Zambia Empowers Health Workers to Tackle SRHR Stigma Through VCAT Training

In a transformative step toward enhancing access to sexual and reproductive health and rights (SRHR), Zambia's Ministry of Health, supported by the World Health Organization (WHO) and partners, has introduced a Values Clarification and Attitude Transformation (VCAT) training programme aimed at challenging stigma and personal biases among healthcare providers. This initiative marks a significant shift in addressing deep-rooted societal and cultural barriers that hinder adolescents and young people from accessing family planning and safe abortion services.

The programme, conducted in March 2025, brought together 30 participants, including community health assistants and provincial community health focal persons from all 10 provinces of Zambia. It aimed to address the uncomfortable truths around judgmental attitudes, misinformation, and hesitancy among healthcare providers when it comes to serving young people.

A Step Toward Attitude Transformation

VCAT, a globally recognized approach, encourages health workers to examine their personal values, beliefs, and cultural assumptions. By fostering critical self-reflection, the training empowers participants to distinguish between personal views and professional responsibilities, promoting non-judgmental, empathetic, and rights-based care.

“In Zambia, deeply rooted cultural, religious, and societal beliefs influence people's views on SRHR, particularly on topics like abortion, contraception, and adolescent sexuality,” explained Dr. Samson Chisele, an Obstetrician-Gynaecologist at Lusaka’s University Teaching Hospital and a leading SRHR advocate.

Dr. Chisele, who facilitated the training, observed that many community health assistants were comfortable offering contraceptives to married adults, but showed reluctance when approached by adolescents. “VCAT helped them realign their duties with public health policy, focusing on the right to care for all, regardless of age or marital status,” he said.

Addressing a Public Health Crisis

The initiative comes at a critical time. According to the Ministry of Health’s Maternal and Perinatal Data Surveillance and Response (MPDSR) system, approximately 760 women died due to pregnancy or childbirth-related causes in 2024. Notably, unsafe abortions contributed to 5.1% of these maternal deaths—deaths that could have been prevented under Zambia's 1972 Termination of Pregnancy Act, which permits abortion under several conditions, including threats to physical or mental health, foetal health risks, or socio-economic hardship.

However, lack of awareness, stigma, and resistance—both within communities and health facilities—have significantly undermined the availability and acceptance of legal abortion and family planning services.

Breaking the Silence, Creating Safe Spaces

Through storytelling, group exercises, and legal and clinical briefings, the VCAT training enabled participants to reframe SRHR issues within the lens of public health, dignity, and human rights.

Helen Mwape, a community health assistant in Copperbelt Province, recalled how the training had a practical impact. “I received an adolescent for family planning, and she had learned about it through a community-based volunteer. That was a breakthrough moment.”

Similarly, Danny Kasongo, from Mansa District in northern Zambia, shared that he had already implemented his post-training action plan:

“I have oriented my colleagues on VCAT, held stakeholder meetings, engaged community volunteers, and established a youth-friendly corner where adolescents can openly discuss SRHR issues.”

Community Engagement and Resistance

While the programme is showing early success, it is not without challenges. Resistance from community members—especially parents and guardians—remains a major hurdle. However, success stories are emerging.

Hamatanga Gwangai, a health worker in Chibombo, shared:

“At first, there was backlash from parents about youth accessing contraception, but after engaging them through community dialogue and sharing real-life consequences, they agreed.”

This engagement underscores the importance of local buy-in and the role of community-based volunteers and leaders in supporting young people’s access to care.

Long-Term Vision and System Integration

VCAT is not just a short-term fix—it represents a paradigm shift in how healthcare is conceptualized and delivered in Zambia. The WHO has emphasized the importance of institutionalizing this approach.

“By targeting the root of stigma and empowering health providers, this programme is helping ensure no one is turned away or shamed when seeking care,” said Dr. Clement Peter Lasuba, WHO Representative in Zambia.

Dr. Chisele believes that for lasting impact, VCAT should be integrated into medical and nursing education curricula, teacher training colleges, and civil service induction programmes. He also advocates for digitizing and modernizing the delivery of VCAT to appeal to younger, tech-savvy healthcare workers.

“We need localized, co-created modules developed with input from community leaders and marginalized groups to ensure relevance,” he noted.

Toward a Healthier, More Inclusive Future

The VCAT initiative, while still in its infancy, is already planting seeds of change across Zambia’s healthcare landscape. It is reshaping the attitudes of frontline health workers, empowering adolescents, and laying the foundation for more inclusive, equitable, and compassionate healthcare.

As the trained participants return to their districts, they are expected to act as change agents—training peers, opening community dialogues, and continuing the fight against stigma, ensuring that no adolescent or woman is left behind when it comes to accessing lifesaving SRHR services.