Trends in health and health care in Zambia

Emmanuela Gakidou, PhD

Associate Professor, Global Health

April 18th, 2013

2

Outline

• Population-level trends in burden of disease and coverage of key interventions

• Facility-level trends in provision of services

• Patient-level satisfaction

3

Zambia overview

1990 2010

Population 7.8 m 13.1 m

GDP per capita (I$) 902 1,552

Average years of education among women aged 15-44

4.66 6.50

% women aged 15-19 currently in school

40% 63%

Life Expectancy at birth 50.6 55.8

Under- 5 mortality (per 1,000) 178 105

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www.healthmetricsandevaluation.org/gbd

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Zambia: trends in top 20 causes of child death

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Trend in under-5 mortality

1990 1995 2000 2005 2010

100

120

140

160

180

Zambia National Trend in Child Mortality 1990-2010

Year

Dea

ths

(per

1,0

00)

Health sector reform

Child Health Week

Catch up immunization with CHWs

IRS

ITN scale up

ACTs

HiB

PMTCT

HR and infrastructure investments

7

Trends in coverage of select key interventions

8

Under-5 mortality

9

DPT3 immunization coverage

10

Scale up of ITN ownership

11

ITN ownership compared to ITN use

12

Key MCH interventions and under-5 mortality

13

Education of women of reproductive age

14

Childhood malnutrition (underweight)

15

Education, malnutrition and mortality

16

Facility-level trends in the provision of services

17

Trend in ART-related visits at health facilities

18

Trend in non- ART related services

19

Trends in volume of care for facilities that provide ART vs. facilities that do not

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What do the customers say?Patient satisfaction across facilities in Zambia

21

Primar

y or

Les

s - U

rban

Post-P

rimar

y - U

rban

Primar

y or

Les

s - R

ural

Post-P

rimar

y - R

ural

0

10

20

30

40

50

60

70

80

Average travel time to urban and rural health facilities, by education

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Proportion of patients waiting over 1 hour, urban and rural facilities, by education

By education level

Primary or Less - Urban

Post-Primary - Urban

Primary or Less - Rural

Post-Primary - Rural

0

0.1

0.2

0.3

0.4

0.5

0.6

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Overall patient satisfaction

MOH HC Priv/NGO HC

MOH Hosp Priv/NGO Hosp

0

1

2

3

4

5

6

7

8

9

10

Urban/Peri-Urban

MOH HC Priv/NGO HC

MOH Hosp Priv/NGO Hosp

Rural

Proportion of patients that would return to facility

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MOH HC Priv/NGO HC MOH Hosp Priv/NGO Hosp

Rural

MOH HC Priv/NGO HC MOH Hosp Priv/NGO Hosp

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Urban/Peri-Urban

No Yes, somewhat Yes, definitely

25

Burden of disease in Zambia, 2010

26

27

Extra slides

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Zambia Health Surveillance Data Sources

Sources for IHME estimates Years

Census of Population and Housing 1990, 2000, 2010*

Indoor Residual Spraying database 2005-2010*

Zambia Health Facility Census 2005-2006*

Medical Stores Limited 2008-2011*

HMIS Database 2000-2009*

Global Precipitation Climatology Centre 1986-2012

*unpublished

29

Zambia Health Surveillance Data SourcesSources for IHME estimates Years

DHS 1992, 1996-1997, 2001-2002, 2007

LSMS 1996, 1998, 2002-2003, 2004-2005, 2006*, 2010*

Malaria Indicator Survey 2006*, 2008*, 2010*

Multiple Indicator Cluster Survey 1999

Sexual Behavior Survey 2005, 2009

Household Health Coverage Survey 2008

NetMark Baseline Survey on Insecticide-Treated Materials (ITMs) in Zambia

2001

ABCE survey data 2012*

*unpublished