kilometre, the figure is 4 persons per square kilometre in the rural areas and 40 persons per square kilometre in urban areas. The dispersion of the rural population presents problems in communications and accessibility to service centres ( Mwansa, 1985, p. 182).
Health care delivery patterns in Zambia have always differed spatially, even though the planning philosophy has changed, particularly in recent years, following the adoption of the WHO and the UNICEF approach based on primary health care.
During the colonial period different health facilities existed for Africans and Europeans; better health facilities were concentrated in urban and mining centers where Europeans lived; missionaries overwhelmingly provided health care in rural areas; fee-paying medical facilities were attached to some of the hospitals; and curative, rather than preventive medicine, was fostered.
Following the attainment of political independence, the Zambian government started to provide health care services free of charge. This was a major move. It also introduced, for remote rural areas, a Flying Doctor Service. More health care facilities, especially clinics, were built. These, however, were concentrated in the urban areas. Zambia, therefore, continued the old colonial model, albeit with some minor changes. Urban areas continued to attract most human and capital resources. Curative, rather than preventive, medicine continued to dominate the health care delivery format.
For both colonial and postcolonial Zambia, therefore, health care facilities were differentiated spatially so that urban areas along the line-of-rail enjoyed better facilities and attracted disproportionate amounts of human and capital resources. Philosophically, health planning and implementation assumed a strategy of health care delivery based on curative approaches.
The adoption of the primary health care approach has meant a change, albeit slow, in planning and delivery. Spatially, a network of hierarchical arrangements is emerging. Catchment areas are a novel introduction, as are the idea of community participation and the notions built around this concept. There are problems, but a clear departure from old patterns and practices has been made.
This chapter has therefore shown that at least three phases can be identified in any analysis of health care patterns in Zambia: the colonial, the postcolonial and the advent of the primary health care approach. This last phase has not dramatically changed the old structure. It is unrealistic to expect dramatic changes this early. There are problems of finance, of acceptance by both practitioners and the various communities, of reordering the planning process and of vested interests. All these problems, coupled with the depressed state of the Zambian economy, will render community participation through minimum fee payments problematic. The erratic arrival of drugs which have to be paid for in foreign