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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).