1 Zambia Service Availability and Readiness Assessment 2010 Summary Report 2010 Foreword Zambia has noted that among the top causes of morbidity and mortality are the following diseases and conditions: HIV/AIDS, tuberculosis and malaria. Other conditions that have recently been added to the causes of morbidity and mortality are non-communicable diseases such as diabetes etc. With international support in the recent past, there has been a huge scale-up in interventions to control these diseases. In order to assess sector readiness to deliver health care to the population, a service availability and readiness assessment was conducted on the availability and provision of health services and programmes. The results of the assessment indicate that there are some gains in the availability of equipment, medicines and commodities and laboratory diagnostics towards the provision of Child Health, Maternal Health, PMTCT, HIV/AIDS, TB, Malaria and Diabetes services. It is a clear testimony that a lot has been done in these areas i.e. the infrastructure has been laid and plans to improve these are underway. Consensus on programs has been reached, denial is slowly disappearing, stigma has been exposed and have targeted interventions towards these aspects. Major successes are foreseen in the prevention of infections to newly born children as PMTCT services have been scaled up to all levels of service delivery. The number of clients testing and being enrolled on ART is increasing. The only challenge remains among adults hence the need to ensure a major shift in the populations’ perception of sexuality and sexual relations. Malaria services have also been scaled up with almost all facilities confirming the Malaria cases through either RDTs or Microscopy tests. TB adherence is also on the rise with the introduction of DOTs. Of concern is the availability of basic amenities in the points of services delivery. The assessment reveals that a number of these facilities remain unconnected to a power grid or a generator, hence operate without any form of electricity. In the advent of technological change, communication in any form is cardinal to the delivery of health services. However, the availability of computers and internet connections to facilitate the transmission of data from one level of health care to the other remains a challenge. Some facilities operate with inadequate transport for referral cases and also lack communication in form of phones or radio frequency. The provision of health facilities within the acceptable range of access remains a challenge as the assessment reveals a current operation to be at 1.1 health facilities per 10 000 population. However, the Government is working tirelessly to reduce the challenge of distances to the facilities of health care. It is my hope that the conclusions of the assessment will encourage our stakeholders and partners to continue with their support as we also improve on our contributions to come up with better interventions on how best to deliver health services. Dr. Joseph Kasonde, MP Minister of Health Zambia | SARA 2010 Summary Report 1 Acknowledgements The Service Availability and Readiness Assessment Report has been developed through a participative process involving considerable contributions and support from various individuals and institutions. I therefore wish to extend my sincere gratitude to all those that contributed to the process of writing this report. Particular recognition go to the Dr. Christopher Simoonga, Mr. Chipalo Kaliki, Mr. Richard Banda, Mr. Trust Mufune, Ms. Brivine Sikapande, Mr. Calvin Kalombo, Mr. Patrick Amanzi, Mr. Masauso Phiri, Ms. Virginia Simushi, Mr. Lewis Mwila and Mr. Kafumukache Bwalya, all under the Monitoring and Evaluation Unit in the Directorate of Policy and Planning, Dr. Wezi Kaonga in the Directorate of Public Health, Ms. Mercy Mwanza from National Malaria Control Centre, participants from MACEPA, National AIDS Council and the University of Zambia for their consented time and efforts towards this report. I also would like to acknowledge the World Health Organisation particularly Dr. Ties Boerma, Ms Patricia Kathryn O’Neill, Ms. Ashley Sheffel, Ms. Marina Takane and Dr. Jason Pickering for the financial and technical support provided to us towards this process. Without their direction and valuable support, we would have not managed to successfully complete the process and the report. Finally, I wish to thank all members of staff in the Ministry of Health, Provincial Medical Offices and District Medical Offices for their time during the data collection period. Dr. Peter Mwaba Permanent Secretary MINISTRY OF HEALTH 2 Zambia | SARA 2010 Summary Report Table of contents List of tables ............................................................................................................................................. 4 List of figures ........................................................................................................................................... 8 Abbreviations and acronyms ................................................................................................................ 13 Executive summary ............................................................................................................................... 15 1 Introduction ................................................................................................................................... 25 2 Methodology and data collection ................................................................................................. 27 2.1 Planning process ................................................................................................................................. 27 2.2 Selection of health facilities ................................................................................................................ 27 2.3 Background on health facilities .......................................................................................................... 29 3 Overview of the assessment ........................................................................................................ 33 4 General service availability .......................................................................................................... 35 4.1 Health facility density .......................................................................................................................... 35 4.2 Inpatient bed density ........................................................................................................................... 37 4.3 Maternity bed density .......................................................................................................................... 39 4.4 Core health worker density ................................................................................................................. 40 4.5 Outpatient visits ................................................................................................................................... 42 4.6 Inpatient admissions ............................................................................................................................ 44 4.7 General service availability summary index ...................................................................................... 45 5 General service readiness ............................................................................................................ 47 5.1 Basic amenities .................................................................................................................................... 50 5.2 Basic equipment ................................................................................................................................... 53 5.3 Standard precautions for prevention of infections ........................................................................... 57 5.4 Diagnostic capacity .............................................................................................................................. 60 5.5 Essential medicines ............................................................................................................................. 64 5.6 General service readiness summary index ....................................................................................... 68 6 Training and guidelines ................................................................................................................ 71 6.1 Training intensity ................................................................................................................................. 71 6.2 Availability of guidelines ..................................................................................................................... 72 6.3 Training intensity and availability of guidelines by health facility ownership ............................... 73 7 Service specific availability and readiness ................................................................................. 74 7.1 Maternal, neonatal, and child health ...................................................................................................... 75 7.2 HIV/AIDS ............................................................................................................................................. 109 7.3 Sexually transmitted infection (STI) services .................................................................................. 129 7.4 Tuberculosis (TB) ..............................................................................................................................