The funding level for this activity in fiscal year (FY) 2009 will remain the same as in FY 2008. Only minor

narrative updates have been made to highlight progress and achievements.

This activity relates to activities in counseling and testing (CT), laboratory infrastructure, palliative care, and

basic health support activities.

Acute human resource shortages in Zambia, particularly in rural areas, necessitate the need for innovative

ways to deliver quality patient care and management. The Churches Health Association of Zambia (CHAZ)

is an interdenominational, non-governmental umbrella organization of church health facilities that was

formed in 1970. The organization has 133 affiliates that consist of hospitals, rural health centers and

community based organizations. All together these member units are responsible for 50% of formal health

care service in the rural areas of Zambia and about 30% of health care in the country as a whole. CHAZ

collaborates well with the Ministry of Health and other stakeholders including the USG in TB control.

CHAZ is one of the four Principal Recipients for The Global Fund to disburse resources in Zambia. Three

agreements in HIV/AIDS, tuberculosis (TB), and Malaria were signed. In July 2005, CHAZ signed as

additional agreement under Round 4 of The Global Fund to scale-up antiretroviral therapy (ART) services in

Church Health Institutions. Similarly, in FY 2008, the Global Fund approved the TB round 7 funding for

CHAZ.

The comparative advantage that CHAZ has is its area of operation which is mainly rural. This has made

CHAZ to be heavily involved in the development and utilization of community level volunteers who assist

with TB treatment adherence and specialized community based volunteers who visits patients to ‘directly-

observe therapy' and to provide a basic check-up. This is an innovative and cost-effective way to address

severe health care human capacity shortages by multiplying skills and knowledge through the population

and further empowering community members to appropriately care for such patients. Evidence has shown

that such community-based treatment supporters have improved TB treatment adherence and outcomes.

The goal of CHAZ TB control program is to improve the quality of TB care in order to reduce the number of

TB related deaths and increase the cure rate through the Stop TB Strategy. With FY07 funds from the

United States Government (USG), CHAZ initiated the TB/HIV collaborative activities at its selected church

health facilities, 34 mission/church health institutions (CHIs) in four CDC priority Provinces (Southern,

Western, Eastern, and Lusaka). In this regard, 34 frontline health workers were trained in Provider Initiated

Counseling and Testing (PICT) commonly known as diagnostic counseling and testing (DCT). Training was

also extended to 115 TB community treatment supporters who were trained in DOTs and TB/HIV

implementation. Treatment supporters were also provided with bicycles to enhance community DOTs and

patient follow up at community level.

The National TB and Control Program in the Ministry of Health with partners embarked on revision of TB

training modules for health workers and training manual for community treatment supporters. The data

reporting tools (registers and report forms) were revised in 2006.

To further strengthen linkages between TB and HIV/AIDS activities and strengthen the Stop TB Strategy in

Zambia, CHAZ in FY 2008 continued with activities begun in FY 2007 in order to scale-up to 44 sites. This

geographic and programmatic expansion was accomplished by mobilizing communities, strengthening the

IEC component to include local languages; and continuing to build capacities of both CHIs and local

communities in the STOP TB Strategy. Specifically CHAZ continued to implement the following

strategies/activities:

•Facilitated and strengthened therapeutic TB/HIV meetings at community level for co- infected

patients/clients;

•Strengthened integration of TB/HIV at all levels through quarterly meetings;

•Increased number of frontline health care workers trained in PICT from 34 to 250. The training addressed

issues related to TB and HIV treatment. After training, health facility workers provided support to community

treatment supporters through technical supervision as an on going activity to ensure maintenance of proper

standards in TB/HIV collaborative activities at community level. The trained health care providers received

follow-up technical supervision from the district, provincial, CHAZ and National program to sharpen their

skills.

•Increased number of community treatment supporters trained in basic TB/HIV link and counseling from 115

to 600. It was expected that these would supervise treatment in 1,309 co-infected patients that were unable

or unwilling to make regular visits to the health facilities;

•Designed and produced IEC materials using both electronic and print media on TB/HIV. Used local drama

performances to create awareness in TB control;

•Strengthened the referral systems to ensure that health care workers were competent in the use of data

collection and reporting systems at CHAZ health facilities and community levels.

• Enhanced the capacity for monitoring and evaluation of TB/HIV program the technical supervision visits

which included a component of training in the use of information for management decisions at health facility

level.

•Improved infrastructure (minor renovations and improve ventilation) for TB/HIV services at CHAZ (mission)

health facility level: This activity facilitated reduction of transmission of infection from un diagnosed and

newly diagnosed smear positive TB patients to HIV infected clients and health care providers. The

renovations were specific to the sites and included improving the ventilation in waiting areas.

In FY 2008, activities were implemented in the same four Provinces (Southern, Western, Eastern, and

Lusaka). Support to community volunteers/treatment supporters was enhanced to provide quality home-

based care that included TB/HIV integration elements such as skills for linking home-based TB patients to

HIV counseling and testing and HIV care services including ART services. Despite the rural set-up of most

of the CHAZ health institutions, it was expected that about 75% of the TB patients referred to ART services

received care and support. The TB patients found eligible for ART were commenced on treatment according

to the National guidelines. A system to track the referrals and ART treatment was developed. Standardized

training was given to community-volunteers to provide home-based care for patients found to be TB/HIV co-

infected e.g. TB and ART treatment adherence, monitoring and management of side effects. This type of

Activity Narrative: service delivery was appropriate for TB/HIV patients who were not able to reach the health facilities.

In view of increasing job satisfaction and quality of services being delivered, each community treatment

supporter was provided with a bicycle and HBC kit. Utilization of already existing structures and systems

such as home care programs and involvement of community volunteers promoted community participation

and program ownership, thereby leading to program sustainability. CHAZ can boast of decades of

community mobilization and partnerships experience through mission hospitals and health centers in rural

Zambia. CHAZ will use this experience to mobilize local communities towards the Stop TB campaign and to

enhance TB/HIV collaboration. Weaknesses have been noted in the integration of TB and HIV/AIDS

programs at both the health facility level and community. It was hoped that the linkage between USG and

Global Funds would enhance the quality of TB and HIV/AIDS services being offered in the selected

Community Health Institutions (CHIs) and ensure continuity and sustainability of the program. Such a

partnership facilitated the support of activities which are not in the USG supported work plan and budget,

such as Income Generating Activities (IGAs) and funding to Faith Based Organizations. CHAZ was not

implementing the use of Isoniazid preventive therapy (IPT) to adult HIV infected clients since the National

guidelines recommends its use only in under five (5) children whose mothers are sputum smear positive for

TB. However had the Ministry of Health adopted this intervention, CHAZ would have implemented IPT. The

acute staff shortage at CHAZ made it difficult to implement some of the USG supported activities in FY 2006

-2007. The CHAZ TB Officer was overwhelmed with Global Fund activities in 133 member units which

included Community based organizations, Rural Health centers and Hospitals.

In FY 2009, the support from the USG will focus on staff placements. The USG will support the employment

of a TB/HIV officer who will work closely with the CHAZ TB Officer, Assistant Laboratory Officer. This Officer

will work closely with the CHAZ employed Laboratory Specialist to coordinate the laboratory activities and

(2) Assistant Information Technology (IT) Officer who will facilitate data entries and timely reporting to USG

requests from the sites. This officer will work closely with the CHAZ employed IT Officer. CHAZ through

global fund will facilitate funding for the activities that will be implemented by the USG employed staff. The

USG will continue paying for the remunerations for the three staff. In addition, the USG will support the

administrative component of the program.

Building on the already existing systems in the selected CHIs with the support of the officers to be

employed, CHAZ through Global fund is confident that FY09 activities will result in: (i) High quality of health

care delivery of CHIs providing counseling and testing according to the national guidelines; (ii) increased in

the number of HIV infected patients attending care / treatment services that are receiving treatment for TB;

(iii) increased number of health workers (100) and community volunteers (150) trained to provide treatment

for TB to HIV infected individuals and community treatment supporters; and (iv) increased number of

registered TB patients (2,000) who will receive counseling and testing for HIV and receive their test results.

To ensure sustainability, these activities are enshrined in the MOH District Plans.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15512

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

15512 3651.08 HHS/Centers for Churches Health 7167 2976.08 CHAZ - $200,000

Disease Control & Association of U62/CCU25157

Prevention Zambia

8992 3651.07 HHS/Centers for Churches Health 5000 2976.07 CHAZ - $200,000

Disease Control & Association of U62/CCU25157

Prevention Zambia

3651 3651.06 HHS/Centers for Churches Health 2976 2976.06 CHAZ TB/HIV $200,000

Disease Control & Association of

Prevention Zambia

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $200,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12: