Our Impact

Our Impact in 2023

On Call Africa is a learning organisation that aims to share all learning from our programmes to influence policy and practice more widely. We also aim to share openly the work that we are doing, and why, so that others can replicate or adapt our approaches and try these in different contexts. We use this space to share the impact our programmes are having, as well as recent publications and reports so that others can learn from what has and hasn’t been successful in our programmes and projects.

We are proud to showcase what we have achieved in 2023 below, and based on learning from our work in 2023, On Call Africa have now taken a new strategic approach to focus on three main programme areas moving forward in 2024.

Facility-Based Quality Improvement Programme (F-QIP)

The Facility-Based Quality Improvement Programme, is aimed at informing best practices in improving access to quality healthcare for rural communities. In 2023 we worked in partnership with the Ministry of Health to develop and pilot a standardised tool for assessing the functionality of rural health facilities, and processes for co­designing tailored quality improvement plans that address identified needs and support the achievement of national standards. To achieve this, we held multiple workshops with key Ministry of Health directorates to pull together all existing standards for rural healthcare in Zambia to create a comprehensive tool.

Once completed, we worked closely with the Ministry of Health, Zimba District Health Office, health workers and community members to run a comprehensive pilot to see how the tool would work in practice and how it could be adopted within the existing health system. Through this pilot we identified the need to adapt the model from a District Health Office led tool, to one that is led by health workers and community members themselves. This shift in approach has helped to strengthen health facility and community buy in, while also ensuring that the programme is delivered in a way that can be sustained by the Zambian health system.

The revised tool, guidelines and resources were completed in December 2023 and approved by the Ministry of Health. In 2024, we will roll the programme out to three healthcare facilities, to support the community and facility led assessment of the functionality of the healthcare facilities and support the development of quality improvement roadmaps to be taken forward by the facility, District Health Office and partners. We will also work with the Ministry of Health to develop training resources and materials to build capacity in healthcare workers.


FQIP Health facility Infrastructure Improvements

During 2023, we worked in partnership with three rural healthcare facilities identified through FQIP as being in significant need of health facility infrastructure improvements to ensure the achievement of national standards. This work has been delivered in these facilities alongside the capacity building of staff and community health workers.  Achievements at these facilities include:

  • Running water and handwashing stations installed at all points of care at Chalimongela Health Post
  • Began work to install solar pump, tank stand and reticulated water networks to all points of care at Kanyanga Health Post
  • Began work to construct an inclusive toilet and shower block for Kanyanga Health Post and an inclusive toilet and shower block for Kanyanga Mothers’ Shelter
  • Began work at Simonga Health Post to construct: two staff houses; a new waste management area; a youth friendly space; inclusive toilet and shower blocks for the health facility and school; ramps and walkways to improve accessibility
  • Began work to renovate and expand the maternity annex and main clinic building at Simonga Health Post.

Work conducted in 2023 ensured that after two years of development, Chalimongela Health Post now meets the national standards for health facility infrastructure, complementing the work carried out to train health workers and pilot the new national Community Based Volunteer (CBV) programme. Work carried out in Kanyanga and Simonga Health Posts is scheduled to be completed in 2024, ensuring that all three facilities will meet the national standards and improve access to quality care for 40,000 people.

Community Based Volunteer Development Programme

Over the last four years, On Call Africa and co-operating partners have supported the Ministry of Health to develop a community health service package, a standardised CBV programme, a legal framework to protect CBVs, and standardised incentives to recognise their work. These interventions aim to address the challenges within the fragmented Zambian community health system and improve access to quality care as close to the patient’s home as possible.

With the help of On Call Africa, in 2023, MoH officially launched these new standardised packages, marking a huge step forward for the community health landscape in Zambia. However, the MoH lacks the funding to implement these new policies, systems and programmes. To address this, the MoH asked On Call Africa to pilot the training, supervision, support, equipping and incentivising of CBVs to help generate evidence for wider adoption and government investment.

Funds secured from CRI Foundation helped On Call Africa to launch the pilot in two healthcare facilities with 29 CBVs (13 in Simonga and 16 in Chalimongela) in 2023. Following a design phase with the MoH, in which On Call Africa supported the MoH to revise and refine their guidelines, On Call Africa were able to begin training in November 2023. We expect to complete training and continue to provide supervision, support and incentives in 2024 with a view to generating evidence for scale.



WASH in Healthcare Facilities

In 2023, On Call Africa completed work in 20 healthcare facilities in Sesheke and Mwandi Districts, in partnership with WaterAid and the Ministry of Health. Work carried out included:

  • Supported the design of new national standards for WASH in HCFs in Zambia
  • 20 Healthcare facilities with improved waste management infrastructure
  • 15 Healthcare facilities with improved water supply networks and inclusive toilets installed
  • 19 Healthcare facilities with improved maternal health infrastructure
  • 16,220 people reached with hygiene behaviour change messages
  • 190 handwashing facilities installed
  • 175,000 people with access to clean safe water
  • 75,000 people with access to inclusive sanitation
  • Launched the opening of HCFs with support from the Vice-President of Zambia, helping to generate national media coverage to advocate for wider government investment in WASH in Healthcare facilities.

None of the facilities targeted met the national standards for WASH in healthcare facilities prior to the work commencing, with the majority not having access to their own clean supply of water, or access to flushing toilets. None were able to dispose of medical waste appropriately and none met the national standards for maternal healthcare. We expect that improvements at the facilities and extensive hygiene behaviour change training, will help to reduce maternal death, reduce facility acquired infections and improve hygiene practices for 175,000 people served by the facilities.


“We really appreciate for the project that has happened, it is a dream come true. You know, this facility was opened in 1993, and from then, we have never had water before. We are very thankful.”

Gertrude, nurse in charge, Mukusi Rural Health Centre

Solar for Improved Rural Health Systems (SIRHES)

In 2023, On Call Africa’s solar programme worked with three rural healthcare facilities and the Kazungula District Health Office to improve access to quality care and drive improvements in hygiene practices in healthcare facilities.  On Call Africa:

  • Equipped 3 rural healthcare facilities with solar power to suit current and future needs
  • Trained 82 Neighbourhood Health Committee members to support health facility and community initiatives that promote health
  • Installed 1 solar powered chlorine production unit at Kazungula District Health Office, and supported the monthly production of low-cost chlorine for 27 healthcare facilities

Prior to the installation of solar systems at the three facilities, there was no access to power or lighting and healthcare workers were delivering babies and seeing patients at night using the torches on their phones. Access to power in these facilities has been transformative in providing access to lighting to improve care, and by providing power to charge laptops, phones and basic medical devices to enhance care and improve data flows.

Since establishing the low-cost chlorine production unit, Kazungula District has been able to provide all 27 healthcare facilities in the district with their monthly supply of chlorine for cleaning and disinfecting water supplies. This is the first time they have had a regular supply of this basic necessity, and it has been vitally important during a recent Cholera outbreak.

Read our report on our SIRHES project here

Stakeholder Engagement

Throughout the year On Call Africa continued to engage with stakeholders at all levels of the Zambian health system to support the achievement of shared objectives. Some of the work carried out in 2023 included:

  • Supporting the development of the Community Health Strategy
  • Contributing to provincial and district planning meetings
  • Working with Dtree and the MoH on the development of a new digital health programme for CBVs
  • Engaging with partner organisations to share learning

For more information on where we work and what we do click here.