Every year, over 40,000 people in Zambia get tuberculosis; over 60 percent of these also have HIV. These are very high figures. The areas with the greatest prevalence of HIV also have the highest incidence of tuberculosis.
Zambia is a middle-income country, but it also has much poverty. The health system has few resources and few trained health care workers. Large distances make it difficult to get health care to everyone. Therefore, Zambia has long traditions of involving NGOs, especially in work directed toward people with tuberculosis and HIV.
Many people in Copperbelt Province in Zambia currently work or have worked in the large copper mines. Miners are at increased risk of getting tuberculosis due to inhalation of silica dust as well as cramped and unventilated work and living conditions.
Affiliates in Zambia
In Zambia, we have a long-term partnership with CHEP, and in 2015, we started up a new collaboration with In But Free. Norad supports LHL International's work in Zambia. We have also received funds from LHL's local chapters.
Copperbelt Health Education Project (CHEP) has been involving local communities in Copperbelt Province in HIV/AIDS prevention since 1988. In 2004, LHL International entered into a contract with CHEP to help strengthen local community participation in the fight against tuberculosis.
In But Free (IBF) is a small, volunteer-based organisation that has worked with preventing HIV in Zambian prisons since 1995. LHL International has collaborated with IBF through CHEP since 2012.
Our work in Zambia
In local communities:
An important part of CHEP's work is the involvement of former tuberculosis patients, peers, and other volunteers who support patients during treatment. Through CHEP, LHL International supports more than 40 community based organisations in Copperbelt Province. The organizations consist of treatment supporters who visit TB patients at home; they help the patients take their medications and discuss the disease with them and their families. In addition, they educate the public about TB through song and drama, helping to reduce TB stigma.
In rural areas, those who become ill are most likely to go to traditional healers first. CHEP also trains these traditional healers to be treatment supporters.
CHEP has defined which groups in the Copperbelt Province are most at risk for tuberculosis and therefore have the highest need for support during treatment. Going forward, the aim is therefore that miners, migrants, prison inmates, and travelling sales agents get more educated about tuberculosis and know who they can turn to for help if they develop symptoms. CHEP also wants to support patients in treatment for multidrug-resistant tuberculosis.
Those held in Zambian prisons are especially at risk for contracting tuberculosis. In But Free (IBF) and LHL International believe that it is unacceptable for inmates to be exposed to TB contagion during incarceration. Therefore, we work with training prison employees and lobbying prison authorities in a total of seven prisons in Copperbelt Province, in addition to teaching inmates about TB and HIV.
Commemoration of World Tuberculosis Day at Kamfinsa State Prison in Kitwe, Zambia.
Prisoners' peers disseminate information through roleplay, song, and conversation in the cells. In addition, they give help and support to inmates in treatment.
LHL International and IBF are now working toward compulsory screening for new inmates as well as follow-up of prisoners who are in treatment when they are released.
Objectives and results in Zambia
The objective of this work has largely been to develop strong local organisations that support health services in the area and spread information about tuberculosis. In 2015, more than 40 organisations, with a total of 700 treatment supporters, worked actively on behalf of people sick with tuberculosis. After receiving training and support for their own income-generating work, several of the organisations are now ready to stand on their own feet.
CHEP and LHL International have developed patient-friendly brochures about TB. The goal is that these brochures can be used by all tuberculosis patients in Zambia as well as by health workers and volunteers involved in TB work.
A study from 2012 showed that patients who had a treatment supporter and access to the brochure had much better knowledge about tuberculosis than others. CHEP has also trained many in health communication, and the Ministry of Health in Zambia is interested in including this in the curriculum for nursing students.
Read more about why good health communication is important for tuberculosis patients.
Going forward, LHL International will work to reach out to additional vulnerable groups in Zambia with both information and support. This can be achieved through a stronger cooperation with In But Free and CHEP in their efforts to better include vulnerable groups (including miners and migrants) in educational work and to support patients with multidrug-resistant TB.