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The Zambia Malaria Foundation seeks to both encourage and assist
development in the Zambian health sector. By providing a forum for
communicating operations research activities and “best practices”
experiences, information in the following three technical areas can
be collected and then utilized to inform national policy and support
monitoring and evaluation efforts.
Health Sector Development
At the time of independence in 1964, Zambia inherited a health system
that was efficient although divided on urban-rural and racial lines. There
were few health facilities for the majority of the population and
therefore no equity of access to health. Although malaria was the
main health problem, cases were largely confined to rural areas with
most urban centres and large towns being malaria-free. Rigorous
enforcement and adherence to public health measures contributed to
the decline of malaria in urban areas.
After independence, health
infrastructure was expanded with a new emphasis on health for all. This resulted in
notable improvements in some health indicators. Unfortunately, an
environment of severe economic decline beginning in the 1970s made it
impossible for the government to sustain these expansion programmes
let alone maintain what had been achieved. As a result, by the late
1970s to the mid 1980s,
- the services offered in and
government allocations to urban and rural areas were unequal and
favored urban areas.
- urban and rural health facilities
faced regular shortages of supplies, equipment, drugs, and
vaccines.
- staffing shortages and morale
problems compromised the quality of care and health sector
productivity.
- cuts in capital budgets resulted
in cutbacks in the maintenance of hospitals, health centres and
already modest staff accommodations.
Health
Sector Reform
Following the 1978 Alma Ata International Conference on Primary Health
Care, the Zambian
government committed itself to the concepts of the
Alma Ata
Declaration and launched a pilot study in 1982 to determine how the
principles contained in Alma Ata could be adapted to Zambian
conditions. A number of problems, including extreme financial
constraints, were faced in implementing the Alma Ata concepts.
Inadequate community participation, lack of teamwork, lack of
physical infrastructure, and inadequate transport led to few
successes and limited progress in many planned activities.
Phase 2 of the reform process (1985-1990) incorporated some lessons
from the pilot phase, among these was the need to update the legal
framework for health services, leading to the Health Services Act of
1985. Some elements from the Bamako Initiative were included, as were
the concepts of autonomy, user charges, and decentralisation.
Decentralization
In 1992, a new national health policy document was produced that
decentralized decision-making in the health sector, making the
district level the main administrative unit (MOH, 1992). This
document outlined the aims and objectives of what is now the current
health reform process in Zambia and the process under which the
Zambian Roll Back Malaria programme is being implemented. This phase
of health reforms provided a new health management structure flexible
enough to allow for private sector and NGO participation in service
delivery.
Decentralisation has provided room for flexibility and
innovation in health services. But perhaps more importantly, the new
system has equalized opportunities for health sector development throughout the country. This has been made possible through a
system of more equitable distribution of resources to all districts,
including financial, human, material, and skills training for health
improvement.
The decentralised system is largely transparent with workable
accounting procedures in force. The government
Auditor General noted that from its inception the Ministry of Health,
in relation to other government departments, has had the least number and
magnitude of accounting queries. Since decentralisation, the system has become better and more
efficient and data is readily available on demand for the most
recent accounting periods. For
a more detailed description of health sector reform in Zambia click
here. |
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