1. Trends in health and health care in Zambia Emmanuela Gakidou, PhD Associate Professor, Global Health April 18th, 2013

2. Outline Population-level trends in burden of disease and coverage of key interventions Facility-level trends in provision of services Patient-level satisfaction 2

3. Zambia overview 3 1990 2010 Population 7.8 m13.1 m GDP per capita (I$) 9021,552 Average years of education among women aged 15-44 4.666.50 % women aged 15-19 currently in school 40%63% Life Expectancy at birth 50.655.8 Under- 5 mortality (per 1,000) 178105

4. 4 www.healthmetricsandevaluation.org/gbd

5. Zambia: trends in top 20 causes of child death 5

6. Trend in under-5 mortality 6 Health sector reform Child Health Week Catch up immunization with CHWs IRS ITN scale up ACTs HiB PMTCT HR and infrastructure investments

7. Trends in coverage of select key interventions 7

8. Under-5 mortality 8

9. DPT3 immunization coverage 9

10. Scale up of ITN ownership 10

11. ITN ownership compared to ITN use 11

12. Key MCH interventions and under-5 mortality 12

13. Education of women of reproductive age 13

14. Childhood malnutrition (underweight) 14

15. Education, malnutrition and mortality 15

16. Facility-level trends in the provision of services 16

17. Trend in ART-related visits at health facilities 17

18. Trend in non- ART related services 18

19. Trends in volume of care for facilities that provide ART vs. facilities that do not 19

20. What do the customers say? Patient satisfaction across facilities in Zambia 20

21. 21 Average travel time to urban and rural health facilities, by education

22. Proportion of patients waiting over 1 hour, urban and rural facilities, by education 22

23. Overall patient satisfaction 23

24. Proportion of patients that would return to facility 24

25. Burden of disease in Zambia, 2010 25

26. 26

27. Extra slides 27

28. Zambia Health Surveillance Data Sources 28 Sources for IHME estimatesYears Census of Population and Housing1990, 2000, 2010* Indoor Residual Spraying database2005-2010* Zambia Health Facility Census2005-2006* Medical Stores Limited2008-2011* HMIS Database2000-2009* Global Precipitation Climatology Centre1986-2012 *unpublished

29. Zambia Health Surveillance Data Sources 29 Sources for IHME estimatesYears DHS1992, 1996-1997, 2001-2002, 2007 LSMS1996, 1998, 2002- 2003, 2004-2005, 2006*, 2010* Malaria Indicator Survey2006*, 2008*, 2010* Multiple Indicator Cluster Survey1999 Sexual Behavior Survey2005, 2009 Household Health Coverage Survey2008 NetMark Baseline Survey on Insecticide-Treated Materials (ITMs) in Zambia 2001 ABCE survey data2012* *unpublished