Improving health care in rural Zambia
In order to bring about long-term change within the communities in which we work, On Call Africa addresses the root causes of poor access to, and quality of healthcare and strengthens community led programmes that are vital for remote rural communities. As an organisation we strive to support the achievement of national strategic objectives, while ensuring that we listen to, and are responsive to the communities that we support. We are a learning organisation that openly shares findings to influence policy and practice in Zambia, and to expand our reach globally.
“At On Call Africa, we aim to improve access to quality care in rural healthcare facilities and as close to people’s homes as possible, enhancing the continuum of care at all levels of the rural health system. To achieve this, we deliver our holistic Community Health Improvement Programme (CHIPs) by working in partnership with the Ministry of Health, health workers, and communities”.
Nkandu Chikonde, CEO, On Call Africa
To do this, we work with our stakeholders to deliver our Community Health Improvement Programme (CHIPs):
We recognise that rural health systems in Zambia face complex challenges that cannot be addressed with simple solutions. To support sustainable improvements that enhance the continuum of care, our CHIPs programme focuses on delivering the following three complementary areas of work.
- Facility-Based Quality Improvement
- Community Health Worker Training
- Health Facility Infrastructure Improvements
While we prefer to deliver our holistic CHIPs approach in all partner communities, we recognise that each health system is unique, and it is not always possible or desirable to do so. For this reason, each area of our work is designed to be complementary but can also be delivered independently
Facility-Based Quality Improvement
On Call Africa is working with Zambia’s Ministry of Health to develop simple, community-led health system assessment tools that evaluate rural healthcare facilities against national standards and identify gaps in healthcare provision and infrastructure. We are also creating processes to support the community-led generation of quality improvement roadmaps for healthcare facilities, based on assessment results. These roadmaps enable the Ministry of Health, health workers, and communities to optimise resource allocation and address identified gaps.
In addition, we are providing training resources and programmes for healthcare facilities that address common challenges, enhance clinical care, and strengthen clinical governance. To further empower communities, we provide funds to establish income-generating activities, enabling them to carry out some of the identified improvements themselves.
We are currently piloting this project in five healthcare facilities. Our goal is for these systems and tools to be adopted and used across an entire district by 2026.
Community Health Worker Training
On Call Africa supports the Ministry of Health in developing high-quality, highly functional, and standardised community-led health programmes that improve access to healthcare as close to people’s homes as possible. Our achievements to date include:
- Supporting the development of a nationally standardised Community-Based Volunteer (CBV) package in partnership with the Ministry of Health. This package includes: a community health service package, training guidelines, incentives, and a legal framework for CBVs.
- Assisting in the design of new digital health tools to enhance CBV delivery and supervision, as well as improving community health data.
Supporting the first pilot of the new national CBV programme for Zambia in three healthcare facilities in 2024. - Delivering training to Neighbourhood Health Committees to enhance the functioning of rural health systems.
By 2026, we plan to:
- Support the Ministry of Health in learning from the pilot of the new national CBV programme and continue to improve and enhance the support and supervision of CBVs.
- Expand the reach of the new CBV programme by delivering it directly to all healthcare facilities in Zimba District and two additional districts.
- Generate evidence of impact to support the Ministry of Health in building the case for wider investment in the new CBV package for Zambia.
Health Facility Infrastructure Improvements
On Call Africa partners with high-need rural healthcare facilities to improve access to quality health services through infrastructure improvements.
Through this project, we use our Facility-Based Quality Improvement assessment tool and quality improvement roadmaps to identify where health facilities fall short of national standards. Our team then collaborates with health workers, communities, and the Ministry of Health to co-design health facility improvements that meet both national standards and local needs.
We focus our efforts on infrastructure improvements that enhance water, sanitation, and hygiene (WASH), maternal health, youth-friendly health services, staff housing, and access to power.
As part of this work, we recently constructed a Mothers’ Waiting Shelter at Kanyanga Health Post to reduce healthcare access barriers for women who live up to 40 km from the health facility and have no means of transport. This simple infrastructure improvement led to a 32% increase in facility-based births.
We have already implemented this project in five high-need facilities in Zimba and Livingstone districts, reaching an estimated 55,000 people with improved healthcare services. We aim to partner with all healthcare facilities in Zimba District by 2026, as well as roll out the programme to two additional districts.
