Trial version, Version d'essai, Versão de teste

Social determinants

From AHO

Jump to: navigation, search

OLD CONTENT -

Back to Country Profile Index


Zambia attaches significant importance to the need to achieve equity and universal coverage for health, and has over the years made significant efforts towards developing and implementing policies that incorporate the principles of the Social Determinants for Health (SDH) (see the report of the Commission on Social Determinants for Health for more information on SDH).

In this respect, the country has undertaken major political, social and economic reforms aimed at achieving meaningful and sustainable socio-economic development and improving the health standards of its citizens. The country also complies with and places the relevant international protocols and initiatives that deal with the issue of inequities and its implications on health high on the agenda. These include: the United Nations (UN) Millennium Declarations and Millennium Development Goals (MDGs); the Highly Indebted Poor Countries’ (HIPC) initiative; the Paris Declarations on health; the Abuja and Maputo Declarations on Health; and other specific initiatives, such as the Roll-Back Malaria.

Zambia is recognized as a credible actor regarding SDH, which partly explains why it is one of the first wave countries that have signed the International Health Partnerships and Related Initiatives (IHP+) (see the IHP+ 2008 Taking Stock Report for Zambia). The Zambian health sector is also very much influenced by international trends and initiatives through the critical collaboration with international cooperating partners and other sector partners through the SWAp and Sector Advisory Groups (SAG) governance system and structures.


Over the past years, this commitment to incorporate the concept of SDH materialized through a combination of actions and strategies taken in the various sectors, aimed at reducing inequities and improving health and living conditions. Some of the examples of the actions taken in various sectors, presented along the classifications adopted by the WHO Commission on SDH, are presented below. Some of these examples are further illustrated in next sections of this chapter:

  • Improve daily conditions:
  • Nutrition: scaling up of nutrition and young child feeding activities, particularly in schools and vulnerable groups in rural areas, throughout the country, in collaboration with the MOH, Ministry of Agriculture, Food and Fisheries (MOAFF), Ministry of Education (MOE),the Office of the Vice President, and various local and international development partners;
  • Hygiene and sanitation: the “keep Zambia clean” campaign, spearheaded by the republican president through the local authorities, was launched in 2006 and is being implemented in all the districts, aimed at ensuring cleanliness and hygiene in public places;
  • Political leadership in HIV/AIDS awareness: the promotion of active participation of political leaders in the HIV/AIDS awareness campaign initiated by the president;
  • Road safety initiatives aimed at reducing accidents, with specific safety legislation, such as speed controls, no cell phones and alcohol when driving and the use of helmets for motor bike riders;
  • intensification of the fight against drug abuse by the Drug Enforcement Commission (DEC);
  • strengthening of primary health care and scaling up health information and education, particularly in respect of non-communicable diseases, by MOH and other relevant sectors, such as the Ministry of Information and Broadcasting.
  • Equitable distribution of power, money and resource:
  • Decentralization policy in the health sector in 1995, recently restructured in 2005. Impacts of the latest development on the participation of the communities are still in question (also see the next section);
  • Social Health Insurance (SHI) is one of the option the MOH is currenlty contemplating. Studies are ongoing since 2007 and have now reached an advanced stage:
  • Equitable distribution of health workers: efforts have been intensified through the scaling up of of the health workers’ retention scheme and development of bonding mechanisms for sponsored students in health training schools;
  • The free Anti-retroviral Treatment (ART) initiative has facilitated equitable access to treatment for about 200,000 HIV positive patients across the country, on equal basis
  • Intensification of out reach operations, intended to bring health services closer to the families, particularly in rural areas.
  • Measure and understand
  • The existing HMIS is computerised, comprehensive and flexible, allows for in-depth socio-economic analysis of health data and for a performance ranking of districts and facilities (see Structural organization of HIS;
  • The recently introduced Joint Annual Review (JAR since 2006) under the SWAp arrangements allows for an annual harmonized assessment and interpretation of the sector’s performance, in coordination with all stakeholders.
  • SWAP institutional arrangements are constantly being improved towards enhancement of the participation of other sectors and previously excluded stakeholders (e.g. civil society);
  • Various performance feedback through the active commitment of Zambia into a set of international initiatives aimed at strengthening harmonisation and coordination of monitoring and evaluation, and evidence-based decision making (see above).


This section on Social determinants is structured as follows:

Contents

Analytical summary

The social and economic environment is a major determinant of health. It includes factors such as the demographic situation and trends, income and socio-economic status, education and literacy, employment and working conditions.

Demographic situation and trends
The population of Zambia has rapidly grown from about 3 million people in 1964, to 13.2 Million in 2010 . The average life expectancy at birth has also increased from 40.5 years in 1998 to 51.3 years in 2010. This rapid population growth, places an increasing burden on the national economy, particularly the country’s capacity to keep pace with the health needs of a rapidly increasing population and its dynamics.

Education and Literacy
Education is the gateway to better employment and improved household income, while literacy is an important tool for accessing health information and education. Zambia has recorded major improvements in education and literacy.

According to the Economic Report for 2009, net enrolment of children in primary education (Grade 1 – 7) and completion rates have increased from 80% and 64% in 1990 to 101.4% and 93% in 2009, respectively. However, the completion rate for girls at secondary school level remained low, at 17.4% in 2009. It is estimated that 64% of women and 82% of men are literate, with urban areas having higher literacy levels than rural areas. Literacy rates among men are fairly high across all provinces, ranging from 71% in Eastern to 90% in Copperbelt province.

Social and cultural environments: Zambia is among the most politically stable countries in Africa, and has continued to experience uninterrupted peace since its independence in 1964. The country has a multi-cultural society, characterized by different racial and ethnic groups, religious and traditional groupings, urbanization, and increasing access to the internet and other sources of information, with significant potential for promoting good health. However, there are some social, cultural and religious beliefs and practices that negatively affect health. These include cultural practices, such as sexual cleansing of surviving spouses, unsafe traditional male circumcision procedures, early marriages for the girl child, gender discrimination in favour of males, and risky traditional health practices.

The family and community: The families and communities have an important role in shaping the character and behaviours of the people. Peer pressure also has potential to mislead people, particularly the adolescents, into practices that are risky to health, such as alcohol and substance abuse, smoking, sexual abuse, and violence. These could lead to severe consequences on health, including the risks of contracting HIV and other Sexually Transmitted Infections (STIs), trauma, teenage pregnancies and mental illnesses.

Income and socio-economic Status: The country is experiencing high levels of unemployment and weak socio-economic status of the population, which have implications on the health status of the population. Income inequity among the population has remained high, with the Gini Coefficient at 0.57 in 2004 (a drop from 0.66 in 1998). High poverty levels (67% in 2006) and poor access to safe water and sanitation also remain serious factors on health.

In 2009, Zambia ranked at 163 out of 182 countries on the 2009 United Nations Human Development Index (HDI). The standard of living is low while per capita annual incomes are currently much below their levels at independence in 1964, and that of the African average. Figure xxx presents the trends in GDP Per Capita for Zambia, from 1962 to 2006.

Zambia GDP per Capita and Anual Growth

Economic Status: Zambia has, however, realized strong economic performance in recent years. Over the past 5 years, average Real Gross Domestic Product (GDP) growth has been above 5%, and reached 6.3% in 2009. This economic growth has been led by increased mining output, thanks to the large investment in the mining sector, construction, agriculture and a growing tourism sector. Inflation has declined to single digits since 2009 and has continued to drop in 2010. The external position has strengthened, as the recovery of copper prices and a weak Kwacha have helped to reduce the current account deficit.

However, these achievements have not yet significantly impacted on the socio-economic status of the majority of the population, most of whom have continued to face poverty and socio-economic deprivation.

The situation is further compounded by the inequities in the distribution of wealth and socio-economic infrastructure across the country, which currently favours the urban areas and adversely impacts on the provision of social services, such as health and education in rural hard-to-reach areas.

Table xxx below presents a summary of selected demographic and socio-economic indicators for Zambia. More socio-economic data on Zambia could be accessed at www.zamstats.gov.zm and www.boz.zm).

Zambia Selected Demographic and Socio-Economic Indicators 2010


Demography

The population of Zambia has rapidly grown from about 3 million people in 1964, to 13.2 Million in 2010 . The average life expectancy at birth has also increased from 40.5 years in 1998 to 51.3 years in 2010. This rapid population growth, places an increasing burden on the national economy, particularly the country’s capacity to keep pace with the health needs of a rapidly increasing population and its dynamics.


Resources and infrastructure

Poverty and income inequality

Gender equity

Education

Education is the gateway to better employment and improved household income, while literacy is an important tool for accessing health information and education. Zambia has recorded major improvements in education and literacy. According to the Economic Report for 2009, net enrollment of children in primary education (Grade 1 – 7) and completion rates have increased from 80% and 64% in 1990 to 101.4% and 93% in 2009, respectively. However, the completion rate for girls at secondary school level remained low, at 17.4% in 2009. It is estimated that 64% of women and 82% of men are literate, with urban areas having higher literacy levels than rural areas. Literacy rates among men are fairly high across all provinces, ranging from 71% in Eastern to 90% in Copperbelt province.


Global partnerships and financial flows

Science and technology

Emergencies and disasters

Governance

Endnotes: sources, methods, abbreviations, etc


Back to Country Profile Index