Zambia scraps medical fees

This is meant to help the poor access medical care. The announcement was made by the ministry of Health last Saturday following Zambia’s attainment of Highly Indebted Poor Countries (HIPC) completion point. Money saved from paying back the debt should now help cushion medical bills. In Zambia malaria is still the foremost killer disease accounting for over 20 percent of the recorded deaths. According to the Living Conditions Monitoring Survey (LCMS) 22 percent of the deaths in all the households were caused by malaria/fever, while Diarrhoea and Tuberculosis accounted for 11.8 percent and 10.4 percent, respectively. The survey conducted by Central Statistical Office (CSO) and released last week says chest infection is the other main cause of deaths with 9.6 percent. In rural areas, Malaria accounts for most of the deaths, 22.1 percent, followed by Diarrhoea, 13.3 percent and Coughs or chest infections, 10.9 percent. In urban areas, Malaria accounted for most of the deaths. Analysis by sex shows that deaths caused by Malaria and Tuberculosis were more among males than females. Malaria accounted for 23.5 percent of male deaths compared to 19.8 percent for female deaths while tuberculosis accounted for 11.1 percent of male deaths and 9.7 percent of female deaths. Diarrhoea on the other hand accounted for more female deaths with 13.7 percent compared to 10.1 percent for male deaths. The amount that people spent on medication and consultation on average overall, was K9,167about US$3. The average amount spent in rural areas is 4 times less than that spent in urban areas. The survey also reveals that Western Province had the highest proportion of persons reporting to have paid directly for consultation to different health personnel. Northern Province had the lowest proportion of persons paying directly for consultation and it also had the highest proportion reporting not to have paid for their consultation. The proportion of persons that paid directly was the same in urban areas and rural areas at 55 percent. However, the rural areas had a higher proportion of persons that did not pay for consultation, 38 percent, than urban areas with 28 percent. The proportion that used pre payment schemes were higher in urban than in rural areas. Overall it was indicated that a proportion of 35 percent did not pay for their consultation. The proportion of persons that used pre-payment schemes were low, with a total of six percent for both high and low cost schemes. Only one percent reported that employers paid for their consultation. While to some people medicine for malaria is affordable, others, especially those in rural areas of Zambia and many other southern African countries hardly have any money to buy the drugs when it is available in the rural health centres. According Southern Africa Malaria Control (SAMC) in the region the death rates the last ten years have been worsened by the advent of HIV/AIDS which weakens the immune system meant to fight the disease. “Mortality levels within SAMC countries have risen markedly in the last decade. This is primarily due to high HIV prevalence levels. Estimating the precise impact of HIV on mortality is very difficult and is reflected in the wide range mortality estimates available for SAMC countries,” says the Zimbabwean based centre on its website. It is estimated that between 200,000 and 300,000 malaria deaths occur annually in Southern Africa. Qualitative reports as well as surveillance data indicate that malaria deaths are rising in some countries such as Namibia, South Africa and Zimbabwe. According to SAMC, in Southern African, countries that have unstable transmissions and are particularly prone to malaria epidemics are Botswana, Namibia, South Africa, Swaziland and Zimbabwe. Countries with predominantly stable transmission are Angola, Malawi, Mozambique, Tanzania and Zambia. In the region Malaria is the first or second leading cause of illness and death, it accounts for between three percent in Swaziland and up to 50 percent in Malawi of outpatient attendances As for people dying of the disease in the region at three percent Swaziland is the least affected while Mozambique is the highest with 24 percent of inpatient deaths. SAMC says the chief determinant of the disease is the climate which affects both the life of the anopheles mosquito (malaria carrier) and the development of malaria parasites. The development of the malaria parasite is greatly retarded below 20 Degrees Celsius while relative humidity of over 60 percent lengthens the life of the mosquito enabling it to transmit the infection. Poverty has also had its toll in worsening the malaria situation in most households in the region. It has been established that in poor households a greater proportion of income is likely to be spent on malaria treatment than in richer households, if only because it costs both the same. By and large malaria illness has been attributed to be cause of absenteeism from work and school, poor performance in schools, lack of labour for cultivation, and a decline in child care. According to SAMC, “Malaria deaths can lead to funeral costs, loss of an income-earner and a rise in orphanhood resulting in a negative spiral with malaria causing and deepening poverty which, in turn, exacerbates inequalities in society. Within Southern Africa the burden of malaria is greatest within poor communities located in malarious areas.”

April 2006
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