In 2016, the World Humanitarian Summit set a target of 25% of all international aid to go to grassroots organisations by 2020. Yet recent estimates of such assistance reaching local non-governmental organisations (LNGOs) range from between 2% (Development Initiatives) and 8% (Donor Direct Action, from OECD data).

In Zambia, however, the UKAID-funded Ascend programme is investing in the capacity of LNGOs as a key part of its strategy in supporting the Ministry of Health to eliminate or control selected neglected tropical diseases (NTDs). Nearly 60% of Ascend’s country budget in Zambia is contracted to local organisations, for activities including the prevention of lymphatic filariasis (also known as elephantiasis) and trachoma, and support for the country’s COVID-19 response.

This local capacity is being built using Ascend’s contracting model, which allows for competitive tendering of activities within a country. This means that any organisation registered in Zambia is eligible to bid, with priority given to those which have worked with the Ministry of Health and meet the technical requirements. This tendering process has been used for many of the programme’s core field-implementation activities: mass drug administration (MDA), morbidity management and disability prevention (MMDP), and disease-specific assessments, whilst tailored responses to COVID-19 were single-sourced due to the specific nature of the activities.

In Zambia these activities include:

• A knowledge, attitudes, and practices (KAP) survey on COVID-19 — implemented by the Centre for Infectious Disease Research in Zambia (CIDRZ), a Zambian non-governmental organization (NGO) together with Viamo, a digital technology firm founded in Ghana (and now headquartered in Canada).
• MDA and morbidity mapping for lymphatic filariasis (LF) — implemented by Akros Inc., a small firm with most of its staff based in Zambia.
• MDA, MMDP, and surveys for trachoma — implemented by Lions Aid Zambia, a Zambian NGO.

These organisations were selected based on the strength of their experience and respective bids in Ascend’s competitive tendering process. In turn, Ascend has entrusted them with representing the programme in critical, public-facing roles, while helping to build the LNGOs’ managerial and technical capacity. By widening the pool of partners that remain present in Zambia, Ascend is helping to avoid the loss of local technical capacity that can occur as a project comes to a close.

ASCEND IN PRACTICE

Opening local organisations up to larger, international partners

Under Ascend, the local organisation, CIDRZ, has had the chance to collaborate with new international partners, such as Viamo. Together, these partners are conducting Zambia’s first COVID-19-related Knowledge, Attitude and Practices (KAP) survey, on behalf of the Ministry of Health (MoH) and the Zambia National Public Health Institute (ZNPHI).

As part of the project, CIDRZ and Viamo completed a national phone survey of more than 8,000 people. This data is to be used by the MoH and ZNPHI to finalise a national risk communication and community engagement (RCCE) plan in response to COVID-19. The aim is “to engage communities and individuals in understanding and taking ownership of their situation, so that they can take the necessary actions to prevent the spread of the virus.” This will include “healthy behaviours that can reduce personal and societal risk.” A “feedback loop” is also being instilled so communities can fully understand “surveillance, quarantine and burial service protocols” and health service providers can more easily respond to the communities’ needs. (1)

Anjali Sharma, Senior Research Technical Advisor at CIDRZ, noted the importance of the work, stating that “the survey can serve as a baseline and inform interventions. It’s timely. When other surveys and qualitative work emerge this can be used to triangulate information. It will serve as a baseline for a third wave of COVID-19, and for designing and evaluating interventions.”

This new opportunity has given CIDRZ a seat at the table in Zambia’s wider response to COVID-19.

Enabling smaller organisations to lead

Akros is supporting the MoH in conducting mass drug administration for LF, in 80 districts with a target population of over 10 million people. The fifth and latest round of MDA is a critical step in Zambia’s LF elimination programme – if the required treatment coverage (65% of the total population in each district) is reached, the Ministry will be ready to proceed with a pre-transmission assessment survey (pre-TAS) as a first step toward assessing whether it is safe to stop MDAs.

Alongside this, Akros is also supporting the MoH in identifying cases of LF morbidity, mainly people with hydrocele (swollen scrotum) and lymphedema (swollen limbs), in the same districts. The information collected will enable those affected to receive surgery or hygiene-based services.

This is Akros’ first time helping to lead these LF-related activities, as well as working directly with the national NTD programme on LF. Through the Ascend programme, Akros was technically supported on how to structure an MDA in collaboration with the MoH; how to support the MoH in using its existing delivery, monitoring, and reporting systems; and on the design of morbidity mapping components. The organisation is now prominent in the country’s NTD space.

Helping local NGOs work directly with ministries on a national scale

In 2019, Lions Aid Zambia (LIAZ) supported Zambia’s MoH in conducting the very first Ascend-supported MDA across the entire 11-country programme. This included conducting MDA to treat 111,621 people for trachoma in two districts of the country’s Western Province.

Ascend guided LIAZ and the MoH through forecasting and quantification of the medicines required for this MDA, including a physical audit of stocks beforehand to confirm their locations and expiry dates.

Ascend coached LIAZ to use the WHO-recommended Supervisors’ Coverage Tool (SCT), which is used by sub-district-level supervisors to quickly assess treatment coverage. This work enabled both districts receiving the MDAs to exceed the required 80% treatment coverage.

“The support received in the development and roll-out of the tool from Ascend was invaluable. Lions Aid will continue to use the tool and plans to digitalise the data collection to ensure real-time analysis of data and make timely corrective action,” said Nicholas Mutale, Executive Director, Lions Aid Zambia.

In 2021, LIAZ will carry out a broader range of activities for trachoma control under a second contract with Ascend, including supporting the Ministry in conducting additional trachoma MDA in 15 districts.

LIAZ will also support the MoH in finding and treating people living with the painful eye condition known as trachomatous trichiasis (TT). Both the MDA to reduce active infection and the TT surgeries to manage morbidity are required to achieve the elimination of trachoma as a public health problem in Zambia.

This opportunity has enabled LIAZ to lead as an implementing partner for trachoma control in Zambia for the first time, working at national scale. By working directly with the Ministry, with reduced layers of administration, the NGO is providing strong value for money.

This new role has significantly raised the organisation’s profile both within the Ministry and with other partners and potential donors, and is helping to ensure that technical and organisational capacity remain available in the country well into the future.

(1) Standard Operating Procedures (SOPs) for Community Engagement in Zambia during the COVID-19 pandemic (draft),” MoH Health Promotion Department, 30 June 2020.