SOCIOECONOMIC STATUS, HEALTH STATUS AND HEALTH EQUITY: A CASE STUDY OF ZAMBIAN HOUSEHOLDS IN SELECTED AREAS

In the light of the above objective, have the health reforms been progressing in the right direction? A lot of causal empirical evidence and heuristic research seem to indicate that not only has this objective not being realized but that, despite the health reforms, the country has been moving in reverse gear in this regard. Comparative data from a series of Living Conditions Monitoring Surveys and Demographic and Health Surveys show that the incidence of diseases, morbidity and mortality have been persistently high. In the 2001 economic report, the government does indicate that even though the delivery of basic health care services has slightly improved, the disease burden has worsened. The incidence rates for malaria, HIV/AIDS, and TB for instance have worsened between 1999 and 2001. The incidence rate for malaria increased by 2%, while those for HIV/AIDS and TB increased by 8% and 19% respectively. Admittedly, there have been some improvements in some areas. Improvements have been recorded in, among others, health expenditures per capita, number of drug kits, and health centre staff loads. The question that still remains unanswered is: how equitably have the achievements been distributed? To what extent have equity issues been addressed? Are the improvements only in average figures while conditions especially for the many in poverty have worsened ?Zambia has for long been experiencing high levels of poverty and inequality. This has been manifest in a number of ways, health poverty and inequality being one of them. The causes of the worsening poverty in Zambia have been clearly outlined by the Government in its Poverty Reduction Strategy Paper, PRSP. Over the years, the country has at best experienced marginal economic growth. With a population growth rate of almost 3% per year, the population has more than trebled over the last 40 years. While economic growth has been marginal, successive governments have failed to follow pro-poor strategies. Lack of sustained economic growth and inadequate pro-poor strategies together with unfavourable land ownership laws and unsupportive land tenure systems as well as the fact that most of the population lead a subsistence existence without access to credit facilities has led to a continuous decline in productivity. Above all, due to poor governance, lack of transparency and accountability, drought, unfavourable international market relations and the huge debt burden, well over 73% of the population has been living below the poverty datum line. The situation has been compounded by the HIV/AIDS epidemic that has been impeding human capital formation necessary for sustainable growth

Inequities in utilization of maternal health interventions in Namibia: implications for progress towards MDG 5 targets

<p>Abstract</p> <p>Background</p> <p>Inequities in the utilization of maternal health services impede progress towards the MDG 5 target of reducing the maternal mortality ratio by three quarters, between 1990 and 2015. In Namibia, despite increasing investments in the health sector, the maternal mortality ratio has increased from 271 per 100,000 live births in the period 1991-2000 to 449 per 100,000 live births in 1998-2007. Monitoring equity in the use of maternal health services is important to target scarce resources to those with more need and expedite the progress towards the MDG 5 target. The objective of this study is to measure socio-economic inequalities in access to maternal health services and propose recommendations relevant for policy and planning.</p> <p>Methods</p> <p>Data from the Namibia Demographic and Health Survey 2006-07 are analyzed for inequities in the utilization of maternal health. In measuring the inequities, rate-ratios, concentration curves and concentration indices are used.</p> <p>Results</p> <p>Regions with relatively high human development index have the highest rates of delivery by skilled health service providers. The rate of caesarean section in women with post secondary education is about seven times that of women with no education. Women in urban areas are delivered by skilled providers 30% more than their rural counterparts. The rich use the public health facilities 30% more than the poor for child delivery.</p> <p>Conclusion</p> <p>Most of the indicators such as delivery by trained health providers, delivery by caesarean section and postnatal care show inequities favoring the most educated, urban areas, regions with high human development indices and the wealthy. In the presence of inequities, it is difficult to achieve a significant reduction in the maternal mortality ratio needed to realize the MDG 5 targets so long as a large segment of society has inadequate access to essential maternal health services and other basic social services. Addressing inequities in access to maternal health services should not only be seen as a health systems issue. The social determinants of health have to be tackled through multi-sectoral approaches in line with the principles of Primary Health Care and the recommendations of the Commission on Social Determinants of Health.</p

Effects of global financial crisis on funding for health development in nineteen countries of the WHO African Region

<p>Abstract</p> <p>Background</p> <p>There is ample evidence in Asia and Latin America showing that past economic crises resulted in cuts in expenditures on health, lower utilization of health services, and deterioration of child and maternal nutrition and health outcomes. Evidence on the impact of past economic crises on health sector in Africa is lacking. The objectives of this article are to present the findings of a quick survey conducted among countries of the WHO African Region to monitor the effects of global financial crisis on funding for health development; and to discuss the way forward.</p> <p>Methods</p> <p>This is a descriptive study. A questionnaire was prepared and sent by email to all the 46 Member States in the WHO African Region through the WHO Country Office for facilitation and follow up. The questionnaires were completed by directors of policy and planning in ministries of health. The data were entered and analyzed in Excel spreadsheet. The main limitations of this study were that authors did not ask whether other relevant sectors were consulted in the process of completing the survey questionnaire; and that the overall response rate was low.</p> <p>Results</p> <p>The main findings were as follows: the response rate was 41.3% (19/46 countries); 36.8% (7/19) indicated they had been notified by the Ministry of Finance that the budget for health would be cut; 15.8% (3/19) had been notified by partners of their intention to cut health funding; 61.1% (11/18) indicated that the prices of medicines had increased recently; 83.3% (15/18) indicated that the prices of basic food stuffs had increased recently; 38.8% (7/18) indicated that their local currency had been devalued against the US dollar; 47.1% (8/17) affirmed that the levels of unemployment had increased since the onset of global financial crisis; and 64.7% (11/17) indicated that the ministry of health had taken some measures already, either in reaction to the global financing crisis, or in anticipation.</p> <p>Conclusion</p> <p>A rapid assessment, like the one reported in this article, of the effects of the global financial crisis on a few variables, is important to alert the Ministry of Health on the looming danger of cuts in health funding from domestic and external sources. However, it is even more important for national governments to monitor the effects of the economic crisis and the policy responses on the social determinants of health, health inputs, health system outputs and health system outcomes, e.g. health.</p

Materials management in developing countries case study of Zambia

SIGLEAvailable from Bibliothek des Instituts fuer Weltwirtschaft, ZBW, Duesternbrook Weg 120, D-24105 Kiel A 199911 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

EXECUTIVE SUMMARY OF THE SOCIOECONOMIC STATUS, HEALTH STATUS AND HEALTH EQUITY: A CASE STUDY OF ZAMBIAN HOUSEHOLDS IN SELECTED AREAS

If Zambia is ever to turn the corner on development - that is, move away from severe poverty conditions and advance towards sustainable livelihoods for all - there must be a marked improvement in the delivery of education and health services. No country develops without an educated and health population. Sometimes this fact is referred to as the human capital resource basis for a well- ordered society based on justice. Because we at Jesuit Centre for Theological Reflections (JCTR) believe in the basic human rights of every citizen for good education and good health care, we have done research, education and advocacy programmes touching on these topics. Our monthly Basic Needs Basket highlights the average cost of living for families, contrasting with the take - home pay from average salaries. The findings of this survey show that very little money is available to meet family need s for education and health.Zambia has for a long time been experiencing high levels of poverty and inequality. This has been manifested in a number of ways, health poverty and inequality being one of them. The cause of worsening poverty in Zambia has been clearly outlined by the government in its poverty reduction paper, PRSP. Over the year years the country has at best experienced marginal economic growth.With a population growth rate of almost 3% per year, the population has more than tripled over the last 40 years. While economic growth has been marginal, successive governments have failed to follow pro - poor strategies together with unfavourable land ownership laws and unsupportive land tenure systems as well as the fact that most of the population lead a subsistence existence without access to credit facilities has led to continuous decline in productivity. Above all due to poor governance, lack of transparency and accountability, drought, unfavourable international market relations and a huge debt burden, well over 73% of the population has been living below the poverty datum line. the situation has been compounded by the HIV/AIDS epidemic that has been impeding human capital formation necessary for sustainable growth

The SAZA study: implementing health financing reform in South Africa and Zambia.

This paper explores the policy-making process in the 1990s in two countries, South Africa and Zambia, in relation to health care financing reforms. While much of the analysis of health reform programmes has looked at design issues, assuming that a technically sound design is the primary requirement of effective policy change, this paper explores the political and bureaucratic realities shaping the pattern of policy change and its impacts. Through a case study approach, it provides a picture of the policy environment and processes in the two countries, specifically considering the extent to which technical analysts and technical knowledge were able to shape policy change. The two countries' experiences indicate the strong influence of political factors and actors over which health care financing policies were implemented, and which not, as well as over the details of policy design. Moments of political transition in both countries provided political leaders, specifically Ministers of Health, with windows of opportunity in which to introduce new policies. However, these transitions, and the changes in administrative structures introduced with them, also created environments that constrained the processes of reform design and implementation and limited the equity and sustainability gains achieved by the policies. Technical analysts, working either inside or outside government, had varying and often limited influence. In part, this reflected the limits of their own capacity as well as weaknesses in the way they were used in policy development. In addition, the analysts were constrained by the fact that their preferred policies often received only weak political support. Focusing almost exclusively on designing policy reforms, these analysts gave little attention to generating adequate support for the policy options they proposed. Finally, the country experiences showed that front-line health workers, middle level managers and the public had important influences over policy implementation and its impacts. The limited attention given to communicating policy changes to, or consulting with, these actors only heightened the potential for reforms to result in unanticipated and unwanted impacts. The strength of the paper lies in its 'thick description' of the policy process in each country, an empirical case study approach to policy that is under-represented in the literature. While such an approach allows only a cautious drawing of general conclusions, it suggests a number of ways in which to strengthen the implementation of financing policies in each country