From The Plague Horrors of Cholera, What Partnership Lessons Can Be Learnt in Addressing COVID-19 In Zambia (preprint)

Abstract Since the outbreak of COVID-19 on 31 December 2019, different public health systems have been grappling with how to address the spread of the virus. During the cholera outbreak and the Covid-19 pandemic in Zambia, values such as equity, partnership and collaboration have been recognized as central to resilience and an effective response to the pandemic. In this study we identify lessons that can be used for addressing the COVID-19 pandemic from partnership approach used in confronting the cholera outbreak of 2017-2018 in Zambia Chipata Compound. Method: Data was collected using a qualitative approach; 26 interviews were conducted with Public Health Professionals and community Leaders. Document reviews from government institutions and non-government institutions were also conducted. The Bergen model of Collaborative Functioning was used to guide the analysis of data. Results: A top-down approach was observed to be important in addressing cholera but there was a need to improve a bottom-up approach. Synergistic results, avoidance of duplication, Oral cholera vaccination intervention and collaborative capacity building. Challenges in the partnership collaboration included inadequate resources, poor communication, poor coordination, lack of clear shared vision, reactive response, poor involvement of the community, hegemonic powers and mistrust and resentment Conclusion: From the experience of cholera outbreaks, partnerships are vital in addressing pandemics. Based on the lessons from the cholera outbreaks, we note that there is a need to improve collaboration in partnership if COVID-19 and cholera are to be effectively addressed.

Integration of Systematic Screening for Tuberculosis in Outpatient Departments of Urban Primary Health-Care Facilities in Zambia: A Case Study of Kitwe District (preprint)

Background: Tuberculosis (TB) is the leading cause of death from a single infectious agent globally, yet 3 million cases are missed every year. The World Health Organization recommends systematic screening of suspected active TB patients among those visiting the healthcare facilities. While many countries have scaled-up systematic screening of TB, there has been limited assessment of the extent of its integration into the health system. This study sought to explore factors that shaped the integration of systematic screening of TB in outpatient departments of primary healthcare facilities in Kitwe district, Zambia. Methods This was a qualitative case study with health providers including district managers, TB focal point persons and laboratory personnel working in six purposively selected primary healthcare facilities. Data was collected through key informant (n=8) and in-depth (n=15) interviews. Data analysis was conducted using QDA Miner software and guided by Atun’s Integration framework. Results Integration was facilitated by perceptions of the magnitude of the TB burden, alignment of the intervention with national TB aspirations, knowledge of stakeholder interests, power and values, regular performance management and intra-facility collaboration. Constraining factors included external partners’ influence in the TB screening program, unbalanced incentivization mechanisms, donor-driven financing and social determinants of health such as gender and stigma including the COVID-19 pandemic. Conclusion Systematic screening of TB is not well integrated into the primary healthcare facilities to capture all those suspected with active TB that make contact with the health system. Finding the missing TB cases will, therefore, require contextual adaptation of the systematic screening for TB and strengthening the health system.

The Potential Role of Community Actors in The Response Against COVID-19: Lessons From Three African Countries, Tanzania, Uganda and Zambia (preprint)

Objective: With the spread of COVID-19 to most low-and middle- income countries, global concerns arise on how to respond to the pandemic. We seek to highlight the early response to COVID-19 of Tanzania, Uganda and Zambia and draw lessons on how community actors could be engaged in the global efforts to prevent its spread and resurgence. This is envisioned to guide COVID-19 prevention efforts as well as implementation of interventions, especially in areas with relaxed, no or partial lockdown measures. Results: Community actors can be useful in the promotion of behavioural change including consistent use of face masks, handwashing, social distancing, as well as act as whistle-blowers who identify new residents, report suspected COVID-19 cases and those breaking self-quarantine directives. Furthermore, community actors can encourage adherence to government directives on COVID-19 prevention through integrating COVID-19 information into their routine services. Countries across the globe have the opportunity to tap into the potential role of community actors, especially as we move towards more inclusive health systems. Increased involvement of community health systems is vital in sustaining the gains that have been made in areas where COVID-19 cases have reduced.