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Zambia’s five main referral hospitals are the Arthur Davison Children’s Hospital (Ndola), Chainama Hills College Hospital (Lusaka), Kitwe Central, Ndola Central and the University Teaching Hospital (Lusaka). There are provincial and district hospitals and health centres throughout the country. Health providers other than the government include faith organisations and health care companies. There are four main manufacturers of pharmaceutical products, all based in Lusaka. Products include tablets, painkillers, syrups and some antibiotics. About 85–90% of pharmaceuticals are imported.
The WHO Country Specific Strategic Agenda has identified a need for Zambia to provide support to health care financing to facilitate equitable access to health care. The agenda also points to the need for strengthening health systems, budgeting and accountability. It is also recommended that the potential of public–private partnerships in investigated to harness the resources of the private sector to improve health care coverage.
Communicable diseases along with maternal, neonatal and nutritional conditions in Zambia accounted for an estimated 67% of all mortality in 2012. The prevalence of HIV in Zambia, as a percentage of people aged 15–49 years, stood at 12.4% in 2014. There has been a gradual and continuous decline in the prevalence of HIV since 1993. There were 2,976,395 reported cases of malaria in 2009, but the number of deaths from malaria fell by around a third in the decade 2001–11. In the period 1996–2012 there was a reduction of more than a third in the estimated incidence of tuberculosis (TB). Estimated mortality (when mortality data excludes cases comorbid with HIV) from the disease showed a marked decline in the period 1990–2012. Non-communicable diseases (NCDs) in Zambia accounted for an estimated 22% of all mortality in 2012. The most prevalent NCDs in Zambia are cardiovascular diseases, which accounted for 8% of total deaths across all age groups in 2008. Cancer, non-communicable variants of respiratory diseases and diabetes contributed 4%, 1% and 1% to total mortality, respectively (2012).
Zambia’s public spending on health was 2.9% of GDP in 2013, equivalent to US$62 per capita. In the most recent survey, conducted in 2010, there were 7 doctors, and 78 nurses and midwives per 100,000 people. Additionally, in the period 2007–12, 47% of births were attended by qualified health staff and in 2013, 80% of one-year-olds were immunised with a dose of measles. In 2014, 65% of people were using an improved drinking water source and 44% had access to adequate sanitation facilities. The most recent survey, conducted in the period 2000–11, reports that Zambia has 13 pharmaceutical personnel per 100,000 people.
Only a third of health care in Zambia (34%) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 6.5% of GDP in 2012, of which 64% (US$62 per capita) was covered by the government. In 2013 public spending on health care was equivalent to 3% of GDP.
Zambia was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1984 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination.