Monitoring and evaluation of primary health care in rural Zambia. A comparative study

This paper presents the major findings of an on-going monitoring and evaluation study of Primary Health Care with emphasis on child and maternal health services sponsored by UNICEF and the Government of Zambia. The objectives of this research are to evaluate and monitor the implementation of Primary Health Care in remote rural areas. Two contrasting ecological regions were selected for investigation, one in Western Province and the other in Northern Province and a core sample of 100 households from each area were selected to be monitored for 4 years. The research methodology included structured questionnaires, observation of community activities, designing and implementing community and household-based information systems, key informant interviewing, and reviewing health facility records and village registers. The findings regarding disease patterns, health service untilization, nutrition, maternal/reproductive data, health recording systems, and activities of community health workers are compared and constrasted for the two areas. Environmental and other constraints have impeded the effective provision of health services and has resulted in high morbidity, nutrition problems and inadequate child/maternal health, in both areas. An alternative model for health provision which emphasizes community-level needs is presented. Finally, the importance of community-based studies to national health policy planning is stressed.