SOCIOECONOMIC STATUS, HEALTH STATUS AND HEALTH EQUITY: A CASE STUDY OF ZAMBIAN HOUSEHOLDS IN SELECTED AREAS

In the light of the above objective, have the health reforms been progressing in the right direction? A lot of causal empirical evidence and heuristic research seem to indicate that not only has this objective not being realized but that, despite the health reforms, the country has been moving in reverse gear in this regard. Comparative data from a series of Living Conditions Monitoring Surveys and Demographic and Health Surveys show that the incidence of diseases, morbidity and mortality have been persistently high. In the 2001 economic report, the government does indicate that even though the delivery of basic health care services has slightly improved, the disease burden has worsened. The incidence rates for malaria, HIV/AIDS, and TB for instance have worsened between 1999 and 2001. The incidence rate for malaria increased by 2%, while those for HIV/AIDS and TB increased by 8% and 19% respectively. Admittedly, there have been some improvements in some areas. Improvements have been recorded in, among others, health expenditures per capita, number of drug kits, and health centre staff loads. The question that still remains unanswered is: how equitably have the achievements been distributed? To what extent have equity issues been addressed? Are the improvements only in average figures while conditions especially for the many in poverty have worsened ?Zambia has for long been experiencing high levels of poverty and inequality. This has been manifest in a number of ways, health poverty and inequality being one of them. The causes of the worsening poverty in Zambia have been clearly outlined by the Government in its Poverty Reduction Strategy Paper, PRSP. Over the years, the country has at best experienced marginal economic growth. With a population growth rate of almost 3% per year, the population has more than trebled over the last 40 years. While economic growth has been marginal, successive governments have failed to follow pro-poor strategies. Lack of sustained economic growth and inadequate pro-poor strategies together with unfavourable land ownership laws and unsupportive land tenure systems as well as the fact that most of the population lead a subsistence existence without access to credit facilities has led to a continuous decline in productivity. Above all, due to poor governance, lack of transparency and accountability, drought, unfavourable international market relations and the huge debt burden, well over 73% of the population has been living below the poverty datum line. The situation has been compounded by the HIV/AIDS epidemic that has been impeding human capital formation necessary for sustainable growth