Improving health outcomes for Zambians through integrated, client-centered care and strengthened local capacity

It is a bright, sunny day in Solwezi, a town in the northwestern part of Zambia. Health care workers and clients mill about Muzabula Clinic, a local health facility that provides critical services such as HIV treatment, maternal and newborn health care, malaria treatment, and more. Chile Makayi is getting ready to see her first client of the day. She pulls her lavender apron over her head and ties it at her sides. Her uniform is unique at the clinic, printed with the words “Mentor Mother” in large white letters across the front.

Makayi mentors mothers in the area, as the title on her apron suggests. But not just any mothers. Her clients are mostly mothers or expectant mothers who are HIV-positive or unaware of their HIV status.

In 2023, Makayi, who had two children – a 9-year-old son and 3-year-old daughter – visited the clinic seeking maternal health care services. She had not been tested for HIV, so staff encouraged her to get tested. That’s when she learned she was HIV-positive. She was worried about her future and her children, but today Makayi is thriving. She uses her experience to support other women through their pregnancy, birth, breastfeeding, and beyond.

“I talk to clients about the importance of testing, adherence to treatment, breastfeeding, and hygiene. I’m there to advise them, but also to encourage them by showing examples [of HIV-positive mothers who are doing well]. It is important to be open because it helps with adherence [to treatment],” Makayi said.

Community-based services that recognize and respect each client’s needs and preferences are vital for improving health outcomes. Many patients face long distances to health facilities, lack of transportation, and, particularly for women, a lack of time when balancing other duties and priorities, such as taking care of the family. Community-based services can increase demand for services and help reach people with services who are more difficult to reach through more formal health systems.

Additionally, although a lot of progress has been made since the height of the HIV epidemic in Africa in the 1990s, stigma and nondisclosure of a person’s HIV status remain two of the top barriers to HIV care and treatment across Africa. 

“Most community members here don’t have phones,” Makayi said. “We [Mentor Mothers] walk to their homes with them, but we don’t wear our uniforms in the community because stigma is still in the community.” 

Meeting community members where they are and using the trusted voices of community-based volunteers like Makayi shows how barriers to health care can be overcome, leading to improved health outcomes.

Community outreach was a key component of Zambia Integrated Health Activity, a project funded by the U.S. Department of State and implemented by a Pact-led consortium. The project, which Pact led until mid 2026, worked to improve health outcomes of Zambians in Central, Copperbelt, and North-Western provinces by providing equitable access to high-quality HIV, TB/HIV, nutrition, and maternal, newborn, and child health services and information. The project began in April 2023.

The Mentor Mothers initiative was just one of the innovative ways the team closed gaps in care and treatment and expanded access to health care with a client-centered focus.

To address stigma and access for hard-to-reach populations, the project established health outposts at markets. Markets are frequented by men, mothers selling food at stalls, and bus and truck drivers. For people selling products at the market, it is hard for them to leave their trading posts to go to a health clinic.

“The market here is open from 5 am to 10 pm every day. They depend on what they sell that day and lots of people travel far to sell here,” said Tisha Bauleni, the head of a market in Kitwe in Copperbelt province.

New HIV infections tend to be seen in people who move around. With a clinic in the market, market goers could more easily access critical health services, including HIV testing, medications, and counseling, even if they are away from their communities. For some, they are more likely to visit a clinic away from their homes to avoid potential stigma in their community.

Zambia Integrated Health also learned from the private sector and developed roadshows that focused on health, instead of selling a product.

Music and dance were hallmarks of roadshows, but the most important element was the clinic. Community members not only received important health information in an engaging environment; they could get tested for HIV, receive medications, get screened for cervical cancer, and more.

No matter the community or the type of clinic, everything was underpinned by strong data and systems to ensure people did not fall through the cracks.

One of the hallmarks of the system was index testing. Once a person was notified of a positive HIV test, health workers began a mapping process to identify other people connected to the person so they could be tested. This is known as an index and includes household members, sexual partners, children, and other family members.

“We follow up with them at subsequent appointments about the index. Building a good relationship with them helps with indexing because not everyone wants to tell you about their partners,” said Dr. Tandwa Syakayuwa, the project’s former Senior Technical Advisor for Community Services at Pact.

Testing is a non-negotiable in the fight against HIV. 

“You can’t know your status and get on treatment if you aren’t tested,” Syakayuwa said. “If someone is negative, we want them to get on PrEP and screen for cervical cancer. For people who are positive, we need to start index testing. If the person can’t contact their partners, we’ll do it for them.”

It is also an opportunity to check in on other aspects of a person’s health.

Every person, no matter their HIV status, was linked to whatever type of care they needed. Integration of services reduces the likelihood that providers will miss opportunities to help people with something they didn’t initially come to the health facility for. It also improves access, particularly for rural or remote populations, is more efficient than fragmented or vertical approaches, and strengthens health systems by reducing duplication and better utilizing health workers.

At project-supported health facilities, every client received a standard set of care – vitals, temperature check, weight, blood pressure, HIV testing, counseling – beyond the issue that brought them to the facility. 

In total, Zambia Integrated Health tested more than 3.1 million people for HIV. Of those who tested positive, 94% were newly enrolled on treatment. The project also screened HIV-positive women for cervical cancer, treated nearly 3,000 people for TB, and provided maternal, newborn, and child health services for families. 

To ensure these gains last, the team worked hand in hand throughout the project with Zambia’s Ministry of Health, filling critical gaps and building the capacity of health care workers, laboratories, and community volunteers. 

Staff of the Zambia Integrated Health project were stationed in health facilities throughout the three provinces where the project worked. In addition to supporting health facilities, they trained community-based volunteers and certified them as counselors. These volunteers are critical pieces of the health care system in Zambia; they know the clients, are part of the same communities, and can build strong relationships with them. 

The project’s District Hub Coordinators made sure facilities had the staffing and transportation they needed. They reviewed data and plans with teams, addressed human resources needs, and provided technical capacity building. 

The project also brought health care staff together for training on new and emerging topics, like mental health. 

“Zambia Integrated Health has helped with staff shortages, especially in ART [antiretroviral therapy], training of community-based volunteers, testing, tracking, integration, and more,” said Christine Matulula, Ministry of Health staff in charge of Epafu Rural Health Center in Chingola District, Copperbelt Province. “They [Zambia Integrated Health staff] look at service delivery and records and give guidance and training on gaps. We look at this once a month at our facility.”

The work of the Zambia Integrated Health project helped Zambia continue to make progress toward its national health goals, including reaching HIV epidemic control.

“I’m proud of the capacity we’ve built and the strong partnership we’ve had with the government. This project has been unique because it has gone beyond HIV services alone to strengthen how care is delivered for whole communities,” said Zizwa Phiri, a District Hub Coordinator with the project.

The legacy of Zambia Integrated Health lives on not only in stronger systems and better-integrated services, but also in community members like Makayi, whose experience now helps others access care with dignity, trust, and support. In that way, the project’s impact will endure not only in clinics and data systems, but in the relationships and community-based networks that continue to connect more Zambians to the care they need.