Politics, Planning and Primary Health Care in Zambia
PAUL J. FREUND
Development planning in Zambia has been guided by a political ideology that espouses social justice, equitable distribution of income and access to medical care for the whole population. While considerable progress has been made since independence toward achieving this ideal, wide disparities between urban and rural areas, in terms of services/resources and income distribution, still remain. Moreover, the economic constraints brought about by the fall in world copper prices, Zambia's major foreign exchange earner, along with rapid population growth and urbanisation, have resulted in a deterioration in existing health services which threatens the progress that has been made.
This chapter examines the major health-related issues surrounding the politics and planning dialectic in Zambia, with particular reference to overall development planning, health policy and health resources.
Zambia is a relatively new nation-state whose history can be divided into three distinct phases: (1) a long pre-colonial period, followed by (2) a period of British colonial rule from the end of the nineteenth century to (3) the eventual attainment of political independence under the Commonwealth in 1964.
The country is landlocked with an area of 758,000 square kilometers. The landscape consists of mostly undulating plateau that ranges between 900 and 1,500 meters. The varying combinations of climate, topography and soil types give rise to four major ecological zones: Northern--high plateau, high rainfall and low soil fertility; Western--lowest, driest and low agricultural potential;