An evaluation of the restructuring of the Ministry of Health: A case study of Kabwe District(2006-2011)

Abstract

The provision of quality health services has always been a cornerstone of the Zambian health care system. In this vain, the Government of the Republic of Zambia (GRZ) made a policy decision to restructure the Ministry of Health(MOH) in 2006.This dissertation discusses whether the 2006 restructuring of the Ministry of Health(MOH) has led to improved service delivery with particular focus on Kabwe District from 2006-2011.

The general objective of the study was to evaluate the 2006 restructuring of the MOH in Kabwe district. The specific objectives of the study were; To assess the quality of health services provided by the MOH after the 2006 restructuring, To assess the extent to which the community participates in decision making concerning health service provision at the local level; To establish the constraints faced by health providers in the provision of health services and To identify the challenges faced by the service users in accessing health services.

The research design used was a case study. Both qualitative and quantitative techniques were used. The researcher used both primary and secondary data. Primary data was collected from key informants through interviews using interview guides and from members of the public and health workers by using a questionnaire with open and closed ended questions. Secondary data was collected through document reviews. The study used a sample size of 190 respondents comprising of 70 health workers, 94 service users and 26 key informants.

The two provincial hospitals and one rural health centre were selected purposively, the other four health facilities from which the sample of health workers was drawn was selected by using systematic random sampling.The proportional method was used to select respondents from the rural and urban health facilities. The service users were selected randomly from among those accessing the health facilities as out- patients.

The study found out that the 2006 restructuring of the MOH has led to an improvement in the quality of health service delivery in terms of drug availability, nursing care and the positive perception of both service users and health workers on the quality of services offered. However, other indicators of quality of care still do not fare well such as shortage of health personnel and long waiting time. The study also revealed that community participation in decision making is minimal in nearly all health centers and non existent in hospitals. Challenges faced by service users included long waiting time, accessibility to health facilities and poor attitude of health workers in some instances whilst health workers main constraints were; low staffing levels, lack of transport, inadequate medical equipment and infrastructure.

The researcher recommends that: Hospitals form advisory committees so as to enhance community participation and improve service delivery.Facilities to research further on the root causes of long waiting time so as to improve service delivery. Government to invest in: infrastructure, equipment, transport and deploy more health workers to the facilities.