The cost-sharing policy and health service delivery in Lusaka's shanty compounds: A case study of Chainda and Kalikiliki(1992-2005)
Mukanda, Gertrude Kalumbu
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This study aimed at assessing the effects of the poHcy of costsharing on the utilization of health care services in the particular localities of Chainda and Kalikiliki shanty compounds of Lusaka Urban District from 1992 to 2005. More specifically, it determined the extent to which the households used the In and Out-Patient Services, and the reasons for utilization and non utilization of health services. A comparison of the extent to which the findings of the study relate to the national situation was also done. A purposeful systematic sample of 100 households was drawn from Chainda and Kalikiliki shanty compounds which were selected as the study population on the basis of low income, thereby representing the low income shanty compounds in Lusaka Urban. The heads of the households were interviewed using a structured questiormaire. The results presented in this study established that the general impression regarding the health service utilization levels, the quality and quantity of health services in the Chainda and Kalikiliki shanty compounds is of a declining trend especially in terms of attendance. The findings also reveal that there has been a distinct deterioration in the quality of the services provided at public health facilities which has been associated with the introduction of user fees. The low income households in the shanty compounds could not afford to contribute to their health care services and thus, defeating the purpose of the Primary Health Care (PHC) as the services were not only unavailable, but also inaccessible. The study found that utilization of health care services was influenced by a number of factors namely, fees charged, perceived quality of care, availability of alternative providers, income of the local population, private costs such as transport, and the availability of drugs.The study points to the proposal that, as a way forward, user fees should be charged according to different economic levels in the locality. The study also proposes improvement in the supply of drugs, medical and surgical items in all public health facilities regardless of its level and put in place monitoring mechanisms. Furthermore, it is proposed that other means should be found of subsidising medical and surgical supplies to health facilities, as well as partnering with some private business agencies or individuals who are economically sound. Finally, extensive meetings should be held between the government and its collaborating partners to come up with other sources for financing health services.This research work is dedicated to my only daughter Cecilia Sungatawho gave me the moral support and encouragement and without whose love, patience and prayer, my studies would not have been possible.