A WORK IN PROGRESS

Zambia 2014 | HEALTH & EDUCATION | REVIEW: HEALTH

Zambia has traditionally suffered from serious shortages of medical-care professionals and has faced major health challenges, but forward-thinking government policy combined with international assistance is achieving measurable success.

According to the UNDP, over the past decade Zambia has made visible progress in the fight against three of its main health challenges—HIV, TB, and malaria—with the support of many major international donors. By the end of 2013, more than 580,000 people, of whom 49,419 are children, had access to current antiretroviral therapies, with the effect that HIV incidence has fallen by 25% and overall AIDS deaths have decreased by more than half. The TB case detection rate is above 80% and nearly 90% of TB cases in 2012 were treated successfully. Access to malaria prevention and treatment is also continuing to expand. Despite serious constraints in health infrastructure, financial resources, equipment, and monitoring systems, Zambia can only be commended for its successes in facing these problems.

Training health staff is a key priority. For most of its years an independent nation, Zambia had only one medical school, which was based at the University Teaching Hospital (UTH) in Lusaka. According to Consultancy Africa Intelligence, at most the school could produce between 55 and 67 doctors per year, a figure that was unable to properly serve a population of 13 million people. This production of doctors was well below the national target of 100 medical doctors a year, as outlined by the Ministry of Health. Three new medical schools have since been opened, namely the Cavendish University School of Medicine (Cavendish SOM), Lusaka Apex Medical School (LAMU), and, most recently, the Copperbelt University School of Medicine (CBU-SOM), which opened in the Copperbelt province in 2011. Yet the impact of these new schools will only be realized in 2016, when the first intake of students graduate and begin work. In 2010, it was reported that Zambia had 1,072 doctors. The current doctor to population ratio is 1:23,000, in contrast to the World Health Organisation's (WHO) recommended doctor to population ratio of 1:5,000 for Africa. Dr. Lackson Kasonka, Managing Director & Senior Med. Superintendent, University Teaching Hospital (UTH) tells TBY that they are working to fill this gap: “We have various training programs, specific numbers for the last graduating group are as follows: for post-graduates we graduated quite a small number of 18 post-graduates, but suffice to say that we have increased the number of undergraduate intakes. We used to graduate 35 to 50, but this year we have almost a double intake expected to graduate."

Zambia offers universal healthcare to all its citizens. However, by Western standards this healthcare is very basic. Zambia's public healthcare system remains underfunded and only 50% of rural people have access to a basic heath facility, compared to 99% of urban dwellers. There are good public hospitals such as the UTH in Zambia's larger cities, particularly Lusaka. In the health sector for the 2015 budget, Finance Minister Alexander Chikwanda allocated ZMW4.5 billion out which ZMW268.2 million was for the construction and rehabilitation of health infrastructure in various parts of the country. He said ZMW53.5 million had been set aside for the procurement of essential drugs and medical supplies while ZMW52.5 million would be for the recruitment of more than 2,000 health officers. Yoshihide Teranishi, the Resident Representative of Japan International Cooperation Agency (JICA) told TBY that the international community is working to launch programs to improve standards across the nation: “Our project is upgrading the health centers in Lusaka to the same level as the UTH. This ensures that people who cannot afford to go to the hospital, can still have access to good healthcare. The quality of and capacity to provide health services will be increased by this project." Even the best hospitals need assistance. To take UTH as an example: it has approximately 1,655 beds and 250 infant cots. It provides a full range of medical services on both an inpatient and outpatient basis. Yet the hospital, which Zambia's largest public-health facility, has less than half of the nurses, and only 62% of the doctors, needed to serve an urban population of more than 1 million. The government has pumped more money into the health sector, but international donor assistance remains vital.

WINNING THE WAR

According to UNICEF, malaria affects more than 4 million Zambians annually, accounting for approximately 30% of outpatient visits and resulting in almost 8,000 deaths each year. Children under 5 and pregnant women are the most vulnerable, especially those in more remote and impoverished areas, with 35-50% of under-five mortality and 20% of maternal mortality attributable to malaria. Moreover, 591 maternal deaths occur per 100,000 live births while the infant, neonatal and under-five mortality rates are at 70, 34, and 119 per 1,000 live births, respectively. These mortality rates are considered to be unacceptably high.

However, despite many challenges, there are also a number of successes. Zambia has been held up as a model for the fight against malaria. Between 2006 and 2011, international donors invested more than $300 million in the country to help eradicate the disease. Zambia was the first country in Africa to adopt modern combination therapies to treat malaria. More than 24 million insecticide-treated bed nets were distributed to protect against the mosquitoes that transmit the disease. Screening for the disease was increased. The efforts paid off, with dramatic drops in malaria cases and deaths in many parts of the country. Yet such gains need to be vigilantly defended, and this requires money and training. Between 2006 and 2011, the World Bank, the US President's Malaria Initiative, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and other donors directed more than $300 million into the country to combat the disease, making it a test bed for prevention and treatment. Malaria cases had declined by about 7% per year between 2000 and 2013, reducing deaths by about 60% over that period.

Zambia has also suffered through one of the world's most devastating HIV-AIDS epidemics in Africa. More than one in every seven adults in the country are living with HIV, and life expectancy at birth has fallen to just 49.4 years. Avert, a global NGO fighting AIDS and HIV, reports that in 2011, nearly 42,000 adults and 9,500 children were newly infected with HIV, which is about 115 new infections each day. However Zambia has received hundreds of millions of dollars for HIV programs (as well as TB and Malaria) from governments in the developed world; the Global Fund to Fight Aids, TB and Malaria reports the following sums have been signed for, committed to, and dispersed: To fight AIDS in Zambia: $674,706,931 was signed, $663,941,519 was committed, and $584,715,418 was dispersed. For tuberculosis the sums were $49,882,675 signed, $48,210,685 committed, and $46,522,523 dispersed. For Malaria: $121,247,622 was signed for, $119,395,565 committed, and $119,395,565 dispersed.

The loss of workers due to AIDS, TB, and malaria has surely affected Zambia's economic productivity. Agriculture, from which the vast majority of Zambians make their living, is particularly affected by the impact of AIDS. A decline in the number of individuals able to work at the crucial periods of planting and harvesting can significantly reduce the size of the harvest, and thus the economy as a whole. Yet Zambia is facing its challenges head on. The much-discussed Zambia Vision 2030 guides current government policy: the national goal is to become a “Prosperous Middle Income Nation" by 2030. The plan holds that the nation should have an economy that is competitive, self-sustaining, dynamic, and resilient. Zambia is moving in the right direction, and the international community must continue to support its efforts.