Putting MDGs into perspective

THE 2013-2014 Zambian Demographic and Health Survey (ZDHS) report was officially launched recently by the Central Statistical Office. The ZDHS is an internationally recognised survey that collects nationwide information on various health and population-related issues, useful for health, demographic and social development planning.
The current ZDHS is arguably very timely for at least two reasons. Firstly, the Revised Sixth National Development Plan (SNDP) will come to an end in 2016 and the ZDHS can give insights about the achievement of health outcomes during the SNDP period and where gaps remain. This is important for drafting the Seventh National Development Plan which will follow. Secondly, the report has come when the Millennium Development Goals (MDGs) are coming to the end at the end of 2015, meaning it can be used to assess Zambia’s progress on health MDGs. This second issue is the main preoccupation of this article.
The MDG targets, in relation to health outcomes in Zambia include reducing maternal, infant and under-five mortality rates. Maternal mortality is the number of deaths of women of child-bearing age from pregnancy-related complications. Infant and under-five mortality on the other hand refers to deaths of children before ages one and five years respectively.
In 1996, about 649 women out of every 100,000 live births were dying from child-bearing related complications. Compared to countries like Botswana, who stood around 300 during the same period, this was unacceptably high for Zambia. However, the recent ZDHS show that this number has now dropped to 398, making child-bearing safer in Zambia than before. Additionally, while the MDG target was set at 162 deaths per 100, 000 live births, efforts by Government and development partners have paid off and set good ground for further improvements.
Increased antenatal care use, plus deliveries in health facilities assisted by skilled providers remain the main factors contributing to these desirable results. However, pregnant women still face challenges that hinder them from accessing these important services.
In some cases, the lack of a mix of health staff may be a barrier to access as most women in Zambia have a preference for being attended to by either male or female health staff. If hiring and assigning of health staff is insensitive to this fact, more pregnant women may continue to shun services. Costs of transportation to facilities and lack of involvement of male partners are some of the barriers.
Infant and under-five mortality have also dropped significantly to as low as 45 and 75 per 1,000 live births, against targets of 35 and 63 respectively. Indeed chances of children born in Zambia surviving beyond ages one and five have now risen.
These achievements also form a good basis for further investments in these areas. Increases in vaccination coverage and improvements in child nutrition have contributed to this progress. However, immunization coverage has appallingly remained same after seven years at 68 percent regardless of investments in this regard.
Child nutrition also needs extra attention as a good number of children (40 percent) are stunted, or too short for their height, which is a sign of ill health.
The MDG aims also aimed at reducing the number of people living with HIV to 15 percent or less at the end of 2015 and put 80 percent of those with advanced HIV on antiretroviral treatment (ART).  HIV prevalence now stands at 13.3 compared to 14.3 in the 2007 ZDHS. There are two important observations from this result. Zambia has achieved and exceeded the MDG target on HIV prevalence.
Secondly, while the reduction of only 1 percentage point after seven years may seem worrisome, it is in essence not. It is an indication that more people with HIV are living longer. This result is also consistent for rural areas where prevalence rates now stand at 9 percent compared to 10 percent in 2007. Thus, the roll out of ART may be paying off although there are still challenges in access to ART in the rural areas.
The MDGs also included malaria, which is a common cause of death in Zambia. The actual target was to have less than 255 new malaria cases and less than 11 deaths per 1,000 population resulting from malaria by the end of 2015. Malaria indicators have since improved significantly.
Though the current ZDHS does not have numbers on new malaria cases and deaths caused by malaria, use of insecticide treated nets (ITNs), which is one of the main malaria prevention activities has gone up sufficiently. More pregnant women (41percent) now use ITNs compared to 33 percent in 2007.
Similarly, 68 percent of all households have at least one ITN. The survey also shows that 75 percent of children who had malaria symptoms sought treatment, 40percent of whom received an anti-malaria drug.
The new ZDHS has put Zambia’s MDG progress in clear perspective. It is hoped that the subsequent national plans will put the findings into consideration and guide policy in terms of maintaining the momentum generated during the MDGs.
The author is a researcher at the Zambia Institute for Policy Analysis and Research (ZIPAR). For details contact: The Executive Director, ZIPAR, corner of John Mbita and Nationalist roads, CSO Annex building, P.O. Box 50782, Lusaka. Telephone: +260 211 252559. Email: ZIPAR, Twitter:@Ziparinfo

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