Applying a Systems Thinking Approach to Health Care for Women & Children in the Flood Plains of Western Zambia

Abstract

At least half of the world’s population are reportedly unable to obtain essential health services with significant gaps being noted in sub–Saharan Africa and Southern Asia. Access to health services incorporates physical accessibility, acceptability and affordability and is influenced by multiple factors. Environmental factors such as flooding and changing weather patterns due to global climate change, contribute to limited geographical access to health services particularly for rural communities. Like many low- and middle-income countries, Zambia, a predominantly rural country in southern Africa has some poor health indicators such as high infant and under-five mortality rates, demonstrating that some communities are lacking access to essential health services. The aim of this research was to apply a systems’ thinking framework to the investigation of contextual factors influencing access to maternal and child health (MCH) services in Zambia’s Western Province where there is increasing variability in seasonal floods, with a view to improving mitigation strategies. The main objectives of this study were: 1) To identify the effects of flooding on access to maternal and child health services in flood prone areas of Western Province, Zambia. 2) To explore the perceptions of environmental change among residents of the Zambezi flood plains in Western Province and how these changes influence health outcomes. 3) To understand the interaction of contextual factors on public health interventions for maternal health from a systems perspective and identify potential leverage points for improvement. A qualitative study design was used for this research based on interviews, focus group discussions observations and some document reviews. Data collection for this research was undertaken over several field visits between June 2019 and February 2021. The findings of the research indicate that there were four main effects of flooding on access to care. These were disruption of the health service delivery system, disruption of routes of access and transportation challenges, negative economic effects and negative effects on water and sanitation. Environmental changes most reported by residents in the flood plains were changes in timing of the different seasons and rainfall patterns and increasing intensity of both droughts and floods with devastating consequences on the livelihoods. Consequently, residents’ resort to use of traditional remedies and self-medication to treat illness. Home deliveries are common for remote communities with many complications reportedly being experienced. Contextual factors that are influencing the effectiveness and outcomes of maternal health interventions included political and developmental factors, socio-cultural factors, and environmental factors. The findings illustrate the effects of floods on access to essential health services in the flood plains of Western Province. They also describe the perceptions of residents on environmental changes observed and the resulting health outcomes experienced. The interaction of different systems in influencing access to health services and public health interventions is presented demonstrating that long term solutions require a multipronged strategy involving multiple departments and the participation of local communities. The study makes several significant contributions. It builds on existing knowledge on the potential of a systems approach to strengthening design of interventions for health system challenges. By applying a systems framework and using some systems tools it makes theoretical and methodological contributions. It also adds to the body of knowledge on the effects of flooding on health systems in LMICs such as Zambia. These findings are significant for the global community to be aware of the wide-reaching effects of ongoing climate change among communities that contribute minimally to such change.