Strengthening the systems that deliver health services is a priority for DFID in Zambia. Under Zambia’s Joint Assistance Strategy, DFID is the overall lead donor in the health sector during 2007 and has responsibility for coordinating the contributions of 15 multilateral and bilateral agencies.
In 2006-07, DFID provided an estimated £5.5 million to support health systems in Zambia, of which approximately £4.7 million was through Direct Budget Support.
DFID is also providing technical support to the implementation of the Zambian Government’s human resources strategic plan which is working to address Zambia’s severe human resource crisis in the health sector. In addition, we are supporting improvements to financial management, monitoring and evaluation, as well as timely procurement of drugs and supplies.
From 2002-03 to 2006-07, DFID provided a total of approximately £30.6 million to support health systems in Zambia.
DFID does not have a formal definition of “health systems” but the following table shows DFID spend in the health sector in Zambia. The top three rows relate most closely to health systems. Direct Budget Support means the funds have been provided directly to the Zambian Government’s budget either for general or sector specific purposes. The data incorporate a notional allocation of 20 per cent. of Direct Budget Support for the health sector.
£ Input sector 2002-03 2003-04 2004-05 2005-06 2006-071 Health sector: Notional allocation of direct budget support — — 1,833,043 4,215,999 4,745,544 Health Policy 8,366,796 4,991,898 2,797,303 2,837,159 810,833 Pro Poor Health Policy and Systems — — — 13,846 — Nutrition — — 13,212 426,551 3,970 Communicable Disease Control — — — 12,813 — Reproductive Health incl. Family Planning Activities 1,198,188 1,502,875 63,072 6,128 — Health Research 97,865 49,926 — — — HIV and AIDS 275,712 135,109 1,978,281 5,211,737 4,273,106 Health total 9,938,561 6,679,808 6,684,911 12,724,232 9,833,453 Of which: Estimated health systems 8,366,796 4,991,898 4,630,346 7,067,003 5,556,377 1 Provisional.
In April 2006, health user fees were removed in all Zambian government-funded health institutions in rural areas. This has made health care free at the point of access in 54 of Zambia's 72 districts. Overall, it is estimated that a third more people are being seen in health facilities. However, there has been concern about the quality of services. In many clinics, drugs ran out, and health workers become even more overworked than before. There is a plan to expand free care to peri-urban areas later in 2007. Expansion to urban areas is expected to follow in time; however this needs to be undertaken with care because of the limited capacity of current facilities such as numbers of clinics, health workers and drug supply systems to cope with additional use.
The Government of Zambia, together with DFID, has therefore prioritised improvements to drug procurement and supply chain systems, and the development of plans to address the human resource crisis. To assist, DFID plans to provide an additional £2.9 million per year for five years in general budget support, which will be used to increase the grants to districts, procure drugs, and recruit and retain more health workers.