Health reforms and health care delivery in Lusaka urban district cby Charles Tennard Banda

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Banda, Charles Tennard
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Health care delivery policy and strategies in Zambia could be said to have evolved through four significant phases. First, the pre-independence era whose health policies and strategies were based on the racial segregation ideology. Secondly, the immediate post-independence era whose health care policies and strategies were aimed at abolishing the imbalances introduced during the colonial era. The third phase was the adoption of the Primary Health Care (PHC) in the provision of health care in the 1980s and fourthly, because of the failures of the Primary Health Care concept in the 1980s when the Movement for Multiparty Democracy (MMD) government took office in 1991, they embarked on Health Reforms whose main thrust was the establishment of District Health Boards as basic management units in the delivery of health care.The aim of this study was to establish the failures of health reforms in ensuring effective health care delivery in Lusaka Urban District which is run by Lusaka Urban District Health Management Board. In realizing the aim of the study, this dissertation takes a comparative study of health care services offered by different health care facilities in Lusaka urban district so as to make a balanced assessment of the performance of the health facilities under the health reforms in ensuring effective health care delivery. This study was conducted in Lusaka district. A total of 193 Health Care Providers, 382 Clients and 503 Community members were interviewed from 22 Health Centers. In arriving at the sample the researcher considered the number of health facilities under study, their staffing levels, and the feasibility of attaining the intended sample size with regard to available resources such as time, manpower and finances. A list of health centers in Lusaka Urban was obtained. Included in this list were University Teaching Hospital (UTH), Chainama Hills Hospital and Maina Soko Military hospital. Under the list of health centers, five (5) health centers that offer baby delivery services and five (5) that do not offer baby delivery services were randomly chosen. All health care providers who were found on duty (averaging 15-20) on the days of the survey were interviewed. Likewise,all the Health Care Providers on duty in the Out-patient and Specialist clinics were also interviewed. Social Science (SPSS Versionl 1.0) was used to analyze the data. The study established that although the health reforms has contribute in the introduction of District Health Boards with a view of bringing health care service delivery as close to the family as possible, a number of issues still remain unresolved.The study established that although there are clear indications that there is some movement towards availing health care providers in sufficient numbers to all the health care facilities in the district, there is need also to balance gender of the staff distributed to these facilities. However, the lack of feed back on referred patients and the charging of user fees were some of the issues cited for the dissatisfaction amongst users of health care facilities in Lusaka Urban District. Critical questions pertaining to equity of access and quality of delivery of health care system were highlighted. All these questions reflected concern and indeed this study, clearly demonstrated these concerns: Implementing user fees with persistent drug shortages, efforts to decentralize power to the districts without resolving de-linkage and staff motivation and equity of access to health care, setting of quality standards without involving stakeholders are some of the issues requiring immediate attention.
Health reforms--Zambia , Health care delivery