Fighting HIV/AIDS while strengthening the national health system: A winning combination in Zambia

What will it take to get to zero? The search for answers to this question will be a major focus of this week’s International Conference on AIDS and Sexually Transmitted Infections in Africa, the largest gathering of its kind on the continent. In Zambia, while we are still a long way off from zero, we have made monumental progress in the fight against HIV and AIDS.

Since May 2009, the Zambia Prevention, Care and Treatment Partnership (ZPCT II) project, with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), has both strengthened and expanded access to quality HIV/AIDS services in Zambia. In close partnership with the Government of Zambia, the project operates in six provinces (Central, Copperbelt, Northwestern, Luapula, Northern and Muchinga), supporting services in 60 percent of the nation’s districts and nearly 50 percent of the government health centers in the supported provinces.

ZPCT II provides a comprehensive package of HIV/AIDS services that is improving the health and well-being of millions of people living in Zambia. Services include HIV testing and counseling, prevention of mother-to-child transmission (PMTCT) of HIV, clinical care, male circumcision and antiretroviral therapy, which are supported by strengthened laboratory and pharmaceutical systems. Nearly 40 percent of Zambians receiving antiretroviral therapy access these services at ZPCT II-supported sites. Over 2.9 million people have received counseling and testing services, and 70,000 men have been circumcised through the project. Over 870,000 pregnant women have received PMTCT services in ZPCT II-supported health facilities, which has greatly assisted the Government’s push to eliminate mother-to-child transmission.

While the numbers are impressive, ZPCT II is doing much more than addressing HIV and AIDS. The project has also built the capacity of provincial health offices, district management teams and health facilities to manage information, monitor supplies of essential medical supplies and measure impact. Clinical trainings and technical assistance provided to health workers and other staff are measured using a routine quality assurance, quality improvement assessment process. Districts that achieve a pre-determined standard of performance in four key domains (technical capacity, commodity management, human resources and data management) are graduated from intensive to less intensive project support. Currently, 61 percent of the districts served by ZPCT II have graduated to less intensive project support, with an additional 17 districts on track to graduate before the end of August 2014.

By focusing on strengthening the health system, ZPCT II has strengthened the capacity of the Government of Zambia to tackle a wider set of public health issues, such as the reduction of maternal and neonatal mortality and morbidity (through the United States Government’s efforts in Saving Mothers, Giving Life) and improving access to voluntary family planning.

The combined strategy of addressing HIV and AIDS while strengthening the national health system has been a success in Zambia. The approach has helped create the conditions for continued success in the fight against HIV and AIDS while creating the conditions to address more effectively other public health priorities. Adopting this approach in more countries throughout Africa would likely move everyone closer to meeting our goal of getting to zero, while improving outcomes for other public health challenges.

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