Bibliography

Theme area
Equity in health
Author
Chitah B; Jonsson D
Title of publication Universal Health Coverage Assessment: Zambia
Date of publication
2015 June
Publication type
Report
Publication details
Universal Health Coverage Assessment: Zambia, Global Network for Health Equity (GNHE), June 2015
Publication status
Published
Language
 
Keywords
Zambia, universal health coverage, health financing, health equity
Abstract
This document provides a preliminary assessment of the Zambian health system relative to the goal of universal health coverage, with a particular focus on the financing system and related aspects of provision. Zambia is making continuous progress in all the key areas of its health system. However, there are gaps which need to be resolved for the country to be able to realise the goal of universal coverage, including universal financial protection and access to care. First, a more equitable distribution of resources between urban and rural areas is required. Second, resources need to be allocated to promote access to, and utilisation of, health care by the poorer socio-economic groups. The higher consumption of public inpatient health care services by wealthier groups is a striking example of inequitable utilisation, as is the relatively greater levels of government subsidy received by wealthier groups, even for primary health care. Third, the impoverishing effect of out-of-pocket payments exposes poorer households to financial risk, driving households into poverty or further into poverty. This requires reconsideration of public hospital user fees, both in terms of the level of fees and the application of bypass fees (which are charged when patients bypass primary health care facilities, including because of the severity of their conditions and their proximity to higher-level health facilities). Finally, Zambia’s ambition to introduce social health insurance as a mechanism for improving the pooling and purchasing of services needs to be scrutinised for its possible impacts on equity. The proposed social health insurance scheme would require co-payments and perhaps other contributions, which would increase the financial burden on households. This means that the proposed scheme could effectively run counter to the ambition of attaining universal health coverage. There should be a critical evaluation of the alternative option of simply continuing – and strengthening - the current tax-based financing system.
Country
Zambia
Publisher
Global Network for Health Equity