Sunday, 21 July 2013


Zambia is enjoying a good, positive spotlight in health matters in the United States of America. What more with the recent visit of former President George W Bush who visited the country for the second time in June, 2013
President Bush and his wife Laura Bush were in Zambia last June and specifically in Livingstone to promote their cancer fighting initiative, the  Pink Ribbon Red Ribbon Campaign and to help refurbish the Mosi-o-Tunya clinic.
In March this year, Kristie Mikus the President’s Emergency Plan for AIDS Relief (PEPFAR) Country Coordinator in Zambia was in Washington DC and noted, at a Center for Strategic and International Studies panel discussion that work already accomplished through US government sponsored HIV programs has paved the way for broader women’s health gains in Zambia
Last May, First Lady Dr. Christine Kaseba  Sata was in New Orleans to attend the 61st Annual Collage of Obstetricians and Gynaecologists (ACOG) Conference.
She took time to appeal for support projects aimed at supporting projects aimed at improving maternal health with ACOG President Dr. Breeden James.
Meanwhile,the Center for Strategic and International Studies (CSIS) also joined in the accolades and applauded the new level of political will and leadership on women’s health issues in Zambia. This was at a high powered panel discussion of distinguished discussants and health experts who were joined by Zambia’s Ambassador to the United States of America Palan Mulonda.
In introducing the discussion entitled “Strengthening Women’s Global Health Through Partnerships: Challenges and Opportunities, moderator and Senior Associate of the CSIS Global Health Policy Center, Ms Janet Fleischman, first gave an overview of roundtable discussion and noted that in March 2013, a CSIS delegation had undertaken a trip to Zambia to explore the opportunities and challenges in women’s health.
 She said CSIS chose to visit because of the new level of political will and leadership on women’s health issues and also cited the First Lady Dr. Christine Kaseba Sata as one of the women leaders who “are driving the country forward in issues related to women.”
Ms. Fleischman further said the CSIS delegation while in Zambia examined programs focused on three women’s health issues,  that is maternal mortality, cervical cancer and access to voluntary family planning.
The delegation also explored the opportunities and challenges on how the United States leverages the President’s Emergency Plan for AIDS Relief (PEPFAR) and how it works with its partners to prioritize women’s health.
Particular attention was focused on two recent public private partnerships (PPP) – Saving Mothers, Giving Life (SMGL), which addresses maternal mortality and Pink Ribbon Red Ribbon (PRRR), which integrates cervical cancer screening and treatment with HIV/AIDS services and increases breast cancer awareness.
Contributing to the debate, Ambassador Mulonda stated that Zambia recognized the need to partner with the private sector in order to fight against disease to improve women’s health noting that with the scarcity of resources, the Zambia government would have to partner more to use other resources.
He observed that Zambia was looking to strengthen partnerships with partners who could support the country’s agenda and stressed the need to work towards the right culture in as far as women’s health was concerned.
“The two new initiatives, that is the SMGL and PRRR have considerable promise to improve women’s health in Zambia, he said.
This is evident when one considers their roll out plans and the results already registered in the short space of time that the initiatives have been in existence. The two initiatives make use of existing platforms under PEPFAR and are already established institutional frameworks thereby guaranteeing sustainability in the long term,” he said.
Answering to a question by the moderator as to how Zambia has seen the value and the challenges of PPPs, Ambassador Mulonda went on to explain that the traditional thought in Zambia had been that the delivery of health services was done by the government alone but with the recent HIV epidemic this had been proved wrong – help in delivering health services had come from the outside, particularly from the United States.
“Following the PEPFAR example, we recognize that in order to fight against disease to improve women’s health, in addition to bilateral programs, our government needs to partner at the bilateral, international level and with other sectors as well. Going forward with the scarcity of resources, the Zambian government will have to partner more to use other resources,” he concluded.
Another panelist Jeffrey Blander, the Acting Director of Private Sector Engagement,  Office of the Global AIDS Coordinator said the public-private partnerships was an area which the Office of the Global AIDS Coordinator (OGAC) and the President’s Emergency Plan for AIDS Relief (PEPFAR) started in 2006 in order to leverage more resources from the outside.
He said, “For example, we have had over 150 partners that leverage more than US$800 million dollars and resources, but this is not about monetizing the financials, this is about what do partnerships bring to the table. These partnerships bring academia, technology and management expertise. It is important to recognize that these partnerships bring tremendous value.”
Other discussants included Asiak Brun, the Director, Department of Climate, Global Health and Sustainable Development of the Norwegian Ministry of Foreign Affairs who  stated that his country had put particular focus on women’s health globally as part of the government’s policy.
John Kraemer who is a member of the Pink Ribbon Red Ribbon Secretariat who noted that PEPFAR had a large partnership in the public and private sector whose coordination was taken seriously. He said the coordination was done in two ways, coordination of substance and coordination of the work the partners do.
“For substance coordination, focus is on the national ownership aligning under the country’s own policies. Our model has been to look at the country’s priorities and gaps, and using our partnership to fill the gaps. At the coordination of work level, we use country coordination mechanisms with their specific teams and other partners on the ground,” said Kraemer.
And Ms. Celina Schocken, the Head of the Secretariat, Saving Mothers, Giving Life and Director, Policy and Government Relations, Merck for Mothers noted that the governments of Zambia and Uganda were by far their most important partners as there were huge amounts of money coming from Merck, the United States Government and other partners.
To support her statement she said, “One of our goals is to show that our program works. For example, we had a 15 percent increase in pregnant women receiving ART in Uganda and we will show better results at the end of this year. It is important for PEPFAR to know that our initiative is showing good results and that we are delivering services that work.”
All said and done, public private partnerships are absolutely essential for the continuing viability of our health systems in beyond current donor funding. A good example is the HIV and AIDS response which is funded by donors in excess of US$400 million per year.
According to Dr. Mannasseh Phiri, a HIV/AIDS and Health Activist, in the past the public private partnerships existed in Zambia although they were named such. The mining industry had an extensive private health system running parallel to public services and of a much better quality and standards, catering for large sections of the population in the mining towns and relieving pressure from the public sector.
He observes that the private sector has in the past led the way in HIV and AIDS treatment. Luckily, a forthcoming collaboration between Barclays Bank and the drug company Glaxo-Smith Kline has been announced but is yet to take off.
“It will aim to provide a private distribution system for drugs that can supplement public systems. The new system will include small private pharmacies and drug stores in the remote parts of the country,” he says. It is a model that has been tried in other parts of Africa and has great potential.
Another example is Cola-Life, an upcoming initiative aiming to use the very extensive Coca-Cola distribution network to distribute Oral Rehaydration Salts for diarrhea in infants. If it works, it could be extended for distribution of other medicines such as anti malarials, mosquito nets and condoms.

The writer is Deputy Chief of Mission at the Embassy of the Republic of Zambia in Washington DC.

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