Since 2013, SJN has partnered with the Institute for Health Metrics and Evaluation (IHME) to share instances of exceptional progress and success in public health using research and data produced at IHME. This weekly series highlights a timely example of positive deviance (places where data outcomes are better than expected) and shows you places that have seen the most gains. We don’t, however, always know why such successes took place, which is why we look to journalists like you, in hopes that you’ll use these data as inspiration for stories. Run with the data. Report. Research. Find out how these countries are succeeding–and publish what you find with the world.
Photo Credit: Matthew Schneider, Child Health Week, Katete, July 2010.
As improving the quality of health services and people’s access to them becomes more of a global priority (especially in the wake of the Ebola crisis), it’s easy to forget that “health” – how we live and die, and how we interact with health systems – rarely happens at the country-level. Global health leaders want to “ensure that every country [have] a robust and resilient health system,” but we also need to look at the wide variations happening within a country to learn from successful, local initiatives.
In a paper just published in BMC Medicine, researchers from the University of Zambia (UNZA) and the Institute for Health Metrics and Evaluation (IHME) charted district-level trends for a broad range of maternal and child health interventions in Zambia. These district-level data allowed them to map out local gains and gaps over time, and to really hone in on the country’s evolving health landscape.
What did they find? For a number of more routine health services (or those that required multiple contacts with the health system), national levels of intervention coverage stagnated, or even declined over time. This was particularly evident for antenatal care, skilled birth attendance, and polio immunization.
However, a number of districts bucked these national trends (the black line represents the national average for Zambia; the green line reflects the district trend):
1. Antenatal care
- What: antenatal care (ANC) involves check-ups by health professionals during pregnancy; at least four ANC visits (ANC4) prior to delivery are recommended by the World Health Organization (WHO).
![Mwense, ANC4]()
- District success story: Mwense. As Zambia experienced declines in antenatal care between 1990 and 2010, Mwense was one of the few districts with the opposite trend: by 2007, ANC4 coverage increased to 97% (and stayed at this level through 2010).
- How did Mwense do it? We’re not completely sure, but the district may have benefited from Jhpiego’s Maternal and Child Health Integrated Program.
2. Polio immunization
- What: by receiving three doses of the oral polio vaccine, children receive protection against this disabling disease.
![Chavuma, polio immunization]()
District success story: Chavuma. Though Zambia was certified as polio-free in 2005, Chavuma is considered a high-risk district for polio importation because it shares a border with Angola (a place where wild poliovirus transmission still occurs). While some high-risk districts saw declines in polio immunization rates between 2000 and 2010, Chavuma maintained high levels of vaccination coverage during this time. In fact, the district posted Zambia’s highest polio immunization coverage in 2010 (99%).
- How did Chavuma do it? It’s not immediately clear why Chavuma fared better than other high-risk districts, but perhaps coordinating immunization activities along the Angolan border played a role.
3. Skilled birth attendance
- What: the proportion of women who give birth with a skilled attendant present (doctor, clinical officer, nurse, midwife).
![Senanga, skilled birth attendance]()
What district is doing it well? Senanga. While Zambia saw minimal progress for improving rates of skilled birth attendance (SBA), Senanga saw its (SBA) coverage rise markedly, rising from 14% in 1990 to 68% in 2010. The district’s gains were particularly impressive considering its levels of SBA were well below the national average in 1990.
- How did Senanga do it? Again, we can’t say for sure, but it’s possible that the district’s implementation of Safe Motherhood Action Groups (SMAGs) contributed to its rising rates of SBA. Originally developed by the United Nations’ Population Fund (UNFPA) in 2002, local SMAGs work with women and girls to encourage them to give birth at health facilities rather than at home.