Use of mobile hospitals to improve access to health services and promote primary health care: lessons from Zambia (2011-2018).

Background: Mobile hospitals play a critical role in serving difficult to access populations. In 2011, they were introduced by the Zambian government to improve access to health care. However, little is known about and/or documented about their use in Zambia, and other similar settings where people rely on them to access critical health care, or have to travel long distances to the nearest health centre. Objective: To understand the use of mobile hospitals in Zambia and share lessons on their implementation that may be useful for similar settings. It describes their design, implementation, and challenges. Methods: The qualitative research employed document review, key informant interviews with 15 respondents, and observation of the operations of the mobile hospitals in the field. Results: The research finds that while they help to reduce inequities associated with accessing health services, there needs to be careful resource planning and addressing of the major issues in health care such as human resources, infrastructure, and disease prevention before long term use. Conclusion: The research not only highlights conditions that must be considered for the effective implementation of mobile hospitals, but also the need for engagement of various key stakeholders during agenda setting in order to build trust and buy in, which contribute to smoother implementation.

Child Health Week in Zambia: costs, efficiency, coverage and a reassessment of need.

Child Health Weeks (CHWs) are semi-annual, campaign-style, facility- and outreach-based events that provide a package of high-impact nutrition and health services to under-five children. Since 1999, 30% of the 85 countries that regularly implement campaign-style vitamin A supplementation programmes have transformed their programmes into CHW. Using data drawn from districts' budget, expenditures and salary documents, UNICEF's CHW planning and budgeting tool and a special purposive survey, an economic analysis of the June 2010 CHW's provision of measles, vitamin A and deworming was conducted using activity-based costing combined with an ingredients approach. Total CHW costs were estimated to be US$5.7 million per round. Measles accounted for 57%, deworming 22% and vitamin A 21% of total costs. The cost per child was US$0.46. The additional supplies and personnel required to include measles increased total costs by 42%, but reduced the average costs of providing vitamin A and deworming alone, manifesting economies of scope. The average costs of covering larger, more urban populations was less than the cost of covering smaller, more dispersed populations. Provincial-level costs per child served were determined primarily by the number of service sites, not the number of children treated. Reliance on volunteers to provide 60% of CHW manpower enables expanding coverage, shortening the duration of CHWs and reduces costs by one-third. With costs of $1093 per life saved and $45 per disability-adjusted life-year saved, WHO criteria classify Zambia's CHWs as 'very cost-effective'. The continued need for CHWs is discussed.