Lions Aid Norway

Zambia 2012 Annual Report

Helping bring eye health into focus

2012 Annual Report

Table of Contents.
1. Message from the Country Director.......................................2 2. Background........................................................................3 3. Human Resource Development............................................4 - 5 4. Maboshes Story.................................................................6 5. Focus on Kaoma MDA........................................................7 6. Focus on Infrastructure......................................................8 7. Data and Statistics Summary...............................................9 8. Service Delivery.................................................................10 8. Discussion of Results by Dr. David Kasongole ....................11 9. Planning and Coordination.................................................12 9. Other Projects.................................................................13 10 Financial Report...............................................................14

1. Lions Aid Norway

Focusing on Eye Health

Welcome Message

From the Country Director

given us a green light to start supporting Eye Health in I would like to welcome you to our 2012 annual report. Central Province. This past year has had its own share of successes and challenges. In this report, you will find updates from all Advocacy and Service delivery: In Western Provour three sectors of engagement i.e Human Resource ince, one of the key objectives in 2012 has been to addevelopment, infrastructure, and service delivery. vocate for the integration of Eye health activities within the District health plans and budgets. We are happy to have seen almost all Districts respond to this call. LAN believes that delivery of Eye Health services can only be sustained if planning for Eye health is achieved at District level.

Trachoma elimination: LAN has continued to support

Kaoma District in its Trachoma elimination efforts. The highlight of this support for 2012 has been the successful implementation of the Mass Drug Administration (MDA) exercise by the District. This exercise was not only the first ever to happen in Kaoma but for the whole country at large. The MDA exercise is a huge milestone in the elimination of blinding Trachoma in that District. You can read more on this exercise on page 7. Infrastructure and Equipment: LAN has procured equipment and furniture for the specialised eye department. On rather a sad note, I regret to inform you that the completion of the specialised Eye Department at which this equipment is to be used has been delayed due to various reasons beyond our control. I am however confident that the unit will be completed before A Tribute to Ministry of Health: Lions Aid Norway is the end of the first quarter of 2013. particularly encouraged with the commitment that Ministry of Health through the National Eye Health office May I also take this opportunity to mention that after has shown in bringing eye health on the National working in Zambia for over 2 years, and working for Agenda. The Ministry has made a number of significant LAN for many years, I have decided to retire at the end efforts in ensuring that Eye Health is given the attention of April. I am happy with the partnership and collaborait needs at all levels. The launch of the Master of Medi- tion I have had with various stakeholders within the Eye cine (MMED) program for training of Ophthalmologists Health sector. I would also like to extend my gratitude at the University Teaching Hospital (UTH), the purchase to my fellow Lions, friends and my staff who have made of Eye Health Equipment for District Hospitals, the com- my stay in Zambia very worth while and encouraging pletion of the National mapping exercise for Trachoma and the initiative to engage parliamentarians in the fight Enjoy your reading. against Trachoma all goes to show that MOH has prioritised Eye Health. We are also happy that MOH has

Jan Erik Larsen

2. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Who we Are.
Photo: Taken at Ndapula Community School in Chongwe.

Introduction
Lions Aid Norway is a non governmental organisation working in three countries namely Uganda, Malawi and Zambia. LAN started its work in Zambia in 2010 after entering into a Memorandum of Understanding (MOU) with the Ministry of Health. The MOU mandates LAN to support Affordable, Accessible and Available Eye Health services in Zambia. LAN is working in close collaboration with the Ministry of Health and other partners to build, strengthen and support existing Eye Health systems and services in Western Province in a sustainable and cost effective manner. LANs support is within the context and framework of the National Eye Health Strategic Plan.

Our Vision
To provide the people of Western Province with equity of access to cost effective quality Eye Health as close to the family as possible within the global initiative for elimination of avoidable blindness The V2020: The Right to Sight.

Our Aims
1. To support the development of Eye Health infrastructure. 2. To support the development of Human Resource for Eye Health. 3. To promote and provide appropriate technology and Infrastructure necessary for delivering Eye Health services. 4. To create awareness on Eye Health conditions and related issues.

Our 2012 Objectives

1. Complete construction of an Eye Department at Lewanika General Hospital. 2. Sponsor 4 health workers to be trained as Ophthalmic Clinical Officers. 3. Train 60 Primary Eye Health (PEH) workers in 3 districts. 4. Support 2 surgical outreach activities in 2 districts.

3. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Human Resource development

Photo: An Ophthalmic Nurse (ON) currently in training removes a bandage from a patient after surgery Lewanika Eye clinic, Mongu

Training of Ophthalmic Clinical Officers and Nurses. (2012 Objective: 8 to be trained by the end of 2013)
Two (2) candidates from Lewanika General Hospital (LGH) have completed their training in Gambia and are now actively working in the eye clinic. 1 candidate from LGH, 1 from Mongu District and 2 candidates from Lukulu and Kaoma Districts will be entering their second year of training at Chainama College of Health Sciences in 2013. An additional 4 candidates from Shangombo (1), Lukulu (1) and LGH (2) are scheduled to commence their training at Chainama in January 2013. 1 candidate from Kalabo District is currently in training in Gambia and is expected to complete in July 2013.

2. Primary Eye Care Training (2012 Objective: 30 health workers, 30 community health workers trained in PEC by end of 2012)
In 2012, LAN planned to support 3 Primary Eye Care trainings in 3 districts namely Sesheke, Senanga and Lukulu. The objective of the training is to establish and strengthen District Eye Health referral system by equipping health workers with the basic skills in disease identification, diagnosis and treatment. A combined total of 30 health workers and 30 community health workers have been trained from three above mentioned districts by end of 2012. This represents a 100% progress against the planned objective for the year.

4. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Focus on Human Resource

Need for Human Resource
Human resource is the most important asset of any health system and their availability and quality are key determinants of efficiency and quality of health services provided. It is crucial to the success and sustainability of all health care provision interventions. Western Province is among the provinces that has had a lack of Human Resource for Eye Health. As at the beginning of 2012, the Province with a population of over 1 million only had 3 active Ophthalmic Clinical personnel and 1 Ophthalmologist trained to provide Eye Health services. At the minimum, the Province needs 20 mid level Ophthalmic personnel in order to ensure that the Lewanika General and all District Hospitals have trained staff providing Eye Health Services. Lions Aid Norway has been working to help bridge this gap by supporting the training of Human Resource for eye health

Photo: Wamulume and Precious reviewing a patient after a minor surgery earlier.

Helping Make a Difference ( Wamulume and Precious Story)

Wamulume and Precious are two of the candidates who have just completed their ophthalmic training program in Gambia with support from Lions Aid Norway. They now work at Lewanika General Hospital, the biggest hospital in the Province. With the increase in the demand for Eye Health Services, Wamulume and Precious explain that since they came back from training, the number of patients seen at the clinic has increased with more than 50 people seen every day. We are able to perform minor surgery such as excisions, eviscerations and TT surgeries Wamulume explained. Before the two candidates came back from training, the eye clinic depended on one ophthalmologist for everything. Dr. Kasongole said that the two Ophthalmic Nurses (ON) are well trained and are able to provide support both in the clinic and in theatre. He added that he was now able to concentrate on much more completed surgeries such as cataract as he now has other tasks in the clinic being covered by the two Ophthalmic personnel. Wamulume and Precious are among the 14 Lions Aid Norway supported candidates expected to be stationed across the province by the end of 2015.

5. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Maboshes Story
Photo: Moboshe undergoing surgery at Lewanika General Hospital Mongu.

Maboshes is a 32 year old man of Mongus Mbo compound in Western Province Zambia. Maboshe walked in the Eye Clinic at Lewanika General Hospital with what he thought was a feeling of sand in his eye. Maboshe explained to the Ophthalmic Nurses (ON) that it all started with what felt like some sand sensation. Over time, it started becoming painful and realised that something was growing in his eye Maboshe explained during his review visit at the eye clinic. Maboshe was screened at the clinic by the recently trained ONs and his condition was clinically diagnosed to be what is known as Squamous Cell Carcinoma. (SCC) After undergoing screening, a surgical intervention was recommended for him. The ON under the supervision of the ophthalmologist carried out an excision surgery to remove the tumor and hence stop the spread of the condition to the rest of the eye and adjacent structures. Wamulume Namushi, the ON who carried out the surgery explains that there is a high chance of recurrence and the patient has been put on close monitoring and medication. Wamulume said that Maboshe is lucky that his condition has been diagnosed and treated early as failure to do that would have led to a full spread of the cancer and eventually blindness. Lack of awareness about this and other conditions have led to many having to lose an eye because in most cases, people have come in late and we have had to completely remove the eye. Wamulume added. Lions Aid Norway is working with Ministry of Health to raise community awareness on various eye conditions so that community members can seek the service they need at the

What is Squamous Cell Carcinoma of the conjunctiva? Squamous Cell Carcinoma of the conjunctiva is a malignant tumor arising from the membranous lining of the eyeball and eyelids. If untreated, the condition has potential to lead to blindness and may also spread to the brain. Dr. David Kasongole.

6. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Focus on Kaoma Mass Drug Administration

What is Mass Drug Administration (MDA) ? The Mass Drug Administration (MDA) exercise is the implementation of the A component of the WHO recommended SAFE strategy for the elimination of blinding Trachoma. It involves the distribution of Zithromax antibiotic to the whole population in a District that has a Trachoma prevalence of 10% and above. Kaoma District has recorded the one of the highest prevalence rate of 32.7% among children aged from 1-9 years. On 24th September 2012, the District embarked on its first round of the implementation of the Mass Drug Administration (MDA) exercise for the elimination of Trachoma with support from Lions Aid Norway. Scope of the Exercise : Lions Aid Norway co funded the MDA exercise by supporting the training of 66 health workers, 199
Photo: A child in Kaoma receives a dose of Zithromax in Kaoma District Photo: A Community Health Worker (CHW) measures the height of a child at a health centre in Kaoma

community volunteers, sensitization of 46,000 community members and the distribution of the The trainings were designed to equip health

drug in the whole district.

workers and the community volunteers with knowledge on administering, managing, monitoring and reporting for the MDA exercise. The community was sensitized on Trachoma and the need to take the drug in order to avoid the spread of the disease. Results : Kaoma District reported that 94 % (177,478 people) of the population received the drug. This was a 14% above the WHO set target of 80%.

7. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Focus on Infrastructure.
Construction of the Eye Department which commenced in September 2011 has been progressing with some major challenges. These challenges resulting from a number of factors have caused some delays leading to the extension of the completion date. It is now expected that the Eye Department will be completed before the end of the 1st quarter of 2013. Lions Aid Norway has procured all the equipment and furniture for the unit. Various dignitaries who have visited the site have expressed happiness at the rate that the works have moved despite the various challenges that have been encountered. These include the Minister of Health, Dr. Joseph Kasonde, The Permanent Secretary, Dr. Peter Mwaba, The Deputy Minister of Sport and Member of Parliament, Mr. Nathaniel Mubukwano and the former International Director of Lions Aid Norway, Eline Oftedal.
Second from right: Minister of Health Dr. Joseph Kasonde tours Construction site in April 2012 Lewanika General Hospital Eye Department under construction as at January 2013.

8. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Lewanika General Hospital Statistics

Morbidity
Cataract Allergic Conjunctivitis Refractive Error Glaucoma Viral /Bacterial Conjunctivitis Ophtalmia Neonatorum Corneal Ulcers Stye Retinoblastoma Trachoma Orbital Cellulitis Enophthamitis Optic Atrophy Optic Neuritis Uveitis Pterygium/Pinguecular 17 6 12 11 38 197

2011
371 553 252 77 165 43 71 19 0

2012
424 732 277 79 294 13 208 23 2 44 3 13 7 48 356 163

% increase
13 24 9 3 44 -70 66 17 100 100 -82 54 -42 77 89 -17 22 42 81 -36 -15 88 88 28 32

Conjuctiva Squamous Cell Carcinoma Foreign Body Chalazion Trauma Corneal Scar Squint Retinopathy Others Total number of patients

29 29 26 100 33 8 18 1,515 3,637

37 50 137 64 28 64 151 2113 5330

9. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Service Delivery

LAN fully supported one (1) surgical outreach camp in 2012 out of the planned two (2) in Lukulu District. At this camp, 38 cataract patients were operated on. LAN also supported one (1) surgical outreach camp for lid rotation surgery in Kaoma District at which 28 eyes were operated on. LAN also partially supported six (6) surgical outreach camps through the Ministry of Health Western Province mobile outreach services. LANs support included the provision of consumables and equipment while transport and allowances were covered by Ministry of Health. 182 cataract operation have been performed through Mobile Health outreach services alone in 2012.

10. Lions Aid Norway

Focusing on Eye Health

2012 has been a very productive year

when it comes to service delivery. In this year, the number of people who have accessed Eye Health services has increased by 32% compared to last year. This increase indicates that the demand for Eye Health services in the Province is increasing and that many of our people are getting the help they need when it comes to Eye ailments. Thanks to our cooperating partners Lions Aid Norway, we have had a boost in human resource with the coming of the two Ophthalmic Nurses who recently graduated from Gambia. This has particularly led to a sharp increase in the number of patients seen from July onwards. Western Province has recorded the highest number of cataract operations in 2012 than in any other year. Availability of consumables and the mobile health services has made it possible for us to reach even the furthest parts of the Province. Our outlook and prospects for 2013 are even more ambitious than the last year. Our specialised Eye Department will be fully operational before the end of the first quarter. We have planned to implement a robust sensitization program across the whole province to ensure that people are sensitized on the availability of these services. We are expecting our cataract surgical output to increase by at least 20%. We will also be focussing on children by ensuring that we implement school screening activities so that all children with visual impairment can get the help they need at our department. The biggest challenge we anticipate this year is the limited human resource for Eye Health across the province. Thanks to LAN, the province will receive 5 Ophthalmic personnel by the end of this year. However the need for these specialised is still high. Finally looking back to 2010 when we started with the program, I can confidently say that we have had significant success in ensuring that the people of this province get the services they need. Thanks to my Ministry and Lions Aid Norway for the support they have continued to render us.

2012 Annual Report

Performance review Dr. David Kasongole

The number of people accessing eye health services has increased by

32%

Dr. David Kasongole

Photo: Dr. David Kasongole posses for a Photo during a home visit with one of the patients who has had the vision restored after a cataract operation.

11. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Planning and coordination

Activity When it was conducted Details

Provincial Plan- January 2012 ning Meeting

The second LAN supported Provincial planning meeting was held at the end of January 2012. The meeting was attended by 6 District Medical Offices, District Eye Health focal point persons and planners. Key staff from the Provincial Office and Lewanika General Hospital were in attendance. The aim of the meeting was to review progress thus far and to develop a road map for the future. The first LAN board meeting was held in February 2012.

Lions Aid Norway February 2012 Board Meeting. Visit by Lions Aid March 2012 Norway, International Director

Former LAN International Director visited Zambia in March 2012 on a familiarisation tour of the LAN supported project. Ms Eline Oftedal who was accompanied by LAN advisor Prof Jan Holtet also paid a courtesy call on the Litunga, King of Barotseland and also toured the construction site of the Eye department. LAN represented by the Accountant / Administrator attended training in Community Eye Health. The training focused on the management of Eye Health programs at community level.

Training of Lions March 2012 Aid Norway staff in Community Eye Health Management Provincial Inte- April 2012 grated Meeting (PIM)

District visits May 2012 Development of MoU.

LAN represented by the Program Officer attended the Provincial Integrated Meeting (PIM). PIM is an annual meeting attended by all MoH units and partners in the Province to share progress, experiences and challenges in relation to delivering Health services. LAN was given an opportunity to showcase their work in supporting Eye Health delivery in the Province. In May 2012, LAN team led by the Country Director visited all the seven Districts to discuss and develop agreements with individual districts. The aim of the agreements is to formalise and create a framework of LAN support to individual districts. LAN represented by the Program Officer attended the Provincial Planning launch meeting. The meeting which is attended by all MoH units and partners is the first activity in the Provincial Planning cycle. The second LAN board meeting was held in July 2012

Provincial Planning Launch.

June 2012

Lions Aid Norway July 2012 Board Meeting.

Provincial Planning Launch.

N o v e m b e r LAN represented by the Program Officer attended the Provincial Integrated 2012 Meeting (PIM). PIM is an annual meeting attended by all MoH units and partners in the Province to share progress, experiences and challenges in relation to delivering Health services. LAN was given an opportunity to showcase their work in supporting Eye Health delivery in the Province. P a r l i a m e n t a r y D e c e m b e r LAN represented by the Assistant Director attended a parliamentary session were presentation on 2012 Ministry of Health was asked to present on Trachoma. The aim of the meeting Trachoma was to create awareness among political leaders on the dangers and impact of

12. Lions Aid Norway

Focusing on Eye Health

2012 Annual Report

Other Projects

In February 2012, Lions Aid Norway partnered with Mongu Lions Club to improve the water reticulation system at Senanga School for the hearing Impaired. The project which was funded by Lions Club Jevnaker of Norway involved the construction of a borehole and water tank to proThe improvement of the water reticulation project at Senanga School for deaf has benefited 72 speech and hearing impaired children vide 24 hour running water to the school. The project was officially commissioned by the then Western Province Minister Hon. Nathaniel Mubukwano. In his speech, Hon. Mubukwano said that he was aware of the poor water supply at the school and as such was happy to have been invited to commission it. The water Project is expected to benefit 72 hearing impaired pupils with 24 hour water supply. Speaking on behalf of the children, Namakau, a grade seven pupil at the school said that she was Community members gather for a meeting to discuss the Ndapula community school improvement project at Ndapula community school in Chongwe. grateful to Lions of Norway for supporting the project. She said that she and her friends would no longer have to walk long distances hence avoiding the risk of being hit by cars or attacks from crocodiles at the river . Other future projects include the construction of a girls dormitory at the School for the deaf in Senanga, construction of teachers houses at Ndapula community school in Chongwe, construction of a 1 X 3 classroom block at Namilangi Community members listen to the Country Director of Lions Aid Norway and Kaoma District Education board Secretaryduring a meeting to discuss the school improvement project at Namilangi community school, Kaoma. community school in Kaoma.

13. Lions Aid Norway

Other Projects

2012 Annual Report

Financial Report

ZAMBIA ACCOUNTS 2012

ZMK A. Investments Buildings Inventory and equipment Sum 3,957,168,877 1,119,169,868 5,076,338,745 4,563,117 1,290,556 5,853,673 NOK

B. Running expenses Norwegian personnel Local personnel Consultants Transport Operating equipment Operating expenses Teaching and training Publicity Support to clinics Trachoma Sum 222,165,000 408,399,712 15,000,000 104,504,052 17,292,250 249,887,162 233,744,554 3,000,904 56,848,210 290,526,880 1,601,368,724 257,185 469,995 16,623 119,956 19,973 288,221 273,510 3,728 64,132 320,802 1,834,125

Sum A+B

6,677,707,469

7,687,798

14. Lions Aid Norway

Financial Report

For more information please contact

Lions Aid Norway Plot 30991 Thabo Mbeki Road Lusaka, Zambia

+260 211 840 234 +260 211 840 233

admin@lan.co.zm

Compilation, layout and design by Lions Aid Norway staff