, has a health care system in dire need of reform and investment. 60% of the population live in rural areas where access to hospitals and doctors is extremely limited. In a move to alleviate this problem, President Rupiah Banda has recently commissioned nine mobile hospitals to provide care to those in remote areas. The trucks, equipped with facilities such as X-rays, mini theatres, power and water supply, and run by trained medical staff, are said to be capable of crossing almost any terrain and reaching up to 8.7 million people. Speaking to Think Africa Press, President Banda said that these mobile hopsitals "will bring affordable, cost-effective and quality healthcare to all Zambians, regardless of where they live". Yet in a country where basic health care is limited and riddled with problems, is the money not better spent elsewhere?

Statistics from organisations such as the World Health Organisation (WHO) and Médecins Sans Frontières (MSF) all show the same findings: Zambians’ average life expectancy is a shocking 46 years. Although many basic services are available and health care in urban centres such as Lusaka, the capital, and Ndola can be effective, across the country the number of medical facilities falls far short of what is needed to cater for its population. For instance, instead of the 3,000 health posts recommended by the WHO, Zambia has only been able to build 22. With poor infrastructure across the country, mobile hospitals seem like the optimal solution; theoretically, all those previously without medical help in the vicinity now have it coming to their doorstep. However, Zambia is a large and sparsely populated country. It is questionable whether the mobile hospitals, one in each of the nine provinces, can bring adequate health care to provinces as large as 57,075 square miles (147, 823 square kilometres, and larger than Malawi).

Zambia battles with very high numbers of HIV infections, maternal mortality and child mortality, all of which require consistent and reliable medical care. Over half of all births are still carried out at home without adequate equipment and medical staff, resulting in 449 maternal deaths for every 100,000 births. Lack of health education and consistent care also leads to mother-to-child transmission of HIV being the largest source of infection for children under the age of 5. President Banda asserted that his mobile hospitals would be pivotal in reducing maternal mortality, yet antenatal care, vital in ensuring healthy pregnancies, demands close and regular monitoring of mother and child. It is questionable whether mobile hospitals will be able to provide medical care beyond basic short-term remedies. Dr Joseph Katema, a Chilonga member of parliament, calls this government initiative a “misplaced priority” and says it is unacceptable to subject more than half of the Zambian population to mobile health care.

Aside from the medical limitations of mobile hospitals, it is also problematic that such mobile health facilities do not constitute a building block of an improving health system. Critics such as Dr Katema are adamant that investments in infrastructure, existing health facilities and equipment, and training of medical staff would be far more beneficial in the long-term. A lack of nurses, doctors and other personnel is a serious barrier to health service improvements: WHO statistics show that out of a recommended 2,300 doctors, Zambia only has 815, and it fills less than half of the recommended quota for nurses. Yet President Banda has admitted that "we have some way to go", and stresses that the mobile hospitals are only a small factor in improving health care services throughout Zambia. In the past four years 3,600 health-workers have been recruited and trained, and President Banda has commissioned 12 new district hospitals as well as drawn up plans for a second school of medicine in Ndola. Certainly the health care sector is high up on the priority list, yet with so much planned reform, it is unclear whether the new mobile hospitals have been a worthwhile investment.

The commissioning of the mobile hospitals has been criticised heavily by opponents of the president and his party, the Movement for Multiparty Democracy (MMD). Michael Sata, leader of opposition party Patriotic Front, has charged that corruption was the motivating factor behind this move: the nine trucks were acquisitioned from the Chinese firm China National Aero-Technology Import and Export Corporation (CATIC) for $53 million. With presidential elections scheduled for October 2011, questions have also been raised as to whether this was intended as a popularity boost for President Banda’s political campaign; Dr Katema calls it a mere “campaign gimmick” that will be discarded after the elections.

Yet President Banda’s government has taken a step in the right direction. UNICEF and MSF campaigns in the past have shown that mobile health clinics can provide effective medical care to some degree – for instance in providing HIV medication – and investments have been made in new district hospitals, the rehabilitation of nursing schools and updating medical equipment. President Banda has emphasised the importance of "balanc(ing) these factors", finding solutions to both the lack of access in remote areas and the quality of health care. A long-term strategy, serious commitment and follow-through are now necessary to reform the Zambian health sector on a larger scale, and provide "a sustainable and practical health care system" for the 12 million people living in Zambia.

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ok, china china china election etc, horrible, but i'd be curious to know how these could work most effectively. is the use of the trucks combined with some kind of communications system? do they just wander around malawi sized areas looking for women about to give birth?

While I appreaciate the need to try to reach out  to our rural population the medical and health facilities that they have been denied for  so a long time, all cause of our poor economy as well as bad governance,I say do so through the acquisation of mobile clinic is yet another misplaced decision.Zambian road network mighty be a challange especially in these same rural areas that these units are primarily meant to be working and serving.They also too expensive to maintain.Besides the loan aquired from china,I would like to know what are the montly costs associated with running one units??I would also want to know what these funds would have done to the improvement of health system as a whole especially in the rural parties of zambia if had been invested in the main stream healthy facilities and constructions of new permanent medical structures??Without satisfactory answers to these questions,I say this is yet again a move meant to foster mmd's political fortunes and a waste our govt mines.