Geographical Locations - Zambia

• (Statistical) Number of Inhabitants per Doctor: 10,920
• CIA World Factbook : Zambia

Organisations and Networks

UN and Multinational

• WHO
  - WHO Country Profile - Zambia
  - WHO - Tobacco Control: Country Profile: Zambia
  - WHO - Environmental Burden of Disease: Country Profile – Zambia
  - WHO - Malaria Country Profile - Zambia
• WHO - Regional Office AFRO in Brazzaville, Congo

Government

Non-Government

• Care International in Zambia
  CARE International began operating in Zambia in January 1992 at the invitation of the Zambian Government. Activities initially focused on emergency relief in response to the severe drought of the early 1990s, and on interventions to mitigate the effects of escalating inflation and extreme poverty in urban areas. The emphasis of programming has now shifted to long-term, community-based development

Academic Institutions

National Policy and Related Documents

Reports, Guidelines, and Projects

• Abortion as a public health problem in Zambia
  "Zambia, with a population of some 9.2 million people, has a birth rate of 50 per 1000, and thus 450,000 births per annum. In Lusaka alone, there are 40,000 births a year. Of these, some 12,000 occur in hospital, 24,000 in the urban health clinics and the remainder in the woman's own home. Maternal mortality is estimated to be about 500 per 100,000 live births, and abortion is a major contributor to this figure (about 30 per cent)." [Journal of Public Health Medicine, Vol. 18, No. 2, pp. 232-233]
• Assessment of Reproductive Health for Refugees in Zambia
  "The reproductive health of refugees is being addressed in Zambia as evidenced by the wide-ranging efforts of United Nations organizations and numerous local and international nongovernmental organizations in the country. In general, most refugees - with the exception of the urban/peri-urban refugee population, which suffers from transportation and communication barriers - have good access to safe motherhood services. The extent of unsafe abortion demands additional study. The availability of the Minimum Initial Services Package in transit centers and other areas where arriving refugees cross into the country was not investigated. Both of these areas require further exploration to determine the level of need. Supplies for syphilis testing of pregnant women are not consistently available. Community health workers play an active role in most camps to educate refugees about their family planning options, but there is a lack of community-based distribution of supplies which hinders refugees’ access. Also, refugees are reluctant to use family planning methods due to the losses these communities have suffered from the ongoing conflicts in their countries. Generally, there appears to be a good level of awareness concerning the prevention of sexually transmitted infections, including HIV/AIDS; however, perception of risk differs within the refugee population." [Women’s Commission for Refugee Women and Children, On behalf of the Reproductive Health for Refugees Consortium, September 2001]
• Cholera Epidemic Associated with Raw Vegetables—Lusaka, Zambia, 2003-2004
  "Zambia experienced widespread cholera epidemics in 1991 (13,154 cases), 1992 (11,659), and 1999 (11,327)… Although no outbreaks were reported during 2000-2002, cholera remained endemic. Epidemic cholera returned to Zambia in November 2003, when cases of toxigenic Vibrio choleraeO1, serotype Ogawa, biotype El Tor were confirmed in the capital city, Lusaka. During November 28, 2003–January 4, 2004, an estimated 2,529 cholera cases and 128 cholera deaths (case-fatality rate [CFR] = 5.1%) occurred in Lusaka. In February 2004, the Lusaka District Health Management Team (LDHMT) invited CDC to assist in an investigation of the epidemic. This report summarizes the results of that investigation, which implicated food-borne transmission via raw vegetables and demonstrated a protective role for hand washing with soap. The results underscore the importance of hygiene, clean water, and sanitary food handling for cholera prevention." Precedes an editorial by CDC on cholera in the world today. [JAMA. 2004; 292(17): 2077-2078]
• Cigarette smoking among school-going adolescents in Kafue, Zambia
  Introduction: Cigarette smoking is a leading cause of global morbidity and mortality. Interest in developing countries smoking prevalence has been growing since 1999. Objectives: To estimate the prevalence of current cigarette smoking and associated factors among school-age adolescents in Kafue, Zambia. Methods: A cross sectional study was conducted using standard Global Youth Tobacco Survey (GYTS) methodology. Frequencies and odds ratios were obtained to assess the association between selected factors and current cigarette smoking. Results: Data on current smoking were available for 1872 adolescents, of whom 891 (47.6%) were males and 981 females. Overall 154 (8.2%) adolescents were current cigarette smokers, while 93 (10.4%) males and 61 (6.2%) females were current smokers (p <0.001). The majority of the smokers usually smoked at their own home or at a friend’s house. Having some pocket money, having friends or parents who are smokers, and being exposed to pro-tobacco advertisements at social gatherings were associated with being a current cigarette smoker. Conclusions: The traditional factors associated with smoking among adolescents elsewhere are also associated with smoking among adolescents in Kafue, Zambia. Public health interventions aimed to reduce adolescent smoking should be designed with these identified associations in mind. [author abstract] [Malawi Medical Journal; 19(2):75 - 78, June 2007]
• Human Resources for the Delivery of Health Services in Zambia: External Influences and Domestic Policies and Practices: A case study of four districts in Zambia
  Background: Efficient delivery of quality, cost-effective health services as close to the family as possible [MoH vision] requires coordination of related health programmes and optimal utilisation of available resources in a deliberate move to strengthen health systems. Human resources for health (HRH) constitute a key component of the national health system, and Zambia faces a serious HRH crisis. Not only is there an absolute shortage of staff, the available workforce is often ill-distributed and attrition rates are high. There is little systematic insight into the actual human resource constraints at the operational level of hospitals, health centres and other institutions that produce services. Anecdotal evidence suggests that there is severe competition for personnel and staff time between various health programmes and between public and private providers. Such competition is reinforced by the vertical nature of various funding mechanisms supported by external, donor funded programmes. This has intensified the call for increased harmonisation of donor support and its alignment with national policies, so as to take maximum advantage of their potential and minimise any disruptive effects on system-wide planning and management of HRH across the sector. Three main factors are believed to directly influence this problem: inadequacies in staff recruitment, in deployment and in retention. Study objective: To analyse in what way HRH recruitment, deployment and retention at the district level are influenced by external funding; and to what extent this is in line with national and district policies and strategies… Results: This study has shown that the HRH crisis in Zambia’s public health sector is characterised by high vacancy rates, high rates of staff turn over (especially in rural areas), skewed staffing patterns (between various cadres) and general dissatisfaction among health workers with their working environment and conditions of service. Recruitment and deployment of health staff is highly centralised (after a brief spell of decentralised authority, in 2003-2004) and this has clearly affected the human resource situation at the district level and below. The HRH situation has not improved over the past five years and remains alarmingly poor, with just 50 to 60% of the established posts filled in districts like Chama and Chingola. While some districts managed to get a few extra staff, some districts turn out to be relying more heavily on untrained casual workers (CDE’s) than ever before. This does in no way compensate for the severe staff shortages of higher qualified cadres. Although this cannot be proven, the negative effect that this has on health outcomes, such as maternal and infant morbidity and mortality, is very likely. Examples of projects that are competing for scarce staff time are not abundant. District resources for HRH have in fact declined and are largely limited to HRD (including workshops). This prevents health managers to provide some extra incentives to their staff or to recruit (and remunerate) additional staff. The abolition of user fees in rural health facilities is expected to further affect negatively the income of the DHMT and hence their capacity to support health service delivery in rural areas. Districts employ a variety of strategies to address the HRH crisis and retain staff, but none of these have a significant impact. Conclusion: While external funding does not seem to directly affect HRH recruitment, deployment and retention at district level, the DHMT’s are rendered rather powerless because of a combination of three factors: their restricted mandate (because of centralised authorities), the meagre financial income from districts’ own resources and the limited extent to which external funding can be used to strengthen the human resource base… [author abstract]
• IMF Programs and Health Spending: Case Study of Zambia
  This case study examines the interaction between IMF program design and health spending in Zambia. Its aim is to investigate a number of potential criticisms of IMF-supported programs, including that (i) the macroeconomic frameworks underlying the programs take a too conservative view of what is needed for macroeconomic stability and on the prospects for aid flows; and (ii) some of the specific aspects of program design, notably the use of wage bill ceilings, have adverse consequences for the health sector. The study concentrates on two recent periods: (i) 2003 and early 2004, after the earlier IMF-supported program had gone off-track and as the Government implemented an informal (“staff-monitored”) adjustment program in an effort to restore macroeconomic stability and qualify for full HIPC debt relief. It was during this period that explicit ceilings on the overall wage bill were first introduced into programs; and (ii) The period covered by the most recent set of programs under the Poverty Reduction and Growth Facility (PRGF), from mid-2004 to 2006. In this period, especially following the achievement of comprehensive debt relief, the main macroeconomic policy challenge shifted from addressing short-term macroeconomic instability to making good choices on how to utilize the potential for greater fiscal space created by additional external support. Key questions for this period are how well IMF policy advice and program design are adapting to these new challenges and how macro policy choices have interacted with a potential scaling-up of health spending. The authors conclude with lessons for the IMF, the Government of Zambia, and donors. This paper informed the deliberations of the Center for Global Development’s Working Group on IMF Programs and Health Expenditures. [Center for Global Development, Working Group on IMF Programs and Health Expenditures Background Paper, February 2007]
• Lost opportunities in HIV prevention: programmes miss places where exposures are highest
  Background: Efforts at HIV prevention that focus on high risk places might be more effective and less stigmatizing than those targeting high risk groups. The objective of the present study was to assess risk behaviour patterns, signs of current preventive interventions and apparent gaps in places where the risk of HIV transmission is high and in communities with high HIV prevalence [in Zambia]. Methods: The PLACE method was used to collect data. Inhabitants of selected communities in Lusaka and Livingstone were interviewed about where people met new sexual partners. Signs of HIV preventive activities in these places were recorded. At selected venues, people were interviewed about their sexual behaviour. Peer educators and staff of NGOs were also interviewed. Results: The places identified were mostly bars, restaurants or sherbeens, and fewer than 20% reported any HIV preventive activity such as meetings, pamphlets or posters. In 43% of places in Livingstone and 26% in Lusaka, condoms were never available. There were few active peer educators. Among the 432 persons in Lusaka and 676 in Livingstone who were invited for interview about sexual behaviour, consistent condom use was relatively high in Lusaka (77%) but low in Livingstone (44% of men and 34% of women). Having no condom available was the most common reason for not using one. Condom use in Livingstone was higher among individuals socializing in places where condoms always were available. Conclusion: In the places studied we found a high prevalence of behaviours with a high potential for HIV transmission but few signs of HIV preventive interventions. Covering the gaps in prevention in these high exposure places should be given the highest priority. [author abstract] [BMC Public Health 2008, 8:31]
• National Malaria Control and Scaling Up for Impact: The Zambia Experience through 2006
  With its 2006–2011 National Malaria Strategic Plan, Zambia committed to control malaria at a national scale. This scale-up for impact approach was facilitated by sound business planning and financing in 2006 of approximately US$35 million. Compared with surveys in 2001 and 2004, a 2006 national survey of 14,681 persons in 2,999 households at the end of the transmission season showed substantial coverage increases for preventive interventions. Ownership and use rates of insecticide-treated mosquito nets (ITNs) among vulnerable groups doubled, with 44% of households owning ITNs and 23% of children less than five years of age and 24% of pregnant women using them. Roll Back Malaria Abuja targets for intermittent preventive treatment in pregnancy (IPTp) were exceeded, with 62% of pregnant women receiving at least two doses of IPTp. As of 2006, Zambia is demonstrating substantial progress toward the national targets (80% population coverage rates for the interventions) and aspires to show that malaria need not be its leading health problem, and that malaria control is a sound national investment. [author abstract] [American Journal of Tropical Medicine & Hygiene, 79(1), 2008, pp.45-52.]
• Pharmaceutical Society of Zambia: The Lusaka Statement on the Role of the Pharmacist in the Prevention & Management of HIV/AIDS and in Maternal, Neonatal and Child Health (MNCH) in Zambia
  "Pharmacists can contribute their knowledge, skills and expertise in the prevention and management of HIV/AIDS and in Maternal, Neonatal and Child Health (MNCH) and are committed to working collaboratively with National Control programmes in the support of nationwide goals. Pharmacists are accessible health professionals who maintain the respect of their communities through provision of confidential and equitable service and care." [Commonwealth Pharmacists Association, c2004]
• Profiling Domestic Violence: A Multi-Country Study
  This study uses household and individual-level data from the Demographic and Health Surveys (DHS) program to examine the prevalence and correlates of domestic violence and the health consequences of domestic violence for women and their children. It uses data from nine countries - Cambodia (2000), Colombia (2000), the Dominican Republic (2002), Egypt (1995), Haiti (2000), India (1998-1999), Nicaragua (1998), Peru (2000), and Zambia (2001-2002).
• Promotion of couples' voluntary counselling and testing for HIV through influential networks in two African capital cities
  Background: Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples' Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. We present our experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia. Methods: Influence Network Agents (INAs) from the health, religious, non-governmental, and private sectors were trained to invite couples for CVCT. Predictors of successful promotion were identified using a multi-level hierarchical analysis. Results: In 4 months, 9,900 invitations were distributed by 61 INAs, with 1,411 (14.3%) couples requesting CVCT. INAs in Rwanda distributed fewer invitations (2,680 vs. 7,220) and had higher response rates (26.9% vs. 9.6%), than INAs in Zambia. Context of the invitation event, including a discreet location such as the INA's home (OR 3.3–3.4), delivery of the invitation to both partners in the couple (OR 1.6–1.7) or to someone known to the INA (OR 1.7–1.8), and use of public endorsement (OR 1.7–1.8) were stronger predictors of success than INA or couple-level characteristics. Conclusion: Predictors of successful CVCT promotion included strategies that can be easily implemented in Africa. As new resources become available for Africans with HIV, CVCT should be broadly implemented as a point of entry for prevention, care and support. [author abstract] [BMC Public Health 2007, 7:349]
• Summary country profile for HIV/AIDS treatment scale-up: Zambia
  "Zambia’s first AIDS case was reported in 1984. Today Zambia has a generalized HIV/AIDS epidemic that appears to be stabilizing. The Ministry of Health estimates that 1 000 000 adults and children were living with HIV/AIDS at the end of 2004. According to the Zambia Demographic Health Survey of 2002, the national HIV seroprevalence among adults 15-49 years old was about 16%. The mode of transmission is predominantly heterosexual. Mother-to-child transmission is also significant. Data show that AIDS cases peak among women 20-29 years old and among men 30–39 years old, suggesting significant transmission from older men to younger women. The HIV seroprevalence is significantly higher among women (18%) than men (13%) and much higher among the urban population (25-35%) than the rural population (8–16%). The epidemic is estimated to have left at least 600 000 children orphaned. HIV/AIDS morbidity and mortality also result in an estimated 50% of general hospital admissions and more than 70% of specialized medical hospital admissions."
• Telemedicine Project to improve Zambia’s health delivery
  "People living in rural areas in Zambia struggle to access timely, quality specialty medical care primarily because specialists and physicians are located in urban areas and some have trekked to work in other countries. However, owing to innovations in computing and telecommunications technology, many elements of clinical practice and public health can now be accomplished through telemedicine, even though the patients and health care providers are separated geographically. This, however, requires capacity in terms of telecommunication and computer equipment. Through telemedicine, skilled hands-on treatment, such as surgery, is often conducted. Telemedicine or tele-health enables patients-providers to exchange information which leads to an appropriate diagnosis and treatment plan, which can then be administered by less highly trained health staff or even the patient alone." [I-Connect Online]
• The reach and impact of social marketing and reproductive health communication campaigns in Zambia
  Background: Like many sub-Saharan African countries, Zambia is dealing with major health issues, including HIV/AIDS, family planning, and reproductive health. To address reproductive health problems and the HIV/AIDS epidemic in Zambia, several social marketing and health communication programs focusing on reproductive and HIV/AIDS prevention programs are being implemented. This paper describes the reach of these programs and assesses their impact on condom use. Methods: This paper assesses the reach of selected radio and television programs about family planning and HIV/AIDS and of communications about the socially marketed Maximum condoms in Zambia, as well as their impact on condom use, using data from the 2001–2002 Zambia Demographic and Health Survey. To control for self-selection and endogeneity, we use a two-stage regression model to estimate the effect of program exposure on the behavioural outcomes. Results: Those who were exposed to radio and television programs about family planning and HIV/AIDS were more likely to have ever used a condom (OR = 1.16 for men and 1.06 for women). Men highly exposed to Maximum condoms social marketing communication were more likely than those with low exposure to the program to have ever used a condom (OR = 1.48), and to have used a condom at their last sexual intercourse (OR = 1.23). Conclusion: Findings suggest that the reproductive health and social marketing campaigns in Zambia reached a large portion of the population and had a significant impact on condom use. The results suggest that future reproductive health communication campaigns that invest in radio programming may be more effective than those investing in television programming, and that future campaigns should seek to increase their impact among women, perhaps by focusing on the specific constrains that prevent females from using condoms. [author abstract] [BMC Public Health 2007, 7:352]
• Who is getting or will get anti-retroviral treatment in Zambia?: Equity, access and fairness in the governance of 'scaling-up' HIV/AIDS medication
  "The article draws on the considerable challenges in broadening access to treatment facing Zambia. Many of these barriers concern cost recovery measures, perceptions of bias towards government employees, and, especially, co-ordination between development aid donors, recipients, and state-civil society relations. Not least, the Global Fund, Country Coordinating Mechanisms, and the creation of National AIDS Councils represent new and welcome policy departures in improving co-ordination of responses to HIV/AIDS. But the question remains, how effective are they in Zambia?" [Norwegian Centre for Human Rights, Research Notes 06/2004]
• Zambia: The right to health and international trade agreements
  This paper, produced as part of an EQUINET Capacity building programme in January 2007, "aims to investigate, analyse and raise awareness on the major implications of WTO agreements on the delivery of health services to the poor and vulnerable thereby affecting the realisation of the right to health in Zambia. One of the much vaunted benefits of globalisation is that innovations of science and technology can be more readily available and shared by the citizens of the world. Proponents of globalisation further argue that significant gains in the advancement of treatment of diseases would be available to people in the furthest regions. However, as recent experience has shown, availability does not mean accessibility – especially in the case of life-saving drugs and affordable health services in developing countries… This report undertakes an analysis of the relevant provisions of the World Trade Organisation (WTO) Trade Related Aspects of Intellectual Property Rights (TRIPs) and the General Agreement of Trade in Services (GATS) agreements with respect to the provision and accessibility of health services…".
• Zambia Country Report: Multi-sectoral AIDS Response Monitoring and Evaluation – Biennial Report, 2006-2007
  "Zambia, a country with an estimated population of 12.2 million in 2007 based on a 2.9 percent annual growth since 2000 has an estimated HIV prevalence of 15.6% among the 15-49 years age group, making it one of the countries in Sub-Sahara Africa worst affected by the HIV and AIDS pandemic. Sub-Sahara Africa has an estimated prevalence of 7%. In 2007, Zambia was one of the countries with the highest dependency ratios in the world which was reported as 0.9 against 0.4 respectively. Unemployment is high and presents a serious social problem. A combination of high dependency ratio and high unemployment presents a significant challenge for HIV and AIDS for Zambia."
• Zambia Health Services and Systems Program
  "This is the first in a series of HSSP Occasional Papers highlighting the health system strengthening work of the project in Zambia. The focus of this paper is on human resources for health (HRH). The paper presents an overview of the current HRH situation in Zambia, provides comparisons with other countries in the region, and summarizes the work accomplished under the human resources component of HSSP in the project’s first year of operation, namely: Identifying and analyzing priority HRH issues in Zambia; Developing solutions and presenting them to stakeholders; and Assisting the Ministry of Health (MOH) and Government of the Republic of Zambia (GRZ) in setting the HRH agenda." [Occasional Paper Series, Human Resources for Health, Number 1. Bethesda, MD: Health Services and Systems Program (HSSP), Abt Associates Inc. for USAID, 2006]

Educational Resources

• Forum for Food Security in Southern Africa
  The purpose of the Forum for Food Security in Southern Africa, which has operated since 2003, is to provide a platform for improved linkages between food security analysis, policy making and implementation in the Southern Africa region. It covers the region as a whole and five specific countries: Lesotho, Malawi, Mozambique Mozambq, Zambia and Zimbabwe. It has brought together those in government, official donors, NGOs, civil society, the private sector, and international and regional researchers concerned with food security.
• Southern Africa Research and Documentation Centre
  SARDC is an independent regional information centre involved in the collection, production and dissemination of information about the SARDC region, with offices in Harare, Maputo and Dar es Salaam; and network partners in all SARDC member states including Zambia
• UNAIDS/WHO Epidemiological Fact Sheets on HIV and AIDS, 2008 Update – Zambia
• Zambia Online
  This site provides a gateway to Internet resources related to Zambia.
• Zambian.com
  The Zambian was founded in January of 1999, with the goal of serving the information needs of the Zambian community.