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Monday, 25 April 2011

MMD Manifesto : Health Services

When reviewing the opposition’s proposals on health services, we made the following observations on the present situation :
The current challenges in health services are humongous. I was recently at Ndola Central Hospital and saw many horror stories – an entire city hospital for example with only one dialysis machine. HIV patients are kept with people suffering from severe skin diseases. Patients sleep on the floor. Stories abound of people jumping from the sixth floor to commit suicide because of poor conditions. The stench alone is enough to consign an alien visitor to mental asylum. That is in the province that is the "home of copper"! Now, what about rural hospitals? Then there’s the never ending corruption and procurement scandals. It is no surprise that the sector continues to experience a massive "brain drain". The challenges facing any new government appear insurmountable.
So that is where we are, but now for the MMD proposals on what it plans to change.

What are the main specific policy proposals?

Many of the MMD proposals in this area are too generic, but the following are more specific. 

Infrastructure: There’s a specific proposal to “provide mobile hospitals in every district” as a stop gap measure until more permanent structures are built. This would represent a substantial escalation of their current programme if re-elected. The more permanent proposals relate to construction of health posts “at every basic school”; and, an effort to build district hospitals “in every district”. 

Human Resource: MMD plans to increase the intake of nursing trainees in various (undefined) institutions and provide (undefined) incentives to retain workers, especially in rural areas.

Procurement and Medicines: There’s a general commitment to “strengthen procurement systems and capacities” of essential drugs and medical supplies. In particular, they plan to strengthen “local manufacturing capacities” to improve supply. But again, they do not state how this would be done.

What is the rationale?

The MMD manifesto is again very thin on problem definition. The best we can do is glean something from what they regard as their objective : “The MMD government is committed to providing equity of access to cost effective and affordable health services as close to the family as possible”. From this one can logically deduce that all things being equal, MMD believes that the current level of provision in health services is not as equitable, cost effective, affordable and close to the family as it should be (we must bear in mind that they think much progress has already been made in this direction). We are probably being too generous here, but I think it makes sense to draw this inference because if these are already achieved then there would be no need for setting objectives toward that end. That MMD has set objectives in that direction, it means it also holds that more can still be done. 

What is our main assessment?

In light of the above, the basic question in front of us is whether the MMD solutions (as reflected in their proposals) match well to the four underlying problems (as reflected in their general commitment).

Equity:  There are no specific MMD proposals that address the lack of equitable provision. For example we don’t have any specific proposals that are meant to specifically reduce cost of care to the poor, the disabled, the elderly and other vulnerable groups.

Cost effective: Nothing proposed in the manifesto that is aimed at cost effectiveness. The term is slightly nebulous and MMD makes no attempt to define it. However, we can see this as broadly from the tax-payers perspective. The standard economic appraisal  in health economics relies on technique called  “cost effective analysis”. Due to the challenge of measuring benefits, health economists tend to focus on valuing the "least cost" option that meets the intended outcomes (e.g. a life saved). When one looks at the MMD policies, particularly the intention to expand mobile hospitals it is difficult to know whether that is driven by any credible “cost effectiveness analysis”. The proposal does not appear to stand up to good economic reasoning. To date no proper economic analysis has been done on the existing procurement which appears marred in corruption. It also goes without saying that all of the MMD proposals cannot be justified as cost effective because they have not provided any figures to justify them. No costings have been done.

Affordable : That is affordable to the poor. Again no specific proposals from MMD that are specifically focused on this.

Close to the family (access):  This appear to be the main goal of the MMD proposals. The policy solutions to expand local health infrastructure will significantly improve accessibility to health services especially in remote areas (relative to the present). However for us to judge the value of this improved access, two additional analytical questions are pertinent. First, is the improved access tangible? In other words, is it likely to lead to equitable and affordable provision of health services? Without those two areas access becomes an abstract idea. We have already seen that there are no tangible policies by MMD that makes clear how this will be achieved. The second question relates to economic efficiency. Will the policy proposals provide value for money for the Zambian tax payer? The honest answer at present is that we simply don’t know. The MMD infrastructure proposals have not been costed. It is a little difficult to know how they plan to deliver them and where the appropriate funding sources.

In short based on the MMD's own view of the likely challenges facing health, it has not actually proposed any policies that addresses those proposals adequately. The drive for greater access is well intended but it comes far short when its not accompanied by proper costings and careful attention to affordable and equitable provision

In general, we find the MMD proposals are mundane and lacking in innovation. There are no specific proposals relating to need for greater information, cutting corruption and leverage private sector investment in health. This does not appear to be a transformational agenda for our health services.

Related Posts :

PF Manifesto : Health Services

Zambian Economist is currently reviewing manifestos of leading political parties in Zambia. All posts in this ongoing review can be found at Manifesto Analysis.


  1. zambian -economist i thing this is a good analysis. The problem MMD sees, is poor access to health equitable health care by the poor rural communities. I think the problem is bigger than that ranging from human resource, infrastructure to the style of funding health care system. But MMD may be in thinking that improving the rural poor’s access to health care, eventually it may lead to better health outcomes and a stability in the cost of health care. In the long run the tax payer would have gotten value for money if good outcomes are achieved.
    when health care services are brought closer to people’s homes, the poor will have preventive care e.g health information ,screening for diseases, antenatal care etc. all this can improve health outcomes and prevent costly treatments later . so when you look this idea of mobile hospitals makes sense. So yes theoretically you can say access to affordable care will increase.
    Its a question of whether this is affordable to the country in its current composition. My answer is no. With this idea of mobile clinics, mmd is focusing on curative medicine which will be expensive may not be needed by the rural poor and it will still not bring the desired outcomes. Better results would be achieved with improving referral systems instead. Health teams with lower cadres without sophisticated and expensive equipments should have been a better option. These teams would identify people needing specialised care and get those to a hospital where the more skilled health workers and expensive and sophisticated equipment is. So you can do more work with fewer health workers this way .that cost is effectiveness

  2. Aaron,

    Some good points there.

    It does certainly bring us to the question of prioritisation.
    I suppose if I was writing the MMD manifesto what I may have said is that we are prioritising infrastructure. When that is in place we plan to deal with other aspects.

    But unfortunately, even that does NOT work well. It's quite obvious the first important problem to deal with is COST EFFECTIVENESS. But this is also the weakest of the MMD proposals in this area.

    Your suggestions in improving referral systems is in line with PF proposals which identifies that as one of the key things.

  3. zambian Economist which PF proposals talk about referal system? i see they want bring specialist from abroad to come and do specialisted medical work at home. this will not be feasible with the kind of medical equipment and facilities. but more importantly PF want to take the entire Health as a gov entity. why should they be the ones to call experts to come and do operation at our cost. if a portion health sector is allowed to fund itself eg via medical schemes/insurance health facilities, equipment and human resource will be improved almost immediately. all this with little or no gov fund. experts will be invited by the private sector at their cost and gov become a beneficiary.
    PF will simply continue with this MMD health program and only improve thing at the expense of higher taxes other than lower taxes like they seem to suggest.

  4. One of the points from the PF Manifesto which I did not mention for brevity says :

    "Establish a strong referral system for complicated cases, such as emergency obstetric patients".

    You can find that on page 11 of their manifesto (under Service Provision)


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