PROGRESS IN CHILD SURVIVALPROGRESS IN CHILD SURVIVALThe Zambian ExperienceThe Zambian Experience

Countdown Conference Countdown Conference on Child Survivalon Child SurvivalLondon, UKLondon, UK

13 - 14 Dec 200513 - 14 Dec 2005

Presented byPresented byDr. K. MwingaDr. K. Mwinga

Prepared byPrepared byDr V Mukonka, Dr B Tambatamba Dr V Mukonka, Dr B Tambatamba Dr J Kasonde, F Zulu, Dr K Mwinga Dr J Kasonde, F Zulu, Dr K Mwinga

PROGRESS IN CHILD SURVIVAL PROGRESS IN CHILD SURVIVAL IN ZAMBIAIN ZAMBIA

Child mortality can be reduced in spite of Child mortality can be reduced in spite of the burden of HIV/AIDSthe burden of HIV/AIDS

Health Sector Reforms have improved Health Sector Reforms have improved access to health services access to health services

Partnerships have facilitated increased Partnerships have facilitated increased coverage of child health interventions coverage of child health interventions

1955-59 65-69 75-79 85-89 95-99 2010-15

Years (Estimate at five-years intervals)

0

50

100

150

200

250

Un

de

r-fiv

e m

ort a

lity

rate

(p

er

100

0 li

ve b

irth

s)Zambia, U5MR, 1955 to 2000 and MDG

Projections to 2015

MD

G G

oal 4

64

Data Source: W orld Health Chart, W HO 2001, HDR 2003, W HR 2004

Trend in <5 HIV/AIDS Morbidity

4000

4500

5000

5500

6000

6500

7000

1999 2000 2001 2002 2003

Cases

Trend in <5 suspected HIV/AIDS Morbidity

Source: Child Health in Zambia, A Background Paper June 2004, A. Henn

Health Sector Reforms in Zambia:Health Sector Reforms in Zambia:Underlying PrinciplesUnderlying Principles

Leadership: Leadership: Building capacities of health providers Building capacities of health providers at the various levels of operationat the various levels of operation

Accountability: FAccountability: For the quality of the services they or the quality of the services they provide, and in terms of their responsiveness to the provide, and in terms of their responsiveness to the communities they serve.communities they serve.

Partnership: Partnership: Bringing together a positive Bringing together a positive relationship between and among all stakeholders.relationship between and among all stakeholders.

Affordability/Sustainability: Affordability/Sustainability: Adopting tools and Adopting tools and structures according to resource availabilitystructures according to resource availability

Health Sector Reforms in Zambia:Health Sector Reforms in Zambia:Changes MOH made to achieve its goalsChanges MOH made to achieve its goals

National Health National Health Services Act (1995)Services Act (1995)

Central Board of Central Board of HealthHealth

Provincial OfficesProvincial Offices Defining Basic Defining Basic

Package of CarePackage of Care

Government grantsGovernment grants External aid through External aid through

bilateral contributions bilateral contributions ( Basket Funding + ( Basket Funding + other)other)

Community contribution Community contribution (User-Fees)(User-Fees) Exemption Policy Exemption Policy

existsexists

HSR have improved access to HSR have improved access to health serviceshealth services

''There is qualitative evidence that There is qualitative evidence that decentralization, combined with the other decentralization, combined with the other components of HSR, as a kind of partnership components of HSR, as a kind of partnership with the community had a significant effect on with the community had a significant effect on the efficiency of health services at district level the efficiency of health services at district level thus making health care accessible'.thus making health care accessible'.

Child health care and Health ReformsChild health care and Health Reforms

Initially priority given to child survival differed Initially priority given to child survival differed from one district to anotherfrom one district to another

Later child health as high priority became Later child health as high priority became common to all districtscommon to all districts Child health is one of the six health thrusts of the Child health is one of the six health thrusts of the

reforms and is part of the basic health care packagereforms and is part of the basic health care package Child health programming was a challenge as Child health programming was a challenge as

central Ministry of Health was contractedcentral Ministry of Health was contracted Current Ministry of Health re-structuring will Current Ministry of Health re-structuring will

bring back a Maternal and Child Health unit with bring back a Maternal and Child Health unit with increased personnelincreased personnel

Partnerships around key Partnerships around key intervention areasintervention areas

Integrated Management of Childhood Integrated Management of Childhood Illness (IMCI)Illness (IMCI)

Roll Back Malaria (RBM)Roll Back Malaria (RBM)

National Measles CampaignNational Measles Campaign

CHILD SURVIVAL IN ZAMBIACHILD SURVIVAL IN ZAMBIAImpact of PartnershipsImpact of Partnerships

Trends in Malaria in ZambiaMOH: A Road Map for Impact on Malaria in Zambia 2006-2010

0

1000

2000

3000

4000

5000

6000

1999 2000 2001 2002 2003 2004Year

Rep

ort

ed

un

der-

5

Death

s

Measles CampaignMeasles Campaign

National Measles Campaign EffectivenessMOH and Partners Measles Supplemental Immunization 2003:

Technical Report.

05000

10000150002000025000300003500040000

2000 2001 2002 2003 2004

Year

Measle

s C

ases

0

50

100

150

200

250

300

Cases

Deaths

National campaign (6mo-14yr)

Campaign in 35 districts (9mo-4yrs)

Coverage of Key Child Survival Coverage of Key Child Survival Interventions in ZambiaInterventions in Zambia

93

27

4340

93

58

67

84

70 69

52

6.5

6764

78

0

20

40

60

80

100

Source: DHS, Zambia, 2001-2002, Unicef-2004

Government Coordinating Mechanisms Government Coordinating Mechanisms for Partners in the Health Sectorfor Partners in the Health Sector

Swaps arrangement with partners at all levels:Swaps arrangement with partners at all levels:-- Joint planning and reviewsJoint planning and reviews-- Pooling of resources (basket arrangement)Pooling of resources (basket arrangement)

Coordinating meetings/structures:Coordinating meetings/structures:-- Annual Consultative MeetingAnnual Consultative Meeting-- Health Sector Committee/Sector Advisory Health Sector Committee/Sector Advisory GroupGroup-- Inter-agency Coordinating Committee for Inter-agency Coordinating Committee for

Child HealthChild Health Provincial and District Development Provincial and District Development

Coordinating Committee (Multi-sectoral)Coordinating Committee (Multi-sectoral)

Lessons learnt from PartnershipsLessons learnt from Partnerships

To succeed, partnership initiatives need:To succeed, partnership initiatives need:

Resources to be sustained after the short-Resources to be sustained after the short-term action: “a guarantee fund”.term action: “a guarantee fund”.

The health system to be strengthened as The health system to be strengthened as part of the implementation process.part of the implementation process.

A plan for scaling up.A plan for scaling up.

CONCLUSIONCONCLUSION

Child mortality can be reduced in spite of Child mortality can be reduced in spite of increasing burden of HIV/AIDS and increasing burden of HIV/AIDS and povertypoverty

Decentralization needs to be further Decentralization needs to be further developed but is effective in increasing developed but is effective in increasing access to health services access to health services

Partnership is an effective mechanism for Partnership is an effective mechanism for increasing coverage of essential increasing coverage of essential interventions .interventions .