DOCSLIB.ORG

Initial Implementation of Prep in Zambia: Health Policy Development and Service Delivery Scale-­Up

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Initial Implementation of Prep in Zambia: Health Policy Development and Service Delivery Scale-­Up Open access Original research BMJ Open: first published as 10.1136/bmjopen-2020-047017 on 9 July 2021. Downloaded from Initial implementation of PrEP in Zambia: health policy development and service delivery scale- up Cassidy W. Claassen ,1,2,3 Daliso Mumba,4,5 Mwansa Njelesani,6 Derrick Nyimbili,7 Linah K Mwango,8 Mundia Mwitumwa,2,3 Ellen Mubanga,4 Lloyd B. Mulenga,2,3,5 Tina Chisenga,5 Brooke E. Nichols ,9,10 Cheryl Hendrickson ,10 Lastone Chitembo,11 Jackson Okuku,12 Heidi O'Bra13 To cite: Claassen CW, ABSTRACT Strengths and limitations of this study Mumba D, Njelesani M, et al. Introduction Daily pre- exposure prophylaxis (PrEP) Initial implementation of for HIV prevention is highly effective, but not yet widely ► This study documents how the Zambian pre- PrEP in Zambia: health policy deployed in sub- Saharan Africa. We describe how Zambia development and service exposure prophylaxis (PrEP) Task Force, consisting developed PrEP health policy and then successfully delivery scale- up. BMJ Open of health professionals from government, donors implemented national PrEP service delivery. 2021;11:e047017. doi:10.1136/ and implementing partners, rapidly drafted and im- Policy development Zambia introduced PrEP as a key bmjopen-2020-047017 plemented national PrEP health policy. strategy for HIV prevention in 2016, and established ► This study describes the national implementation ► Prepublication history for a National PrEP Task Force to lead policy advocacy and scale up of PrEP to >700 health facilities and this paper is available online. and development. The Task Force was composed of To view these files, please visit nearly 27 000 clients in 2 years. government representatives, regulatory agencies, the journal online (http:// dx. doi. ► PrEP service delivery is examined by key population international donors, implementation partners and civil org/ 10. 1136/ bmjopen- 2020- type as well as mapped to population density and society organisations. Following an implementation pilot, 047017). HIV prevalence. PrEP was rolled out nationally using risk- based criteria ► A limitation of this study is the use of aggregate data; Received 07 December 2020 alongside a national HIV prevention campaign. thus it does not include patient-level data for better Accepted 10 June 2021 National Scale-up In the first year of implementation, understanding of PrEP uptake and continuation. ending September 2018, 3626 persons initiated PrEP. ► The Zambia PrEP health policy development model By September 2019, the number of people starting PrEP http://bmjopen.bmj.com/ may be useful to other countries seeking to imple- increased by over sixfold to 23 327 persons at 728 sites ment PrEP. across all ten Zambian provinces. In the first 2 years, 26 953 clients initiated PrEP in Zambia, of whom 31% were from key and priority populations. Continuation when adherence is >70%0.7 PrEP has the remains low at 25% and 11% at 6 and 12 months, potential to limit HIV acquisition among respectively. at- risk populations, including those who Lessons learnt Risk- based criteria for PrEP ensures access to those most in need of HIV prevention. Healthcare may not be able to negotiate condom usage worker training in PrEP service delivery and health needs or who engage in high- risk activities. PrEP on September 27, 2021 by guest. Protected copyright. of key and priority populations is crucial. PrEP expansion can be taken discreetly, it offers high rates into primary healthcare clinics and community education is of protection, and does not require negoti- required to reach full potential. Additional work is needed ation with partners, unlike barrier methods to understand and address low PrEP continuation. Finally, and microbicide gels.8 9 PrEP is also associ- a task force of key stakeholders can rapidly develop and ated with few safety risks, and there is limited implement health policy, which may serve as a model for evidence of behavioural risk compensation.7 countries seeking to implement PrEP. Despite these promising results, PrEP roll-out has been slow in sub- Saharan Africa with only © Author(s) (or their a handful of countries implementing large employer(s)) 2021. Re- use INTRODUCTION scale national PrEP programmes, including permitted under CC BY-NC. No commercial re- use. See rights Daily pre- exposure prophylaxis (PrEP) with South Africa, Kenya, Uganda, Zimbabwe and 10 and permissions. Published by tenofovir disoproxil fumarate and emtricit- Zambia. BMJ. abine for the prevention of HIV infection Initial PrEP demonstration implementa- For numbered affiliations see is a highly effective prevention tool, recom- tion projects have shown high uptake among end of article. mended for persons at substantial risk of HIV serodiscordant couples (SDCs),11 12 adoles- 1 13 14 Correspondence to infection by WHO since 2015. PrEP effective- cent girls and young women (AGYW), 2–6 15–17 Dr Cassidy W. Claassen; ness is highly correlated to adherence, with female sex workers (FSWs) and men who cclaassen@ ihv. umaryland. edu studies showing that PrEP is most effective have sex with men (MSM).18 19 Interest in, and Claassen CW, et al. BMJ Open 2021;11:e047017. doi:10.1136/bmjopen-2020-047017 1 Open access BMJ Open: first published as 10.1136/bmjopen-2020-047017 on 9 July 2021. Downloaded from uptake of, PrEP is high but PrEP continuation remains a government agencies, donors, and implementing part- challenge in many groups, particularly AGYW. Successful ners for the roll-out of PrEP in Zambia. We also report national PrEP programmes in Africa have invested in on the current status, challenges faced, and lessons learnt creating PrEP awareness and demand via mass media and from PrEP policy and service delivery implementation in community health talks, have streamlined PrEP delivery Zambia. via not only ART clinics but also drop-in centres for key populations (KPs) and DREAMS (Determined, Resil- PrEP policy and implementation ient, Empowered, AIDS- free, Mentored, Safe) centres for Development of PreP health policy and implementation guidelines AGYW, and have built PrEP capacity among healthcare in Zambia workers (HCWs) via trainings and mentorship. Chal- In 2016, the Zambian Ministry of Health (MOH) adopted lenges in PrEP programming persist, including the need the 2015 WHO guidelines1 recommending daily oral to improve PrEP access, streamline PrEP delivery models, PrEP for people at substantial risk of HIV infection, increase HCWs trained in PrEP and finally increase PrEP defined as HIV incidence greater than 3 per 100 person- continuation.10 years (see figure 1 for a timeline of PrEP policy and imple- Zambia’s HIV epidemic is generalised, with a persistently mentation). PrEP was introduced in the 2016 Zambia high prevalence of 12.0% and annual incidence of 0.61% Consolidated Guidelines for Treatment and Prevention among adults 15–59 years old.20 Concentrated pockets of of HIV Infection27 and further expanded in the 2018 high HIV transmission disproportionately affect popu- version.28 In September 2017, the National PrEP Task lations who face substantial psychosocial and structural Force was established, comprising key personnel from barriers to accessing health services and continue to drive MOH, National HIV/AIDS/STI/TB Council, WHO, epidemic transmission. These include SDCs; AGYW; UNAIDS, US President’s Emergency Plan for AIDS Relief FSW and their clients; MSM21; transgendered (TG) indi- (PEPFAR), US Agency for International Development viduals22 and high- risk men, particularly those under (USAID), US Centers for Disease Control and Prevention 30, engaged in migrant work (eg, truck drivers,23 cane (CDC), PEPFAR implementing partners (IPs) and civil cutters24 or in prison).25 26 These groups have a higher HIV society organisations (CSOs). The Task Force’s mandate prevalence compared with the general population, and was to lead policy advocacy and formulate a national would benefit the most from HIV prevention methods, PrEP implementation framework to guide PrEP service including biomedical interventions such as PrEP. delivery. The Task Force created three sub- committees: Beginning in 2016, Zambia introduced PrEP as a (1) medical/technical service delivery and monitoring component of combination HIV prevention services, and evaluation (M&E); (2) logistics and supply chain and which also includes counselling, family planning, volun- (3) social behavioural change communication and policy tary male medical circumcision and condom distribution. advocacy. Within each subcommittee, technical experts http://bmjopen.bmj.com/ In this paper, we present a model of integrated health reviewed the latest evidence and guidelines for the larger policy and technical service delivery accomplished by Task Force (table 1, next page). Additionally, the Task on September 27, 2021 by guest. Protected copyright. Figure 1 Timeline of PrEP policy and implementation in Zambia. PrEP, pre- exposure prophylaxis; SDC, serodiscordant couples; UMB, University of Maryland Baltimore; UTH, University Teaching Hospital. 2 Claassen CW, et al. BMJ Open 2021;11:e047017. doi:10.1136/bmjopen-2020-047017 Table 1 Subcommittee membership, mandates and activities for PrEP policy development Subcommittee Chaired by Members Mandates Activities Medical/Technical MOH and University Doctors and ► Guide the development of the ► Reviewed PrEP implementation literature. of Maryland Baltimore nurses from the 2018 PrEP guidelines. ► Assessed PrEP deployment in other sub- Saharan countries. MOH, PEPFAR ► Guide the development of the ► Developed
Load more

Recommended publications
  • Mozambique Zambia South Africa Zimbabwe Tanzania
    UNITED NATIONS MOZAMBIQUE Geospatial 30°E 35°E 40°E L a k UNITED REPUBLIC OF 10°S e 10°S Chinsali M a l a w TANZANIA Palma i Mocimboa da Praia R ovuma Mueda ^! Lua Mecula pu la ZAMBIA L a Quissanga k e NIASSA N Metangula y CABO DELGADO a Chiconono DEM. REP. OF s a Ancuabe Pemba THE CONGO Lichinga Montepuez Marrupa Chipata MALAWI Maúa Lilongwe Namuno Namapa a ^! gw n Mandimba Memba a io u Vila úr L L Mecubúri Nacala Kabwe Gamito Cuamba Vila Ribáué MecontaMonapo Mossuril Fingoè FurancungoCoutinho ^! Nampula 15°S Vila ^! 15°S Lago de NAMPULA TETE Junqueiro ^! Lusaka ZumboCahora Bassa Murrupula Mogincual K Nametil o afu ezi Namarrói Erego e b Mágoè Tete GiléL am i Z Moatize Milange g Angoche Lugela o Z n l a h m a bez e i ZAMBEZIA Vila n azoe Changara da Moma n M a Lake Chemba Morrumbala Maganja Bindura Guro h Kariba Pebane C Namacurra e Chinhoyi Harare Vila Quelimane u ^! Fontes iq Marondera Mopeia Marromeu b am Inhaminga Velha oz P M úngu Chinde Be ni n è SOFALA t of ManicaChimoio o o o o o o o o o o o o o o o gh ZIMBABWE o Bi Mutare Sussundenga Dondo Gweru Masvingo Beira I NDI A N Bulawayo Chibabava 20°S 20°S Espungabera Nova OCE A N Mambone Gwanda MANICA e Sav Inhassôro Vilanculos Chicualacuala Mabote Mapai INHAMBANE Lim Massinga p o p GAZA o Morrumbene Homoíne Massingir Panda ^! National capital SOUTH Inhambane Administrative capital Polokwane Guijá Inharrime Town, village o Chibuto Major airport Magude MaciaManjacazeQuissico International boundary AFRICA Administrative boundary MAPUTO Xai-Xai 25°S Nelspruit Main road 25°S Moamba Manhiça Railway Pretoria MatolaMaputo ^! ^! 0 100 200km Mbabane^!Namaacha Boane 0 50 100mi !\ Bela Johannesburg Lobamba Vista ESWATINI Map No.
    [Show full text]
  • (SSA) Countries IDA19 Fourth Replenishment Meeting, December 12-13, 2019, Stockholm, Sweden
    African Countries are Awakening Hope for a Better Tomorrow with IDA Statement by Representatives of 49 Sub-Saharan African (SSA) Countries IDA19 Fourth Replenishment Meeting, December 12-13, 2019, Stockholm, Sweden 1. IDA countries have only 10 years to achieve the globally agreed targets of the Sustainable Development Goals (SDGs). Given that it takes 9 years for pledges under any IDA cycle to be fully paid up, IDA19 is therefore, the last replenishment to help finance the SDGs in the time left to 2030. 2. Africa as a continent is making progress towards the SDGs. Growth in many economies has outpaced global benchmarks. More children are in school and health service coverage is expanding. A continent-wide free-trade agreement shows regional cooperation is alive and deepening, including in building roads and power lines that bring countries together and make markets bigger. The support of donors to the 18th replenishment of the International Development Association (IDA18) has been pivotal and has underpinned the partnership between African countries and the World Bank Group (WBG) that has never been stronger. Indeed, Africa’s absorptive capacity to carefully use concessional funds has ensured that the pace of commitment for IDA18 has been record-breaking. 3. We want to acknowledge the strong partnership between IDA and most of our countries. We commend all donors for the important role that IDA has been playing in the transformation agenda of most SSA countries. We are happy with the negotiated IDA19 package and the continuation of all the special themes of IDA18, the Private Sector Window, and the improvements to the various facilities especially under Fragility, Conflict and Violence (FCV).
    [Show full text]
  • African Dialects
    African Dialects • Adangme (Ghana ) • Afrikaans (Southern Africa ) • Akan: Asante (Ashanti) dialect (Ghana ) • Akan: Fante dialect (Ghana ) • Akan: Twi (Akwapem) dialect (Ghana ) • Amharic (Amarigna; Amarinya) (Ethiopia ) • Awing (Cameroon ) • Bakuba (Busoong, Kuba, Bushong) (Congo ) • Bambara (Mali; Senegal; Burkina ) • Bamoun (Cameroons ) • Bargu (Bariba) (Benin; Nigeria; Togo ) • Bassa (Gbasa) (Liberia ) • ici-Bemba (Wemba) (Congo; Zambia ) • Berba (Benin ) • Bihari: Mauritian Bhojpuri dialect - Latin Script (Mauritius ) • Bobo (Bwamou) (Burkina ) • Bulu (Boulou) (Cameroons ) • Chirpon-Lete-Anum (Cherepong; Guan) (Ghana ) • Ciokwe (Chokwe) (Angola; Congo ) • Creole, Indian Ocean: Mauritian dialect (Mauritius ) • Creole, Indian Ocean: Seychelles dialect (Kreol) (Seychelles ) • Dagbani (Dagbane; Dagomba) (Ghana; Togo ) • Diola (Jola) (Upper West Africa ) • Diola (Jola): Fogny (Jóola Fóoñi) dialect (The Gambia; Guinea; Senegal ) • Duala (Douala) (Cameroons ) • Dyula (Jula) (Burkina ) • Efik (Nigeria ) • Ekoi: Ejagham dialect (Cameroons; Nigeria ) • Ewe (Benin; Ghana; Togo ) • Ewe: Ge (Mina) dialect (Benin; Togo ) • Ewe: Watyi (Ouatchi, Waci) dialect (Benin; Togo ) • Ewondo (Cameroons ) • Fang (Equitorial Guinea ) • Fõ (Fon; Dahoméen) (Benin ) • Frafra (Ghana ) • Ful (Fula; Fulani; Fulfulde; Peul; Toucouleur) (West Africa ) • Ful: Torado dialect (Senegal ) • Gã: Accra dialect (Ghana; Togo ) • Gambai (Ngambai; Ngambaye) (Chad ) • olu-Ganda (Luganda) (Uganda ) • Gbaya (Baya) (Central African Republic; Cameroons; Congo ) • Gben (Ben) (Togo
    [Show full text]
  • Optimizing Assessment for All May 2020
    OPTIMIZING ASSESSMENT FOR ALL MAY 2020 OPTIMIZING ASSESSMENT FOR ALL Classroom-based assessments of 21st century skills in the Democratic Republic of Congo, The Gambia, and Zambia OPTIMIZING ASSESSMENT FOR ALL Authors Helyn Kim was a fellow in the Global Economy and Development Program at the Brookings Institution Esther Care is a senior fellow in the Global Economy and Development Program at the Brookings Institution Optimizing Assessment for All (OAA) is a project of the Brookings Institution. The aim of OAA is to support countries to improve the assessment, teaching, and learning of 21st century skills through increasing assessment literacy among regional and national education stakeholders, focusing on the constructive use of assessment in education, and developing new methods for assessing 21st century skills. Acknowledgements The authors and the OAA Africa National Teams appreciate the support of UNESCO’s Teaching and Learning Educators’ Network for Transformation (TALENT) and our thanks are extended in particular to Davide Ruscelli. The authors gratefully acknowledge the Democratic Republic of Congo National Team; The Gambia National Team; and the Zambia National Team for their substantial contributions to their respective country sections of the report. Additionally, the authors thank Joesal Jan A. Marabe of the Assessment Curriculum and Technology Research Centre, University of the Philippines Diliman, for technical contributions, and Aynur Gul Sahin for her creative and editorial support. The Brookings Institution is a nonprofit organization devoted to independent research and policy solutions. Its mission is to conduct high-quality, independent research and, based on that research, to provide innovative, practical recommendations for policymakers and the public.
    [Show full text]
  • Kenya Zambia
    REPUBLIC OF KENYA CONVENTION BETWEEN THE GOVERNMENT OF THE REPUBLIC OF KENYA AND THE GOVERNMENT OF THE REPUBLIC OF ZAMBIA FOR THE AVOIDANCE OF DOUBLE TAXATION AND THE PREVENTION OF FISCAL EVASION WITH RESPECT TO TAXES ON INCOME The Convention between the Government of the Republic of Kenya and the Government of the Republic of Zambia for the avoidance of double taxation and the prevention of fiscal evasion with respect to taxes on income. The Government of the Republic of Kenya and the Government of the Republic of Zambia. Desiring to conclude a Convention for the avoidance of double taxation and prevention of fiscal evasion with respect to taxes on income. Have agreed as follows:- Article I [Taxes covered] 1. The taxes which are the subject of the present Convention are: (a) in Zambia (and hereinafter referred to as "Zambian tax"): (i) the income tax; (ii) supertax; (iii) the undistributed profits tax; and (iv) the personal levy; (b) in Kenya (and hereinafter referred to as "Kenyan tax"): (i) the income tax; (ii) corporation tax; (iii) the undistributed income tax; and (iv) the graduated personal tax. 2. The present Convention shall also apply to any other taxes of a substantially similar character imposed in Zambia or Kenya subsequently to the date of signature of the present Convention. At the end of each year the taxation authorities of the Contracting States shall notify to each other any changes which have been made in their respective taxation laws. Article II [General definitions] 1. In the present Convention, unless the context
    [Show full text]
  • ZAMBIA-ZIMBABWE-BOTSWANA-NAMIBIA INTERCONNECTOR (Zizabona) – PHASE ‘A’
    Language: English Original: English PROJECT: ZAMBIA-ZIMBABWE-BOTSWANA-NAMIBIA INTERCONNECTOR (ZiZaBoNa) – PHASE ‘A’ COUNTRY: ZAMIBA & ZIMBABWE ABBREVIATED RESETTLEMENT ACTION PLAN (ARAP) SUMMARY Date: November 2018 1 ABBREVIATED RESETTLEMENT ACTION PLAN (ARAP) SUMMARY Project Title: Zambia-Zimbabwe-Botswana-Namibia Interconnector (ZiZaBoNa) – Phase A Country: Zambia/Zimbabwe Project Number: P-Z1-FA0-135 Project Category: Category 1 Departments: PESD/RDGS 1. INTRODUCTION The ZIZABONA transmission project consists of the development, financing, construction and operation of new transmission facilities in Zambia and Zimbabwe, Botswana and Namibia with the view to facilitate the establishment of a western transmission corridor in Southern Africa. The project derives its name from the first two letters of each of the four countries involved. The electricity utilities of Zimbabwe, Zambia, Botswana and Namibia signed an Inter-Utility Memorandum for the development of the transmission network called ZIZABONA in 2007, and an Inter-Governmental Memorandum of Understanding was signed by the governments of the four countries in 2012 to ensure improved transmission of electric power between the participant nations. ZIZABONA is to be developed as three components, namely: • Component A: Hwange (Zimbabwe) to Mukuni (Zambia) 400 kV transmission line network (115 km) • Component B: Victoria Falls (Zimbabwe) to Pandamatenga (Botswana) 400 kV transmission line network (59 km) • Component C: Mukuni (Zambia) to Zambezi (Namibia) 400 kV transmission line network
    [Show full text]
  • Tanzania-Zambia Railway: Escape Route from Neocolonial Control? Alvin W
    University of South Florida Scholar Commons Anthropology Faculty Publications Anthropology 1970 Tanzania-Zambia Railway: Escape Route from Neocolonial Control? Alvin W. Wolfe [email protected] Follow this and additional works at: https://scholarcommons.usf.edu/ant_facpub Part of the Anthropology Commons Scholar Commons Citation Wolfe, Alvin W., "Tanzania-Zambia Railway: Escape Route from Neocolonial Control?" (1970). Anthropology Faculty Publications. 10. https://scholarcommons.usf.edu/ant_facpub/10 This Book Chapter is brought to you for free and open access by the Anthropology at Scholar Commons. It has been accepted for inclusion in Anthropology Faculty Publications by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. f.~m NONALIGNED THIRD WORLD ANNUAL 1970 ';;~~: Books International ot DH-T~ %n~ernational St. Louis, Missouri, USA . \ ESCAPE ROUTE ALVINW. WOLFE* THE FIRST REQUISITE for African development is that African countries combine what little wealth and power they have toward the end of getting a greater share of the products of world industry. They may be able to get that greater share by forcing through better terms of trade or better terms in aid, but they will never get any greater share by continuing along present paths, whereby each weak and poor country "negotiates" separately with strong and rich developed countries and supranational emities such as the World Bank and major private companies. If they hope to break thos.e ne,ocolonial bonds, Africans must unite-
    [Show full text]
  • Inquiry-Based Science Education: a Scenario on Zambia's High School
    Science Education International Vol.23, No.4, December 2012, 307-327 Inquiry-based science education: A scenario on Zambia’s high school science curriculum Vivien M. Chabalengula*, Frackson Mumba Southern Illinois University, USA Abstract This paper is aimed at elucidating the current state of inquiry-based science education (IBSE) in Zambia’s high school science curriculum. Therefore, we investigated Zambian teachers’ conceptions of inquiry; determined inquiry levels in the national high school science curriculum materials, which include syllabi, textbooks and practical exams; and determined the extent to which inquiry tasks and skills are emphasized in the science curriculum materials. Based on the results, we have proposed ways in which IBSE in Zambia can be improved, particularly in teacher preparation curriculum, assessment and pedagogy. The major results emerging from this study were that teachers’ have a narrow conception of inquiry; there is a discrepancy in the coverage of inquiry levels in syllabi, textbooks and practical exams; and there is much emphasis on lower inquiry tasks and skills in textbooks and exams. These findings laid a basis for our proposed plan for improved inquiry-based science education in Zambia, as discussed herein. It is anticipated the proposed plan on IBSE will prove useful to Zambian science teachers, teacher educators, professional development providers and curriculum developers in resituating Zambian’s science curriculum to be in line with current IBSE models. Key words: inquiry, science curriculum, syllabi, textbooks, practical exams Introduction The concept of inquiry-based science education (IBSE) was well articulated by Joseph Schwab during the 1960s, when he protested the teaching of science as a presentation of scientific facts (Schwab, 1962).
    [Show full text]
  • Country Reports
    COUNTRY REPORTS DISPLACED & DISCONNECTED UNHCR CONNECTIVITY FOR REFUGEES Innovation Service COUNTRY REPORTS DISPLACED AND DISCONNECTED Made possible thanks to the generous support of: In partnership with: The GSMA represents the interests of mobile operators worldwide, uniting more than 750 operators with over 350 companies in the broader mobile ecosystem, including handset and device makers, software companies, equipment providers and internet companies, as well as organisations in adjacent industry sectors. The GSMA also produces the industry-leading MWC events held annually in Barcelona, Los Angeles and Shanghai, as well as the Mobile 360 Series of regional conferences. For more information, please visit the GSMA corporate website at www.gsma.com Follow the GSMA on Twitter: @GSMA TABLE OF CONTENTS INTRODUCTION INTRODUCTION 1 These country reports provide information on the legal situation for displaced populations, namely AFGHANISTAN 2 asylum seekers, refugees, and returnees, where relevant, regarding access to mobile services, in BANGLADESH 6 each country covered. Each report contains information on: BRAZIL 10 BURUNDI 14 • Registration and Identification of Displaced Persons CAMEROON 18 • SIM Registration CENTRAL AFRICAN REPUBLIC 22 • Know Your Customer Rules • Mobile Money CHAD 26 • Data Protection DEMOCRATIC REPUBLIC OF CONGO 30 ETHIOPIA 34 Information sources cover freely published information from the relevant regulators or ministries, JORDAN 38 academic papers and other internet sources. Specific information on the practical situation in KENYA 42 country has been provided by UNHCR local staff. LEBANON 46 MAURITANIA 50 The content of this report, including information and links, is provided free of charge and is NIGER 54 intended to be helpful to the widest range of people and organizations.
    [Show full text]
  • Economy and Globalization in Zambia
    Economy and Globalization in Zambia At the time of independence, Zambia was expected to become of the wealthiest nations in Africa. With access to raw materials such as copper and land, Zambia seemed to have all it needed to succeed in the global economy. However, it is now one of the world’s poorest nations. So how did this dramatic change take place in less than 30 years? Much of Africa has experienced economic decline in the past decades. How does Zambia’s situation compare to other countries in sub-Saharan Africa, and how is it affected by the geographic context in which it exists? Examining the economic situation and Zambia’s place in the global economy will help these questions to be understood. Lusaka, Zambia Zambia is a land-locked country located in central Africa. About the size of Texas, it is home to 11 million people. The population is made up of a variety of ethnic groups, most of whom speak Bantu. Zambia is currently one of the poorest countries in Africa, and is identified by the United Nations Development Program as a HIPC – Highly Indebted Poor Country. “Lusaka is the product of a country battling to find its way in a new world, caught between colonial beginnings, years of socialist independence and now democracy.” -Zambian National Tourist Board Lusaka became the capital of Zambia in 1930 but growth really took place in the 1960’s. The Lusaka City Council describes the city as a metropolis home to 2.5 million people. Lusaka is constantly changing. New shops are being built, and a multi-million dollar shopping mall is being constructed.
    [Show full text]
  • Zambia Country Analysis Summary Refer to This Publication As: Zambia Country Analysis (2015)
    Zambia Country Analysis Summary Refer to this publication as: Zambia Country Analysis (2015). This is a summary of a country analysis prepared by an independent consultant for the United Nations Country Team in Zambia. Copyright: United Nations Country Team, Zambia Contact for further detail: UN Resident Coordinator’s Office, Zambia Zambia Country Analysis Summary CONTENTS Acronyms 05 Boxes Leaving no one behind 15 Progress towards middle-income Zambia comes with addressing inequality, strengthening social protection and reducing vulnerabilities 17 Where some are more equal than others… 22 Chapter I Introduction 09 Chapter II Background 13 Overview 13 Economic Performance 13 Human Development Challenge 13 Poverty Reduction Policies and Strategies 14 Inequality and Vulnerability 14 Causes of Vulnerabilities 15 Employment 16 Nutrition and Food Security 18 Mortality and Morbidity 19 Education 19 Water and Sanitation 20 Environmental Sustainability 20 Peace and Security 23 Migration and Refugees 23 Governance 25 Chapter III Key Priorities for Ensuring Equity in Zambia 31 Chapter IV Comparative Advantages of the United Nations in Zambia 35 Chapter V Way Forward 39 ACRONYMS CA Country analysis Joint United Nations Programme on HIV/ UNAIDS AIDS Common Market for Eastern and COMESA Southern Africa United Nations Capital Development UNCDF Fund FAO Food and Agriculture Organization UNCT United Nations Country Team FNDP Fifth National Development Plan United Nations Conference on Trade and UNCTAD GDP Gross domestic product Development GRZ Government
    [Show full text]
  • Country Profile: Zambia
    COUNTRY PROFILE: ZAMBIA A descriptive overview of Zambia’s country and health system context including the opportunities for innovation. Prepared by: BERTHA CENTRE FOR SOCIAL INNOVATION & ENTREPRENEURSHIP UNIVERSITY OF CAPE TOWN Athenkosi Sopitshi – [email protected] Lindi Van Niekerk – [email protected] ______________________________________________________________________ Executive Summary Zambia has made some gains in growing its economy and improving its health outcomes. However, an elevated diseases burden, under resourced health system and poor infrastructure in its rural areas has stunted its progress in reducing the spread of HIV, malaria, and child and maternal mortality. According to the World Health Organization, children in Zambia still die from preventable diseases such as diarrhea, malaria, pneumonia, HIV/AIDS and malnutrition. Poverty still remains the major factor in combating the country’s health challenges. Table of Contents Executive Summary .......................................................................................................... 1 1. Country at a Glance ............................................................................................................. 2 2. Country Context .................................................................................................................. 3 2.1. Country history and political system ..................................................................................... 3 2.2. Population ............................................................................................................................
    [Show full text]