PROGRESS IN CHILD SURVIVAL The Zambian Experience Countdown Conference on Child Survival London, UK Dec 2005 Presented by Dr. K. Mwinga Prepared by Dr V Mukonka, Dr B Tambatamba Dr J Kasonde, F Zulu, Dr K Mwinga

PROGRESS IN CHILD SURVIVAL IN ZAMBIA  Child mortality can be reduced in spite of the burden of HIV/AIDS  Health Sector Reforms have improved access to health services  Partnerships have facilitated increased coverage of child health interventions

Trend in <5 suspected HIV/AIDS Morbidity Source: Child Health in Zambia, A Background Paper June 2004, A. Henn

Health Sector Reforms in Zambia: Underlying Principles  Leadership: Building capacities of health providers at the various levels of operation  Accountability: For the quality of the services they provide, and in terms of their responsiveness to the communities they serve.  Partnership: Bringing together a positive relationship between and among all stakeholders.  Affordability/Sustainability: Adopting tools and structures according to resource availability

Health Sector Reforms in Zambia: Changes MOH made to achieve its goals  National Health Services Act (1995)  Central Board of Health  Provincial Offices  Defining Basic Package of Care  Government grants  External aid through bilateral contributions ( Basket Funding + other)  Community contribution (User-Fees) Exemption Policy exists

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

Child health care and Health Reforms  Initially priority given to child survival differed from one district to another  Later child health as high priority became common to all districts Child health is one of the six health thrusts of the reforms and is part of the basic health care package Child health is one of the six health thrusts of the reforms and is part of the basic health care package  Child health programming was a challenge as central Ministry of Health was contracted  Current Ministry of Health re-structuring will bring back a Maternal and Child Health unit with increased personnel

Partnerships around key intervention areas  Integrated Management of Childhood Illness (IMCI)  Roll Back Malaria (RBM)  National Measles Campaign

CHILD SURVIVAL IN ZAMBIA Impact of Partnerships

Measles Campaign National campaign (6mo-14yr) Campaign in 35 districts (9mo-4yrs)

Coverage of Key Child Survival Interventions in Zambia

Government Coordinating Mechanisms for Partners in the Health Sector  Swaps arrangement with partners at all levels: -Joint planning and reviews -Pooling of resources (basket arrangement)  Coordinating meetings/structures: -Annual Consultative Meeting -Health Sector Committee/Sector Advisory Group -Inter-agency Coordinating Committee for Child Health  Provincial and District Development Coordinating Committee (Multi-sectoral)

Lessons learnt from Partnerships To succeed, partnership initiatives need:  Resources to be sustained after the short- term action: “a guarantee fund”.  The health system to be strengthened as part of the implementation process.  A plan for scaling up.

CONCLUSION  Child mortality can be reduced in spite of increasing burden of HIV/AIDS and poverty  Decentralization needs to be further developed but is effective in increasing access to health services  Partnership is an effective mechanism for increasing coverage of essential interventions.