AFRO-NETS> WHO on the Zambian Health Reforms

forwarded by: HEALTH-L, THE ZAMBIAN ELECTRONIC MAILING LIST ON HEALTH ISSUES

WHO on the Zambian Health Reforms
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THE WORLD HEALTH ORGANISATION ON THE ZAMBIAN HEALTH REFORMS: A MESSAGE FROM
DR. WILFRED S. BOAYUE, THE WHO COUNTRY REPRESENTATIVE - ZAMBIA.

Welcome to the first E-mail transmission of THE WORLD HEALTH ORGANISATION ON
THE ZAMBIA HEALTH REFORMS that will feature on HEALTH-L every Monday.

I hope that this feature will create dialogue among us all. We hope to share
activities that take place between WHO and our key partners. We also hope
that you, the reader will respond to some of the issues that are of interest
to you.

The World Health Organisation and Zambia have been partners in the promotion
of health of the Zambian people since 1966 when the two signed the document
of cooperation. From that time onwards, we have worked together in good and
bad times to raise the level of health of Zambians.

During the good times, when the economy was good and the Zambian Kwacha
currency was strong, Zambia built and equipped over 1200 static health units
throughout the country. The Government was able to provide cost free health
care services to all the Zambians. Those days are referred to as the
"cadillac era". It did not last because the economic fortunes changed for
the worst with the escalating price of oil, while at the same time the price
of copper was falling.

As partners, our commitment to the principle of primary health care has
never wavered. Health can be sustained if each individual and family take
responsibility for their own health. The desire to promote quality health
care as close to the family as possible can succeed. This is possible if we
empower the people to be in charge of the factors that affect their health.

When it became apparent to the Government that the cadillac system was
neither effective nor affordable, Zambia began to look for a more equitable,
affordable and sustainable solution. The new health system, was therefore,
based on equity access to quality health care as close to the family as
possible. The people who use the service have a greater voice in running the
system. Consequently, the Zambia Health Reforms 1992 were born. These caught
the attention of WHO and other partners that were willing to collaborate
with the Ministry of Health in bringing the vision of the new health order
into reality. The vision, courage and leadership of the officials of the
Ministry of Health have made this experience a global example of health care
delivery system reform. The process is dynamic and pragmatic. There exists,
among the Zambian health care providers, the courage to learn by doing.

We were recently visited by a team of eminent health care professionals led
by Dr. Halfdan Mahler, former WHO Director General. The team reviewed the
process of the new health order and shared with the Ministry of Health their
thoughts on the way forward. The Team's preliminary observations were
encouraging. The Team noted that our goals were ambitious.
Consequently, the Team suggested that we step forward and see if we would
have the resources needed for the effective implementation of the Health
Reforms. We now need to begin to see how this new structure would respond to
the challenge of delivering the goods to the Zambian people. As in the past,
WHO is ready to work with the Ministry of Health in this challenging and
exciting venture.

The WHO feature of HEALTH-L has come at an exciting time in the history of
health care delivery experience in the country. The new structure of health
care delivery system is designed to be flexible in order to meet the
challenges of changing priorities in a dynamic setting.

WHO endeavours to work with the Ministry of Health to develop appropriate
human resources that are equipped and motivated for the tasks at hand.
Together, we must face the HIV and AIDS pandemic, which threatens to wipe
out the gains made in the march towards health for all in the past decades.
Malaria, the leading cause of morbidity in the country must be tackled. We
have to eradicate polio and bring other childhood diseases under control.
The districts must be assisted in grasping the new concepts of reproductive
health so that they can effectively implement them. We must apply the
effective tools available to us to bring tuberculosis under control. The
list is endless. The challenge is great. How do we effectively use the
inadequate resources that we have in order to control this magnitude of
problems?

During the course of 1996, we were visited by Dr. Ebrahim M. Samba,
Regional Director, WHO Regional Office for Africa. He witnessed the changes
that were taking place in the Zambia Health Reforms. He was very impressed
when he talked to some village folks and found out that they were also part
of the health reforms changes that were taking place. Health sector reform
is one of the priority programmes for the Africa region.

Zambia serves as an example for some countries that are at different stages
of developing their own health sector reforms. Dr. Samba, strongly pledged
his full support to the success of the Zambian health reforms.