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Grantee stories

If you build it, they will come: Improving healthcare for transgender, intersex, and gender diverse communities

Grantee Partner: Transbantu Association Zambia

Grant type: Strengthening

Priorities: Stigma, Access

Country: Zambia

Transbantu Association Zambia (TBZ) share how they are working to ensure comprehensive, safe, and non-judgmental healthcare services for trans-diverse and intersex people across Zambia.

Access to healthcare is a cornerstone of human rights. The constitution of the World Health Organisation states that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” Despite this, in many places across the globe, comprehensive, quality healthcare is out of reach. Furthermore, stigma and discrimination are a pervasive barrier to accessing healthcare for many people, including lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ) communities. However, LGBTIQ civil society and grassroots organisations are leading the charge to improve health access and outcomes for their communities.

Transbantu Association Zambia (TBZ) is based in Lusaka, Zambia. TBZ is committed to creating an enabling environment where trans-diverse and intersex people enjoy their full potential and have access to social justice, better health outcomes, and opportunities through a rights-based approach, advocacy, and collaboration.

The organisation operates with staff and volunteers in four districts of the Western Province and with trained peer leads in three towns in Copper-Belt Province, Livingstone (Southern Province), and recently, Kabwe (Central Province). Western Province is highly traditional, overseen by the leadership of the Royal Litunga (King of Barotseland). Livingstone is Zambia’s tourist capital, while Copper-Belt is a mining province home to people from diverse backgrounds. Lusaka, being the capital city, is populated by a myriad of people from all walks of life looking to earn a living in the fast-paced city.

Four people sit at a table with notepads.

Zambia is a highly conservative nation that uses ‘Christian values’ as a benchmark for its laws and policies. The reality of how these are implemented varies widely, and access to healthcare is a complicated journey for the Zambian LGBTIQ community. Over a number of years, TBZ has engaged with healthcare providers to create an enabling environment for safe, prejudice-free, and equitable access to health services. As a result of this work, the team identified specific areas for improvement:

  • There is a general lack of sensitivity by healthcare staff, perpetuated by a gap in training curricula about the needs of diverse individuals, including considerations for respectful, non-judgemental treatment to key populations.
  • There is a limited coherent and comprehensive understanding of the intersecting healthcare needs of transgender, gender diverse, and intersex individuals, and other sexual and gender minorities.
  • There is a need for optimal knowledge and skills in addressing the transgender-, gender diverse- and intersex-specific health needs that interact with intake of hormones and other treatments.
  • There are gaps in policy documents and guidance on how to manage transgender, gender diverse and intersex patients. These documents are needed to serve as a blueprint for other satellite health facilities around the country to avoid long-distance health referrals to Zambia’s biggest hospital, University Teaching Hospital (UTH), based in Lusaka.

Using this learning, TBZ established the ‘If you build it, they will come’ project to develop a model healthcare facility for equitable, gender-affirming healthcare for transgender, gender diverse, and intersex individuals and other sexual and gender minorities. The project leverages the expertise, resources and influence of UTH to effect change. A number of activities have already led to incredible progress in healthcare for the Zambian LGBTIQ community.

TBZ embarked on a series of project-based trainings on sexual orientation, gender identity, gender expression and sex characteristics (SOGIESC) sensitivity with UTH and other health facilities’ staff. These trainings raised awareness on specific issues and needs of transgender, gender diverse, and intersex individuals and other sexual and gender minorities, as well as built rapport among staff. TBZ mapped out the healthcare facilities providing services to key populations to support the roll out of improved services and a referral system for gender-affirming care. By strengthening the referral system across healthcare facilities, more LGBTIQ individuals seeking support and care understand where they can safely go to access services.

Seven people are sat around a table inside a conference room.

Through using a process called Setting the Levels (STL), peer leaders trained by TBZ collected feedback on service quality at these facilities through a participatory community-led platform for monitoring service provision. The STL process built understanding of perceptions and perspectives from the LGBTIQ community as they accessed health services. Feedback was shared with all mapped facilities, including UTH. This gave TBZ an opportunity to engage with UTH management on the issues raised. As a result, UTH reported improved interaction and service provision to transgender, gender diverse and intersex patients that seek services at the UTH – Adult Infectious Disease Centre (AIDC). This process has additionally led to an official memorandum of understanding between TBZ and UTH to collaborate as partners to improve overall service delivery at the Adult Centre of Excellence at UTH. TBZ and UTH are now working towards setting up a model that would serve as a blueprint in supporting access to gender-affirming services for other facilities across the country.

While the project so far has seen key successes in improving service provision for transgender, gender diverse and intersex individuals, there has also been a number of challenges that TBZ has identified that they are working to address through the project. These include:

  • The gap in SOGIESC sensitivity and understanding of providers outside of the UTH-AIDC space, such as in the outpatient department and other general clinics at UTH. TBZ are holding ongoing conversations around sensitivity training with further UTH staff.
  • The move or transfer of healthcare staff trained in SOGIESC sensitivity from other facilities, making it difficult to track and measure the impact of the trainings in specific healthcare facilities.
  • The gap in specific gender-affirming services such as hormone replacement treatment and mastectomy at UTH even though these services are ordinarily available and provided to menopausal women and breast cancer clients, respectively. More evidence gathering from affected communities and advocacy on these treatments will follow.
  • A gap in operating procedures to guide the provision of care to pre- and post-transition clients and intersex clients, as well as mental health services tailored to the specific and unique needs of sexual and gender minority groups.

The project is ongoing, and to date, TBZ have made great strides in strengthening quality, comprehensive healthcare to transgender, gender diverse, and intersex individuals in Zambia. Building on this work, TBZ look forward to establishing relationships and engaging with key government stakeholders such as the Ministry of Health, National AIDS Council, parliamentarians, Ministry of Justice, Ministry of Home Affairs, and research institutions, as well as global bodies such as the UN, UNFPA, and the Human Rights Commission, to establish further improvements for the lives of LGBTIQ individuals in Zambia.

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