SPEECH BY HONOURABLE SYLVIA T. MASEBO, MP MINISTER OF HEALTH DURING THE ANNUAL CONSULTATIVE MEETING HELD AT Mulungushi International Conference Centre ON WEDNESDAY 7TH FEBRUARY, 2024
REPUBLIC OF ZAMBIA
HONOURABLE SYLVIA T. MASEBO, MP
MINISTER OF HEALTH DURING THE ANNUAL CONSULTATIVE MEETING
Mulungushi International Conference Centre
7TH FEBRUARY, 2024
• Your Excellency, the Swedish Ambassador to Zambia (who is also the outgoing Lead Cooperating Partner), Mr Johan Hallenborg;
• The Country Manager, World Bank (who is also the incoming Lead Cooperating Partner), Mr. Achim Fock
• The Permanent Secretary in Charge of Donor Coordination, Dr George Sinyangwe;
• The Permanent Secretary in Charge of Administration, Professor Christopher Simoonga;
• The Permanent Secretary in Charge of Technical Services, Dr. Kennedy Lishimpi;
• Your Excellences, High Commissioners, and Ambassadors;
• Representatives from the United Nations Agencies;
• Representatives of International NGOs;
• Representatives from Civil Society Organisations;
• Representatives from the Private Sector;
• Senior Government Officials;
• The Media;
• Distinguished Ladies and Gentlemen.
I would like to welcome you all to this Annual Consultative Meeting for 2024. Let me reiterate that we have a collective responsibility to ensure that our people are provided with quality health services as near as possible to where they live, go to school, and work. It is therefore, imperative that we continue to strengthen our bilateral and multilateral coordination mechanisms with you our Development Cooperating Partners. It is a well-known fact that coordination removes duplication and promotes efficiencies and synergies in the sector.
Your Excellencies, Distinguished Guests, ladies and Gentlemen:
The Ministry of Health is cognizant of the support you continue to render to the health sector, through Government to Government and bilateral and multi-lateral mechanisms. The financial, material and technical support that you continue to provide, has and will continue strengthening our health system for improved access to essential health services.
Ladies and Gentlemen;
Allow me highlight a few issues in this meeting. I will begin with
Health Service Delivery, under which I will speak to select disease areas, starting with:
a) Maternal Health
Your Excellencies, Distinguished Guests, while notable progress has been made, more needs to be done to accelerate the reduction of maternal mortality to the aspirational level of mortality of less than 100 deaths per 100,000 live births by 2026. The Ministry of Health will, therefore, continue investing in strategies aimed at strengthening maternal, child, newborn, and adolescent health, and nutrition services to reduce morbidity and mortality. Some of the strategies being implemented include:
• Mentorship in maternal and new-born care interventions;
• Conducting maternal death surveillance and response meetings;
• Engaging traditional and religious leaders as champions for safe motherhood; and
• Expanding infrastructure for maternity services.
Malaria remains Zambia’s biggest public health challenge with the following profile:
• Zambia records 27,000 new cases of malaria each day;
• Zambia records 4 deaths from malaria each day, translating to approximately 1,260 deaths per year; and
• Malaria remains one of the top five causes of morbidity and mortality in the country.
It is against this background that we have placed Malaria elimination at the highest level of our political and development agenda, with a call to action to fill both short-term and long-term resource gaps. In addition, we have also continued implementing a cocktail of evidence-based interventions such as in-door residual spraying, prompt treatment of malaria, and distribution of insecticide-treated mosquito nets. In 2024, we plan to conduct a Malaria Indicator Survey to allow us to continue managing the malaria program with information.
b) HIV and AIDS
All countries are expected to reach and /or exceed the numerical goals of HIV epidemic control of 95-95-95 by 2025. According to the Zambia Population-based HIV Impact Assessment results, Zambia has achieved the following:
a) On first 95: we are at 89% of people living with HIV/AIDS know their status;
b) On second 95: we are at 98% of people living with HIV/AIDS who know their status are on the life-saving HIV treatment;
c) On third 95: we are at 96% of people on HIV treatment are virally suppressed.
These are commendable gains. The Ministry of Health will work to ensure that these gains are sustained through the following interventions:
a) Increased domestic financing for the HIV program;
b) Ensuring that the HIV program is sufficiently integrated into other Primary Health Care Interventions;
c) Maintaining effective treatment options such as the current first-line treatment regimen;
d) Updating guidance based on evolving evidence;
e) Providing equipment, human resources, and medical supplies;
f) Developing a sustainability framework as part of our HIV response plan, aiming to boost domestic investments through a multisectoral approach; and
g) Lastly, increasing investments in prevention interventions to reduce new HIV infections.
c) Tuberculosis (TB)
Regarding TB, Zambia has intensified interventions towards TB elimination and has made significant progress, including:
a) Attaining a TB treatment coverage of 92%;
b) Reducing TB incidence by 26%, thereby surpassing the 2020 benchmark of 20%;
c) Expanding our diagnostic capabilities to ensure that TB patients are identified and treated early. As a result, we identified 53,000 new cases of TB against the target of 51,000 in the year 2023.
However, there are still outstanding challenges that the country must work on urgently. These include:
a) An unacceptably high annual TB mortality rate of 27 per 100,000 population;
b) Low uptake of TB preventive therapy among under-five children who are in contact with TB patients;
c) 58% of our TB patients are facing catastrophic costs, especially among the Multidrug-resistant TB patients; and
d) Case finding for Multidrug-resistant TB patients remain low despite the increase in Surveillance tools and activities across the country.
The Ministry of Health will partner with you to ensure that TB patients are identified and started on treatment early through:
a) Scaling up of the molecular diagnostic tools;
b) Using community-based treatment supporters;
c) Scaling up of shorter TB treatment regimens; and
d) Supporting food supplements to vulnerable TB patients.
On the issue of Health Security, Zambia has continued to prioritize public health security to anticipate, prevent, and mitigate emerging and re-emerging public health threats through the following activities:
a) Resource mobilization: The Ministry of Health continues to mobilise resources from the treasury and bilateral and multilateral partners such as yourselves. In addition, the Government has made a policy decision to ringfence resources for public health security through the establishment of the public health emergency fund;
b) Laboratory strengthening: The Ministry of Health has continued to build laboratory capacities of both public health and clinical laboratories. This includes increasing the range of pathogens that can be detected by a single instrument through multiplexing;
c) Regarding Disease Surveillance: The Ministry of Health has embarked on capacity building at subnational levels to facilitate timely detection, confirmation and response to public health threats and/or diseases; and
d) In terms of Human Capacity Development: The Government has continued to train healthcare workers to strengthen their capacities to respond to threats.
These activities/actions are crucial in mitigating the effects of public health threats that our country faces.
Your Excellencies, Distinguished Guests, ladies and Gentlemen:
The Ministry of Health has also established the Zambia National Public Health Institute whose mandate is to provide disease intelligence related to emerging health threats.
The Institute has played an important role is spearheading the fight against various public health threats. In the recent past, we have responded to COVID-19, anthrax, measles, mumps, polio and at present, to cholera outbreaks.
Allow me to move to another important health building block which is Health Systems Management. In this regard, I will begin with:
Supply Chain Management
The Ministry of Health believes in and wants to achieve the six ‘RIGHTS’ of a good supply chain system:
a) Right medicines and/or products;
b) Right quantity;
c) Right condition;
d) Right Place,
e) Right time, and
f) Right cost.
Therefore, the Government has continued investing in the supply chain to make sure that nothing goes wrong with the six ‘RIGHTS’. Activities include the following;
a) Increased domestic financing for commodities;
b) Inclusive selection, forecasting and quantification and supply planning processes;
c) Increased visibility of products within the supply chain system;
d) Infrastructure development to optimise storage;
e) Improved governance over the supply chain;
f) Advocating for local manufacturing of medicines and medical supplies and;
g) Operationalising of the Medicines and Medical Supplies Fund that was established under the Zambia Medicines and Medical Supplies Agency Act, No. 9 of 2019 through the Statutory Instrument No. 14 of 2023. It is envisaged that the Medicines and Medical Supplies Fund will be capitalized by:
• The treasury;
• The National Health Insurance Management Authority;
• The Donors; and
• Other sources.
It is worthy to note that interventions put in place improved the availability and access to quality essential medicines and medical supplies from an average of 43% in 2022 to over 80% in 2023 at primary health care level and 70% at hospital level. This was achieved through the acquisition of the health centre kits and bulky procurement of medicines and medical supplies. However, we are still working hard to stabilise the drug supply system at all levels of care.
On local manufacturing, the Government has already developed a strategy and an implementation plan. As of now, the local manufacturing companies contribute only 3% of the drugs used in our public sector. The strategy aims to increase the contribution by local manufacturing companies to 20% by the end of 2030.
Excellencies, Distinguished Guests,
Let me speak to another pre-requisite for a strong health system, the Human Resource for Health. A skilled and motivated workforce in the sector is a fundamental pre-requisite to attaining Universal Health Coverage. To this end, the Ministry of Health has prioritized training, recruitment, and equitable distribution of healthcare workers throughout the country. The approved structure for the Ministry of Health stands at 139,590 of which 78,114 positions are funded and operationalized, translating into 56% of the establishment being filled. This improvement is mainly due to the recruitment of over 11,276 and over 3,000 health workers undertaken in 2022 and 2023 respectively. In 2024, the Government has further committed to recruiting a total of 4,000 health workers across the country, which shall increase the filled positions to 58%.
Infrastructure development remains a key area in the development agenda for the Government. The Ministry has continued to rehabilitate, upgrade and construct health facilities countrywide.
In 2024, the Ministry of Health will focus its attention on:
a) Completing the 87 remaining health posts, thereby bringing the total number of new health posts to 650;
b) Completing 4 health centres, thereby bringing the total number of new health centres to 115;
c) Completing 4 level one hospitals, thereby bringing the total number of new level one hospitals to 5;
d) rehabilitating and upgrading the Cancer Diseases Hospital in Lusaka; and
e) Constructing two new cancer hospitals in Livingstone and Ndola.
The Ministry will also continue to pursue the policy of ensuring that all health facilities have a maternity annex to improve access to maternal and neonatal services. This is in line with the recent Presidential directive.
I wish to inform you that as of December, 2023, the Ministry had completed 15 maternity annexes using domestic resources under the Ministry of Health. During the same period, the Ministry of Health had also completed 71 maternity annexes with support from you, our partners. Of the 71 partner-supported maternity annexes, only 46 are equipped. I therefore wish to appeal to your good will to help the Ministry of Health to equip and furnish the rest of annexes so that they can start offering services.
Currently, with support from you our cooperating partners, 62 Maternity annexes are under construction while an additional 30 out of 500 planned maternity annexes will be constructed during 2024.
Regarding the Decentralization agenda, Zambia has aggressively embarked on the decentralization of District Health Services to Local Authorities. This implies that the entire decision space of managing district health services and the resources with which to manage the services will shift to the Local Authorities.
Working in conjunction with the Ministries of Finance and National Planning and Local Government and Rural Development, the Ministry of Health has budgeted for the devolved functions for fiscal year 2024. These resources will be channeled to the local authorities in form of grants.
The goal of decentralization is to improve efficiencies in the delivery of health services through context-specific solutions, with greater participation of local stakeholders.
In terms of Health Care Financing, the Government of the Republic of Zambia has continued to increase treasury allocation to the health sector, with the aspiration of attaining the Abuja Declaration, which requires Governments to allocate 15% of their national budgets to the health sector. In line with this aspiration, the treasury allocated K20.9 billion in the 2024 budget, representing 11.8% of the national budget compared to 10.4% in 2023. This represents a huge financial and political commitment to the health sector. Going forward, sources of funding to the health sector will largely be from the treasury, Social Insurance, Medicines and Medical Supplies Fund, Donors, and corporate social responsibility.
Our request to you, our Cooperating Partners, is to continue to increase support to the health sector, especially through Direct Budget Support. Overall, direct budget support presents an opportunity for more efficient and effective utilization of resources, enabling the Government to address health challenges more comprehensively and sustainably.
Further, we appeal to all the Partners to release the pledged funding to the Health Sector for us to heighten the implementation of the high-impact interventions in line with our National Health Strategic Plan 2022 – 2026.
Your Excellencies, Ladies and Gentlemen,
Health Information is critical to improved health outcomes. In this regard, the Zambia Demographic and Health Survey (ZDHS) provides an opportunity to inform policy and provide data for planning, implementation, and monitoring and evaluation of national health programmes. A total of 6 surveys have been conducted so far with the most recent being in 2018. In 2023, the Government started conducting the 7th demographic and health survey.
The following Major activities have been undertaken so far:
a) Development of the survey roadmap, protocol and budget;
b) Formation of Steering and Technical committees;
c) Formal engagement of Cooperating Partners to solicit support for various components of the survey;
d) Adaptation and translation of survey instruments;
e) Household listing;
f) Conducting trainings; and
g) Data collection.
The country has set tight implementation timelines for the Survey to allow for timely compilation and dissemination of results. To stick to the timelines, the country needs all the funding to be in place. The total budget for the 2023/2024 ZDHS is US$7,478,378.00, out of which only US$3,385,638 has been honored. The other funds remain in pledge form. I would like to take this opportunity to express my sincere appreciation for the financial and technical support received so far. I also wish to appeal to the Partners that have made pledges to fulfill them so that the implementation process is not jeopardized.
Leadership and Governance are critical components for effective and efficient delivery of health services. In the calendar year 2023, the Swedish Government took the leadership role of the Health Cooperating Partners Group for the health sector. The strong coordination of Cooperating Partners that you put in place during the year, was responsible for the positive outcomes in the Health Sector. The Ministry of Health would like to take this opportunity to thank and appreciate the Swedish Government for their effective coordination role in 2023.
The Ministry of Health is delighted to note that the Cooperating Partners have unanimously agreed that the World Bank takes over the leadership of the Health Cooperating Partners Group for the calendar year 2024. The Ministry of Health is therefore happy to formally welcome the appointment of the World Bank, as the Lead Cooperating Partner for the year 2024. May I therefore take this opportunity to congratulate the World Bank Country Office, Zambia for taking up this challenging and yet exciting leadership role for the Health Cooperating Partners Group in the health sector for the year 2024. The Ministry of Health also wishes to congratulate U.S Government for taking up the Deputy position of Lead Cooperating Partners. We look forward to yet another warm and cordial relationship.
May I now focus on other major Highlights for the year 2024.
The Ministry will this year ensure full operationalization of the Medicines and Medical Supplies Fund.
This will offer several benefits to the healthcare system including:
• The enhancement of transparency and accountability in the procurement and distribution of essential medicines and medical supplies, ensuring efficient use of resources.
• Mitigation of stockouts and shortages, thereby improving access to essential medicines for all citizens.
• Facilitation of better planning and forecasting of medicine needs, leading to more effective management of healthcare services and improved patient outcomes.
The government has set aside K4.9 billion in the 2024 budget towards the operationalization of the Medicines and Medical Supplies Fund. It is also expected that Cooperating Partners, as well as the National Health Insurance Management Authority (NHIMA) will significantly support this initiative.
On the Medicines and Medical Supplies Fund, I want to appeal to cooperating partners who procure drugs and medical supplies for the Ministry of Health to consider channeling their support through the Fund. This will serve to strengthen our systems as well as making procurements cheaper through economies of scale.
Let me now draw your attention to the National Health Strategic Plan 2022 2026 Mid-Term Review. This year, 2024, is a significant year for us, as it marks the midpoint of the implementation of the National Health Strategic Plan for 2022-2026. The Ministry of Health plans to conduct a thorough mid-term review of the performance of the Health Sector. This milestone will provide us with the opportunity to evaluate our progress in the last two years against the 2026 targets and identify any challenges that need to be addressed. The Ministry of Health kindly requests for technical support from you, our partners to conduct the mid-term review of our National Health Strategic Plan.
The Zambia Household Health Expenditure and Utilization Survey is an exercise that gathers data on healthcare expenses, healthcare service utilization, costs of healthcare services, and how they are paid for across different levels of the healthcare system. The survey also collects information on the type, cost, and extent of healthcare insurance held by households. This survey is the only one that provides data on key policy parameters such as:
• How much households are spending out of their pockets on healthcare;
• What impact healthcare expenditures have on households financially; and
• Access and utilisation of healthcare services and health outcomes based on socioeconomic characteristics and insurance status.
The last time Zambia conducted this survey was in 2013/14. This means that as a country, we cannot accurately assess the progress being made towards Universal Health Coverage because we are relying on outdated data and unreliable projections. As a result, in 2023, the Ministry of Health initiated the second round of the Zambia Household Health Expenditure and Utilization Survey, at an estimated cost of K15.5 million. The Ministry of Health has so far implemented preparatory activities which include developing a concept note, creating data collection tools, pre-testing the data collection tools, developing a questionnaire manual, and creating a sampling frame. There are still some outstanding activities to be carried out such as training data collectors, collecting data, cleaning and analyzing data, and report writing. The Ministry of Health has allocated a total of K1.5 million in the 2024 budget for this activity. However, there is still a resource gap estimated at K14 million for this activity to be undertaken effectively. We therefore appeal for support towards the completion of activities on the Zambia Household Health Expenditure and Utilization Survey.
Joint Annual Review:
You may agree with me that the health sector has a wide range of partners, including multilateral and bilateral organizations, as well as non-state actors, who provide financial and technical support to the sector. The Ministry of Health is committed to improving efficiency in the use of domestic funds and external development assistance by integrating them into a joint sectoral framework, through a sector-wide approach (SWAp). Currently, the SWAp is administered through Technical Working Groups, policy meetings, and Annual Consultative Meetings (ACM). The Ministry believes that our collaboration can be further strengthened through a platform that allows for joint planning and joint reviewing of progress. I want to suggest that the Ministry of Health, and you Cooperating Partners, find time in March 2023 to look at ongoing and planned partner support to align activities within the sector. This will allow us to move forward as a sector and/or partnership with one strategic plan, one implementation plan, and one monitoring framework. To monitor the effectiveness of our joint planning and/or partnership, I further propose that we resume holding joint annual review meetings in the fourth quarter of every year, starting this year. I am therefore making a request for both technical and financial support to actualize these endeavors.
Malaria Indicator Survey
The Ministry of Health will be conducting a Nationally representative Malaria Indicator Survey (MIS) in April this year. The aim of the survey is to measure the coverage of key malaria interventions at household level and assess malaria morbidity among children.
The Malaria Indicator Surveys have been playing a crucial role in understanding the progress in controlling and eliminating malaria in line with the National Malaria Elimination Strategic Plan 2022-2026. The 2024 Survey will continue the legacy of the past seven surveys conducted in 2006, 2008, 2010, 2012, 2015, 2018 and 2021.
TB Prevalence Indicator Survey
The Ministry of Health is getting ready to conduct the second TB prevalence survey in 2024/2025. The first ever survey was carried out 10 years ago in 2013/2014. This new survey will provide valuable information to help develop strategies to eliminate TB by 2030.
Emergency Obstetric and Newborn Care Needs Assessment
Ministry of Health conducted the first Emergency Obstetric and Newborn Care services needs assessment in referral facilities in 2005. Based on this assessment the Government of the Republic of Zambia (GRZ) decided to introduce Emergency Obstetric and Newborn Care services in all delivery health facilities to address complications relating to pregnancy and childbirth. The decision also included training healthcare workers to strengthen their clinical and midwifery skills to effectively manage obstetric and neonatal emergencies, and ensuring the availability of equipment to provide those services. A follow up assessment was conducted in 2014/15 to better understand progress made since 2005 and to identify gaps and of Emergency Obstetric and Newborn Care services across the country. This assessment highlighted challenges relating to quality and distributive inequities between rural and urban areas of Emergency Obstetric and Newborn Care services, and critical care service delivery. Additional interventions were put in place following the 2015 assessment. The Ministry of Health, with support from the University of Zambia Department of Demography, Population Science, Monitoring and Evaluation (DPSME), and United Nations Population Fund (UNFPA) will be conducting another assessment in 2024. This will inform the new interventions to further improve maternal and child health outcomes.
Let me conclude, I wish to thank you all, our Cooperating Partners, for the support you continue to render to the health sector in Zambia. I wish to assure Your Excellences of our commitment, transparency and accountability, particularly to the Zambian people, you our partners, and all our stakeholders. It is my sincere hope that this unique partnership will continue to flourish in our journey to attaining Universal Health for all.
Thank you for your attention