Kapiri Mposhi was selected for a PLACE study because data from antenatal clinics and official pro... more Kapiri Mposhi was selected for a PLACE study because data from antenatal clinics and official projections suggest that the level of HIV prevalence in Kapiri Mposhi is high. HIV prevalence among women attending antenatal care was 20.2% in 2004. Official projections estimate an overall prevalence of 17.4% in Kapiri Mposhi district for 2006. The town of Kapiri Mposhi located along the Great North Road is a major transportation hub. The TAZARA rail line that links Zambia and Tanzania terminates in Kapiri Mposhi. At a junction just north of the town the Lusaka-Ndola road to the Copperbelt merges with the Great North Road leading to neighbouring Tanzania. A large number of people from all parts of Zambia and from many other countries pass through the town of Kapiri Mposhi over the course of a year and many spend at least one night in or near the town. Because of its central location the town is susceptible to a high prevalence of sexually transmitted infections (STIs)/HIV/AIDS and road tr...
Box 4.1:Community views about user fees at Itufa and Kaanja Clinics………………16 Box 4.2: Users' react... more Box 4.1:Community views about user fees at Itufa and Kaanja Clinics………………16 Box 4.2: Users' reactions to user fees in the urban health centres……………………17 Box 4.3: Providers' reactions to user fees in the urban health centres………………...19 Box 7.1: Community views about quality of care…………………………………….47 Box 7.2: Providers' views about quality of care………………………………………48 PREFACE In 1994, the World Bank published its report Better health in Africa, which outlined policies to improve the quality of Primary Health Care by increasing participation of local populations and to ensure its financial sustainability. The latter was to be realised by the principle of cost-sharing. The report was the logical sequel to the World Bank's previous report (World Development Report 1993: Investing in Health) in which it had sketched the economic implications of improved health conditions. That report emphasised that development is not possible without a healthy population; health, in other words, is an economic asset. In the same year, 1994, the Zambian government launched its Health Reforms which aimed at a revitalisation of Primary Health Care by introducing cost-sharing as a key principle of community participation and sustainability. Two years later, researchers from the Zambian Institute for African Studies (later to be renamed as the Institute of Economic and Social Research) and the University of Amsterdam, the Netherlands, met and designed a research plan to study the achievements of Health Reforms in Zambia. The Danish Ministry of
adjustment is a cut in public spending on social services including health services. The governme... more adjustment is a cut in public spending on social services including health services. The government of Uganda has introduced cost-sharing as one way of achieving this objective. However cost-sharing is frustrating to implement in a country where information regarding the costs in real terms of the health care services is lacking and where the response of the citizens to flscal measures is not high on the priority list of policy makers These two conditions make it impossible for the merits of alternatives to government health services to be easily mapped, and subsequently masks fiscal abilities and preferences of Citizens. Government support for social services• principally health and education has declined radically from the early 1970's. The deterioration of the health service system in Uganda is partly attributable to the complex ethnic legacy of colonial rule which helped to push the country into political, economic and social turmoil from which it may only now slowly be recovering. The effects of the turmoil on service provision were devastating. As a resifit of this Uganda's aggregate health indicators, today, such as infant mortality and life expectancy at birth are among the world's worst. Government's capacity to deliver social services is further hampered by a low revenue base and therefore low resources available to government for expenditure on social services. This is further exacerbated by an ineffectual prioritisation, lack of a "living wage" for government employees and extremely low rural incomes. This forms the backdrop to state capacity to provide services.. Public sector support for improved services cannot be matched by adequate budgeting allocation-while government is financing the strengthening of the economic base. There are significant systemic and structural inequalities in both the emplacement of facilities and accessibility to health services in Uganda: between urban and rural areas and within them. Almost all public facilities are in a sorry state. There exists little effective management and the staff are inadequately jaid The management issue is partly a matter of training but mainly one of motivation. it is also a reflection of the poorly coordinated structure of responsibility for health services in Uganda 6
The Global HIV/AIDS Initiatives Network (GHIN) is a network of researchers established in 2006 th... more The Global HIV/AIDS Initiatives Network (GHIN) is a network of researchers established in 2006 that aims to track the effects of the major global HIV/AIDS initiatives: • The World Bank’s Global HIV/AIDS Programme including the Multi-country AIDS Programme (MAP)
Zambia adopted the policy of internal contracts, as part of the broader health sector reforms. Dr... more Zambia adopted the policy of internal contracts, as part of the broader health sector reforms. Drawing on insights from New Institutional Economics, this study investigated the policy of internal contracts between District Health and Referral Hospital Boards. The objectives of the study were: to describe the nature of contracts between districts and hospitals; assess the impact of different types of contract settings on referrals; and explore the processes through which contracts impacted on referrals. The study used a combination of qualitative and quantitative methods. The study found that internal contracts had produced positive outcomes such as the delineation of service provision functions among providers, devolution of authority to devolved units, and increased interaction between districts and hospitals. These outcomes were, however, marred by a narrow decision making space, which was characterized by staff inadequacies and management difficulties and service delivery constra...
This study investigated the growing relation between Ethiopia and China in the last decade. It is... more This study investigated the growing relation between Ethiopia and China in the last decade. It is possible for Chinese-Africa relations to be either complementary or competitive (or indeed both) and it has multifaceted features. Notwithstanding this multifaceted linkage, the study focused on one of the channels-the investment (FDI) channel. Other channels are explored depending on the degree at which they shed light on understanding the Chinese-Ethiopian investment relations, which is the subject of this study. With this broader objective this study includes:
Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the ep... more Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the epidemic. This paper presents, the Priorities for Local AIDS Control Efforts (PLACE) method which focuses on understanding the venues where people are meeting new sexual partners and behaviors which put people at risk. A comparison of data from two PLACE studies in Zambia with a national household survey, the Zambia Sexual Behavior Survey (ZSBS) 2005, indicated that the PLACE population was at greater risk of acquiring HIV. Respondents in the two PLACE studies were significantly more likely to report 1+ new partners in the past 4 weeks, 2+ partners in the past 12 months, 1+ new partner in the past 12 months and transactional sex. Data from the PLACE method is important for targeting interventions for those most likely to acquire and transmit HIV.
Universal health coverage depends on having the necessary human resources to deliver health care ... more Universal health coverage depends on having the necessary human resources to deliver health care services. Zambia is among the African countries currently experiencing a crisis in the area of human resources for health (HRH). The major causes of the crisis include inadequate and inequitable distribution of health workers; high vacancy rates; insufficient education capacity to supply the desired levels of health workers needed by the market, inadequate wages and working conditions to attract and retain people into health work, particularly in rural underserved areas. This shortage affects most of the available health worker categories. The shortage and maldistribution of health workers stems from various labour market and governance factors, including an exodus of trained professionals to other countries in Africa and elsewhere. This document provides an overview of the HRH labour market in Zambia, highlighting the importance of a comprehensive approach to understanding the driving f...
ABSTRACT A number of problems plague the current Farmer Input Support Programme (FISP), including... more ABSTRACT A number of problems plague the current Farmer Input Support Programme (FISP), including: late delivery of inputs; distribution of standardized inputs that may not be appropriate for all agro-ecological zones or soil types; crowding out of private sector; poor targeting, and; high cost to the government treasury.
Hospitals have been relatively neglected although their high resource consumption implies that ga... more Hospitals have been relatively neglected although their high resource consumption implies that gains from improving the services they deliver may be substantial. Nevertheless, the challenges posed by hospital reforms are great. Hospital autonomy usually consists of both decentralisation, and a greater measure of exposure to market forces. In Uganda and Zambia, more traditional 'decentralisation' of authority to district level authorities includes district hospitals; and some measure of 'autonomy' (known as 'self-accounting status' in Uganda) has been applied to some or all second and third level referral hospitals. The hospital policies pursued in both countries present opportunities to tackle their hospital sectors. In Zambia, purchasing of services means that new incentives and policy mechanisms can come into play. Little advantage has been taken of these opportunities to date. In Uganda, there is no financial link between districts and higher levels of the system, but decentralisation of control over personnel is more advanced. These two components--the alignment of incentives (to promote access and quality for those intended to be covered by the public budget) and the effective decentralisation of control over key resources--seem to us the key tools to address the stubborn problems of hospitals.
Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the ep... more Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the epidemic. This paper presents, the Priorities for Local AIDS Control Efforts (PLACE) method which focuses on understanding the venues where people are meeting new sexual partners and behaviors which put people at risk. A comparison of data from two PLACE studies in Zambia with a national household survey, the Zambia Sexual Behavior Survey 2005, indicated that the PLACE population was at greater risk of acquiring HIV. Respondents in the two PLACE studies were significantly more likely to report 1+ new partners in the past 4 weeks, 2+ partners in the past 12 months, 1+ new partner in the past 12 months and transactional sex. Data from the PLACE method is important for targeting interventions for those most likely to acquire and transmit HIV.
Age, poverty and alcohol use are seen as risk factors for HIV among women in sub-Saharan Africa. ... more Age, poverty and alcohol use are seen as risk factors for HIV among women in sub-Saharan Africa. The objective of this study was to understand the influence of socioeconomic factors (including age and poverty) as well as alcohol use on risky sexual behaviors among women in Mongu, Zambia. This study examines these factors in the local context of Mongu, Zambia using the Priorities for Local AIDS Control Efforts (PLACE) methodology. This methodology allows for the study of risky behaviors while taking into consideration local factors. The two outcome variable studied were transactional sex in the past year and having two or more sexual partners in the past year. In this study age was not a significant factor, but alcohol use and poverty/desire for economic advancement were significant factors. Programs and policies need to address the influence of alcohol on risky sexual behaviors and also the important but complex influence of poverty.
Kapiri Mposhi was selected for a PLACE study because data from antenatal clinics and official pro... more Kapiri Mposhi was selected for a PLACE study because data from antenatal clinics and official projections suggest that the level of HIV prevalence in Kapiri Mposhi is high. HIV prevalence among women attending antenatal care was 20.2% in 2004. Official projections estimate an overall prevalence of 17.4% in Kapiri Mposhi district for 2006. The town of Kapiri Mposhi located along the Great North Road is a major transportation hub. The TAZARA rail line that links Zambia and Tanzania terminates in Kapiri Mposhi. At a junction just north of the town the Lusaka-Ndola road to the Copperbelt merges with the Great North Road leading to neighbouring Tanzania. A large number of people from all parts of Zambia and from many other countries pass through the town of Kapiri Mposhi over the course of a year and many spend at least one night in or near the town. Because of its central location the town is susceptible to a high prevalence of sexually transmitted infections (STIs)/HIV/AIDS and road tr...
Box 4.1:Community views about user fees at Itufa and Kaanja Clinics………………16 Box 4.2: Users' react... more Box 4.1:Community views about user fees at Itufa and Kaanja Clinics………………16 Box 4.2: Users' reactions to user fees in the urban health centres……………………17 Box 4.3: Providers' reactions to user fees in the urban health centres………………...19 Box 7.1: Community views about quality of care…………………………………….47 Box 7.2: Providers' views about quality of care………………………………………48 PREFACE In 1994, the World Bank published its report Better health in Africa, which outlined policies to improve the quality of Primary Health Care by increasing participation of local populations and to ensure its financial sustainability. The latter was to be realised by the principle of cost-sharing. The report was the logical sequel to the World Bank's previous report (World Development Report 1993: Investing in Health) in which it had sketched the economic implications of improved health conditions. That report emphasised that development is not possible without a healthy population; health, in other words, is an economic asset. In the same year, 1994, the Zambian government launched its Health Reforms which aimed at a revitalisation of Primary Health Care by introducing cost-sharing as a key principle of community participation and sustainability. Two years later, researchers from the Zambian Institute for African Studies (later to be renamed as the Institute of Economic and Social Research) and the University of Amsterdam, the Netherlands, met and designed a research plan to study the achievements of Health Reforms in Zambia. The Danish Ministry of
adjustment is a cut in public spending on social services including health services. The governme... more adjustment is a cut in public spending on social services including health services. The government of Uganda has introduced cost-sharing as one way of achieving this objective. However cost-sharing is frustrating to implement in a country where information regarding the costs in real terms of the health care services is lacking and where the response of the citizens to flscal measures is not high on the priority list of policy makers These two conditions make it impossible for the merits of alternatives to government health services to be easily mapped, and subsequently masks fiscal abilities and preferences of Citizens. Government support for social services• principally health and education has declined radically from the early 1970's. The deterioration of the health service system in Uganda is partly attributable to the complex ethnic legacy of colonial rule which helped to push the country into political, economic and social turmoil from which it may only now slowly be recovering. The effects of the turmoil on service provision were devastating. As a resifit of this Uganda's aggregate health indicators, today, such as infant mortality and life expectancy at birth are among the world's worst. Government's capacity to deliver social services is further hampered by a low revenue base and therefore low resources available to government for expenditure on social services. This is further exacerbated by an ineffectual prioritisation, lack of a "living wage" for government employees and extremely low rural incomes. This forms the backdrop to state capacity to provide services.. Public sector support for improved services cannot be matched by adequate budgeting allocation-while government is financing the strengthening of the economic base. There are significant systemic and structural inequalities in both the emplacement of facilities and accessibility to health services in Uganda: between urban and rural areas and within them. Almost all public facilities are in a sorry state. There exists little effective management and the staff are inadequately jaid The management issue is partly a matter of training but mainly one of motivation. it is also a reflection of the poorly coordinated structure of responsibility for health services in Uganda 6
The Global HIV/AIDS Initiatives Network (GHIN) is a network of researchers established in 2006 th... more The Global HIV/AIDS Initiatives Network (GHIN) is a network of researchers established in 2006 that aims to track the effects of the major global HIV/AIDS initiatives: • The World Bank’s Global HIV/AIDS Programme including the Multi-country AIDS Programme (MAP)
Zambia adopted the policy of internal contracts, as part of the broader health sector reforms. Dr... more Zambia adopted the policy of internal contracts, as part of the broader health sector reforms. Drawing on insights from New Institutional Economics, this study investigated the policy of internal contracts between District Health and Referral Hospital Boards. The objectives of the study were: to describe the nature of contracts between districts and hospitals; assess the impact of different types of contract settings on referrals; and explore the processes through which contracts impacted on referrals. The study used a combination of qualitative and quantitative methods. The study found that internal contracts had produced positive outcomes such as the delineation of service provision functions among providers, devolution of authority to devolved units, and increased interaction between districts and hospitals. These outcomes were, however, marred by a narrow decision making space, which was characterized by staff inadequacies and management difficulties and service delivery constra...
This study investigated the growing relation between Ethiopia and China in the last decade. It is... more This study investigated the growing relation between Ethiopia and China in the last decade. It is possible for Chinese-Africa relations to be either complementary or competitive (or indeed both) and it has multifaceted features. Notwithstanding this multifaceted linkage, the study focused on one of the channels-the investment (FDI) channel. Other channels are explored depending on the degree at which they shed light on understanding the Chinese-Ethiopian investment relations, which is the subject of this study. With this broader objective this study includes:
Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the ep... more Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the epidemic. This paper presents, the Priorities for Local AIDS Control Efforts (PLACE) method which focuses on understanding the venues where people are meeting new sexual partners and behaviors which put people at risk. A comparison of data from two PLACE studies in Zambia with a national household survey, the Zambia Sexual Behavior Survey (ZSBS) 2005, indicated that the PLACE population was at greater risk of acquiring HIV. Respondents in the two PLACE studies were significantly more likely to report 1+ new partners in the past 4 weeks, 2+ partners in the past 12 months, 1+ new partner in the past 12 months and transactional sex. Data from the PLACE method is important for targeting interventions for those most likely to acquire and transmit HIV.
Universal health coverage depends on having the necessary human resources to deliver health care ... more Universal health coverage depends on having the necessary human resources to deliver health care services. Zambia is among the African countries currently experiencing a crisis in the area of human resources for health (HRH). The major causes of the crisis include inadequate and inequitable distribution of health workers; high vacancy rates; insufficient education capacity to supply the desired levels of health workers needed by the market, inadequate wages and working conditions to attract and retain people into health work, particularly in rural underserved areas. This shortage affects most of the available health worker categories. The shortage and maldistribution of health workers stems from various labour market and governance factors, including an exodus of trained professionals to other countries in Africa and elsewhere. This document provides an overview of the HRH labour market in Zambia, highlighting the importance of a comprehensive approach to understanding the driving f...
ABSTRACT A number of problems plague the current Farmer Input Support Programme (FISP), including... more ABSTRACT A number of problems plague the current Farmer Input Support Programme (FISP), including: late delivery of inputs; distribution of standardized inputs that may not be appropriate for all agro-ecological zones or soil types; crowding out of private sector; poor targeting, and; high cost to the government treasury.
Hospitals have been relatively neglected although their high resource consumption implies that ga... more Hospitals have been relatively neglected although their high resource consumption implies that gains from improving the services they deliver may be substantial. Nevertheless, the challenges posed by hospital reforms are great. Hospital autonomy usually consists of both decentralisation, and a greater measure of exposure to market forces. In Uganda and Zambia, more traditional 'decentralisation' of authority to district level authorities includes district hospitals; and some measure of 'autonomy' (known as 'self-accounting status' in Uganda) has been applied to some or all second and third level referral hospitals. The hospital policies pursued in both countries present opportunities to tackle their hospital sectors. In Zambia, purchasing of services means that new incentives and policy mechanisms can come into play. Little advantage has been taken of these opportunities to date. In Uganda, there is no financial link between districts and higher levels of the system, but decentralisation of control over personnel is more advanced. These two components--the alignment of incentives (to promote access and quality for those intended to be covered by the public budget) and the effective decentralisation of control over key resources--seem to us the key tools to address the stubborn problems of hospitals.
Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the ep... more Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the epidemic. This paper presents, the Priorities for Local AIDS Control Efforts (PLACE) method which focuses on understanding the venues where people are meeting new sexual partners and behaviors which put people at risk. A comparison of data from two PLACE studies in Zambia with a national household survey, the Zambia Sexual Behavior Survey 2005, indicated that the PLACE population was at greater risk of acquiring HIV. Respondents in the two PLACE studies were significantly more likely to report 1+ new partners in the past 4 weeks, 2+ partners in the past 12 months, 1+ new partner in the past 12 months and transactional sex. Data from the PLACE method is important for targeting interventions for those most likely to acquire and transmit HIV.
Age, poverty and alcohol use are seen as risk factors for HIV among women in sub-Saharan Africa. ... more Age, poverty and alcohol use are seen as risk factors for HIV among women in sub-Saharan Africa. The objective of this study was to understand the influence of socioeconomic factors (including age and poverty) as well as alcohol use on risky sexual behaviors among women in Mongu, Zambia. This study examines these factors in the local context of Mongu, Zambia using the Priorities for Local AIDS Control Efforts (PLACE) methodology. This methodology allows for the study of risky behaviors while taking into consideration local factors. The two outcome variable studied were transactional sex in the past year and having two or more sexual partners in the past year. In this study age was not a significant factor, but alcohol use and poverty/desire for economic advancement were significant factors. Programs and policies need to address the influence of alcohol on risky sexual behaviors and also the important but complex influence of poverty.
Uploads
Papers by Jolly Kamwanga