Zambia health sector public expenditure review: accounting for resources to improve effective service coverage
This publication examines the performance of the health sector in Zambia using quantitative techniques. While there have been a number of health sector assessments in the country, they have relied on qualitative and anecdotal evidence for the most part. For the first time, this public expenditure re...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Book |
| Language: | English |
| Published: |
Washington, D.C.
World Bank
2009
|
| Series: | A World Bank country study
|
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Summary: | This publication examines the performance of the health sector in Zambia using quantitative techniques. While there have been a number of health sector assessments in the country, they have relied on qualitative and anecdotal evidence for the most part. For the first time, this public expenditure review of the health sector brings together the results of three separate but related analytical efforts: multi-year national health accounts, a public expenditure tracking and quality of service delivery survey, and resource and impact modeling using the Marginal Budgeting for Bottlenecks software. These exercises combine to yield more powerful findings on the weaknesses and prospects of the Zambian health system.--Publisher's description. |
| Item Description: | Includes bibliographical references |
| Physical Description: | XIX, 92 S. zahlr. graph. Darst. |
| ISBN: | 9780821378045 9780821378052 |
Staff View
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Record in the Search Index
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| adam_text | Titel: Zambia health sector public expenditure review
Autor: Picazo, Oscar F.
Jahr: 2009
Contents
Acknowledgments ix
Acronyms and Abbreviations xi
Executive Summary xiii
Key Findings xiii
Key Recommendations xvi
1. Background, Objectives, and Analytical Tools 1
Impelling Factors for the Health Sector PER 1
Objectives and Analytical Tools of the Health Sector PER 2
Uses of the PER 4
2. Health System Challenges 5
Health System Goals and Structures 5
Challenges at the Health Outcome Level 7
Challenges at Health Service Level 10
Challenges at the Service Delivery Level 15
3. Sources and Uses of Funds in the Health Sector: Results
of the National Health Accounts Exercises, 1999-2004 17
Total and Per Capita Health Expenditures 17
Sources of Health Expenditures 21
Health Expenditures by Service Provision and Administration 24
Health Expenditure Patterns of Donors, MOH, and Households 26
Financing of Service Providers 28
Uses of Health Expenditures 30
4. Budget Allocation, Release, and Spending: Results of the Public
Expenditure Tracking Component of the PET/QSDS, 2005-06 33
Funds Flow and Resource Envelope 34
MOH Budget Process and Allocation Formula 37
MOH Allocations versus Release of Resources 40
Allocation and Releases of District Grants 44
Health Facilities Management of Vertical Funds 49
Health Facilities Management of Internally-generated Funds 50
Overall Resource Availability at the Facility Level 54
iii
iv Contents
5. The State of Health Facilities and Services: Results of the Quality
of Service Delivery Component of the PET/QSDS, 2005-06 57
Management of Infrastructure, Utilities, and Equipment 57
Management of Health Personnel 60
Management of Drugs and Other Medical Supplies 67
Clinic and Patient Management 68
6. Scaling Up Health Service Delivery to Reach the MDGs: Results
of the Marginal Budgeting for Bottlenecks Modeling Exercise, 2006 69
Health Sector Response to the Challenges: Strategy and Resources 69
Bottlenecks in the Service Delivery Chains 71
Scenarios for Scaling Up Service Coverage 74
Statistical Appendix 79
References , 91
List of Tables
1. Health Facilities in Zambia, 2000s 6
2. Summary Statistics on the Major Diseases, 2000-05 8
3. Selected Health Service Delivery Indicators, 2000-04 11
4. Service Coverage Indicators of Key Childhood Health Interventions
in Selected African Countries, 2000s 13
5. Maternal Mortality Ratio and Service Coverage Indicators of Key
Maternal Health Interventions in Selected African Countries, 2000s 14
6. Government Health Expenditures (ZK Billion) Using Alternative
Definitions, 1995-2007 20
7. Health Expenditures (ZK Billion) Under the Discretion of the Government,
by Source, 2001-07 20
8. Trends in Health Expenditures by Source, 1995-2004 22
9. Total Financing of Health Facilities, 2002-04 29
10. Health Sector Resource Envelope, FY05 and FY06 36
11. Range of Cost Estimates to Meet the Health MDGs in Zambia 36
12. Amount of GRZ Budget Provided by DHMTs to Their Health
Facilities, FY05 46
13. Health Centers Reponses on Whether They Received an Amount More
Than, Equal to, or Less Than Their Annual Allocations, 2006 46
14. Uses of GRZ Budget and Basket Funds by Health Facilities, FY05 48
15. Composition of Average Debt Per Facility, FY05 48
16. Donors Vertical Funds Received by Health Facilities, FY05 49
Contents v
17. Uses of Vertical Funds by Health Facilities, FY05 50
18. Internally Generated Funds of Health Facilities, 2005 51
19. User Fee Practices, 2005 52
20. Percent of Health Facilities Rate of Retained Fee Revenues, FY05 53
21. Uses of User Fee Revenues by Health Facilities, FY05 53
22. Expected Versus Actual User Fee Revenues for OPD, FY05 54
23. Level of Annual Resources at the Facility Level, by Major Sources, FY05 54
24. Health Facilities Reporting Inadequate Medical Equipment, Instruments,
and Lab Test Supplies, 2006 60
25. Vacancy Rates in Health Facilities, by Cadre, 2006 61
26. Established Posts and Average Number of Actual Staff by Major Occupational
Groups, 2006 62
27. Salary Management, 2006 66
Annex A. MOFNP and Local Government Authorities Health Expenditures
by Recipient, 1995-2004 79
Annex B. Donors Health Expenditures by Recipient, 1995-2004 80
Annex C. Employers and Households Health Expenditures by Recipients,
1995-2009 80
Annex D. Total Health Expenditures by Service Provision, Administration,
and Rest of the World Transactions, 1995-2004 81
Annex E. Total Health Expenditures by Service Provision and Administration
and by Type of Providers, 1999-2004 82
Annex F. Donor Health Expenditures by Type of Providers and Administrators,
2002-04 83
Annex G. MOH/CBOH Health Expenditures by Level of Care and Administration,
1999-2004 84
Annex H. Household Health Expenditures by Type of Providers,
1999-2004 85
Annex I. Health Expenditures by Line Items by Type of Facility, 1999-2004 86
Annex J. Resources at the Disposal of a Typical DHMT, FY05 87
Annex K. Self-Reported Versus Actual Capacity to Deliver Selected Health Services
in Rural Health Centers, 2006 88
Annex L. Self-Reported Versus Actual Capacity to Deliver Selected Health Services
in Urban Health Centers, 2006 89
List of Figures
1. Comparison of IMR and U5MR in Selected African Countries, Latest
Year Available 9
2. Trends in Neonatal, Infant, and Under-Five Mortality in Zambia, 1992,1996,
and 2001/02 Rates (Per 1,000 Live Births) 9
vi Contents
3. Trends and Levels of Major Diseases in Zambia, 2002-04 10
4. Coverage of Key Health Services, 2000-04 11
5. Provincial Inequities in Health Service Coverage by Region 12
6. Differences in Selected Maternal and Child Health Indicators Between
Rural and Urban Households in Zambia, 2000/01 12
7. Differences in Selected Maternal and Child Health Indicators Between
Lowest and Highest Asset Quintile Households in Zambia, 2000/01 13
8. Unfilled Posts by Profession 14
9. Gaps in Numbers of Health Facilities 15
10. Trends of Child Mortality in Zambia, 1990-2015 16
11. Trend of Maternal Mortality in Zambia, 1996-2015 16
12. Total Health Expenditures in Nominal and Real Terms, 1995-2004 18
13. Selected Health Expenditure Ratios, 1995-2007 18
14. Trends in Per Capita Government Health Expenditure and Per Capita Total
Health Expenditure, 1995-2007 21
15. Trends in Health Expenditures by Source, 1995-2004 23
16. In-Budget versus Off-Budget Donor Health Expenditures, 2000-04 24
17. Total Health Expenditures Going to Service Provision and Administration,
2001-2004 25
18. MOH/CBOH Health Expenditures Going to Service Provision and
Administration, 2001-04 27
19. MOH/CBOH Health Expenditures by Level of Care, 1999-2004 28
20. Financing of Health Facilities by Source, 2002-04 29
21. Health Expenditures of MOH, Mission, and For-Profit Facilities by Inputs,
1999-2004 30
22. Flow of Funds and Other Resources in Zambia s Government Health Sector 34
23. Per Capita MOH Released + Supplementary Funding, by Province, FY05 38
24. Budget Release Per Capita Versus Incidence of Malaria and Under-5
Pneumonia, 2005 39
25. Cumulative Budgeted Versus Released Amounts of Total MOH Budget,
by Month, FY05 40
26. Cumulative Budgeted Versus Released Amounts for Personal Emoluments,
by Month, FY05 41
27. Cumulative Budgeted Versus Released Amounts for District Grants,
by Month, FY05 41
28. Cumulative Budgeted Versus Released Amounts for RDCs, by Month, 2005 42
29. Cumulative Budgeted Versus Released Amounts for Essential Drugs,
by Month, FY05 42
Contents vii
30. Cumulative Budgeted Versus Released Amounts for Capital Expenditures,
by Month, FY05 42
31. MOH Allocation Versus Releases to Provinces Included
in the Survey, FY05 43
32. MOH Allocation Versus Releases to DHMTs Included
in the Survey, FY05 43
33. Cumulative Planned Versus Actual Facility Grants by DHMTs to RHCs,
by Month, FY05 , 44
34. Cumulative Planned Versus Actual Hospital Grants, by Month, FY05 45
35. Allocated Versus Received Budgets of Selected District Hospitals FY05 47
36. Allocated Versus Received Budgets of Selected Health Centers, FY05 47
37. Health Facilities With Functional and Nonfunctional Utilities
and Transport Equipment, 2006 58
38. Health Facilities with Imaging Equipment, 2006 59
39. Health Facilities with Functional and Nonfunctional Medical Equipment, 2006 .... 59
40. Personnel Expenditures in MOH Budget and Share of Personnel
Expenditures to Total MOH Expenditures, 2000-07 61
41. Average Number of Hours Worked in a Week by Type of Task, 2006 62
42. Per Capita Health Expenditures and Share of Personal Emoluments
to Health Expenditures, 2006 63
43. Summary Rates of Staff Vacancy, Absenteeism, Tardiness, Involvement
in Income-Augmenting Activities, and Dissatisfaction, 2006 64
44. Composite Monthly Salaries and Allowances of Clinical/Professional
Health Workers, 2005 65
45. Drug Expenditures and Drug Kits Opened Per 1,000 Patients, 1999-2005 67
46. Sequential Relationships of Health Services 72
47. Bottlenecks in Community-Based Services 73
48. Bottlenecks in Population-Based Outreach Services 73
49. Bottlenecks in Facility-Based Services 74
50. Projected Trend in Reaching Child Mortality MDGs 77
51. Projected Trend in Reaching Maternal Mortality Reduction MDGs 78
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| id | DE-604.BV035444333 |
| illustrated | Illustrated |
| indexdate | 2024-07-09T21:35:24Z |
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| language | English |
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| record_format | marc |
| series2 | A World Bank country study |
| spelling | Picazo, Oscar F. Verfasser aut Zambia health sector public expenditure review accounting for resources to improve effective service coverage Oscar F. Picazo ; Feng Zhao Washington, D.C. World Bank 2009 XIX, 92 S. zahlr. graph. Darst. txt rdacontent n rdamedia nc rdacarrier A World Bank country study Includes bibliographical references This publication examines the performance of the health sector in Zambia using quantitative techniques. While there have been a number of health sector assessments in the country, they have relied on qualitative and anecdotal evidence for the most part. For the first time, this public expenditure review of the health sector brings together the results of three separate but related analytical efforts: multi-year national health accounts, a public expenditure tracking and quality of service delivery survey, and resource and impact modeling using the Marginal Budgeting for Bottlenecks software. These exercises combine to yield more powerful findings on the weaknesses and prospects of the Zambian health system.--Publisher's description. Statistik Medical economics Zambia Health Expenditures statistics & numerical data Zambia Health Services economics Zambia Statistics Public Health Practice economics Zambia Statistics Medizinische Versorgung (DE-588)4038270-9 gnd rswk-swf Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf Gesundheitsausgaben (DE-588)4210266-2 gnd rswk-swf Finanzierung (DE-588)4017182-6 gnd rswk-swf Zambia Statistics, Medical Sambia (DE-588)4076986-0 gnd rswk-swf Sambia (DE-588)4076986-0 g Gesundheitswesen (DE-588)4020775-4 s DE-604 Medizinische Versorgung (DE-588)4038270-9 s Gesundheitsausgaben (DE-588)4210266-2 s Finanzierung (DE-588)4017182-6 s Zhao, Feng Verfasser aut HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017364519&sequence=000004&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Picazo, Oscar F. Zhao, Feng Zambia health sector public expenditure review accounting for resources to improve effective service coverage Statistik Medical economics Zambia Health Expenditures statistics & numerical data Zambia Health Services economics Zambia Statistics Public Health Practice economics Zambia Statistics Medizinische Versorgung (DE-588)4038270-9 gnd Gesundheitswesen (DE-588)4020775-4 gnd Gesundheitsausgaben (DE-588)4210266-2 gnd Finanzierung (DE-588)4017182-6 gnd |
| subject_GND | (DE-588)4038270-9 (DE-588)4020775-4 (DE-588)4210266-2 (DE-588)4017182-6 (DE-588)4076986-0 |
| title | Zambia health sector public expenditure review accounting for resources to improve effective service coverage |
| title_auth | Zambia health sector public expenditure review accounting for resources to improve effective service coverage |
| title_exact_search | Zambia health sector public expenditure review accounting for resources to improve effective service coverage |
| title_full | Zambia health sector public expenditure review accounting for resources to improve effective service coverage Oscar F. Picazo ; Feng Zhao |
| title_fullStr | Zambia health sector public expenditure review accounting for resources to improve effective service coverage Oscar F. Picazo ; Feng Zhao |
| title_full_unstemmed | Zambia health sector public expenditure review accounting for resources to improve effective service coverage Oscar F. Picazo ; Feng Zhao |
| title_short | Zambia health sector public expenditure review |
| title_sort | zambia health sector public expenditure review accounting for resources to improve effective service coverage |
| title_sub | accounting for resources to improve effective service coverage |
| topic | Statistik Medical economics Zambia Health Expenditures statistics & numerical data Zambia Health Services economics Zambia Statistics Public Health Practice economics Zambia Statistics Medizinische Versorgung (DE-588)4038270-9 gnd Gesundheitswesen (DE-588)4020775-4 gnd Gesundheitsausgaben (DE-588)4210266-2 gnd Finanzierung (DE-588)4017182-6 gnd |
| topic_facet | Statistik Medical economics Zambia Health Expenditures statistics & numerical data Zambia Health Services economics Zambia Statistics Public Health Practice economics Zambia Statistics Medizinische Versorgung Gesundheitswesen Gesundheitsausgaben Finanzierung Zambia Statistics, Medical Sambia |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017364519&sequence=000004&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| work_keys_str_mv | AT picazooscarf zambiahealthsectorpublicexpenditurereviewaccountingforresourcestoimproveeffectiveservicecoverage AT zhaofeng zambiahealthsectorpublicexpenditurereviewaccountingforresourcestoimproveeffectiveservicecoverage |