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The Zambia Integrated Systems Strengthening Program

 The Zambia Integrated Systems Strengthening Program (ZISSP) was a four-and-a-half year USAID-funded, Abt Global-led project which increased the use of quality, high-impact health services through a health systems strengthening approach in Zambia.

The ZISSP team employed interventions to strengthen processes and capacity at all levels of the health system, while simultaneously enhancing access to and use of high-impact health services. These services addressed malaria, family planning, HIV and AIDS, and maternal, newborn, and child health and nutrition. ZISSP collaborated with communities to encourage the use of public health services by Zambians and their families.

The program addressed human resource constraints by helping ministry personnel develop better strategies, tools, guidelines, and systems to perform routine planning, management, supervision, and evaluation tasks for delivery of high-impact health services. ZISSP worked closely with the Zambian Ministry of Health (MOH) and the Ministry of Community Development Mother and Child Health (MCDMCH) at the national, provincial, and district levels.

ZISSP’s support to the National Malaria Control Center (NMCC) helped to strengthen the ability of the NMCC, the MOH, and the MCDMCH to coordinate, expand, and oversee nationwide indoor residual spraying (IRS) and other malaria program interventions. With program activities in over 30 target districts, ZISSP provided technical and logistical support for the national IRS program and strengthened counterpart capacity to deliver quality services to prevent and treat malaria in pregnant women and in children younger than five. Likewise, ZISSP collaborated with the private sector – including mining and sugar companies – to implement IRS and entomology activities contributing to reductions in the incidence of malaria.

ZISSP also placed staff ‒ Clinical Care Specialists, Management Specialists, and Community Health Coordinators ‒ in ten Provincial Health Offices. The Clinical Care Specialists supported provinces’ technical supervision, mentoring of district managers, and facility clinical care teams to improve the quality of service provision. The Management Specialists built provincial-level human resource skills for planning, budgeting, management, supervision, and reporting. The Community Health Coordinators worked with district teams and communities to improve the interface between the health system and communities.
 ZISSP exceeded quantitative targets in the majority of implementation areas. Highlights of achievements include the following:

  • Human Resources for Health (HRH): Development of a customized Human Resource Information System (HRIS) for the MOH and MCDMCH, evaluation of the Zambia Health Workers Retention Scheme (ZHWRS) and development of the ZHWRS Sustainability Strategy.
  • Maternal, Newborn and Child Health (MNCH) and Nutrition: Increased numbers of health workers trained in infant and young child feeding (IYCF), integrated management of childhood illness (IMCI), emergency obstetric and neonatal care (EmONC), long-acting family planning (LAFP), adolescent health services (ADH), and the Reaching Every Child in Every District (RED) strategy for immunization. Strengthened community capacity and linkages between community volunteers and health centers supported MNCH program implementation at community level. New teaching methods were introduced at nursing and midwifery schools.
  • Clinical care: Harmonization of quality improvement (QI) and clinical care mentorship guidelines, and decentralization of QI and mentorship structures across all levels of the health system. QI Committees at health facility level implemented QI projects to improve health outcomes and 9,745 clinical mentoring sessions were conducted with health care workers.
  • Management: Revised the health sector’s national planning guidelines, developed the Data Quality Audit Guidelines (first edition), and created the Zambia Management and Leadership Academy (ZMLA).
  • Malaria: Worked with the National Malaria Control Program (NMCP) to spray a total of 2,549,693 structures across four Indoor Residual Spray (IRS) seasons, enhance efforts to monitor both insecticide resistance and the resistance mechanisms present in the country, improve malaria case management practices, and create an active case surveillance system in two districts.
  • Community: Scaled up Safe Motherhood Action Groups (SMAGs), built capacity of communities to participate in the annual health planning process, worked through 18 grantee organizations to increase community involvement in health, and conducted gender orientation for Community Health Assistants.

Abt Global led the ZISSP team and led project interventions in close partnership with the MOH and with the MCDMCH. The ZISSP consortium included Akros Inc., the American College of Nurse Midwives, Banyan Global, the BroadReach Institute for Training and Education, Johns Hopkins University Center for Communication Programs, the Liverpool School of Tropical Medicine, and Planned Parenthood Association of Zambia. ZISSP was implemented from July 2010 through December 2014.