Assessment of the Regulatory Framework for Maternal, Newborn Child Health and Nutrition (MNCH&N) Services in Zambia:

Abstract

Many national reports have indicated the decline in both maternal and childhood mortality in Zambia since the Millennium Declaration by the United Nations. The decline has, however, been slower for neonatal mortality. Despite these declines in mortality, Zambia still has significant challenges in achieving both MDG 4 and 5. In an effort to support achievements of MDGs 4 and 5, the Zambian government working with the EU and the United Nations family in Zambia has embarked on a project aimed at achieving the MDGs based on current national objective by improving community maternal, neonatal and child health (MNCH) and nutrition practices and utilisation of quality MNCH+N services in reducing maternal and childhood morbidity and mortality. Guided by the framework on strengthening health system to improve MNCH outcomes as developed by Ergo and colleagues in 2011, this report assesses the regulatory framework in order to analyse and understand the national contextual environment with regard to existing health policies, strategies, legislation, financing mechanisms, management structures and devolution of authority for health care delivery in the programme districts of Lusaka and Copperbelt provinces. The resulting report is, therefore, organised in five main parts namely: Background; Enabling Environment and Governance; Enabling Environment for Health Care Delivery; Monitoring and Evaluation Framework; and Conclusion and Recommendations. Since 1992, the health sector has relied on the National Health Policies and Strategies as mechanisms of supporting health care in Zambia. In 2012, the health sector went further to adopt an overarching National Health Policy that sets clear direction for the development of the sector. This policy development is supported by both the National Health Strategic Plan (2011-2015) and the new Ministry of Community Development, Mother and Child Health Strategic Plan of 2013- 2016. Furthermore, both the MOH and the MCDMCH have jointly developed the Roadmap for Accelerating Reduction of Maternal, Newborn and Child Mortality (2013-2016) with the general objective to accelerate the reduction of mortality in order to enable Zambia attain the set MDG goals 4 and 5 by 2015. The recent realignment of the MCDMCH is further intended to optimise synergies with social welfare and community development structures in order to offer integrated services to the communities at the grass-root level. Despite the highlighted efforts by the Zambian government, the health sector has been operating without a health services delivery legal framework since 2006, except for regulations associated with food and drug safety, health professionals and food and nutrition. Even these regulations are out-dated and are not harmonised with other legal mechanisms within and outside the health sector. For example, while the government has now developed the National Food and Nutrition Strategic Plan (2011-2015), the nutrition governance is still anchored in the Act of 1967 CAP 308 of the laws of Zambia.