This is a two-year (October 2024 – October 2026) project with financial support from AmplifyChange. The project aimed at improving access to SRH services among Adolescents and Young People (AYP). It is designed to address the high teenage pregnancy rate of 29%, low contraceptive uptake, and the high prevalence of HIV and Sexually Transmitted Infections (STIs/HIV & AIDS), gender-based violence, mental health problem, unsafe abortion among other vices affecting young people.
PROJECT SITES:
COPPERBELT PROVINCE
· Chingola District: Chiwempala Clinic, Chawama Mini Hospital and Kings Clinic
· Mufulira District: Butondo Clinic, Kankoyo Clinic 5 & Kamuchanga Hospital
· Kitwe District: Chimwemwe Mini Hospital, Ndeke Clinic & Buchi Clinic
· Ndola District: New Masala Clinic, Lubuto Clinic and Nkwazi Clinic
EASTERN PROVINCE
· Petauke District: Petauke Urban Clinic, Kalindawalo RHC & Petauke Hospital
· Sinda District: Sinda Zonal HC, Mthunya RHC & Mung’omba RHC
· Chipata District: Kapata Urban Clinic, Namseche Clinic & Chipata Trades Clinic
LUSAKA PROVINCE
· Chongwe District: Ngwerere Urban Clinic, Chongwe Hospital & Chalimbana Clinic
· Kafue District: Nangongwe Clinic, Kafue Estate Clinic & Chanyanya RHC
· Chilanga District: Chilanga Urban Clinic, Mwembeshi Clinic & Makeni Konga Clinic
PROBLEM BEING ADDRESSED BY THE PROJECT
Early and Unintended Pregnancies (EUP)
Teenage pregnancy is a serious problem in Zambia. Survey shows that 29% of girls aged 15 to 19 are already mothers or pregnant with their first child (Population Council et al, 2017; ZDHS 2018). Most often, teenage pregnancies are unintended (MOH, 2017).
Adolescent Contraception
According to the 2013-2020 Family Planning Scale-up Plan, sexually active adolescents who fall in the reproductive age group bracket, are eligible to use any method of contraception and must have access to a variety of contraceptive choices. However, Contraceptive Prevalence Rate (CPR) for girls aged 15-19 years is unacceptably low, at 12.1% (ZDHS 2018).
Engaging in unprotected sex puts adolescent girls at higher risk of contracting Sexually Transmitted Infections (STIs), including HIV. One of the reasons most girls are at risk of contracting STIs is due to limited knowledge and capacity to negotiate for safer sex. Therefore, giving knowledge to adolescents makes them make proper decisions on whether to engage in sexual intercourse or not. When they choose to be sexually active, they will have information of safe use of male and female condoms to help protect them against transmission of the STIs
EXPECTED CHANGES/OUTCOMES DUE TO PROJECT IMPLEMENTATION
Overall Goal
To improve and advance the SRH rights of in- and out-school adolescents through the provision of appropriate education and linkage to access services.
Expected Changes/Outcomes
1. Increased community awareness and support for SRHR services for adolescents & young people
2. Increase in parent-child communication on SRHR matters for adolescents & young people
3. Increase in uptake and use of contraceptive services among adolescents & young people
4. Increase in adolescents & young people accessing SRHR services in youth friendly health spaces
MAIN OBJECTIVES OF THE PROJECT
Objective 1: To establish the project advocacy strategy that amplifies voices on improved access to SRHR services for adolescents and young people
Objective 2: To implement the “Lets Speak Up Campaign” to amplify the voices for enhanced access and use of SRHR services by young people
Objective 3: To increase community awareness and support for SRHR services for adolescents & young
Objective 4: To generate evidence on the impact of adolescent health policy and youth friendly health spaces
Objective 5: To improve program monitoring and accountability
This was Pilot project implemented in conjunction with the Ministry of Health, with financial support from the World Bank. The Pilot implementation was aimed at assessing the effectiveness; the efficiency and user friendliness of the WHO Labour Care Guide in the Zambian setting. The Pilot was done in Six (6) implemnation on sites and Six control sites. The implementation sites were Ronald Ross General Hospital, Roan Antelope General Hospital and Ndola University Teaching hospital on the Copperbelt Province; and Kafue General Hospital, Levy Mwanawasa Teaching Hospital & Chilenje Level One Hospital in Lusaka Province. And the control sites for Copperbelt were Nchanga North General Hospital, Kitwe Teaching University Hospital and Chifubu Level One Hospital, while in Lusaka Province were Women & Newborn University Teaching Hospital, Chongwe District Hospital and Chipata Level One Hospital.
Across six facilities, the WHO Labour Care Guide (LCG) is in active use. All sites report daily supportive supervision by hospital managers, moderate-to-high staff confidence, and usability comparable to the partograph, with wider uptake among midwives.
ZAGO has implemented a number of projects including, “The Zambia Self-Managed Medical Abortion Advocacy” (SMAA) project, with support from the International Federation of Gynaecology and Obstetrics (FIGO). This is a one-year project to run from 1st June 2023 to 31st May, 2024. In collaboration with the Ministry of Health, the project comes from the backdrop of the World Health Organization (WHO) Guidelines which were released in March 2022. The guidelines, which Zambia has adopted into local context by way of revising its national Comprehensive Abortion Care (CAC) guidelines – provide an opportunity for all countries to take necessary steps to improve access to safe abortion care. This is especially in light of the new evidence-based recommendations aimed to reduce preventable morbidities and deaths from unsafe abortion.
According to the World Health Organization (WHO), self-managed abortion care is the ability of pregnant individuals to manage their unwanted pregnancies with or without the support of health care providers, particularly, in the early weeks of pregnancy (up to 12 weeks of gestation). The Zambia Self-Managed Abortion Advocacy project sets in to remove barriers that impede access to safe abortion, and lead a way for safer and accessible abortion care to women and girls in need of the service. This project is designed to ensuring that women’s physical and emotional well-being is guaranteed throughout the process. The project focuses on creating a supportive and non-judgemental environment for women and adolescent girls seeking self-managed abortion service, while adhering to the legal and ethical guidelines.
The project is designed to further reduce maternal morbidity and mortality in the country through:
· Increase knowledge of the new guidelines on safe abortion including medical (self-managed) abortion
· Create a buy-in for self-managed abortion among stakeholders
· Advocate for the provision and access to safe abortion service across the country
· Collaborating with key stakeholders to raise awareness about abortion practices (self-managed abortion in particular), and reproductive health rights
Geographic Reach: The project has been rolled out in three provinces, covering ten (10) districts. These include:
1) Copperbelt Province: Kitwe, Ndola, Chingola and Mufulira
2) Lusaka Province: Lusaka, Kafue and Chongwe
3) Eastern Province: Chipata, Petauke and Sinda
The target areas were selected based on the high cases of unsafe abortions. It is anticipated that the results of the activities in the target areas will positively influence change, which in turn will impact reduction of maternal morbidity and mortality countrywide.
ZAGO seeks to further reduce maternal morbidity and mortality in Zambia. Through this project, individuals will be empowered with evidence-based information to enable them to make informed decisions in pursuit for their wellbeing and good health. Within the scope of the three pathways, expected impact of this project is multifaceted:
1. Increased access to safe abortion: This project aims to provide women and adolescent girls with the information necessary to safely terminate a pregnancy in a self-directed manner. This will help women and girls who have been facing barriers to accessing safe abortion care to have access to the service.
2. Reduction in unsafe abortions: It is a fact that when individuals do not have access to safe abortion services, they resort to unsafe methods, including self-induced using dangerous methods or seeking out unqualified providers in the community. This project provides individuals with information about safe abortion methods and resources, potentially reducing the incidence of unsafe abortion and associated complications.
3. Empowerment and autonomy: This project focuses on empowering individuals to make informed decisions about their reproductive health and exercise their autonomy. By providing information, and support, this project will enable individuals to take control of their own reproductive choices.
4. Breaking down stigma and promoting reproductive health: This project will contribute to destigmatizing abortion and challenges, societal negative attitudes towards reproductive rights. By providing accessible information, this project will create a space for open dialogue and discussion, promoting understanding and empathy towards individuals seeking abortion care.
5. Support advocacy efforts: This project will work in collaboration with other advocacy organizations, institutions, and likeminded stakeholders to highlight the challenges faced by individuals seeking abortion care, and advocate for mindset change. This will ensure mobilize support for decriminalization’s and destigmatization of abortion, as well as addressing systematic barriers to access.
6. Enhance public health outcome: By supporting individuals in accessing safe abortion options, this project will be contributing to improved public health outcomes. Safely terminating pregnancies will reduce the incidence of complications and maternal morbidity and mortality associated with unsafe abortions, ultimately benefiting both individuals, communities, and the government.
It is a fact that severe bleeding after childbirth or Postpartum Haemorrhage (PPH) is the leading cause of maternal mortality worldwide. The risk of PPH morbidity and mortality affects more women in low-and middle-income countries, such as Zambia. This is partly due to lack of access to quality obstetric care due to poverty, socio-cultural barriers, geographical barriers and male dominated societies.
Zambia’s maternal mortality is at 252/100,000 live births (ZDHS 2018). Of the direct causes of maternal deaths, obstetrical haemorrhage account for 34% of maternal deaths in 2020 (MPDSR 2020 MoH). And of all the maternal deaths reported in 2020, 89% occurred in health facilities, while 11% were in the community (MPDSR 2020 MoH).
Against this background, ZAGO with financial support from UNTAID, European Union and FIGO is implementing “Accelerating Measurable Progress and Leveraging Investments for Postpartum Haemorrhage Impact” (AMPLI-PPHI) project that aims to reduce maternal mortality and morbidity from PPH. This two year project ((June 2024 – August 2026) is detrmined to achieve this goal by ensuring that the right PPH medications are available at the right time, in the right place, for the right indication, and for the right patient across health systems. It will bring catalytic change, connecting implementation learning with market shaping efforts, by demonstrating the feasibility, acceptability and cost-effectiveness of a defined package of quality-assured PPH drugs – Tranexamic Acid (TXA), Heat Stable Carbetocin (HSC), and use of Calibrated Drapes – at different levels of the health system. The project is focusing on sharing learning with other partner countries in the region through the exchange visits and networks.
For more details here
PROJECT PHOTOS here
PROJECT DOCUMENTS here
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