Analytical summary - Child and adolescent health
The country’s objectives for child and adolescent health are aligned to the MDGs and other relevant global strategies and targets. The main child health interventions being implemented in Zambia are the Expanded Programme on Immunisation (EPI); and the Integrated Management of Child Illnesses (IMCI) programme. Both programmes have recorded significant achievements. However, the national response to adolescent health is not well coordinated and harmonized.
The EPI programme is strong and has scored tremendous success, with significant support from the partners. All the districts are implementing IMCI strategies, but reaching optimal saturation levels (80% health workers managing sick children trained in IMCI) has been a challenge due to resource constraints. Other major factors include: the supportive supervision monitoring tools used at provincial and district levels do not adequately address IMCI; staff shortages; and weak health systems.
Further, the level and quality of care of the severely sick children has been compromised due to limited capacity (equipment and skills of health workers) at first referral levels. For example, access to early infant diagnosis of HIV at 6 weeks, initiation of Co-trimoxazole prophylaxis and initiation of ART for children under the age of 15 years stand at 36%, 24% and 61% respectively (MOH Paediatric Reports). Equally, there has been no significant change in CFR for diarrhoea- fluctuating between 40 and 50 between 2004 and 2008 (HIMS).
Zambia has adopted the Integrated Community Case Management- ICCM aimed at increasing equity access to high impact life saving health interventions close to the family. Of the 16 key family and community practices adopted, 6 have been prioritized for national wide implementation. The monitoring of implementation of these practices remains a challenge because of lack of a formal community HMIS and high turnover of community health workers resulting from inadequate retention mechanisms.
Nutrition is a major determinant of child and adolescent health in Zambia. In general and when compared to WHO standards, nutrition levels in Zambia are unfavourable, which is having a negative impact on child health. Child Malnutrition in Zambia is decreasing but still contributes to 42% of all under five deaths in Zambia . The general situation relating to the nutrition status of women and children is summarized in the table below.
In Zambia, adolescents account for over a quarter (27%) of the total population. Due to the major biological and psychological transformations associated with this age group, adolescents are significantly exposed to risky behaviours, with high consequences on their immediate and long-term health and socio-economic lives. Various surveys have provided evidence of continued high prevalence of health risk behaviours among the adolescents.
Whilst the importance of this age group has been acknowledged in various national policy documents, including the National Population Policy 2007, the National Reproductive Health Policy 2008, and the National Strategy for the Prevention of HIV and AIDS 2009, the health of this population group has not been given the special attention that it deserves. Currently, the response to adolescent health is not clearly defined and packaged.
However, MOH and the partners have identified the need to put in place a comprehensive, harmonized and coordinated response to adolescent health. To this effect, the Adolescent Health Situation Analysis 2009 was conducted in 2009, and the process of developing the Adolescent Health Strategic Plan 2011-2015 has reached an advanced stage.