The impact of health reforms on access to health services and facilities : a comparative case study of Lusaka and Kafue Districts Health Boards
Momba, Moderate M.
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Zambia's health policy and strategies can be said to have evolved through four significant phases. First, was the pre-independence period whose health policies were influenced by the colour-segregation ideology. Secondly, immediately after independence health policies and strategies were formulated that aimed at eliminating the imbalances in the provision of public health. The third phase was the adoption of the Primary Health Care (PHC) approach to the provision of public health services in 1980. The PHC approach, however, did not perform as expected so much that when the MMD government took office in 1991, they embarked on health reforms whose core focus was the establishment of the District Health Boards as the basic management units. The overall purpose of this study was to establish the impact of the decentralised public health provision system on access to health facilities and services by users, both in the urban areas and in the rural areas.The dissertation takes a comparative study of urban and rural District Health Boards so as to make a balanced assessment of the performance of the decentralised health system which is being implemented. This comparative study was conducted in Lusaka and Kafue districts. In Lusaka District four, ordinary clinics, Chainda, Kaunda-Square, Kabwata and Civic Centre clinics, that also represent the diversity of the residential areas where these centres are located were picked. Also picked were two First Referral Centres, Chelston and Chilenje clinics. In Kafue district three (3) ordinary clinics (Chiawa, Chikupi and Mwembeshi) and two urban clinics (Nangongwe clinic and Estates clinic), representing First Referral Centres for the three clinics were picked. The total number of respondents in the two districts were 507, 92 health providers, -65 community leaders and 350 facility users. Unstructured interviews were undertaken with officials of the Lusaka and Kafue District Health Boards.The study established that, although there are clear indications that there is some movement towards autonomous District Health Boards as provided for in the policy documents that establish the health reforms, the level of autonomy is not as high as was visualised by the people who formulated the policy objectives and strategies of the health reforms.The impact that these "somewhat" autonomous district health boards have had on improving users' access to health services and facilities is not significant. The study established that the motivation of health providers is low due to lack of long-term training opportunities, poor remuneration and other conditions of services, and inadequate institutional support from the Boards.The degree of community participation in the provision of public health services and facilities can generally be described as being moderate because there are still some factors that have a negative effect on the level and willingness of users to participate in public health provision.Integration between the District health boards and other social segments of the district in the provision of public health is being accomplished to some good degree, however the church and traditional establishments are not formally integrated into public health provision both at the district and neighbourhood health committee level.