JUNE 2006 — Providing ART services in rural areas is always a challenge.  Reaching rural areas requires transportation, cold chain logistics and most importantly, scarce human resources.  Even in cities, the distance from an outlying clinic to a central hospital can be difficult for a referred individual to travel. In Zambia, only doctors, usually located at hospitals, can initiate ART services. Even with more widespread services, however, the lack of trained doctors to initiate services remains a barrier. Services are mostly limited to hospitals. As a result, patients often travel long distances to hospitals, pay for transportation many cannot afford, and experience long waiting times.  All of this increases the difficulty of accessing ARVs and the possibility of non-adherence to their ART drug regimen.

 

ZPCT is responding to the Government of Zambia's request for equity of services for clients in both rural and urban areas.  In the five northern provinces of Zambia (Central, Copperbelt and the very rural Northern, North-Western and Luapula provinces), ART services are getting support from the ZPCT partnership in 24 districts, reaching many rural areas. ZPCT is working with the Ministry of Health and the Central, Provincial and District Boards of Health to renovate referral hospitals, laboratories and pharmacies to service the increased number of patients. A referral system has been developed to bring CD4 samples from the patient to the laboratory, reducing further travel for the patients.  Patient flow has been streamlined to limit patient movement within a facility and from one facility to another.

 

In the Central and Copperbelt Provinces, ZPCT is assisting the District Health Management Teams (DHMT) and the referral hospitals to manage HIV/ART outreach clinics from the hospitals to established health centers.  Doctors from the hospital or the DHMTs travel to health centers on specific days to organize ART 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.  Doctors then initiate ART services for new clinics and mentor the Clinical Offices to handle the follow-up visits and to deal with patients seeking ART services on unscheduled days.

 

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".

 

These innovations have increased access to ART for the patients in rural areas, reduced transportation and time costs, and decreased waiting times.  With services being provided closer to the client in their community, patient follow-up is now more likely. 

 

PHOTO:  Waiting area at Letita District Hospital, Central Province (FHI/Zambia)