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C ommo nwe a l t h memb e r c o u n t r i e s Health. As a result, there is no approved mental health act currently in place. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Zambia to achieve its targets for the reduction of child mortality, which forms MDG 4, it will need to have reduced underfive deaths per 1,000 live births to 64 and increase measles immunisation to 100 per cent by 2015. In 2013 under-five mortality stood at 87 deaths per 1,000 live births, a notable decrease from 95 in 2011, and measles immunisation had slipped from 91 per cent in 2010 to 80 per cent in 2013. It’s unlikely that Zambia will meet its targets for MDG4, particularly that on measles immunisation, as the number of immunised one-year-olds fell again between 2011 (83 per cent) and 2013. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. In Zambia, maternal mortality should fall to 145 cases per 100,000 live births. In 2013 Zambia had an adjusted maternal mortality ratio of 280 deaths per 100,000 live births (this figure was estimated at 440 by UN agencies/World Bank in 2010). Based on the data reported by the country, this target is unlikely to be achieved. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In the period 2007–12 this figure stood at 47 per cent, so achievement of this target is also looking unrealistic. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. Although there has been a slight reduction in the prevalence of HIV in the period 2011–12, the percentage of the population infected with the disease remains very high, with more than one in ten 15–49-year-olds infected. The number of deaths from malaria has decreased from 4,540 in 2011 to 3,705 in 2012. Mortality (when data excludes cases comorbid with HIV) from TB more than halved in the period 1990–2012, but has risen slightly since then. Consequently, Zambia is unlikely to meet its targets for MDG 6. However, since 2000 the number of new infections of HIV in children has reduced dramatically, with new infections in infants dropping from 27,978 in 2000 to 9,726 in 2011, and from 5,520 in 2009 to 2,946 in 2011, among children between one and four years old. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Only a third of health care in Zambia (34 per cent) 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 per cent of GDP in 2012, of which 64 per cent (US$62 per capita) was covered by the government. 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. 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. Care of the elderly: Around 381,363 people in Zambia are over the age of 65 – three per cent of the total population (2013). At the age of 60 a person in Zambia can be expected to live for an additional 17 years, on average (2013). The Zambian Social Cash Transfer Programme of pension payments dates back to 2007. Monthly social security benefits are paid by the state at a rate of US$12 per person (2007–12) on a universal basis, regionally. Overall, public pension spending is equivalent to 1.4 per cent of the country’s total economic output (2009). Retirement age has recently been raised to 65. The HIV/AIDs epidemic has left some elderly people struggling financially, as they are caring for grandchildren who have lost their parents. AIDS has also seen rising numbers of old people’s homes in Zambia, usually run by charities, not-for-profit organisations or the government, as many elderly people are outliving their children who, traditionally, would have cared for them. Further information Ministry of Health: www.moh.gov.zm Commonwealth Health Online: www.commonwealthhealth.org/health/africa/zambia 300 Commonwealth Health Partnerships 2015 Population over 65 3%


Commonwealth Health Partnerships 2015
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