MPs in public hearings and site visits to advance sexual reproductive health
Moses Magadza in Ndola, Zambia
Zambian Members of Parliament have undertaken oversight visits to health and educational facilities and conducted public hearings as they move from rhetoric to grassroots action to advance of sexual reproductive health (SRH).
The site visits and public hearings were undertaken with financial support from Sweden and Norway which are funding a SADC PF-led four year Sexual and Reproductive Health, HIV and AIDS Governance Project in seven SADC Member States that include Zambia.
Implemented through and with National Parliaments, the SADC PF Project seeks to build the capacity of women Members of Parliament in particular and that of National Parliaments in general, to advocate for universal access to SRHR, HIV and AIDS Governance related services and commodities.
Recently, staff from SADC PF joined Zambian MPs when they conducted site visits to two health facilities and held public hearings with hundreds of citizens in Kabwe and Ndola over two days to assess Zambia’s preparedness in terms of achieving Sustainable Development Goal (SDG) 3 with a special focus on SRH. Overall, SDG 3 seeks to ensure healthy lives and promote wellbeing for all at all ages.
The public hearings were the climax of an intense process of oversight which began much earlier with Zambia’s Parliamentary Committee on Health, Community Development and Social Services receiving presentations from non-governmental organisations, civil society organisations, faith based organisations, community based organisations and officials from the line ministries of health and education.
An assessment of the capacity of selected health facilities to provide SRH as it relates to family planning, antenatal services, prevention of mother to child transmission of HIV, safe abortion care, management of teenage pregnancies, prevention and treatment of sexually transmitted infections, screening for cervical cancer among others followed. The assessment was done at different levels of care facilities from the University Teaching Hospital – a tertiary health care facility – to the smallest clinic, which is a primary health care facility.
Dr Jonas Chanda chairs the Zambia’s Parliamentary Committee on Health, Community Development and Social Services. He led a group of eight MPs during the public hearings and oversight visits, during which access by ordinary people to health facilities, services and commodities was a key issue.
In an interview, Dr Chanda said the site visits had exposed the need to revisit the basis for deployment of human resources for health.
“In Lusaka, for example, we visited a clinic in a densely populated compound called Kanyama with a catchment of about 200 000 people. Each day, between 35 and 40 women give birth there. This is a more than what obtains at the University Teaching Hospital. In fact , Kanyama has the highest number of deliveries in the country, yet it is a very small, first level health facility,” Dr Chanda said.
He said the site visit to Kanyama revealed also that in spite of the high numbers of women giving birth there, there was a serious dearth of midwives and related services, which abound at the University Teaching Hospital.
“This means that a tertiary health facility is offering primary level services such as dispensing condoms, family planning tablets and seeing routine antenatal cases. This should happen at a primary health care facility like a clinic. Tertiary institutions must focus on specialised care,” he said.
He opined that this disparity could explain huge unmet SRH needs in Zambia. For example, the national uptake of contraceptives in Zambia is estimated at 45 percent.
“Maybe the long distance to the University Teaching Hospital is deterring some people from accessing family planning. Queues at the Teaching Hospital are normally long. If we are to achieve SDGs, we must take services to the people. Primary level services should be near where people stay,” Dr Chanda said.
Experts say there is a strong link between health and education. Official estimates in Zambia indicate that about 16 000 girls drop out of school due to pregnancy every year. Additionally, Zambia’s demographic profile shows that young people aged below 35 make up to 60 percent of the population.
Dr Chanda said his committee had been looking at how best to support or collaborate with the Ministry of Education to deliver comprehensive sexuality education (CSE). “As things stand, there is a gap. The Ministry of Education is offering theoretical CSE, but services and commodities for young people are few and far between or not easily accessible,” he said, adding that MPs would advocate, also, for the reduction of distances between were young people stay and attend school. This, after it emerged that in extreme cases, schools were up to 30 kilometres away from learners’ homes.
Dr Chanda said the site visits and public hearings had been “very educative and revealing” for MPs that undertook them. A medical doctor by profession, Dr Chanda said he was amazed to find that findings of a research that he conducted 20 years ago as a medical student on the referral system in Lusaka were as true now as they were 20 years ago. However the most revealing, for him, were the public hearings.
“The community members told us things, some of which we take for granted. Talking about sex has been taboo for many years. It was amazing – for example in Masaiti – to hear elderly people openly engaging in discussions on these issues. Things have changed.”
Dr Chanda said the sheer numbers of people who thronged the public hearing venues were indicative of the paucity of SRH information and the people’s willingness of learn more in this area.
“The enthusiasm by members of the public across age groups was amazing. In the past SRH topics would not have attracted so much attention. Maybe now it is because every Zambian has experienced what we are taking about. People have personalised SRH issues and are demanding action.” Members of the public passionately spoke about a plethora of SRH issues during the public hearings. Issues that that they raised some that are not normally discussed openly in Zambia such as sex work, termination of pregnancy, sexual diversity, key population and conjugal visits for prisoners. They noticeably avoided family planning.
Dr Chanda said this could be attributed to the fact that, since time out of mind, Zambians had tended to put a premium on large families, with some couples having been known to have up to 12 children. Myths still surround family planning methods, with some people associating them with cancer. Other issues that people raised were poor access to health facilities, lack of privacy, hostile attitudes of some health staff, lack of abortion services, high school drop outs and pregnancy among girls, alcohol abuse, the effect of social media – especially as it relates to pornography – , lack of cervical screening facilities, insufficient staff and misallocation of human and other resources for health.
Going forward, Dr Chanda said MPs would advocate for evidence-based planning to ensure that resources go where they are needed most.
At Masaiti Clinic in Ndola, irate villagers complained bitterly to the MPs that they were being asked to pay 50 Kwacha (about US$5) to transport pregnant women on government ambulances. Dr Chanda said that was a case of corruption, which would be investigated.
“I am happy that the District Medical Officer was present when this was raised. He has to take it up. It could be happening in other places. We have to stop it.”
He said corruption would discourage people from accessing government services.
“In a rural setting, 50 Kwacha is significant. That might be the reason why some people give birth at home or miss out on antenatal care.”
Dr Chanda said his committee would compile a detailed report after the public hearings and oversight visits and present it to Parliament.
The committee would also engage the ministers and other senior officials of relevant line ministries to ensure implementation of recommendations.
On what he or his Committee would do differently if they were to conduct site visits and public hearings again, Dr Chanda said: “I would start with the rural areas and compounds because we don’t want these public hearings to be elitist. The data on unplanned pregnancies, abortions, and maternal mortality and so on, shows that rural areas are the worst affected.”
He said he would ensure that MPs, especially those in his Committee, take the lead in the selection of venues for oversight visits and public hearings “rather than do a post mortem of the process.”
A villager in Ndola who spoke on condition of anonymity called for more public hearings and urged the MPs to conduct unannounced site visits to avoid seeing “bandaged institutions”.
Dr Chanda said he would advocate for active engagement and frank discussions, even on seemingly controversial issues.
*Moses Magadza, who wrote this article, is Communications and Advocacy Specialist at SADC Parliamentary Forum.