5. PRSP and Social Investment
Sectors for Social Investment
In the past, most Zambians could access decent basic services (such as education and health). There were also many other “extra” services – ranging from agricultural extension and veterinary services, to probation and vocational training.
Since the economic downfall of the 1970s, social services have had less and less funding. Even as funds reduced, Government did not focus on basic services only, but spread funds very thinly across the full range of services. Nothing has actually been scrapped – but all sectors have deteriorated to a very low level of performance.
The PRSP recognises the importance of a wide range of social services. However, funds should be targeted effectively on the most important priority areas. The PRSP therefore aims to make a significant impact on the two most critical areas for poverty reduction.
The key areas for social investment are health and education.
Social Investment 1: Health
Zambia – A Nation that Suffers
Zambia is terribly affected by ill health. The deadly combination of HIV/AIDS, poverty and malnutrition means that we suffer very badly from malaria, maternal deaths, child deaths, respiratory disease, diarrhoea, measles and many others. In fact over the last ten years, the nation has suffered more and more, as we have more illness and shorter lives than almost any other nation on earth.
Most Zambians have experienced the links between poverty and health. If someone is sick, they can’t work. Instead of earning money, the family must now find extra money for health care. They may fail to pay for food, school, transport and other items. This means other family members might get sick, and are less likely to be able to work. This is the “vicious cycle” of poverty and disease.
Many Zambians are malnourished. They don’t get enough food, and miss certain vitamins, iron and iodine. This means that people get sick quickly and are more likely to die from any illness. Children, women, elderly people and the disabled are most likely to suffer from malnutrition. Malnutrition is part of the “vicious cycle”: poverty leads to hunger; hunger leads to sickness; sickness leads to poverty.
The Health Reform Programme was started in 1992, and appeared to be one of the best programmes in Africa. But Zambians have got sicker, and the health services are not noticeably better. Why is this?
The answer is mostly about money. The Reform Programme set out to provide a “basic health care package” to all Zambians. This package is supposed to be adequate for most health needs. But the proper funding for these services has not been available, so there is no reliable access to the basic package. Zambians have not received the planned services, whilst the health situation has got worse and worse.
Another factor has been health charges. Since 1993, there have been charges for health services, with some key exemptions (see box). The problem has been that most people do not know about all the exemptions, and not all have been implemented. There was also supposed to be a link between health and welfare so that genuinely poor people would get free services, but this scheme has not operated effectively.
The result of the poor services and health charges mean that fewer people access public health services. People might go to private clinics, traditional healers or just buy medicines themselves.
WHO IS EXEMPT FROM HEALTH CHARGES?
Patients who are under 5 or over 65 years old
Patients suffering from:
Antenatal, pregnancy, birth & postnatal care
Family planning services
The result is that sickness is more common than health, and early deaths out number long lives.
Sexually transmitted diseases
Cholera and dysentery
High blood pressure
PRSP & Health
The Health Reform Programme did not fail because it was a badly designed programme – it is a good plan! It didn’t work out because it did not have sufficient resources to offer a decent basic health package. PRSP will support the existing programme, by providing the resources that have up to now been unavailable.
Basic Health Care Package
The basic health care package will provide a decent level of health care to all Zambians. The PRSP will provide funding that will support these services. Patients will still pay fees, but the existing exemptions will remain (see box above). New exemptions that target particular diseases (e.g. malaria) or particular social groups (e.g. street children, orphans) will be introduced. Public awareness campaigns will help everyone to know what services they can access free of charge.
Improved Health Management
Better management of health services can benefit patients without costing a lot. PRSP will assist in ensuring that health staff and funds are fairly distributed around the country, so that vulnerable groups and remote areas are well served. Drug supply will be improved so that health centres get enough of the right sort of drugs in good time. PRSP will also improve infrastructure, replace obsolete equipment, and provide staff training.
Public Health Priorities
PRSP will tackle five key areas of public health:
Malaria – combing mosquito control, preventive programmes, treatment ;
HIV / AIDS - including TB and other sexually transmitted diseases;
Reproductive Health – an integrated approach including family planning, pregnancy, delivery, post-natal, teenage pregnancy and other issues relating to women’s health;
Child Health – focussing on common childhood diseases that can be prevented or cured;
Epidemics – monitoring and controlling any epidemic that might break out.
Improving nutrition is like reducing poverty – it involves lots of different stakeholders! For nutrition programmes to work, the various stakeholders must be co-ordinated to follow a clear nutrition strategy. The PRSP will support the National Food and Nutrition Council, to improve performance and promote improved nutrition.
Social Investment 2: Education
Education in Zambia Today
The PRSP shows us that there is very little good news concerning Zambian education. From pre-school children right through to the students of University of Zambia, the situation is really very bad. For girls, the situation is worse than for boys at every stage. Since education is essential for sustained growth and development, the PRSP is committed to changing this gloomy picture.
About one-third of Zambia’s primary aged children do not go to school. They stay away because school is expensive, or far away, or because they have to work. For those that do attend, the dropout rates are high, affecting girls in particular after grade 4. Children affected by HIV/AIDS are also likely to drop out. For those that stay in school, the number of teachers is constantly shrinking, and in rural areas it is easy to find schools with only one teacher. Children are often hungry, which reduces learning and development. The schools have little or no funds for books or other learning materials.
There is a grave shortage of places in secondary schools. For every ten children that pass grade 7, only one will still have a place in grade 10.
Training and higher education also suffer from a shortage of places. Of those that finish secondary school, there are very few places at UNZA, Copperbelt University and other training colleges. The vocational and technical training institutions are very run down, with old equipment, inadequate staff, and inappropriate courses.
Are the education services today the same as when you were a child?
What are the main differences?
What will be the effect of these
PRSP Support to Education
There are six key activities in PRSP. There will also be a significant expansion in the HIV/AIDS programme, as part of the PRSP “cross cutting issues” programme on HIV.
The BESSIP programme is the “Basic Education Sub-Sector Investment Programme”. BESSIP is a partnership between the Ministry of Education, the World Bank, and other donors. It has been working to improve services in grades 1 to 7, tackling key problems such as infrastructure, staffing, education materials, improved access for vulnerable groups, and health and nutrition. Under PRSP, BESSIP programmes will continue and expand to cover pre-school as well as grades 8 and 9. New programmes will also offer distance learning and evening classes to increase education access to dropouts and adults.
Equity means that all Zambian children should have equal access to education opportunities. At present, equity is lost for poor children, for girls, and for orphans and disabled children. Equity has been a sub-programme under BESSIP, but this has not highlighted these issues effectively. Under PRSP, the new Equity Programme will give special attention to ensure that appropriate education is available to all children.
The PRSP will overhaul the national literacy programme by improving services at community level, especially for vulnerable groups. Literacy programmes will be tied to evening classes, distance learning and other continuing education opportunities.
The Technical Education and Vocation Training Authority (TEVETA) is responsible for offering appropriate training throughout the country. Under PRSP, TEVETA will identify training needs and skills gaps, develop courses and train staff members.
High School Improvement
The new Education Policy is turning primary schools into basic schools, extending up to grade 9. Grades 10 to 12 will now be known as High School. PRSP will help upgrade High Schools by improving infrastructure, curriculum, staffing and education materials.
Universities & Colleges
The PRSP will help Zambia’s Universities and Colleges to improve their education programmes. Students will get a high quality education in subjects that will help them find good jobs on graduation. PRSP will help Universities and Colleges improve staffing and management.