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Dr. Clarance Chiluba

Senior Medical Superintendent-Adult Hospital, University Teaching Hospital (UTH)

Dr. Jabulani Munalula

Medical Director, Fairview Hospital

Increasing access to services and boosting the local expertise, particularly in specialist care, is a priority for these healthcare providers.

How have your respective facilities developed over?

DR. CLARANCE CHILUBA UTH is embarking on a number of projects, particularly in the area of cardiac surgery. We have employed more staff to work in this unit, for example, to perform valve replacements, treat atrial septic defects, ventricular septal defects, and pericarditis infections, and install pacemakers. In addition to robust cardiology services, we are improving our renal services and offerings, as well as dialysis, tissue typing, and transplants. We have linked the renal unit to our infectious disease unit to mitigate against infections caused during transplants. Finally, we look to develop a plastic surgery and reconstructive surgery unit, as well as a burns unit.

DR. JABULANI MUNALULA Since I took up the mantel as director, we have focused on specialty care, in particular surgical specialties, surgical oncology, laparoscopy, neurosurgery, and ear, nose, and throat, as we identified these as lacking in the public and private sectors. We currently boast one of the most active intensive care units, as well as one of the most active private sector operating rooms; therefore, we seek to increase capacity there as well. We are acquiring the necessary equipment for these fields, which, although an expensive process, is a necessary one. The other issue surrounding equipment is that there is a lack of corresponding technical know-how on the part of medical staff. It is necessary to train personnel, holding courses locally or sending staff abroad, and so on. However, this is an investment that must be made if we want to take healthcare in Zambia to the next level and properly develop our specialties.

How has the structure of your services changed in line with expansions across the sectors?

CC UTH is a large institution. In the past, it was managed by one entity, which presented a number of challenges in regard to the efficiency of service provision. Our future focus lies in developing centers of excellence, and we have consequently split up UTH up into several sub-entities, among these, the cancer disease hospital, the emergency unit, internal medicine, and surgery. In internal medicine, we have sub-divided into specialties such as a renal unit, a cardio and cardiothoracic surgery unit, and an endocrinology unit. Developing these centers of excellence will be the cornerstone of our eventual plan to make Zambia a medical tourism hub in the long term.

JM We have a base of general practitioners, who we built almost to capacity and are the gatekeepers, funneling clients to specialists. There are two models: a hospital can either hire specialists, which is not always financially feasible for an institution, or it can partner with privately functioning specialists. At Fairview our strategy is a combination of both. In total, we have seven general practitioners and six specialists.

How are you working with the Ministry of Health to increase access to healthcare across the country?

CC The ministry’s commitment to health promotion and disease prevention is instrumental in the mission to widen access to healthcare across the country. We introduce sports days and health days to raise awareness about the importance of a healthy lifestyle in combating non-communicable diseases. We have also shifted our focus to working with communities, employing a grassroots approach to promoting healthcare. A directive was formed to look into the empowerment and social determinants of public health, and measures have been put in place to improve access to clean water and provide community nurses in all areas of the country.

What are some of the remaining barriers to boosting investment in the sector?

JM One of the major obstacles we face as an institution is reimbursement. The government can do more to foster communication between reimbursers and providers. We have tried to form alliances as private hospitals to generate block agreements with providers; we have tried, as an alliance, approaching the Ministry of Health and seeking support. It would be beneficial for the government to even acknowledge that there is an association of private hospitals in Zambia, and empower us to be able to approach payers as a group to facilitate timely reimbursement for services so that the private sector can continue to provide the level of care our clients need. Another serious problem is the lack of qualified personnel. There has been a big push for decentralization, sending doctors and nurses to more remote parts of Zambia and so on, which in principle is a positive development. However, there should be a more strategic, integrated, and well thought out approach to healthcare personnel distribution. In the last six to eight months, with public sector staff relocating, critical gaps have been left in services, and that has hit us hard.



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