WHILE critics have continued questioning Government's decision to procure mobile clinics to service rural areas, the integrated community mobile voluntary counselling and testing (VCT) and other services, which is being implemented in Itezhi-tezhi District, has left indelible marks on society.

This mobile clinic has been in existence for the past three years and beneficiaries of this service are wondering why the mobile clinics proposed by the Government have suddenly become a controversial topic when it has been used in the past successfully.

The integrated community mobile VCT is aimed at improving people's accessibility to basic health services and about K1.7 billion has been pumped into the project.

This is a UN/Government project under the Service Improvement Delivery Fund (SIDF) at Cabinet Office that was solemnly employed to address four main health problems in the district.

Itezhi-tezhi District has 11 rural health centres and a district hospital. However, only three of these health centres are accessible throughout the year while the remaining eight are out of reach for about six months and this is during the rainy season.

The situation means that health service delivery to these health facilities from the district hospital as well as from the health centres to the community becomes unreliable and erratic.

This has further been compounded by high levels of ignorance about HIV/AIDS and the misconceptions surrounding the fight against it.

For instance, prior to the mobile services when the services were centralised at the district hospital, out of the district population of 91,267 only 1,818, representing two per cent, had accessed VCT while only 468 were put on anti-retroviral treatment (ART).

It was the same case with child health where the district health management team struggled to improve children's health status through intensive immunisations.

Additionally, it was discovered that many expectant mothers preferred to deliver at home because of various strong traditional beliefs, a situation which had escalated the maternal mortality rate in the district.

According to health authorities in the district, many expectant mothers shunned antenatal clinic citing various reasons, while complications in pregnancies were always associated with witchcraft and other mysteries.

Since 2005, the district had been failing to reach the national targets in all the service delivery indicators.

According to district statistics, the percentage of supervised deliveries has been falling since 2005 contrary to national data that showed otherwise.

It was inevitable that the Government felt it a priority to put in place mitigatory measures to such health problems that had plagued the community.

Thus the idea of the integrated mobile VCT and health services was conceived, employed and immediately implemented through the district health management team.

Since its inception in 2007, the integrated community mobile VCT and health services has turned the sorrows of the community into joy wherever it has visited and whoever the services has touched.

Nurses and other health workers have been moving their caravan to the 11 health centres in the district at least once every month to offer health services to many people who might find it difficult to travel long distances to the nearest clinic.

As mentioned earlier, there have been smiles among many people who have benefited from the mobile services while the health management team in the area is convinced that there has been drastic change of attitude by the community towards health.

"Thanks to this arrangement of moving with a vehicle from one clinic to another, I would have died," said Obert Mpamba who was referred to the district hospital from Lubwi, more than 40 kilometres from the district hospital. "When they saw that I was in a critical condition during their (health workers from district hospitals) visit, they decided to bring me here (hospital)."

Mr Mpamba said because of long distances to nearest clinic as well as the hospital, many people were failing to access the health services, which made the mobile services even more appropriate.

"This is the best way you can help those in need of health services especially those in remote areas. For those who are against mobile hospitals, they should realise that tomorrow it will be them who will need it," he said in an interview at his hospital bed.

Sharon Kakoma is 19 -year-old mother of one who has benefited greatly from the lessons on how best she can keep her child health as well as how to keep her environment clean.

"As a young mother, I have learnt so much, starting from when I was pregnant up to now when I am taking my baby to the under-five clinic.

"However, there are others who still feel that it is not necessary to attend ante-natal clinic or under five clinic for reasons I may not know, but for me, the mobile services have been helpful because I have learnt a lot," she said.

She urged the health management team to continue with every effort of educating the people in the community on the importance of attending ante-natal clinic as well as delivering at a health centre.

As for Nelly Shimbizhi, the integrated mobile health services had managed to convince many women to go and deliver at the clinic unlike it had been in the past.

"Apart from the health workers who are coming to see us in the rural health centres, we have traditional birth attendants who have done a good job in educating mothers in villages on the need to attend clinic during pregnancy," she said.

The significant change that the integrated community mobile VCT and other services has brought among the majority poor in Itezhi-tezhi District is evident and observable by all sectors of society.

"This hospital has really worked to address our problems and I just hope they will be able to sustain the movements they are making to remote rural health centres," said Hosea Chaaba.

Mr Chaaba said stigma among the people had reduced as many people were free to talk about AIDS without fear of being laughed at while mothers were educated on good health.

Mr Chaaba's observations were further backed by the statistics at the health management team, which revealed that up to 14,108 people attended VCT since 2007 with the current average of more than 265 people attending VCT compared to 120 for the baseline.

Moreover, 195 deliveries were conducted by TBAs representing 30 per cent of the total 446 deliveries conducted only in the second quarter of this year while first ANC attendance has increased to 87 per cent in 2010 in the same period in comparison to 44 for the baseline.

"Generally there has been a great success that was even recognised by the United Nations last year when they won a UN Public Service award under the 'improvement in service delivery'," said district medical officer, Dr Mulenga Kasoma who is also project coordinator.

But perhaps the most important aspect of the mobile services is that it has managed to attract more people to seek health services by cutting the distance from their villages to the health centres.

Dr Kasoma said before the integrated mobile VCT and health services project, some people used to walk more than a day to the nearest hospital a situation which discouraged many patients.

"There has been a general improvement in the health delivery of service because we have created understanding with the community. Child immunisation has increased while babies that are born from HIV positive mothers are taken care of," she said.

Dr Kasoma said the management had trained 25 TBAs whose job was to identify the dangers in pregnancies and refer the expectant mothers to hospitals.

The integrated health services in the district have undoubtedly proved effective in addressing health difficulties as it has managed to reduce the maternal mortality rate and increase access to basic health by the people.

However, there is need for strong efforts from all stakeholders, community inclusive to ensure that steps taken so far are not reversed but sustained for the good well-being of the people in the district.