The delivery of health services in the Zambian decentralised system : a case study of Lusaka District

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Chama, Kombe William
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This study was an attempt to investigate social services delivery in the Zambia decentralised and integrated system of local government, with particular emphasis on health service delivery. The investigation and analysis focused primarily on Lusaka Urban District Council which was one of the first five urban district councils to be involved in the programme of taking over the running of health facilities from central government.The study was prefaced by the concept of 'participation* especially Bregha's (1973) basic participation model in social service delivery - a continua of progressively Increasing involvment of local people in the delivery mechanism through information/feedback* consultation joint planning and delegated authority. Specifically the study investigated first and foremost, if local people had been raade to participate in social services delivery by the introduction of decentralisation in 1981. Secondary, it investigated the extent to which the objective of creating district based, controlled and co-ordinated health service structure had been achieved. The study tested the following hypotheses: First, that under the decentralised system Party members were nor«c likely to participate in service delivery than non-members. Second, that participation of local people was limited to information/ feedback and consultation. Third, that people did not participate in health service delivery in Che die trie t. Fourth, and last that a district based health service structure has not been created, were collected u»ing three instruments: focused interviews using two questionnaires and secondary literature. The first method involved in-d«pth discussions vith key Informants. The second questionnaire examined the health workers perceptions and underatanding of health delivery in the decentralised eystera. The second questionnaire explored local people's understanding of decentralisation and their role in the delivery of health service. Secondly literature consisted of published and non-published documents. A total sample of 150 respondents was selected consisting of five (5) key informants, a stratified random sample of ninety (90) local residents of Lusaka, and fifty five (55) rank and file medical workers in health centres in Lusaka. Salient findings of the study were that the transfers of district health Jurisdiction to the Lusaka Urban District Council had attempted to create both a district based health delivery system and a district health organisation. However, decentralisation of health system had not increased local peoples' participation in health services. There was an absence of an articulate local structure through which local residents could get Involved in health delivery, and that health workers were Ill-prepared to handle community involvement in health services delivery.The study concluded that there was no general policy guidelines about local participation in health services delivery in LUsaka. What was required was therefore a broad policy defining the nature of the council's commitment to popular participation and clarifying the boundaries, settings, and problems of such involvement. With regard to decentralisation of health services, lack of adequate resources especially finance and personnel hataperad the exercise. Overall, the decentralisation Act was found to have been over ambitious as it envisaged to do more than the resources and circumstances permitted.
Health Services Administration , Healthcare Delivery