Speaking on behalf of Cooperating Partners that are supporting Zambia’s health sector at the Health Sector Annual Consultative Meeting in Lusaka today, Mr Fergus said:
On behalf of the Health Cooperating Partners, let me start by wishing you a productive and fruitful 2017. We thank the honourable Minister and his team for the opportunity to jointly reflect on 2016 and collectively chart a path for improved joint working in 2017.
The Health Sector commenced 2016 on a high note following some success in achieving the 2015 millennium development goals four and six on reducing child deaths and halting the spread of HIV.
The success of Zambia’s national HIV program has put the country on a trajectory to achieving epidemic control. HIV prevalence decreased by just over a third from 15.6% in 2002 to 11.6% in 2016 and the rate of new infections has reduced by 41% within that timeframe. With support from partners under the leadership of the government, more than 800,000 people with HIV/AIDS are on life saving antiretroviral therapy and are living longer. Worryingly however, the prevalence of HIV among women of reproductive age, particularly adolescent girls remains unacceptably high at 14.5 % compared to 8.6% for males of the same age.
The Ministry sustained gains in child health with the successful execution of the measles rubella campaign that reached over 7 million children, age 9 months to fifteen years. The expansion of community based interventions and community oversight structures increased access to malaria and other essential preventative and curative services in poorer rural communities. Furthermore, through support from partners in selected districts, we demonstrated that malaria and trachoma elimination could be achieved in the medium term.
We congratulate the Ministry on recruitment of over two thousand health workers in 2016. This enabled the staffing of newly upgraded hospitals and placement of additional community health assistants on the government payroll to reach the 1,000 mark. We are pleased to note that the budget for continued recruitment of health workers has been secured in the 2017 health sector budget. This achievement will address one of the most critical gaps in the health sector and brings Zambia within reach of the WHO recommended standard of 23 multidisciplinary health workers per 10,000 population. However the impact of increased staffing of health facilities will only be fully realized if health workers are deployed to areas of greatest need and remain there, a strong performance management system is established and health facilities are adequately equipped.
Cooperating partners worked collaboratively with the Ministry to address the multiple disease outbreaks experienced in 2016. Worthy of note is the Ministry’s leadership in the successful containment of the cholera outbreak in eleven districts of the country, and the implementation of the first ever cholera vaccine intervention in Zambia. The plans developed during the year for public health emergency preparedness and response must be finalized and operationalized at all levels. This will place Zambia on the path to systematically detecting and addressing disease and other public health threats as they emerge, and realize the savings gained from early detection and containment of outbreaks.
Cooperating Partners identified and worked to rectify weaknesses in our collective support to the sector. Our work in this area to minimize duplication, fragmentation and strengthen government leadership included the following:-
- Cooperating partners provided the government with comprehensive information on the 328 health, HIV and nutrition projects funded by the 10 major donors in the sector, disaggregated to district level and with budgets for the 3 year period 2016-2018. Over half of partner supported projects (55%) are directed at service delivery, followed by information systems (14%) and drugs and supply chain projects (11%).
We continued with plans for the expansion of the province wide provision of reproductive, maternal, newborn, child and adolescent health and nutrition services across the continuum of care. When plans are finalized in 2017, donor support in this area will span 8 provinces and represent the largest direct investment through government systems since 2009. Terms of reference were also developed for a steering committee for improved coordination and oversight of the main programmes in this area with a collective cooperating partner and Ministry of Health budget of over $200million.
Nutrition partners effectively coordinated efforts and resources under one Scaling Up Nutrition programme with projected pooled funds of upward of $100million over the next five years.
The successes outlined above are even more remarkable when considered against the context of a change of government and the economic downturn in Zambia that adversely impacted all sectors, including the health sector. An analysis of some of the inevitable challenges and risks encountered during the year will help us in our prioritization and planning for 2017 and beyond.
It is to be noted that partners are investing approximately the same budget envelope as the government of Zambia in the health sector. Ongoing parity in funding should however not be expected in the current global political climate. Strong leadership that increases domestic investment in health and maintains the push for greater efficiency to achieve better value for money is required to consolidate gains in the health sector, and meet Zambia’s global health commitments.
The patchy availability of drugs at health facilities remained matters of grave concern to partners in 2016. Zambians have the right to expect essential lifesaving medicines administered by skilled staff as a normal part of accessing health care. Partners worked with the Ministry to direct programme savings and other resources to address gaps in essential medicines and supplies, particularly for malaria and HIV/AIDS. Partners however are troubled by the auditor general’s report confirming that the drug debt persisted through the year and by November 2016 was back at the 2015 level. Reports of expired drugs and leakage across Zambia’s borders compound existing issues. We are also unclear about the current procurement gaps for 2017 against national drugs, family planning and nutrition commodities forecasts.
Honourable Minister, procurement of medicines and medical supplies and the pharmaceutical supply chain is a major area of investment with approximately $175 million being invested across partners. The Ministry led procurement and supply chain planning retreat in March 2017 will be critical to gain a common understanding of bottlenecks and establish a work plan and monitoring framework towards improved management of the health sector procurement and supply chain.
The current government engagement in nutrition lags behind global commitments made in 2013. For instance, there has been slow progress on passing the revised Food and Nutrition Bill, the first proposed revision in the 50 years of the commission’s existence. Enactment of a revised Food and Nutrition Act is urgently required to reposition Zambia to address the multisectoral nature of the response to malnutrition.
Inaccurate national population estimates threaten successful planning and targeting of critical health interventions and we experienced this first-hand with the measles rubella campaign. Direct engagement with Central Statistics Office is required to resolve this issue and agree a way forward, not just for health but for all sectors.
Honourable Minister, your appointment has brought a new impetus to the Health Sector. The renewed focus on health systems strengthening and primary health care as the bedrock of the health system in particular is welcome. Already this has borne fruit with the prioritization of the development of the Community Health strategy 2017-2021 to clearly set the framework for interaction and action for all community based actors.
We fully support the current drive to reinvigorate and position the Ministry of Health’s operating framework and its functions to better address the ambitious Sustainable Development Goals (the health components of which extend beyond SDG 3), and the health mandate articulated in the 7th National Development plan. To achieve good health for all Zambians, leaving no one behind, the health sector must increasingly be outward facing and improve our joint working with others. This is a challenge that we (both Ministry and partners) must meet head on. The continuing reorganization of the sector therefore presents great opportunities but if not well managed, presents perhaps the greatest risk to increasing access and quality of health services and safeguarding donor investments. We reiterate that we will support you in establishing a solid change management process alongside the restructuring process to mitigate risks and realize the clear vision that drives the reorganization agenda.
Honourable Minister, Directors and staff of the Ministry of Health, the CPs have agreed to adopt the following principles to further strengthen our partnership in 2017
Frequent, open and frank dialogue within the framework of a shared vision articulated in the National Health Strategic Plan 2017-2021;
- Commitment to be accountable, to the government of Zambia, the Zambian people and to our tax payers; and
- Commitment to continuing to work with your Ministry towards a sector wide approach.
Our proposal for priority areas of focus for 2017 will be presented later in this meeting for our joint consideration and agreement.
Finally, let me assure you Minister that as health cooperating partners, we are committed to improving the health and wellbeing of all Zambians. Your success is our success. We look forward to a productive outcome to our discussions.