EQUITY GAUGE PROFILES: ZAMBIA

Name of Project: The Zambia National Health Systems Trust

Focus:
Working at district, provincial and national levels, this Gauge will monitor health and health service delivery across social strata including: gender, socio-economic status, religion, geographical location, provinces and districts. Results will be published in The Zambian Health Review.

Partners

• Chessore
• National Assembly (Parliament),
• House of Chiefs,
• Health Centre Committees,
• NGO Coordinating Council,
• Women for Change,
• Medical Council of Zambia,
• Churches Medical Association of Zambia,
• General Nursing Council,
• Defence Forces Medical Services,
• Churches.

Key People:
TJ Ngulube; James Kamana

Indicators under consideration:

• Health Status (Infant mortality rate, Morbidity at household level, Assisted deliveries, Measles, epidemics, Immunization coverage, Top 5 childhood diseases, Malaria incidence rates, First Antenatal attendance, Average Antenatal Attendance, First Postnatal attendance, Maternal mortality rate, Tuberculosis, STD/HIV/AIDS rates, Growth Monitoring);
• Health Financing in the Public Sector (Per capita health budgets (national, by provinces and by districts), Percentage of total national budget allocated to health, education and social welfare, Percentage of national budget allocated to health, Budget Ceilings by Level, Budget Ceiling by Cost Item);
• Access - Distribution of Personnel in the Public Sector (Public sector doctors per 10 000 population, Public sector nurses per 10 000 population, Public sector Clinical Officers per 10 000 population, CHW and TBA per 10000 population (distribution), Public sector Environmental Health Technicians (EHTs) per 10 000 population, Staffing at health institutions (Deployment), In-service training opportunities), Distribution of Services, Access to services (OPD Utilization, Proportion of population living within 12 km of a health facility, Proportion of population who cannot afford to pay the chargeable user fees, Pre-payment scheme Utilization / membership, Forms of payment for services);
• Quality of Care - Available Infrastructure (Percentage of clinics with uninterrupted water supply, Percentage of clinics with electrification, Percentage of clinics with functioning telephone or Radio link, Availability of equipment (thermometers, weighing scale, fridges), Availability of drugs, Availability of emergency resuscitation drugs (trays), Availability of ambulance services), - Process of Care at Health Facilities – (Availability of food for in-patients, Daily provision of key PHC services (immunizations, Outreaches, Drug shortages), Staff knowledge (Absolute, In-service training, Staff performance reviews), Interpersonal relations ratings on staff at health facilities, Health facility OPD and In-patient workloads), - Clinical Care Outcomes (Malaria case fatality, Patients rating of public sector primary care facilities, Mortality rates among the under 5 year olds)
• Socio-economic Inequalities in Zambia (Socio-economic status, Medical aid scheme membership, Health status, Percentage of households with access to various basic facilities by social status, Percentage of those traveling more than one hour to a health facility, Degree of community participation achieved in health service provision)
• Rural/Urban Disparities (Distribution of resources between rural and urban clinics, Percentage of rural and urban clinics offering pathology tests, Household access to services in rural and urban areas)
• Private Versus Public Sector (Distribution of key personnel, Factors affecting the distribution of key personnel between public and private sectors, Utilization of private and public services, First Choice of Provider (Public Sector or Private Sector; Traditional Healers or western trained Health Workers)
• Financing in the Public Sector (Per capita health budgets and expenditure, Per capita spending of Districts within a province (PHC expenditure), Per capita expenditure on hospital services, Actual health budget expenditures in relation to planned budgets, Percentage of total national budget allocated to health, education, and social welfare, Percentage of total national budget allocated to Health, Adherence to planned financial allocation and disbursement schedules, Budget ceilings by Level, Budget ceilings by cost item, Percentage (%) Expenditure by category (between Curative, preventive/ promotive services)
• Gender Inequity (Women with jobs work in elementary jobs, Women job earnings in general, Comparative earnings by levels of education, Gender representation in most high status medical jobs)
  

Data Sources:

• Primary – Through on-going research;
• Secondary – from the Ministry of Health and the Central Board of Health (Routine Health Management Information System data, Review reports, research reports, Budgets, etc),
• Demographic Health Surveys, University of Zambia (Medical School, Institute for Economic and Social Research, other),
• Central Statistical Office (CSO),
• NGO research reports and activity data.

Other information: The Equity gauge will operate at 3 levels, namely, national, provincial and district. Appropriate stakeholders at these levels will be involved.

MAP OF ZAMBIA: DISTRICT ADMINISTRATIVE BOUNDARIES (2001)

Chama: The largest in terms of Size but most rural and remote. Situated in the North-Eastern
part of the country, bordering Malawi. Shaded with vertical lines.
Lusaka: The capital city, a small enclave situated in the centre of the country and sandwiched
between Chongwe, Chibombo, Kafue and Mumbwa districts. Shaded green without
lines.
Choma: Situated in the southern part of the country. It is shaded brown with horizontal
stripes.
Chingola: This is a copper mining town/ district situated in the copperbelt province of Zambia.
It shows with pink/ orange diagonal lines.