Australia Awards Alumnus contributes to health sector reforms at the district level in Zambia

Australia Awards Alumni are effecting positive change on return from scholarship, proving the Australian Government initiative a worthy investment in Africa’s development.

Nowhere are these development contributions more evident than at the district level of Zambia’s health sector, championed by Australia Awards Alumnus Dr Ernest Mutale.

Applying Australian-gained skills and knowledge, the Zambian doctor has improved health indicators in his district, owing largely to new approaches he introduced on return from his award.

Ernest graduated from Griffith University, Queensland, in 2011 with a Master of Public Health. Prior to undertaking his award, he worked for 10 years as a clinician in Zambia’s remote Chilubi District in the Northern Province where he was also the Acting District Medical Officer (DMO).

Ernest returned to Chilubi District in July 2011 as the substantive DMO. In this role, he identified a high incidence of diarrheal diseases in children under the age of five, which had been contributing to increased rates of morbidity and mortality in the District.

Through research and collaboration with a well-placed reference laboratory in Lusaka, the capital of Zambia, where stool samples were taken for a definitive diagnosis, Ernest and his team discovered that a virus – Rotavirus – was responsible for the outbreaks in the district. The team set about addressing the virus with the introduction of an oral Rotavirus vaccine combined with educating mothers on the nutritional and environmental requirements for protecting their children against the virus.

This approach led to a marked reduction in mortality rates in the Chilubi District.  Ernest reports that between 2008 and 2010, two years before he started his Australia Award, out of 1000 children 52.5 instances of diarrhoea outbreak were reported per year. But by 2011, on return to Chilubi and with the introduction of oral therapy, the figure had drastically declined to just 22.5 per 1000, and has remained stable.*

Further, diarrhoea went from being number three on the top ten causes of sickness in children under five in the Chilubi District to number seven.

Ernest and his team took their research findings to the provincial level and, subsequently, national. There, they contributed to evidence-based research leading to the launch of the Rotavirus vaccine as a standard element of the National Vaccination Scheme in November 2013.

Ernest and the district team have applied similar collaborative approaches to the rate of women giving birth at the Chilubi health facilities, with the rate increasing from around 400 per quarter to over 1,000 per quarter. *

Ernest explains that the initial low rate of delivery at Chilubi health facilities was partially due to the district being serviced by predominantly male health providers, causing rural women to shy away from them. In addition, it was District policy that expectant mothers were to provide their own birthing supplies, including buckets and nappies etc., which many could not afford.

Recognising these barriers to safe delivery, Ernest revived the inactive Self Motherhood Action Group comprising of elderly women volunteers. Ernest and his team galvanised the volunteers, held community briefings and provided bicycle ambulances, affectionately named “zambulances,” which transport patients to their nearest health centres before they are taken to the district hospital.

Ernest also successfully changed the obstructive District policy so that pregnant women no longer had to bring their own supplies but were instead guaranteed basic amenities at the health facilities.

Additionally, through a cultural education program and “sensitisation” campaigns, Ernest and his team were able to shift local women’s perception of male health providers – leading to more women successfully delivering at the Chilubi District Health facilities.

Ernest attributes these significant improvements in health indicators and outcomes for women and children in the Chilubi District to his Australia Award. His Australian experience strengthened his understanding of health services management, public health research methods, policy development and implementation. He also learnt management skills including workforce management, and the use of team approaches.

“Before I went to Australia I lacked research grounding,” says Ernest. “But upon completing my Award, I gained valuable research and management skills, which enabled me to effectively lead a team and motivate them to influence change. My skills helped me improve district indicators and achieve the milestones that we did,” explains Ernest.

“I also had very little if any idea or knowledge of how to interact with the community and offer preventive care, health education and promotion. Now, the new skills I gained in Australia made it possible for me to analyse health issues clearly and offer solutions that are simple, effective and less costly,” he adds.

Ernest has since moved on from the rural Chilubi District and is now the official District Community Medical Officer for Luwingu District – a bigger district in the Zambian mainland – also located in the Northern Province. There, Ernest oversees the whole of Luwingu District, which has one district hospital/health office with 69 members of staff and some 17 rural health centres.