Zambia Health Sector Public Expenditure Review

Accounting for Resources to Improve Effective Service Coverage

Oscar Picazo, Feng Zhao

• Publisher: World Bank Publications
• Year: 2009
• eBook ISBN: 9780821378052
• Edition: 0
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

'Zambia Health Sector Public Expenditure Review' portrays the performance of the health sector in Zambia using quantitative techniques. While there have been a number of health sector assessments in the country, they have relied on qualitative and anecdotal evidence for the most part. For the first time, this public expenditure review of the health sector brings together the results of three separate but related analytical efforts: multi-year national health accounts, a public expenditure tracking and quality of service delivery survey, and resource and impact modeling using the Marginal Budgeting for Bottlenecks software. These exercises combine to yield more powerful findings on the weaknesses and prospects of the Zambian health system.

Table of contents

• Contents
• Acknowledgments
• Acronyms and Abbreviations
• Executive Summary
• Key Findings
• Key Recommendations
• 1. Background, Objectives, and Analytical Tools
• 2. Health System Challenges
• 3. Sources and Uses of Funds in the Health Sector: Results of the National Health Accounts Exercises, 1999–2004
• 4. Budget Allocation, Release, and Spending: Results of the Public Expenditure Tracking Component of the PET/QSDS, 2005–06
• 5. The State of Health Facilities and Services: Results of the Quality of Service Delivery Component of the PET/QSDS, 2005–06
• 6. Scaling Up Health Service Delivery to Reach the MDGs: Results of the Marginal Budgeting for Bottlenecks Modeling Exercise, 2006
• Statistical Appendix
• References
• Table 1. Health Facilities in Zambia, 2000s
• Table 2. Summary Statistics on the Major Diseases, 2000–05
• Table 3. Selected Health Service Delivery Indicators, 2000–04
• Table 4. Service Coverage Indicators of Key Childhood Health Interventions in Selected African Countries, 2000s
• Table 5. Maternal Mortality Ratio and Service Coverage Indicators of Key Maternal Health Interventions in Selected African Countries, 2000s
• Table 6. Government Health Expenditures (ZK Billion) Using Alternative Definitions, 1995–2007
• Table 7. Health Expenditures (ZK Billion) Under the Discretion of the Government, by Source, 2001–07
• Table 8. Trends in Health Expenditures by Source, 1995–2004
• Table 9. Total Financing of Health Facilities, 2002–04
• Table 10. Health Sector Resource Envelope, FY05 and FY06
• Table 11. Range of Cost Estimates to Meet the Health MDGs in Zambia
• Table 12. Amount of GRZ Budget Provided by DHMTs to Their Health Facilities, FY05
• Table 13. Health Centers’ Reponses on Whether They Received an Amount More Than, Equal to, or Less Than Their Annual Allocations, 2006
• Table 14. Uses of GRZ Budget and Basket Funds by Health Facilities, FY05
• Table 15. Composition of Average Debt Per Facility, FY05
• Table 16. Donors’ Vertical Funds Received by Health Facilities, FY05
• Table 17. Uses of Vertical Funds by Health Facilities, FY05
• Table 18. Internally Generated Funds of Health Facilities, 2005
• Table 19. User Fee Practices, 2005
• Table 20. Percent of Health Facilities’ Rate of Retained Fee Revenues, FY05
• Table 21. Uses of User Fee Revenues by Health Facilities, FY05
• Table 22. Expected Versus Actual User Fee Revenues for OPD, FY05
• Table 23. Level of Annual Resources at the Facility Level, by Major Sources, FY05
• Table 24. Health Facilities Reporting Inadequate Medical Equipment, Instruments, and Lab Test Supplies, 2006
• Table 25. Vacancy Rates in Health Facilities, by Cadre, 2006
• Table 26. Established Posts and Average Number of Actual Staff by Major Occupational Groups, 2006
• Table 27. Salary Management, 2006
• Annex A. MOFNP and Local Government Authorities’ Health Expenditures by Recipient, 1995–2004
• Annex B. Donors’ Health Expenditures by Recipient, 1995–2004
• Annex C. Employers’ and Households’ Health Expenditures by Recipients, 1995–2009
• Annex D. Total Health Expenditures by Service Provision, Administration, and Rest of the World Transactions, 1995–2004
• Annex E. Total Health Expenditures by Service Provision and Administration and by Type of Providers, 1999–2004
• Annex F. Donor Health Expenditures by Type of Providers and Administrators, 2002–04
• Annex G. MOH/CBOH Health Expenditures by Level of Care and Administration, 1999–2004
• Annex H. Household Health Expenditures by Type of Providers, 1999–2004
• Annex I. Health Expenditures by Line Items by Type of Facility, 1999–2004
• Annex J. Resources at the Disposal of a Typical DHMT, FY05
• Annex K. Self-Reported Versus Actual Capacity to Deliver Selected Health Services in Rural Health Centers, 2006
• Annex L. Self-Reported Versus Actual Capacity to Deliver Selected Health Services in Urban Health Centers, 2006
• Figure 1. Comparison of IMR and U5MR in Selected African Countries, Latest Year Available
• Figure 2. Trends in Neonatal, Infant, and Under-Five Mortality in Zambia, 1992, 1996, and 2001/02 Rates (Per 1,000 Live Births)
• Figure 3. Trends and Levels of Major Diseases in Zambia, 2002–04
• Figure 4. Coverage of Key Health Services, 2000–04
• Figure 5. Provincial Inequities in Health Service Coverage by Region
• Figure 6. Differences in Selected Maternal and Child Health Indicators Between Rural and Urban Households in Zambia, 2000/01
• Figure 7. Differences in Selected Maternal and Child Health Indicators Between Lowest and Highest Asset Quintile Households in Zambia, 2000/01
• Figure 8. Unfilled Posts by Profession
• Figure 9. Gaps in Numbers of Health Facilities
• Figure 10. Trends of Child Mortality in Zambia, 1990–2015
• Figure 11. Trend of Maternal Mortality in Zambia, 1996–2015
• Figure 12. Total Health Expenditures in Nominal and Real Terms, 1995–2004
• Figure 13. Selected Health Expenditure Ratios, 1995–2007
• Figure 14. Trends in Per Capita Government Health Expenditure and Per Capita Total Health Expenditure, 1995–2007
• Figure 15. Trends in Health Expenditures by Source, 1995–2004
• Figure 16. In-Budget versus Off-Budget Donor Health Expenditures, 2000–04
• Figure 17. Total Health Expenditures Going to Service Provision and Administration, 2001–2004
• Figure 18. MOH/CBOH Health Expenditures Going to Service Provision and Administration, 2001–04
• Figure 19. MOH/CBOH Health Expenditures by Level of Care, 1999–2004
• Figure 20. Financing of Health Facilities by Source, 2002–04
• Figure 21. Health Expenditures of MOH, Mission, and For-Profit Facilities by Inputs, 1999–2004
• Figure 22. Flow of Funds and Other Resources in Zambia's Government Health Sector
• Figure 23. Per Capita MOH Released + Supplementary Funding, by Province, FY05
• Figure 24. Budget Release Per Capita Versus Incidence of Malaria and Under-5 Pneumonia, 2005
• Figure 25. Cumulative Budgeted Versus Released Amounts of Total MOH Budget, by Month, FY05
• Figure 26. Cumulative Budgeted Versus Released Amounts for Personal Emoluments, by Month, FY05
• Figure 27. Cumulative Budgeted Versus Released Amounts for District Grants, by Month, FY05
• Figure 28. Cumulative Budgeted Versus Released Amounts for RDCs, by Month, 2005
• Figure 29. Cumulative Budgeted Versus Released Amounts for Essential Drugs, by Month, FY05
• Figure 30. Cumulative Budgeted Versus Released Amounts for Capital Expenditures, by Month, FY05
• Figure 31. MOH Allocation Versus Releases to Provinces Included in the Survey, FY05
• Figure 32. MOH Allocation Versus Releases to DHMTs Included in the Survey, FY05
• Figure 33. Cumulative Planned Versus Actual Facility Grants by DHMTs to RHCs, by Month, FY05
• Figure 34. Cumulative Planned Versus Actual Hospital Grants, by Month, FY05
• Figure 35. Allocated Versus Received Budgets of Selected District Hospitals FY05
• Figure 36. Allocated Versus Received Budgets of Selected Health Centers, FY05
• Figure 37. Health Facilities With Functional and Nonfunctional Utilities and Transport Equipment, 2006
• Figure 38. Health Facilities with Imaging Equipment, 2006
• Figure 39. Health Facilities with Functional and Nonfunctional Medical Equipment, 2006
• Figure 40. Personnel Expenditures in MOH Budget and Share of Personnel Expenditures to Total MOH Expenditures, 2000–07
• Figure 41. Average Number of Hours Worked in a Week by Type of Task, 2006
• Figure 42. Per Capita Health Expenditures and Share of Personal Emoluments to Health Expenditures, 2006
• Figure 43. Summary Rates of Staff Vacancy, Absenteeism, Tardiness, Involvement in Income-Augmenting Activities, and Dissatisfaction, 2006
• Figure 44. Composite Monthly Salaries and Allowances of Clinical/Professional Health Workers, 2005
• Figure 45. Drug Expenditures and Drug Kits Opened Per 1,000 Patients, 1999–2005
• Figure 46. Sequential Relationships of Health Services
• Figure 47. Bottlenecks in Community-Based Services
• Figure 48. Bottlenecks in Population-Based Outreach Services
• Figure 49. Bottlenecks in Facility-Based Services
• Figure 50. Projected Trend in Reaching Child Mortality MDGs
• Figure 51. Projected Trend in Reaching Maternal Mortality Reduction MDGs