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Danstan Kaunda

LUSAKA, Nov 15 (IPS) – In an attempt to drastically reduce child mortality rates and boost maternal health, the Zambian government last year allocated a substantial budget to the public health sector. This move has resulted in a notable drop in child deaths, researchers say.

However, most progress has taken place in Zambia’s cities, while in rural areas health service provision has improved little.

In its 2007/2008 national budget, the Zambian health department received the largest share — 11.5 percent — of the total national budget. The money has been used to scale up services in public health care sector, with focus on boosting paediatric care.

In Zambia, the main causes for high infant and child mortality are diarrhoea, malnutrition, malaria, HIV and acute respiratory infections.

To improve child health, the health department rolled out a programme that provides infants with micro-nutrients, for example through Vitamin A-fortified foods, routine child immunization for measles and scale-up of prevention of mother-to-child transmission (PMTCT) of HIV.

As a result, infant mortality has dropped from 107 deaths per 1,000 live births in 1992 to 70 death per 1,000 live births in 2007, according to the national Demographic and Health Survey (DHS) released in May. Under-five mortality also dropped from 191 deaths per 1,000 live births in 1992 to 119 deaths per 1,000 live births in 2007.

The numbers show that Zambia is on track to meeting Millennium Development Goal (MDG) 4 that aims to reduce child mortality by two-thirds by 2015, which would equal 60 deaths per 1,000 live births.

“We still have a long way to go, [but] if this pace and progress continues we have a fighting chance to reach this MDG by the end of 2015,” national health minister, Dr. Brian Chituwo, told IPS. “This progress is [based on] Zambia’s sustained economic growth in the last few years, increased investment in the social and health sector and a robust national response to health matters.”

Despite the progress, health experts lament the fact that the financial boost into the public health care system has had little impact on the country’s rural areas.

Half of the country’s medical professionals are based in the capital, Lusaka, and about a third are located in other major towns of the country, leaving only a small number of health workers to practice in rural areas, according to the Demographic and Health Survey.

To reverse this trend, the health department recently launched an initiative to train community health providers in remote, rural communities with little access to public health services.

Community health workers educate rural populations about sanitation, hygiene, nutrition, child health and family planning and are trained to treat common illnesses, such as diarrhoea.

James Zimba, one of the community health provider capacity builders of the District Health Management Team (DHMT) in Lusaka, says training community health carers has helped to provide services in far-flung areas, where government programmes have not yet been implemented.

“Most of the [national] health budget is spent on administration work by the ministry and in the three major hospitals. Very little goes to the smaller district clinics,” criticised Zimba. “If we want to reach rural areas, we rely on services by community health providers who are willing to work for a very small salary or no pay at all.”

Zambia’s community health providers mostly work on a voluntary basis and are often “paid” with food instead of money by thankful patients.

Yet, the institution of community health carers is crucial, as they bring health care to communities that are usually cut off from public health services due to long distances.

Mabel Kasoma, head nurse at Kaliga-Kaliga clinic in Lusaka, says community health workers offer a much-needed solution to the health departments severe human resource constraints.

“Because of inadequate use of financial resources, we have a huge lack of trained personnel to attend to the medical needs rural people, especially pregnant women and children,” Kasoma said. “This is why the department decided to train members of rural communities in basic health care, with focus on maternal care.”

Kasoma said she believes community health carers will contribute to reducing infant and child mortality, not only in urban but also in rural areas. “One major success that has already been achieved by community health workers has been a drop in diarrhoea-related diseases in rural areas in children under five,” she explained. “This is an important step in the right direction.”

Copyright © 2008 IPS-Inter Press Service. All rights reserved.

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