Initiative boosts health in rural Zambia

People queue for services at a mobile clinic in Zambia. Photos by Lucie Morangi / China Daily

Support from a Chinese company has enabled the African country to create mobile units to boost care for some of its poorest citizens.

In the Zambian countryside, a shortage of modern healthcare is not just inconvenient. Too often, it's deadly.

"Locals who previously felt excluded from the formal system would resort to traditional ways, which increasingly pushed up mortality rates in remote areas," says Kelvin Moonga, a general surgeon in the southern African country.

Moonga is part of a project that is helping resolve the problem in Zambia, and is being closely watched by other African countries as an effective answer to rural healthcare delivery.

In April 2011, Zambia procured $53 million in custom-made mobile clinics, including diagnostic and treatment facilities and support vehicles. Financed by a low-interest loan from China, the Aviation Industry Corporation of China International delivered a consignment consisting of 63 vehicles, 29 emergency boats and 17 ambulances.

The integrated medical-equipment vehicles provide quick and flexible medical services. The mobility eliminates economic, geographical and cultural barriers that prevent people from accessing primary medical care.

The mobile unit has pushed back ignorance in communities and shifted social perceptions.

"Our experiences have been very enlightening, and people's lives have been transformed," Moonga says. "Our presence here has buoyed their confidence in modern healthcare, especially when they see fellow Zambians tending to their needs."

Moonga is team leader of the unit based in Southern province. He has been with the unit for four years and leads a specialized team of 20 people consisting of general surgeons, anesthesiologists, radiologists, pharmacists and surgical nurses. The unit is affiliated with Livingstone General Hospital, a provincial hospital.

The Chinese conglomerate AVIC, under its international corporate mission of "go beyond commerce for a better world", proposed the mobile clinics initiative to the government of Zambia's then-president Rupiah Banda. Banda was president from 2008 to 2011.

"The concept backs the government's commitment to roll out nationwide healthcare that offers free quality services to 100 percent of the population," says Steve Yang, the project's manager at AVIC.

The company's diverse portfolio in Zambia ranges from infrastructure and real estate to military contracts.

Providing adequate healthcare in rural Africa is a challenge, and Zambia is no exception. The country encompasses 752,609 square kilometers, making it slightly bigger than Texas, the second-largest state in the United States. The copper-rich country's terrain is rugged.

There are approximately 15 million Zambians, most living in rural areas. The World Bank estimates that 60 percent live below the poverty line. People living in Zambia are likely to make 96.6 times less money than those living in Texas, and spend 98.9 percent less money on healthcare, according to ifitweremyhome.com.

The average Zambian family lives an average of 9 kilometers from the nearest health facility. With 42 percent of the people living in dire conditions, a trip to the capital, costing about 10 Zambian kwacha ($1) by road, is burdensome to many.

The 2010 national census shows that the infant mortality ratio is significantly higher in rural areas, with 517 deaths per 100,000 live births, compared with 428 per 100,000 in urban areas. This falls far short of the national target of reducing such deaths to 162. China recorded far fewer still, at 28 per 100,000 live births nationally in 2014, according to World Bank data.

Many experts consider mobile health units critical to addressing healthcare equity and deepening the inclusion of the poorest and most marginalized groups into the formal health system.

Each of Zambia's nine provinces received a fleet of seven vehicles, including an operating theater, laboratory, X-ray and pharmacy vehicles. The ear, nose and throat unit shares a truck with dental services. There also is a vehicle to haul water (350 liters) and provide power (a 100 kilowatt generator) and for unit staff to live in. The units are well rounded and equivalent to a level-two hospital, a middle level with specialized professionals such as surgeons, but less complete than hospitals that handle more complex and acute cases.

In the five years since its launch, the mobile clinic program has targeted groups that are especially vulnerable, such as octogenarians and children, who bear a disproportionate share of the nation's disease burden while simultaneously having limited access to care. Over 700,000 patients have been attended to while operations in excess of 40,000 have been performed. Twenty sites have been covered to date.

On June 21, the seven trucks rumbled into Nasenga Rural Health Unit, 70 kilometers from Lusaka, Zambia's capital, in Chikankata district of Southern province. An outreach trip usually lasts five days and immediately transforms the small health center into a 24-hour hospital.

By the second day, about 20 surgeries had been performed and 1,600 patients received free medical services. This was a 25 percent increase in patients for the rural unit, and a much higher level of care. Forty women got cervical cancer screenings, of whom five received treatment at the mobile unit while two were referred to Lusaka for advanced care.

"There is no room for error here. Thanks to the equipment, we are able to tend to most cases coming our way," Moonga says. The trucks are customized, with an expandable operating theater with room for the medical team and equipment including an operating table, overhead lamp and electronic monitor that records heart and respiratory rate. An air-conditioning unit keeps the suite comfortable despite sweltering conditions outside.

"The mini-theater," Yang says, "is the most important unit as surgeons perform operations that normally would force patients to travel to provincial hospitals. It cuts down costs and time."

Typical cases see the surgeons operate on cysts and hernias. On this day, however, at the behest of the nurses, the doctors performed a colostomy reversal surgery on a 27-year-old woman who had been gored by a bull two years ago. The mother of four had made several visits to Lusaka's University Teaching Hospital, the biggest in the country, but she had returned home without getting help because of long queues.

"You can see the level of confidence patients have in us," Moonga says.

The project's managers say they think it will help put a dent in Zambia's rural mortality rates. At 13.6 deaths per 1,000, it is significantly higher than the 12.5 deaths per 1,000 in urban areas, with the highest mortality rates among those below age 4 and the elderly, government data show.

"People are coming from far and wide to access free medical care here," Yang says. "I think it has stopped death at the doors."

Despite the idea's merit, implementation of the mobile units was not without controversy. Many in the medical community questioned the need for a mobile unit that gobbles up millions of dollars for every outreach instead of building hard infrastructure. But Moonga, once a critic himself, says the achievements of the project far outweigh its costs.

"While the government is working on putting up structures, people who have been marginalized receive specialized care through the mobile clinics. A doctor sitting in the hospital will never understand the struggles patients undergo to access medical services," Moonga says.

AVIC lifts model for medical care delivery

Just like an army marches on its stomach, a modern mobile medical team relies on technical and mechanical expertise and resources to be able to treat patients.

Kelvin Moonga, a surgeon and team leader for mobile medical units, credits the help of Chinese financing and support from AVIC Zambia, a unit of the Aviation Industry Corporation of China International.

"They are the units' umbilical cord," he says.

Moonga was among the local doctors who underwent mobile-hospital training at Southern Medical Hospital in Guangzhou, China. To kick-start the project in Zambia, the local team was backed by 37 Chinese medical experts and 12 engineers for two years. AVIC paid for the team.

The Chinese company also has established vehicle service capabilities in each province to rapidly address problems as they arise. "They seem to be just a phone call away," says Chama Furlong, the unit's technician. He underwent a three-week training session provided by equipment manufacturers in China and was accompanied by Chinese technicians for two years after the launch of the project.

AVIC provided support and maintenance for the mobile units as part of the sale contract from 2011 to 2013, and has been providing the services at no cost since then, according to Steve Yang, the mobile project's manager at AVIC. However, a new, $700,000 contract has been signed to cover the next two years, he says.

"Initially, people could not comprehend the importance of the mobile clinic vis-a-vis hard infrastructure," Yang says. "But now, they can see the visible benefits in the rural areas. We are here for the long haul. These (mobile units) are our babies."

The current global slowdown and tumbling copper prices have created doubt about the sustainability of such projects. The mobile units have had to trim staff and reduce the frequency of its outreach trips as operating funds have dropped.

Yang says, however, that AVIC has no plans to walk away from the effort, evidence that China is a friend in moments of adversity, too.

The situation also may open up opportunities for additional public-private partnerships. South Korea's Samsung Electronics Co, for example, has helped fund a mobile clinic in South Africa, where is works with aid groups, universities and local governments to reach rural populations. Despite the challenges, AVIC officials say the mobile health program has created a momentum in Africa as it improves Zambia's scorecard in achieving the portion of the United Nations sustainable development goals dealing with promoting health and well-being for all.