Declare no conflict of interest. All information presented are my own analysis with information abstracted from: MoF, Financial reports (2010-2017) MoF, Budget speeches (2010-2018) MoH, National Health strategic plan (2011-2016) MoH, National Health strategic plan (2017-2021) WHO, Global Health Expenditure database (http://apps.who.int/nha/database/Select/Indicators/en

1. 2018 Budget: Is healthcare still a
priority in the 2018 national
budget?
Lawrence Mwenge (MSc)
CSC Commonwealth Alumni Dialogue
Thursday 7 December 2017

2. Presentation outline
• Background
• Key policies in brief
• Health systems
• Health financing
• Key components of Zambian budget
• Key healthcare budget components
• Key healthcare budget highlights (2017 & 2018)
• Budget allocation review (11-18)
• Country allocation-Abuja gap
• Healthcare budget performance review (2011-2016)
• Per capita total health expenditure
• Out-of- pocket expenditure
• Summary

3. Declaration of conflict of interest
• Declare no conflict of interest;
• All information presented are my own analysis with
information abstracted from:
• MoF, Financial reports (2010-2017)
• MoF, Budget speeches (2010-2018)
• MoH, National Health strategic plan (2011-2016)
• MoH, National Health strategic plan (2017-2021)
• WHO, Global Health Expenditure database
(http://apps.who.int/nha/database/Select/Indicators/en

4. Background
• Successful attainment of Zambia’s goal of being a
prosperous, middle-income country by 2030 is dependant
on having a healthy and productive population.
• Thus health services delivery is one of the countries priority
areas through MoH.
• The focus is to Provide healthcare services using the primary
health care (PHC) approach.
• with particular emphasis placed on strengthening health systems
and services delivery

5. Key Policies in Brief
• 2011-2016 National Health Strategy Plan (NHSP) to identify
priority interventions for attaining health improvement.
• Overall objective was to reduce the burden of disease through
provision of quality and cost-effective health care services.
• The current NHSP 2017–2021 is built upon the current NHSP
and aligned with the WHO’s six health system building blocks;
• Service delivery, health workforce, health information systems, access
to essential medicines, financing and leadership/governance.
• Key highlights of the current NHSP;
• Focuses on primary healthcare.
• Addresses four key aspects of delivery – non-communicable diseases
(NCD), communicable diseases, maternal & child health and
community/primary healthcare).

6. Health systems
• A four-level system:
• The Ministry of Health (MOH); policy, strategy, regulation,
international relations and resource mobilization;
• Provincial Health Offices; coordination of health services, technical
support, dissemination of health policies and performance
management at the provincial level;
• District Health Offices - management, coordination and supervision of
health facilities at district level;
• Community Health Committees - mobilising community members for
health promotion activities and providing information to the district
on health priorities.
• National boards have been established to oversee specific key
health programmes (e.g. the National Malaria Control Centre
and NAC).

7. Health Financing

8. Key Components of Zambian Budget
Public Order and
Safety
Social Protection Economic Affairs
Housing &
Community
Amenities
General Public
Services
Recreation,
Culture &
Religion
Public Order and
Safety
Environmental
Protection
Health
Education and
Skills
Development
Defence

9. Key Healthcare expenditure components
Health service delivery
Human resource
Drugs & medical supplies
Medical Infrastructure & equipment

10. Key weakness
• Does not provide analysis by expenditure/budget
components.

11. References
• MoF, Financial reports (2010-2017)
• MoF, Budget speeches (2010-2018)
• MoH, National Health strategic plan (2011-2016)
• MoH, National Health strategic plan (2017-2021)
• WHO, Global Health Expenditure database
(http://apps.who.int/nha/database/Select/Indicato
rs/en

12. Key Health Budget Highlights (2017 & 2018)
Key Healthcare Policies & strategies (2018)

13. Budget Allocation Review (2011-2018)
1,772
2,580
3,638 4,228 4,464 4,432
5,762
6,782
15.0%
8.6%
9.3%
11.3%
9.9% 9.6%
8.3%
8.9%
9.5%
0%
2%
4%
6%
8%
10%
12%
14%
16%
2011 2012 2013 2014 2015 2016 2017 2018
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Absolute budget (ZMW' Million) Abuja target (%) Actual allocation (%)
• Absolute Health care budget allocation has progressively increase over time (2018
allocation is 3.8 times 2011 allocation)
• Dropped from 9.6% in 2015 to 8.3% in 2016 but has since seen a steady increase
over the last 2 years
• But still below the Abuja declaration target (15%)

14. Country allocation-Abuja Target Gap
6.4%
5.7%
3.7%
5.1% 5.4%
6.7%
6.1%
5.5%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
2011 2012 2013 2014 2015 2016 2017 2018
• Fluctuating gap between actual health allocation and Abuja target with closest
point reached in 2013 (3.7%) and highest pick in 2011 (6.4%).
• A constant rise since 2016 to date.

15. Health Budget Performance Review (2011-2016)
1,772
2,580
3,638
4,228
4,464
4,432
1,621
1,348
2,521
3,755
2,633
2,152
1,876
1,245
1,320
2,568
2,601
2,147
- 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500
2011
2012
2013
2014
2015
2016
Chart Title
Actual Expenditure
(ZMW' Million)
Funding (ZMW' Million)
Budget (ZMW' Million)
• Budget execution was good in 2011 but there after the data show a significantly
low budget utilization with actual expenditure representing:
• 48% of the health care budget (2012). 36% of the health care budget (2013).
• 61% of the health care budget (2014). 58% of the health care budget (2025).
• 48% of the health care budget (2016)

16. Per Capita Total Health Expenditure in Int$ (PPP)-2014
871
93
1,148
195
108
0 200 400 600 800 1,000 1,200 1,400
Botswana
Malawi
South Africa
Zambia
Zimbabwe
Int$ (PPP)
• Zambia is among the countries in Sub-Saharan Africa with low per capita total
expenditure.
• In 2014 WHO reported per capita for Zambia as Int$195 with Malawi being the lowest
US$93) and South Africa the highest (Int$1148).

17. Out of pocket expenditure (US$)-2014
20
3
37
26
19
0 5 10 15 20 25 30 35 40
Botswana
Malawi
South Africa
Zambia
Zimbabwe
US$
• In 2014 Zambia was the second country in Sub-Saharan Africa with large out-of-pocket
expenditure (US$26) with South Africa (US$37) on top.

18. Summary
• Healthcare allocation as a proportion of 2018 national budget is
progressive
• Zambia’s health budget in 2018 represents 9.5% of the total national
budget, up from 8.9% in 2017.
• Thus health care sector is one of the government priorities in 2018 national
budget.
• 2018 budget allocation is 5.5% points below the Abuja Declaration target
of 15%.
• A progressive increase from 2016 (6.7%).
• Zambia is one of the countries with lowest per capita total health
expenditure in southern Africa.
• Zambia is one of the countries with the highest out-of-pocket health care
expenditure in the region, second from South Africa.
• For such countries high inflation can put household health expenditure
further up, especially for poor families.
• Plans to implement social health insurance need to be accelerated to help
reduce household health expenditure pressure.