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Republic of Zambia Report of the Committee on Health

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Republic of Zambia Report of the Committee on Health REPUBLIC OF ZAMBIA REPORT OF THE COMMITTEE ON HEALTH, COMMUNITY DEVELOPMENT AND SOCIAL SERVICES FOR THE FIRST SESSION OF THE TWELFTH NATIONAL ASSEMBLY APPOINTED ON THURSDAY 6TH OCTOBER, 2016 PRINTED BY THE NATIONAL ASSEMBLY OF ZAMBIA REPORT OF THE COMMITTEE ON HEALTH, COMMUNITY DEVELOPMENT AND SOCIAL SERVICES FOR THE FIRST SESSION OF THE TWELFTH NATIONAL ASSEMBLY APPOINTED ON THURSDAY 6TH OCTOBER, 2016 TABLE OF CONTENTS ITEM PAGE 1.0 Membership of the Committee 1 2.0 Functions of the Committee 1 3.0 Meetings of the Committee 2 4.0 Committee’s Programme of Work 2 PART I 5.0 consideration of Zambia’s preparedness for the implementation of Sustainable Development Goal on Health with special focus on Sexual Reproductive Health Right 3 6.0 Procedure Adopted by the Committee 3-4 6.1 Consolidated Summary of Submissions 4-13 6.7 Committee’s Observations and Recommendations 13-15 PART II 6.8 Local Tour for the First Session of the Twelfth National Assembly 16-36 7.12 Committee’s Observations and Recommendations 36-39 PART III 8.0 Foreign Tour to the Parliament of Rwanda 40 8.1 Committee’s Observations and Recommendations 44-47 i PART IV 9.0 Consideration of the Action-Taken Report on the Committee’s Report for The Fifth Session of the Eleventh National Assembly 48 11. Conclusion 60 Appendix I – List of officials 61 ii REPORT OF THE COMMITTEE ON HEALTH, COMMUNITY DEVELOPMENT AND SOCIAL SERVICES FOR THE FIRST SESSION OF THE TWELFTH NATIONAL ASSEMBLY APPOINTED ON THURSDAY 6TH OCTOBER, 2016 Consisting of: Dr J K Chanda, MP, (Chairperson), Dr C Kalila, MP; Mr J Kabamba, MP; Mr L Kintu, MP; Ms A M Chisangano, MP; Ms P Kasune, MP; Mr L N Tembo, MP; and Dr C Kambwili, MP. The Honourable Mr Speaker National Assembly Parliament Buildings LUSAKA Sir, Your Committee has the honour to present its Report for the First Session of the Twelfth National Assembly. Functions of the Committee 2.0 The functions of your Committee, set out in the National Assembly Standing Orders, are as follows: i) study, report and make appropriate recommendations to the Government through the House on the mandate, management and operations of the Government ministries, departments and agencies under their portfolio; ii) carry out detailed scrutiny of certain activities being undertaken by the Government ministries, departments and agencies under their portfolio and make appropriate recommendations to the House for ultimate consideration by the Government; iii) make, if considered necessary, recommendations to the Government on the need to review certain policies and certain existing legislation; iv) examine annual reports of Government ministries and departments under their portfolios in the context of the autonomy and efficiency of Government ministries and departments and determine whether the affairs of the said bodies are being managed according to relevant Acts of Parliament, established regulations, rules and general orders; v) consider any Bills that may be referred to it by the House; vi) consider International Agreements and Treaties in accordance with Article 63 of the Constitution; 1 vii) consider special audit reports referred to it by the Speaker or an order of the House; viii) where appropriate, hold public hearings on a matter under its consideration; and ix) consider any matter referred to it by the Speaker or an order of the House. Meetings of the Committee 3.0 Your Committee held twelve meetings during the period under review. Your Committee's report is divided into four parts. Part I is on the topical issue on which your Committee undertook a detailed study, while Part II is on the Local Tour and Part III is on the Foreign Tour. Part IV consists of the Action-Taken Report on your Committee's Report for the Fifth Session of the Eleventh National Assembly. Committee’s Programme of Work 4.0 At the commencement of the First Session of the Twelfth National Assembly, your Committee considered and adopted the following programme of work: a) consideration of the Action-Taken Report on the report of the Committee for the Fifth Session of the Eleventh National Assembly; b) consideration of Zambia’s preparedness for the implementation of the Sustainable Development Goal on Health with special focus on Sexual Reproductive Health Rights; c) foreign tour to Rwanda on best practices and sharing of experiences with regard to sexual and reproductive health; and d) consideration and adoption of minutes of the Committee’s meetings and draft report. PART I CONSIDERATION OF THE TOPICAL ISSUE 2 ZAMBIA’S PREPAREDNESS FOR THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOAL ON HEALTH WITH SPECIAL FOCUS ON SEXUAL REPRODUCTIVE HEALTH RIGHTS 5.0 Your Committee recognised that in 2015, the Millennium Development Goals (MDGs) era came to an end and a post-2015 agenda was adopted by 191 United Nations Member countries. Considerable efforts had been made during the MDGs implementation to reduce maternal mortality, cervical cancer and unwanted pregnancies, among many others. As the country is now implementing the Sustainable Development Goals (SDGs), it was imperative to ensure that the unfinished agenda of the MDGs was not abandoned and that the experiences, challenges and lessons learnt therefrom were taken into account in the implementation of the SDGs, particularly SDG 3 and Target 3.7, which states that: “By 2030, ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes”. SDG 3, particularly Target 3.7, has a focus on Sexual Reproductive Health Rights (SRHR) with the following proposed indicators: i) 3.7.1 - Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods; and ii) 3.7.2 - Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group . It was in this vein that your Committee resolved to undertake a study on Zambia’s preparedness for the implementation of the SDG on Health with special focus on Sexual Reproductive Health Rights. Procedure adopted by the Committee 6.0 Your Committee sought both written and oral submissions from relevant Government ministries, non-governmental organisations and interested individuals. The following major stakeholders presented their views: a) Ministry of Health; b) Ministry of National Development Planning; c) Ministry of General Education; d) Ministry of Higher Education; e) Churches Health Association of Zambia (CHAZ); f) United Nations System in Zambia; g) Society for Family Health (SFH); h) The Non Governmental Organisations’ Coordinating Council (NGOCC); i) IPAS Zambia; 3 j) Marie Stopes International; k) University of Zambia – School of Public Health; l) Planned Parenthood Association of Zambia (PPAZ); m) National HIV/AIDS/STI/TB Council(NAC); n) Zambia Medical Association (ZMA); o) Center for Reproductive Health and Education (CRHE) ; p) Restless Development; and q) Zambia National Traditional Counsellors Association (ZNTCA). CONSOLIDATED SUMMARY OF SUBMISSIONS 6.1 Your Committee was informed that Zambia was committed to achieving Sustainable Development Goals, including Goal 3 whose aim is to “Ensure healthy lives and promote well-being for all at all ages” with the associated targets. The Committee learnt that Sexual Reproductive Health and Rights (SRH&R) is a health, human rights and development issue, which allows people to be able to make reproductive choices, and to be empowered to attain a state of complete physical, mental and social well- being in all matters relating to the reproductive processes, functions and systems during a person’s life course. The extent to which sexual and reproductive health is a public health problem in Zambia a) Maternal Mortality Your Committee was informed that although maternal death had reduced by 54% from 1990 to 2014, it was still very high in Zambia as it stood at 398 for every 100,000 live births recorded by women. In health facilities, the main causes of maternal death included excessive bleeding after delivery (34%), sepsis (13%), abortion complications (13.3%), obstructed labour (8%), and eclampsia (5%), among many others. b) Fertility Rate Your Committee learnt that Zambia had one of the highest fertility rates in the world. The National Total Fertility Rate (TFR) had dropped from 6.2 births per woman in 2007, to 5.3 births per woman in 2013. However, rural TFR remained high at 6.6 births per woman compared to 3.7 births per woman in urban areas. c) Unmet Need for Family Planning According to the 2013/2014 Zambia Demographic Health Survey (ZDHS), unmet need for family planning was highest among women aged 15-19 years (25%). Geographically, unmet need was higher in rural areas (24%) than in urban areas (17%). 25% of Zambian married women had an expressed unmet need for family planning, including the need for birth limiting family planning. This was even higher in the rural areas. 4 d) Unsafe Abortions The actual burden of unsafe abortions in Zambia could not be estimated due to the increasing number of illegal provision of the service especially to adolescents and older women. Unsafe and poorly performed abortions were a major cause of maternal mortality and morbidity. Despite the availability of legal safe abortion, available data and clinical impressions pointed to a high and perhaps increasing prevalence of illegally induced abortions with up to 30% of pregnancy-related deaths resulting from unsafe abortion. e) Limited
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