ZAMBIA NATIONAL HEALTH STRATEGIC PLAN 2017 – 2021 .Contents Acronyms ................................................................................................. vii 1. Executive Summary ........................................................................... 1 1.1 Introduction ................................................................................................... 1 1.2 Health Sector Performance ........................................................................ 1 1.2.1 Health Service Delivery ................................................................. 1 1.2.2 Human Resources for Heath ....................................................... 1 1.2.3 Infrastructure Development ......................................................... 2 1.2.4 Drugs and Medical Supplies .......................................................... 2 1.2.5 Health Care Financing ................................................................... 2 1.2.6 Health Information ......................................................................... 2 1.3 Strategic Direction ....................................................................................... 2 1.4 Strategic Framework .................................................................................... 3 1.5 Implementation Framework ....................................................................... 3 1.6 Monitoring and Evaluation (M&E) .............................................................. 3 1.7 Required Financial Resources .................................................................... 4 2. Introduction ........................................................................................ 5 2.1 Country Background .................................................................................... 5 2.2 Achievements and Challenges of the Health Sector Strategic Plan .................................................................................................................. 5 2.3 Disease Burden ............................................................................................. 7 2.4 Health Sector Strategic Programmed Approach .................................... 8 2.5 Socio-economic Determinants of Health ................................................ 9 2.6 The National Health System .................................................................... 10 3. Vision, Mission, Overall Goal, Principles and Priorities ............... 13 4. Health Service Delivery System ..................................................... 15 4.1 Primary Health Care and Community Health ...................................... 15 4.2 Reproductive, Maternal, Child, and Adolescent Health and Nutrition ....................................................................................................... 19 4.2.1 Reproductive and Maternal Health ........................................... 19 4.2.2 Child Health ................................................................................... 22 4.2.3 Nutrition ........................................................................................ 24 4.2.4 Adolescent Health ........................................................................ 27 4.3 Communicable Diseases ........................................................................... 28 4.3.1 General Introduction ................................................................... 28 4.3.2 Malaria ............................................................................................. 28 4.3.3 HIV/AIDS ........................................................................................ 31 4.3.4 Sexually Transmitted Infections ................................................. 33 4.3.5 TB..................................................................................................... 34 4.3.6 Viral Hepatitis ................................................................................ 36 4.3.7 Neglected Tropical Diseases ...................................................... 36 4.4 Public Health Surveillance and Disease Intelligence ............................ 38 4.5 Epidemic Preparedness and Response, and Emerging Issues ............. 40 4.6 Non-Communicable Diseases .................................................................. 42 4.7 Hospital Services ......................................................................................... 44 i 4.7.1 Surgical, Obstetric, and Anesthesia Services .......................... 46 4.7.2 Eye Health Services ...................................................................... 47 4.7.3 Paediatric Services ........................................................................ 48 4.7.4 Renal Health Services .................................................................. 49 4.8 Emergency and Mobile Health Services ................................................. 50 4.9 Diagnostic Services ..................................................................................... 51 4.10 Imaging Services .......................................................................................... 54 4.11 Blood Transfusion Services ....................................................................... 56 4.12 Ear, Nose, and Throat (ENT) Services .................................................. 58 4.13 Nursing and Midwifery Services .............................................................. 59 4.14 Pharmaceuticals and Medical Supplies .................................................... 61 5. Integrated Health Service Support Systems................................. 65 5.1 Leadership and Governance ..................................................................... 65 5.2 HRH ............................................................................................................... 71 5.3 Health Care Financing ................................................................................ 75 5.4 Health Information Technology and Research ..................................... 79 5.5 Infrastructure, Equipment and Transport .............................................. 80 5.6 Implementation, Monitoring and Evaluation.......................................... 82 5.6.1 Legal, Policy and Regulatory Framework ................................. 82 5.6.2 Institutional Framework .............................................................. 83 5.6.3 Key Sector Partners ..................................................................... 84 5.6.4 Planning, budgeting, and capacity building ............................... 85 6. Costing of the NHSP ........................................................................ 87 6.1 Overview ...................................................................................................... 87 6.2 Total NHPS Costs by Major Health Systems Input Components ................................................................................................ 90 7. Key Performance Indicators ........................................................... 93 7.1 Reproductive, Maternal, Neo-natal, Child Health, Nutrition, and Adolescent Health .............................................................................. 93 7.2 Malaria ........................................................................................................... 97 7.3 HIV/AIDS ...................................................................................................... 98 7.4 Tuberculosis ............................................................................................... 100 7.5 Neglected Tropical Diseases .................................................................. 101 7.6 Public Health Surveillance ....................................................................... 102 7.7 Epidemic Preparedness and Response and Emerging Issues ............ 103 7.8 Non-Communicable Diseases ................................................................ 104 7.9 Hospital Services ....................................................................................... 106 7.10 Eye Health .................................................................................................. 107 7.11 Emergency and Mobile Health Services ............................................... 107 7.12 Imaging Services ........................................................................................ 108 7.13 Blood Transfusion Services ..................................................................... 108 7.14 Laboratory Services .................................................................................. 109 7.15 Environmental Health, Food Safety, and Occupational Health ....... 111 7.16 Human Resources..................................................................................... 112 7.17 Health Care Financing Strategy .............................................................. 112 7.18 Health Information Technology and Research ................................... 113 7.19 Health Infrastructure ............................................................................... 113 ii Foreword Despite progress made in reducing maternal and child mortality rates, Zambia remains a country with a high disease burden which is under significant pressure to improve the health status of the people. This plan identifies strategies to significantly reduce the disease burden and accelerate the attainment of the Sustainable Development Goals. The plan is a major departure from the past strategic plans. While the plan recognizes that all health care interventions