Healthcare investments in Zambia: the case of sida.

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