MORE EFFORTS FOR MENSTRUAL HEALTH: Lack of information, high cost of products affect adolescent girls

IN A given month, an adolescent girl from a vulnerable home would be absent from school – sometimes for three to four days straight, due to menstrual poverty, ultimately translating into days of missed classes and lessons.

A 2011 report by the United Nations Educational, Scientific and Cultural Organisation (UNESCO) estimated that one in 10 African adolescent girls miss school during menses and eventually drop out because of menstruation-related issues.

These issues vary from the inaccessibility of affordable sanitary protection, the social taboos related to menstruation and the culture of silence that surrounds it.

Martha Chanda, a Lusaka-based sexual and reproductive health activist, says this cultural scenario is concerning.

“Menstruation is not a choice, unlike other things that everyone seems to be paying so much attention to,” she says.

She says the continued silence around menstruation, combined with limited information at home and schools, is impacting negatively on girls and women’s health. Many girls are affected by menstrual hygiene management issues in schools, hence it has become a serious barrier and threat to their education.

Add also the cost of sanitary pads which could be out of reach to some, especially those from families of low-income status, it has not made things any easier.

“This prompts girls to resort to the use of Banana fibres, sponges, pieces of cloth and cotton. However, such alternatives pose health risks and discomfort to girls, lowering their dignity, concentration and performance levels in class,” she says.

Whereas most urban schools have at least responded positively to the call of menstrual hygiene through establishing menstrual hygiene and sanitation-friendly facilities, the story is different for those in rural areas.

“We should encourage local initiatives that produce reusable sanitary pads and make them accessible and affordable,” she says. “It is also imperative to promote girl talks in schools facilitated by mainly female teachers, counsellors and parents, with the rationale of discussing menstrual hygiene.”

With poverty as high as 78 percent in rural Zambia, girls there cannot afford sanitary pads, which on average cost about K20 per packet of 10 pads. In order to improvise, adolescent girls then resort to using rags and always miss class when their menses are heavy for fear of staining their clothes because most girls lack supplies to safely and hygienically manage menstruation while at school.

Not only that, girls’ school attendance becomes less consistent after fifth grade, according to a report on Zambia by UNICEF, the UN child advocacy agency.

Apart from sanitary supplies, insufficient water and sanitation facilities in schools are also a key factor contributing to adolescent girls dropping out of schools.

A 2008 report of the Ministry of General Education’s education management information systems revealed that “most girls find it difficult to manage their menstruation in environments without water and convenient sanitation facilities, such as washrooms and sanitary disposable points.”

The report estimates that only 29 percent of schools in Zambia met the World Health Organisation’s recommended pupil-toilet ratio of 25 boys per toilet and only nine percent met the recommended ratio of 20 girls per toilet.

While policy pronouncements take time to implement, every time wasted, a girl is dropping out of school because of menstrual-related issues.

“All I know is that when a girl is on her periods, she is unclean,” answered a grade seven pupil at Kamanga Primary School when asked what he knows about menstrual hygiene.

Now, it is this kind of mentality, coupled with all the many other cultural myths and beliefs surrounding menstruation, that has forced the information gap to widen.

Again, in traditional Africa, when a girl or woman is menstruating, she is not, among other things, allowed to cook.

UNESCO says the cost of sanitary pads is a problem throughout the continent and estimates that one in 10 girls in Africa misses school during their menses and eventually drop out.

For most pupils in rural schools, using sanitary pads is a far-fetched dream, at least until free distribution for rural girls begins.

Gender activists have been calling for free distribution of sanitary pads as opposed to condoms because menstruation is not a choice, whereas sex is.

Reigning Miss Zambia Natasha Mapulanga is one such other activist that has taken it upon herself to champion calls for an inclusive menstrual health education and hygiene, especially among adolescents that fall below the privileged divide.

Another such organisation, among many others, is the faith-based organisation Adventist Development and Relief Agency (ADRA). It too has been implementing programmes such as a three-year-long Menstrual Health in Urban Townships (METRO BMZ) project worth 364,000 euros in Lusaka.

Speaking at the launch of the project recently, ADRA Zambia country director Kennedy Habasimbi stated that the project is aimed at increasing gender equality and empowerment of vulnerable township girls and young women.

“We shall do this by addressing some identified barriers and challenges to accessing adequate menstrual health and hygiene management,” he said. “ADRA’s theory of change on menstrual hygiene management is that to enhance access, we need to ensure awareness, availability of services/ products and affordability.”

The project intends to reach about 60,000 community members who include girls, women and boys.

NOTE: This article was also published in the Zambia Daily Mail newspaper of Friday, January 6, 2023.

TAKING CHILD MARRIAGE PERSONAL: Choma youth picks mantle to reduce Zambia's global ranking on early nuptials

WITH 42 percent of women aged between 20 and 24 years married off by the age of 18, Zambia ranks among countries with the highest child marriage rates in the world.

Currently, Zambia is ranked 16th amongst countries with the highest rate of child marriage in the world, and although the Marriage Act establishes a legal age for marriage, and the Penal Code makes sex with a girl under 16 an offence in Zambia, these provisions rarely apply in customary law.

Owing to this, early child marriage has become a vital topic of discussion amongst several development platforms, so much that the vice has now become even more visible to many people, including those that were previously unaware of its existence.

And as the local proverb goes: “One finger cannot crush a louse”. There is indeed strength in numbers.

This proverb holds true in the fight against early or forced marriage.

The future of most girls is threatened by early or forced marriage, making it a national concern, bringing many organisations and people on board, all in an effort to mitigate it – this includes 30-year-old Choma-based activist Genious Musokotwane.

I caught up with the budding youth who has decided to dedicate not only his time, but also resources, to fighting the vice and sending children, especially girls, to school.

At his young age, Mr Musokotwane is also executive director for the Musokotwane Compassion Mission Zambia (MCMZ), a Choma-based non-profit and youth-led organisation that frontiers the fight against child marriages.

Not only that, his organisation, which has on a number of occasions retrieved many girls from forced or arranged marriages in Choma and surrounding areas, has also been ensuring that it meets their needs.

“I am just a simple Zambian, life transformation servant driven leader,” is how Mr Musokotwane describes himself.

Born in Kalomo in 1992, Mr Musokotwane was raised by a single parent, a thing that motivated him to found MCMZ.

“I grew up to know that I was a solution to my community,” he says. “When my mother died when I was 10 years old, I went to live in the village and my time in the village as a young boy birthed my passion to bring about positive change.”

At the age of 14, an opportunity availed itself for him to attend a boy’s camp under Peace Corps as a volunteer.

“At the end of the camp, we were all asked to take a quiet moment and reflect on things we would love to change in our communities,” he says. “It was at this point that the early child marriage problem resurfaced. It was in the same year that the 2007 Demographic Health Survey on Zambia was released and it indicated that half of Zambian women were married before the age of 18 years.”

Out of his passion, Genious, then aged 15, engaged Chief Chikanta of Kalomo district and Chief Cooma of Choma district and shared with them his ideas on the best practices of ending early, forced and child marriages in their chiefdoms.

“It was at this point in 2008 that Musokotwane Compassion Mission Zambia (MCMZ) was founded with the sole purpose of influencing chiefdoms, traditional leaders, government and others to end child marriages and also meet basic needs of girls retrieved from such toxic unions,” he says.

Today, MCMZ is a member of the Girls Not Brides global partnership on ending child marriages worldwide. It is also an approved Public Benefit Organisation (PBO) in the republic of Zambia.

“Since inception, over 500 girls have been retrieved and put back in school under the advocacy, education and capacity building thematic areas,” says Mr Musokotwane.

His organisation has since expanded its operations into Kazungula district, adding on the other three districts, Monze, Pemba and Choma.

MCMZ is also a transit facility for survivors of child marriage. This, he says, is done in accordance with the Government's vision and aspiration to reduce the number of children raised in institutional care through the implementation of an alternative care plan where the organisation partners with a volunteer family to keep and care for any such survivor or child.

The organisation is also a trainer of trainers in organisation strategic planning, data for decision making, monitoring and evaluation and also trainer of trainers in child protection policy and disability inclusion.

It is also building classes for its formal and skills training school at its Choma farm as part of its transition into a transit centre for survivors of sexual violence and child marriage.

Asked what it was like setting up MCMZ, Mr Musokotwane says it was challenging at first, but has no regrets now.

“But I believed in myself, I understood God had called me to this and I never expected a smooth path. With this view in mind, it made everything easy. Also, Chief Chikanta and Chief Cooma supported me with what I needed and knowing that I had such traditional leaders behind me, and being called for this made the whole thing adventurous,” he says. 

“The programmes are being received very well as we have traditional leaders raising the flag to end child marriage and over five chiefs and their headmen have been trained and are now champions of ending child marriage.”

He says in rural areas, it is always important to work with traditional leaders if you want to achieve positive change.

He says child marriage has been a traditional practice that has escalated now because of poverty levels.

He recalls how while in primary school, a school mate got married off and later lost her life during child birth. Up to now, it still hurts him that his schoolmate had no one to stand up for her.

“If someone stood [up] for her not to be married off, she probably would still be alive today. This has continued to pop up in every case that we come across and that's what drives us to stand for girls and help even when we have little to give to the down-trodden girls and children,” he says.

The impact isn’t just on society and the retrieved girls. It has also had an impact on Mr Musokotwane.

He says: “Serving as a lead servant at MCMZ has made me realise that we are all tools in God's hands. The opportunity has changed my view of success as not the acquisition of fame, material things or money but by how our actions, lifestyle and character bring the kingdom of heaven to those in distress.”

He adds: “The privilege to serve under this organisation has made me have a global view on how best we can improve our communities and the country’s social and economic development for all.”

MCMZ retrieves girls from child marriages and provides them with shelter, basic needs, and education support through a school sponsorship programme.

“MCMZ work improves the protection, health and education chances for girls, and widens their economic opportunities in society,” he says. 

“Child marriages are mainly driven by poverty, perception of girls as only good for marriage, inequality among boys and girls, and also [bad] traditional practices. We can curtail these by investing in the education of girls, especially those at risk of falling into the trap and also those already retrieved.”

He adds that improved economic opportunities for families in rural areas are key in the fight against the vice.

“Since inception, we have been dealing with 20 cases on average, annually. We need to abolish all those traditional practices that impede the development of young girls,” he says.

To keep afloat, the organisation has some income generating activities such as farming, beverage brewing and supply, fundraising galas and musical concerts, crowd funding and individual donors.

He says a number of prominent private and public schools in the district have partnered with his organisation to offer scholarships to the girls under its auspices and care.

It operates within four thematic areas, namely, advocacy, capacity building, child protection, and education support.

“We hardly face resistance when rescuing these girls from these toxic marriages,” he says. “We are part of the victim's family support who are mostly the ones that report such cases to us and these are the same families we rely on for alternative care.”

Mr Musokotwane, who has been married for slightly under two years now, has earned himself a name for his actions and contribution to society. While acknowledging a reduction in the number of any such cases, he advises parents to desist from sending their children into early marriages.

 “The reduction could be attributed to concerted efforts by stakeholders and the government's free education policy. However, there is a need to continue addressing the poverty levels among rural areas as the vice is mostly propelled by poverty and hunger in most of these areas,” he says.

Mr Musokotwane who is also a promising young farmer in Southern province studied public relations at Evelyn Hone College and also spent some years in South Africa studying Missions and Leadership and while there, worked for a number of charitable organisations.

NOTE: This article was also published in the Zambia Daily Mail newspaper of Wednesday, January 4, 2023. 

NATIONAL HEART HOSPITAL OUT TO SAVE LIVES: Partnership with Japanese NGO to increase capacity to 50 heart operations per year

IN THE recent past, Zambia has made milestone strides in its voyage to become a regional hub for medical tourism, following successful operations on patients with heart medical issues at the National Heart Hospital in Lusaka.

Previously, Government would spend close to US$1 million annually in expenses to send patients for treatment abroad as there was no capacity to conduct any such surgery, while the burden of heart and other non-communicable diseases still weighed heavily on the country.

Recently, Ministry of Health Permanent Secretary Lackson Kasonka, while officiating at the signing ceremony of a contract between the National Heart Hospital and the Tokushima International Cooperation (TICO) in Lusaka, shared plans to be conducting 50 heart-related surgeries annually.

“Cardiac disease continues to be an enormous source of concern and a lot of our people are affected by congenital heart diseases that require surgical intervention for care,” he said. 

“Within our limited resources and capacity, we have only been able to place these patients requiring such surgery on the plane to other countries where such care can be of course given. Given the financial constraints of the country, we cannot provide that kind of treatment to everyone who deserves that kind of care.”

Dr Kasonka added: “As a result, we have observed the enormous inequity of access to care by most of our people, each one of whom deserves the same care. So, it is for that reason that we thought it is important to expand access to care. We need to invite organisations like TICO to partner with us so that we can provide this treatment within the confines of our country.

“… our ambition is that we should be able to reach 50 patients a year, assuming that TICO will continue to receive favourable support from well-wishers in Japan that are providing resources and other materials for making it easy for TICO missions to happen.”

Now, TICO, a Japanese-registered non-governmental organisation, has been around for some time. It registered in 1993 and has been operating various developmental projects in Asia and Africa ever since.

In Zambia, however, the organisation’s engagement dates back to as early as 1997, when it started its Ng’ombe Township Livelihood Improvement project. Since then, it has been assisting with upgrading of community school infrastructures.

Besides that, the organisation has further provided scholarships to Grade Eight and Grade Nine learners at Mwomboshi Elementary School and has additionally deployed ambulances and supported the training of paramedics to deal with injuries caused by road accidents and crimes that occur in Lusaka.

From that time, TICO has also been collaborating with the National Heart Hospital and the University Teaching Hospitals, culminating in not only knowledge transfer but also 26 heart-related operations, 10 of which were open heart surgeries under the cardiovascular surgery technology transfer project.

It is no wonder Dr Kasonka wants the country to double these numbers.

“On top of that, an almost equal number of patients with rheumatic valvular heart disease are waiting for surgery. In addition, the need for treatment of ischemic heart disease and aneurysms is rapidly increasing due to dietary changes and other factors,” shared TICO director Osamu Yoshida.

Mr Yoshida estimates that about 3,000 patients in Zambia are in need of heart surgery each year.

According to National Heart Hospital senior medical superintendent Chabwera Shumba, the partnership has been saving Government huge sums of money on evacuating patients with heart complications abroad on medical bills alone.

Dr Shumba hopes that, with the partnership now ‘cast in stone’, the hospital, which has performed over 100 cardiac operations so far, will be able to conduct even more surgeries locally with the help of TICO.

“We are proud as a hospital that our operations are reducing the cost of flying people out of the country [for specialised medical attention],” Dr Shumba said. “We are now able to have Zambian-led operations through valuable collaborations such as this one.”

Today, Zambian doctors, led by Chileshe Mutema, with close supervision of those from TICO, have been able to efficaciously conduct heart operations on patients admitted to the National Heart Hospital.

TICO is an international charity recognised and sent by the Japanese government to come and help build capacity in their Zambian counterparts in heart surgery.

Japanese Ambassador to Zambia Ryuta Mizuuchi says he is happy that TICO has been contributing to the advancement of Zambia’s medical technology, which has been transferred literally from hand to hand through the many joint surgery operations between the two.

He believes the partnership seeks to achieve a world-class medical treatment service in the field of cardiac surgery at the National Heart Hospital.

“Dispatching long-term experts is by no means easy. Therefore, TICO and the National Heart Hospital will need to develop more sophisticated operation schemes with the support of all stakeholders concerned, including the Ministry of Health,” he said.

While the recent partnership will see experts in each field trained to be able to perform 50 cases per year, by themselves by 2025, and to also build a safe and low cost system, there is need for multiple and adequately staffed such facilities in the country, given the growing population.

This article was also published in the Zambia Daily Mail of Thursday, January 12, 2023.

LUNGA MINI-SOLAR GRID PROJECT TAKING OFF: REA assures residents of full commitment despite challenges

IN JUNE this year, the Rural Electrification Authority (REA) board of directors, led by its chairperson Likonge Mulenga, took a trip to Luapula Province to familiarise themselves with the authority’s projects – past, present and future.

One such project visited was the Lunga mini-solar grid on the island district of Lunga.

Now, as hard as getting there may be – which may even take days for some due to the choice of a boat – the dwellers on this island that can only be accessed by either water or air transport have to concede to a life without electricity.

Implementation of phase I of this particular mini-grid project commenced in 2015, but it has stalled; prompting outcry from residents, including Chief Kasomalunga of the Unga people who demanded that the authority should expedite the connection of electricity to the island district.

“It’s not like people have refused this project. They have accepted it wholeheartedly. We are even lucky that we have a new government in place and a new board. If it was the previous team, maybe I would not have even come. I would have said that I was just going to waste my time, pantu balifilwa! Icalenga na bantu nomba bafulwa ati nililali fikacitika, pantu ku ncende shimbi ficitika mumwakafye umo (the previous group failed and this annoyed people to a point where they started wondering when they would see electricity because in some areas these projects only take a year),” Chief Kasomalunga told Mrs Mulenga and her team.

Among the assurances that Mrs Mulenga and her team made to the people of Lunga was that by July, the transportation of equipment would commence, to facilitate for the completion of the project.

As they say, delay is not denial. REA chief executive officer Linus Chanda says progress has since been made on the project.

He says: “So far, we have transported all the poles needed to run the distribution network and Standard Micro Grid will start works.”

Mr Chanda adds that a report, with all the details of the project, has already been submitted to the European Union, which is financing it.

He says as financiers, they are supposed to be updated on the project. Another report has also been sent to the Public Private Partnership Unit at the Ministry of Finance and National Planning to justify and clarify certain areas of the deal.

“Since we settled for a private company, and we are a public entity, we are required to send a report to them (PPP Unit) and they have responded and given us comments, which we are looking at,” he said.

He assured Lunga residents that the project remains one of those prioritised by the authority. 

“We are 100 percent committed to it and we are following it vigorously and cannot wait for it to be completed,” Mr Chanda said.

Since its inception, REA seeks to provide electricity infrastructure to rural areas using appropriate technologies and improve life quality in rural communities. 

Currently, it is implementing power projects using grid extension of the existing network, mini-hydro and solar systems to provide electricity to rural areas in Zambia.

Standard Micro Grid, an American and Zambian-registered entity, will be the third contractor to be engaged on the project. The other contractors had their contracts terminated in March 2017 and April 2021 following failure to meet their obligations.

Luapula Member of Parliament Chanda Katotobwe cannot wait for the project to be completed.

But he understands the challenges involved.

“It’s not an easy area to expedite works,” he said. “But we are hoping they can accelerate the completion of the project. I understand only poles have been transported there and works are yet to commence.”

Mr Katotobwe also understands that once completed, the project will trigger a massive economic boost on the island district. 

“We cannot downplay the importance of electricity in any locality,” he said.

As for Lunga District Commissioner Mathews Mwewa, the contractor is also exploring ways of involving the local community in the project.

“At the moment, nothing has been done apart from the transportation of the poles to the island. As you are aware, this is a hard-to-reach area and we are just calling on the authority to expedite this project because it is long overdue,” Mr Mwewa said.

According to REA, past contractors have mostly underestimated the scope of the project, leading to their failure to commence and complete works which include the construction of eight mini-grids on the island that has 18 marshes of land.

Once completed, the mini-grids are expected to directly benefit Lunga Basic School, Lunga Rural Health Centre, Lunga district offices, Chief Kasomalunga’s palace, the market and shops, churches, and over 880 households. 

Not only that. As part of its mandate to electrify rural areas, Mr Chanda has disclosed that REA has engaged Technology Development and Advisory Unit (TDAU) of the University of Zambia to conduct a wind resource assessment for a possible wind and solar hybrid power generation plant in Lunga.

Mrs Mulenga has previously promised to ensure that posterity judges her board differently by seeing to it that the Lunga solar mini-grid project is implemented as soon as possible.

“There is nothing to show for here and you can see that the people really need electricity. This really gives us an opportunity to focus on delivering on the promises and on our mandate. We have a mandate to bring electricity here, and we are going to do it,” she said.

NOTE: This article was also published in the Zambia DCaily Newspaper of Wednesday, December 28, 2022.