Healthcare investments in Zambia: the case of sida.
Date
2020
Authors
Mulenga, Daughtry
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
Background: Improving reproductive, maternal, newborn, and child health (RMNCH) services
and increasing coverage for primary health care services is the focus of many developing
countries. In this agenda, external funds play a crucial role in health service delivery, including
RMNCH services. Skilled attendants assist in about 66% of births worldwide. In Zambia,
80.4% of women are attended to by qualified health providers, with disparities between rural
(73.4%) and urban areas (93.1%). Hence the response by the Swedish International Development
Cooperation Agency (SIDA) to invest in bettering the health of women, children, and adolescents
in Southern and Eastern provinces in Zambia. This study assessed the effect of SIDA’s health
care investments on skilled deliveries in Eastern and Southern province of Zambia.
Methods: The study used a combination of controlled interrupted time series (ITS) analysis and
qualitative analysis. The study used administrative data compiled from 72 Health Management
Information System (HMIS) monthly data points for each district in the two provinces from
January 2013 to December 2018. Four (4) districts from the 22 SIDA funded, which included
two (2) best and two (2) least performing districts were sampled to obtain qualitative insights.
Quantitative Results: The study showed significant shifts in the trend of skilled deliveries
following the interventions in fourteen (14) out of twenty-two (22) recipient districts in the
two (2) provinces. However, controlled ITS analysis showed a significant increase in skilled
deliveries of about 1.52 (p<0.01) in Chadiza, 0.8 (p<0.05) in Mambwe, and a reduction of
about 2.7 (p<0.01) in Vubwi in Eastern province. For Southern province, there appeared to be
an increase in the percentage of skilled deliveries of about 0.44 (p¡0.01) in Gwembe, and 0.51
(p<0.01) in Siavonga. The results also recorded decreases of about 1.9 (p<0.05) in Chikankata,
1.1 (p< 0.01) in Livingstone, and 0.75 (p<0.01) in Mazabuka following the intervention.
Qualitative Results: Factors such as recruitments and training, human resource development,
infrastructure development, transport system improvements, and integrated outreach services
(at both facility and district level) appeared to be facilitators of skilled deliveries in the two
provinces. On the other hand, delayed disbursement of funds, inadequate staffing levels, and
insufficient infrastructure appeared to be inhibitors of skilled births.
Conclusion: Therefore, this study recommends that the primary intervention should provide all
the essential inputs. Input provision should also be timely and sufficient to avoid slow progress
and sub-optimal performance.
Keywords: Controlled, ITS, Analysis, Facilitators, Inhibitors, Intervention, HMIS
Description
Thesis
Keywords
Primary health care--Zambia , Community health services--Zambia , Maternal health care services--Zambia