Health care in a declining economy: the case of Zambia

The severe and worsening economic crisis in Zambia has set into motion various adjustment measures (subsidy withdrawal or reduction, adjustment of exchange rates, import control, a foreign exchange auction system and retrenchment of government expenditure) which is making it increasingly difficult for the government to maintain the network of health and other social services developed in the 20 years since Independence. The situation became critical particularly after the decline of copper prices which provided Zambia with 90% of its foreign exchange earnings. The resulting fall in the GNP along with rapid inflation, population growth and urbanization has had a number of consequences for health care delivery. These effects are described with particular attention to health manpower/facilities, disease morbidity, malnutrition, expenditure patterns and health policy. Finally, some proposed strategies being considered by the government are presented.