Lessons learned from short-lived transfer of maternal and child health services from Ministry of Health to Ministry of Community Development in Zambia provides guidance for deepening of decentralization

Abstract

Government of Zambia restructured the health sector in order to strengthen linkages between Primary Health Care (PHC) and community development health systems in 2012. PHCand local disease responsewere transferred from Ministry of Health (MoH) to Ministry of Community Development. MoH retained health sector coordination policy/strategy and central level disease surveillance. To conduct a rapid assessment of the realigned health sector and inform policy review. A desk review and focus group discussions and key health sector stakeholders were interviewed. Although realignment aimed at demand creation, inadequate preparation was confounding. Continuum of services from central to community levels was constrained. Functionality of the community health strategy was suboptimal.Preventive outreach maternal and child health and community based care services declined. Capacity in detecting and responding to disease outbreaks underperformed. The noble idea was to strengthen disease prevention and control. Instead the process yielded the opposite; weakening of PHC, due to disjoint between community and health facility. The imminent deepening of decentralization of health services need to be informed by lessons learnt from the foregoing. The community health strategy needs to be revitalised and change management introduced to beneficiary institutions prior to devolution.

Keywords: Decentralization of health services, creating demand for quality health services, functionality of community health strategy, continuum of services.