Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia
In: Int J Health Policy Manag. 2016; 5(12):693–703
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In: Int J Health Policy Manag. 2016; 5(12):693–703
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The EPI is a tool developed by the JCTR to comprehensively measure and track the performance of employment. The EPI incorporates two broad indicators – the quality and quantity of employment created. As the ILO Director General Mr. Juan Somavia stated the quality of employment is just as important as creation of employment itself. This index can be used to measure and rank the performance in any company/ institution against certain expected targets of employment. Improvements in the companies' performance will be reflected in the changes of the EPI scores from one period to another. The EPI will be produced on an annual basis and will help track the results from Government's efforts in creating an enabling environment for investments, which ultimately is expected to create employment. The paper continues to give a rationale for the use EPI giving further methods of calculating the EPI. ; The Social Conditions Programme of the JCTR is implementing a project to advocate for increased formal employment. This is against the backdrop that the country is struggling to create adequate formal employment opportunities for its people, despite Government spending significant resources on attracting investors. Zambia's labour force currently stands at 5,410,610 people. Of this, 90% are considered employed although only 10% of the total labour force are in formal employment. The remainder of the workforce is engaged either in the informal sector or in unpaid family work. Clearly, a significant proportion of the labour force cannot find productive and remunerative employment. Realising that employment is one of the major engines of growth and poverty reduction, the programme will consistently and systematically be advocating for an increase in formal jobs as well as improvement of quality of jobs where necessary. This project is consistent with Government's plans to promote employment growth as evidenced by among others the inclusion of employment as a national key performance indicator in the draft Sixth National Development Plan (SNDP) spanning from 2011 to 2015. To strengthen our advocacy, we are in the process of finalising the Employment Performance Index (EPI).
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The Zambian health care system continues to undergo various reforms. The system has experienced health financing and organizational reforms since 2006. Among the notable and common themes underpinning all the health reforms across the different timelines have been the following: the policy commitment continues to be associated with the desire to ensure that resources and health care services are distributed and provided as close to the household or family as possible; and access to quality and affordable health care services continues to be one of the central themes of the reform process. In this regard, health services are supposed to be generally available, adequate, and of reasonable quality and cost. Given that a number of health financing reforms have been implemented in Zambia over the years, this study provides an updated analysis on the extent to which government expenditures on health provide an effective intervention in redistributing health care resources in an equitable manner. The study looks at the health system holistically and does not look at each of the individual reforms.
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Zambia has implemented a number of financing and organizational reforms since the 1990s aimed at increasing efficiency, enhancing equity, and improving health outcomes. This study reviews the distributional impact of these health reforms on enhancing equity at the regional level and for different socioeconomic groups. Data from three nationally representative household surveys were collected, and a benefit incidence analysis was conducted to determine the distributional impact over the period 2010–2015. The results show that distribution of subsidies and utilization of outpatient services at public health facilities in Zambia has consistently been in favor of urban provinces. Further, distribution of health subsidies across the ten provinces in Zambia does not correspond to reported illnesses in each province. The study also shows that utilization of outpatient services at public (hospitals and health centers) and private health facilities is generally in favor of the rich, and utilization of both inpatient and outpatient services at public and private health facilities benefits the rich more than the poor. And although the results show a pro-poor redistribution of benefits across income groups in 2015 compared to 2010 whereby the poorest two income groups received more than a 20% share of benefits in each quintile, the benefits were still lower than their health needs. This is contrary to the richest two income groups whose share of benefits was higher than their health needs in both 2010 and 2015. The study concludes that Zambia has not yet fully attained its long-term health reform vision of "equity of access to quality health care" despite years of successive health reforms. The study calls for the Zambian government to complement strategies on financial risk protection with deliberate supply- and demand-side actions in order to enhance equity. Improvements in long- and short-term planning and regular monitoring and evaluation are critical.
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In: Mediterranean journal of Social Sciences: MJSS, Band 8, Heft 6, S. 171-182
ISSN: 2039-2117
AbstractThe paper examines whether a significant relationship exists between inflation and trade openness in Zambia over the period 1985 to 2015. We use the Toda-Yamamoto approach to Granger causality to test for a causal relationship between inflation and trade openness. The results establish a bi-directional causality between inflation and trade openness. Further, there exists a positive relationship between inflation and trade openness in Zambia. Our findings stress the importance for central banks to understand the consequences of international trade for domestic inflation.
Zambia's health sector has continued to evolve with the government undertaking several reforms aimed at improving the performance of the sector to achieve the Sustainable Development Goals (SDGs) and their precursor, the Millennium Development Goals (MDGs). Amid the ongoing reforms, the health sector has recorded a number of achievements, but some challenges remain. This Public Expenditure Tracking and Quantitative Service Delivery Survey (PET-QSDS) assesses the financing and delivery of health services, and whether the reform objectives have been made. This was achieved by reviewing the flow of financial and other resources in the public health sector from administrative units to service delivery points at the facility level. The data were collected from administrative units, health workers, and patients to gauge the various dimensions of the health system that include financial flows, management of infrastructure, human resources for health, and patient management. Specifically, the issues which were reviewed are: Availability, adequacy, and timeliness of resources for service delivery; implementation of some key policy reforms such as user fee removal and adherence to policy guidelines; donor resource coordination, ownership, and fragmentation at the district level; assessment of human resources management at the district and facility levels; and comparison of staff satisfaction, absenteeism, and service delivery in districts implementing the Results-based Financing (RBF) model and non-RBF districts.
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