WHOandHMN,DRAFT,March2009

Zambia,CHeSS/IHP+

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ZAMBIA

ThisreportwasbasedonamissiontoZambia(1618February2009)byateamofWHO(TiesBoerma,Patrick
Kadama,AnnetMahanani,WilliamSoumbeyAlley)andHealthMetricsNetwork(NosaOrobaton,HabtamuAddo).The
missionincludedconsultationswithMinistryofHealth,

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

1
Background

Thescaleupforbetterhealthisunprecedentedinbothpotentialresourcesandthenumberof
initiativesinvolved.Thisrequiresaharmonizedmonitoringandevaluationeffortthatreinforces
bothcountryandglobalneedstodemonstrateresults,securefuturefunding,andenhancethe
evidence base for intervention. Eventually, the scaleup efforts will be judged by country
progress towards the healthrelated MDGs, the degree to which major health constraints in
countrieshavebeenaddressed,andadherencetotheParisDeclarationonAidEffectiveness.

The IHP+ common framework for monitoring performance and evaluation of the scaleup for
betterhealthaimstoensurethatthedemandforaccountabilityandresultsfromsingledonors
and joint initiatives is translated into wellcoordinated efforts to monitor performance and
evaluateprogressincountries,inlinewiththeprinciplesoftheParisdeclaration.Itstressesthe
importanceofworkinginwaysthatcontributetostrengtheningcountryorganizationalcapacity
and health information systems, as well as enabling evidenceinformed decision making and
improvedcountryperformance.

The global framework needs to be made operational at the country level. The Country Health
Systems Surveillance platform (CHeSS) aims to improve the availability, quality and use of the
data needed to inform country health sector reviews and planning processes, and to monitor
healthsystem performance. 2 There are three dimensions to this process to strengthen the
monitoringandevaluationcomponentofthecountrycompact:
Demandanduseofinformation:improvetheuseofevidenceindecisionmakingprocesses,
focusingoncountryplans
Supply of data and statistics: increase availability and quality of data used for decision
making
Enhance institutionalcapacity:support countrycapacityforassessmentand monitoringof
healthsystemsandtheirperformance

InApril2009,theGovernmentofZambiaandDevelopmentPartnersintendtosigntheCompact
forthescalingupforreachingthehealthMDGs,asanAddendumtotheMemorandumof
Understandingof2006betweentheGovernmentandtheCooperatingPartners.

2
Demandanduseofinformation

2.1
Countryreviewprocessesandmechanisms

TheNationalHealthSectorStrategicPlan20062011(NHSP)setsoutthepriorityareasforhealth
interventionsandprovidesabasisformonitoringprogressinitsimplementation.Therearetwo
majorreviewcycles,namelytheJointAnnualReview(JAR)andthemidtermandfinalreviews.

CountryHealthSystemsSurveillance.ReportofameetinginBellagio,October2008.WHOandRockefeller
Foundation.

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

TheJARprocessincludestheMinistryofHealth(MoH)andCooperatingPartners(CPs).TheJAR
2008isinprogressatthetimeofthisreport.Eachyearthereareselectedthemes,andthe
reviewoutcomesincludehighlightsofthemainachievements,constraintsandchallenges,and
recommendationsonthewayforward.Theprocessusuallyincludesfourphases:deskreviewof
keydocumentsandreports,semistructuredinterviewswithkeystakeholders,fieldvisitsto
selectedprovinces,andpresentationofthefindingstotheHealthSectorAdvisoryGroup(SAG)
meetinginApril.

In2008afairlyextensiveMidTermReview(MTR)wasdonebyateamthatworkedonthebasis
ofagreedTermsofReference(TOR)adoptedbytheMOHandCPs.AswithJAR,theprocess
includesreviewofreportsanddocuments,fieldvisitstoselectedprovinces,interviewswith
stakeholders,andastakeholderworkshopwithsome150participantstopresentpreliminary
analysisandsolicitfeedback.

The Ministry of Health also develops an annual action plan with activity lists. For each action
plan, there are a large number of process and output indicators are developed, with some
outcome indicators. These are discussed at beginning of each year by the monitoring and
evaluationsubcommitteeofSAG.Thesubcommitteeisalsothemaincoordinationmechanism
forM&E.

In addition, Zambia has a broader monitoring process which is based on a performance

assessmentframework(PAF)whichincludesallrelevantsectorsandhasbeenformulatedinthe
contextofthepovertyreductionstrategy.

2.2
Indicators

The NHSP contains some 270 indicators, around 80% of which have clear targets. Sixteen are
consideredcoreindicators.The2008MTRreviewedtheresultsof250indicators,with51core
indicators,mostlyoverlappingwiththoseofNHSP.Datawereavailablefor185oftheindicators
reviewed. The 2009 draft annual action plans includes about 275 indicators with targets. The
IHP+proposalasofFebruary2009includes23indicators.ThePAFincludes5healthindicators
andanother5forHIV/AIDS,outoflessthan40indicatorsforallsectorscombined.

Theclassificationofindicatorsintothecategoriesofalogicalmonitoringandevaluation(M&E)
framework differs from standard practices in several instances. Table 1 shows the number of
indicators by category in different plans and reports (See Annex A for details). 3 There is fairly
goodoverlapoftheindicators,withtheNHSPasthebasis.

The16noninputindicatorsoftheIHP+proposalwerescoredbasedonthefollowingcriteria(seeAnnexB):Good
baseline data; target setting feasible; Sensitive to scaling up / change; Equity dimension well represented;
Measurable with current data sources; Data quality tends to be good. The scores range from 613 points out of
maximumof15.Severalindicatorsscorepoorly,includingmaternalmortality7;condomuseatlastsex6;rural
population within 5 km of facility 5; malaria case fertility rate among children under5 6; CHWs implementing
packagelow.SomeindicatorsthatareinNHSPandscorehighwerenotincludedintheproposedlist,suchasITN
coverage, outpatient attendance and contraceptive prevalence rate. The 7 proposed input indicators on compact
goalsfor"behaviouralchange"includedtwogeneralindicator, threeonfinancing,oneoninformationandtwoon
humanresources.

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

Table1
Useofindicators(withtargets)inNHSPandmonitoringprocesses,bycategory,Zambia

Input Process Output/ Outcome Impact Total

quality
NHSP,core
5
3
6
2
3
19
MTR,core
13
4
3
18
13
51
PAF
2
1
2
4
1
10
IHP+,proposedasofFebruary2008
7
0
5
7
4
23

AIHP+missionofDevelopmentPartnerswasconductedinSeptember2008atwhichtheglobal
IHP+commonmonitoringframeworkwasdiscussedwiththeZambiancountryhealthsector
teamandconsideredwellalignedwiththeresultsframeworkintheHSDPIII.

3
Supplyofdataandstatistics

3.1
Datasources

HealthManagementInformationSystems(HMIS)
The HMIS in Zambia forms the basis for annual data for many indicators. There are efforts to
improvecompleteness,timelinessandaccuracyofreport.TheDHIS/OpenHealthdistrictproject
hasbeendevelopedduringthepastyears,supportedbyanECgrantandtheHISPproject,butis
notyetoperational.WHO/HMNarecurrentlysupportingthefinalization.

Populationbasedsurveys
The Central Statistics Office is in charge of surveys. The most recent Demographic and Health
Surveys (DHS) was conducted in 2007. The intervals between population based surveys to
monitor the key coverage and other indicators are relatively long in Zambia (six years). Most
countriesaremovingtowardsa45yearintervalwithoftenanintermediatenationalcoverage
or other type of health survey. At the same time, Zambia has a record number of sexual
behavioursurveys(fiveintenyears).

Facilityassessments
Afewassessmentsofthestatusoffacilitiesandservicedeliveryhavebeenconducted:
2004:ServiceAvailabilityMapping
2006:NationalFacilityCensus

ThereisnonationaldatabaseoffacilitieswithGPScoordinates.Themostrecentnationalhealth
facilitieslistingwaspublishedin2008.

Vitalevents
There are major gaps in the information which cannot be solved in the short run. Currently,
separateinvestmentsaremadebydonorsintwosystemsofdemographicsurveillance,onerun
by Ministry of Health and one by the Central Statistical Office, without much coordination.
Furthermore, no investments are made into improving cause of death registration in health
facilities and strengthening registration of births and deaths, which should start with urban
areas.

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

Administrativedata
Humanresourcesandfinancialdataareakeycomponentofhealthsystemsstrengtheningand
included in joint annual reviews. The data need to be integrated better in HMIS, as "semi
permanentdata",andbesupportedbyacomprehensivefacilitydatabasethatcoversallpublic
andthebulkofprivatefacilities.

Surveillance
SurveillanceofTBhasbeenfunctioningfairlywellinrecentyears.HIVsurveillanceinantental
clinicsisinfrequent,buthasreliedheavilyonthepopulationbasedsurveys.Outbreakdiseasesis
not integrated within HMIS and may benefit from the advances made by introducing the
DHIS/OHsoftware.

3.2
Dataqualitycontrolmechanisms

Atpresent,thereisnotransparentsystemthatallowsdataqualityassessment,andformsthe
basis for adjustments. For instance, there are no data in the annual reports on completeness,
timeliness and accuracy of reporting, or adjustments made to health facility based coverage
estimatesbasedonpopulationbasedsurveys.

3.3
Access,analysisanddissemination

Statisticalreports
The Ministry of Health publishes annual statistical bulletin and the most recent report is
available for 2006. The 2007 report was being finalized at the time of the mission. The
report is available in printed copies and contains statistics of disease burden, human
resources, availability of essential drugs, and service delivery, by province. However, no
assessmentisprovidedofreportinganddataquality.

Databases
NopublicnationaldatabaseontheMinistryofHealthwebsite
TheCentralStatisticalOfficehasnofunctioningdatabasesaccessibleonthewebatthetime
ofthisreport

Synthesisandanalysis
Joint Annual Review (JAR) report: The use of data is limited to key indicators with recent
dataandincludefinancing,humanresources,morbidityandcoveragedatageneratedfrom
health facility reports (HMIS), often by province. The preparation is fairly standardized,
although the data analysis is often done within a short time frame. The results are
disseminated through printed report and there is some kind of dashboard which evolves
overtime.ThereportisalsoavailableontheMoHwebsite.
MidTermReview(MTR)report:TheMTRfocusedontargetsandtrends,withverylittledata
analysis.ThefinalMTR2008reporthasbeenpublishedandisavailableontheMoHwebsite.

4
Institutionalcapacity

MinistryofHealth

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

MoHhasmanyfunctionsthroughtheMonitoring&Evaluationunitinthedivisionofpolicyand
planning.TherearehoweveronlyfourquantitativeprofessionalswithMasterlevelsdegreesor
higher(epidemiology,demography,statistics,publichealth)

CentralStatisticalOffice
CSOisthekeyinstitutionfordatacollectionandbasicanalysis,withofficesinallprovinces.The
division of Social Statistics has a Population & demography unit which includes the vital
registration unit. The number of staff has been going down and currently there are four high
levelprofessionals,supportedbyastatisticiansanddataprocessingstaff.

UniversityofZambia
SomedepartmentsintheUniversity,suchasDepartmentofEconomicsandtoalesserextent,
CommunityMedicine,carryoutspecificassignmentstosupportmonitoringandevaluation.The
mostprominentactivityistheNationalHealthAccountsexercise.

TheInstituteforEconomicandSocialResearch
ThisinstituteisanNGOwithasmallnumberofpermanentstaffwhichhasacademicstaffand
otherstoworkonspecificprojects.Someactivitiesweremoreanalytical.

Privateorganizations
Therearealsoprivatecompaniesthatareengagedindatacollectionandanalysis.Forinstance,
anationalmalariasurveyfundedbytheWorldBankwastenderedandfourprivatefirmsapplied.
Palm Associates successfully implemented the field work. There are also small organizations,
such as ZamFOHR which is partly supported by the Alliance for Health Systems and Policy
Research.

5
Conclusionandrecommendations

5.1
Demandanduseofinformation

Thereisaneedtostrengthentheanalysisphasepriortotheannualreview.

Theuseofdataandstatisticsshouldbeincreasedinthereviewprocesses,includingsub
nationalanalysisandbenchmarkingwithothercountriesandregionalaverages.

The dashboard approach for a selected number of core indicators needs to be

strengthened.

The PAF health indicators should be included in the IHP+ accountability and results
framework.

The HIV/AIDS indicators in PAF should be reduced to one or two to maintain an

appropriatebalancewiththehealthsector.

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

5.2
Supplyofdataandstatistics

Datasources
o Strengtheningofthedatasourcestoprovidedatashouldbepartofoverallhealth
informationsystemsstrengtheningalongthelinesoftheHMNframeworkcosted
HISplan
o HMIS:
ThereisaurgentneedtolinkthenationalHMISwithothereffortssuchas
theelectronicandsmartcardworksupportedbytheUSgovernmentwhich
coverssomedistrictsandtheWorldBanksupportedworkonresultsbased
financinginninedistricts.
ThereisaneedtostrengthenthesemipermanentdatainHMIS,including
facilities,humanresources,andfinancialinformation.
WHO and HMN, in collaboration with the HISP project, to continue to
supportMOHtocompletetheHMIS/OpenHealthintegrationandmakethe
systemoperational,includingdashboardsforthenationalpriorityindicators
toinformdecisionmakersatdifferentlevel
o Surveys: Plan a mini DHS type of survey in 2010 which should address the key
compactindicatorsandplanthenextDHSsurveyfor2012
o Vitaleventsmonitoring:Harmonizetheeffortstodevelopdemographicsurveillance
sitesbyconveningthemajorpartnersMinistryofHealth,HealthMetricsNetwork/
WHO,CentralStatisticalOffice,USgovernment/CDCandaimtodevelopasystem
run by CSO, in close collaboration with the Ministry of Health. In addition, it is
necessarytodiscussthepossibilitiesofimprovingbirthanddeathregistrationand
causeofdeathcertificationandcodinginhospitals
o Conduct a district assessment mid 2009 in nine districts, building upon the Global
Fund health impact evaluation study assessment that was conducted in nine
districts in 2008. This can evolve into an annual exercise with a rolling district
sample (replacing onethird of districts every year). Funding from WHO/GAVI can
be used to develop the instruments and implement the 2009 round. The district
assessment includes the status of service delivery, district financing, and data
quality(HMISdata).The2009reportshouldbeavailablebyNovembertofeedinto
the 2010 annual review. It is critical that a country institution is involved with
externalsupportintheinitialyears.
Dataqualityassessment
o There is a need to increase data access and transparency to allow regular
assessmentofdataquality
o ThisshouldalsoincludetheadjustmentsmadetotheHMISbasedonsurveyresults
o Increasedinstitutionalcapacityandinvolvementinthisprocesswillbeessential

Synthesisandanalysis
o Thejointannualreviewprocessesneedtobeinformedbyrecenthighqualitydata.
The HMIS data are important for such review but need to be complemented by
regular reviews of a selected number of districts in which a facility census, a data
qualitycontrol,andfinancialreviewisdone.Suchareviewshouldbedoneabout3
5months priortothejointannualreviewbyanindependentinstitutionorreview
team

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

5.3
Institutionalcapacity

Thereisaneedtomakeinstitutionalcapacityanintegralpartofthemonitoringandevaluation
component of the country compact. Currently, this occurs in a fragmented manner and core
partnersshouldworktogethertodevelopshortandlongtermplanstostrengthenandsupport
Zambia'scapacity.

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

AnnexA

NumbersofIndicatorsinNHSP,MTR,IHP+Proposal,PAF

NHSP

Section in NHSP

Key indicators

Expected
outputs

MTR
National
Health
Priorities

"Core"
Indicators

Indicators

Indicators

Data
available

Process (1)

17

10

Input (1),
Output (1)

Process (1),
Outcome (1)

Output (1)

Output (1)

Impact (1),
Outcome
(1)
Impact (1),
Outcome
(1)
Impact (1),
Outcome
(3), Output
(1)

Outcome
(1)

With
clear
target

Total

With
clear
target

With clear
target

Human Resources

15

15

Public Health Priority

Interventions
Basic Health Care Package

Child Health

Impact (1),
Output (1)

Integrated Reproductive Health

Impact (1),
Output (1)

10

HIV/AIDS & STI

10

10

Output (1)

11

Tuberculosis

13

10

Output (1)

15

Malaria

12

Impact (1),
Output (1),
Outcome

PAF

Reviewed
outputs
or
indicators

Total

"Core"
Indicators

IHP+

Outcome
(1)
Outcome
(1)

Outcome
(1)
Input (1),
Process
(1),
Output (1),
Outcome
(1),
Impact (1)

Outcome
(1)

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

NHSP
Section in NHSP

Epid. control & PH surveillance

Env. Health & Food Safety
Other PH interventions
Nutrition

Mental Health
Oral Health
Bilharzia & other parasitic
infections
Other NCD
Health Education & Promotion
Eye Care
Clinical Care & Diagnostics
Services
Essential Drugs & Medical
Supplies
Lab. Support Services
Blood Transfusion Services
Medical Imaging Services
Infrastructure & Equipment
Infrastructure
Medical Equipment &
Accessories
Transport

Key indicators

Expected
outputs

MTR
National
Health
Priorities

"Core"
Indicators

x
x

Reviewed
outputs
or
indicators
4
11

Data
available

10

2
9

1
0

4
10

4
10

11

10

10

5
4
6

0
1
0

4
10
6

4
5
3

7
9
8

4
4
5

4
0
0

0
0
0

5
6
0

4
4
0

6
5
3

3
5
3

10

10

10

10

Input (1)

8
5
6

8
3
3

8
8
8

8
7
8

Input (1)

7
10
9

7
10
5

Output (1,
also Child
Health)

"Core"
Indicators

IHP+

PAF

Indicators

Indicators

2
9
Impact (1,
also Child
Health)

Output (1)

x
6
5

5
5

6
5

5
5

7
5

6
5

10

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

NHSP
Section in NHSP

Support Systems
Strengthening
M&E
Health Systems Research
HMIS
FAMS
Procurement MS
Health Systems Governance
Policy & Legislation
Organization & Management
Gender & Health
SWAp
Hospital Management
External Coordination
Health Care Financing
Resource Mobilization
Resource Allocation
Costing & Financing of
Strategic Plan
Total

Key indicators

Expected
outputs

MTR
National
Health
Priorities

"Core"
Indicators

Reviewed
outputs
or
indicators

Data
available

11

6
4

4
3

6
7
10
7
3
4

6
6
9
7
3
3

252

185

"Core"
Indicators

IHP+

PAF

Indicators

Indicators

x
10
6
4
7
5

10
5
4
6
5

10
6
4
7
5

10
5
4
6
5

5
9
8
7
0
0

4
7
5
5
0
0

5
16
8
7
0
0

4
7
5
5
0
0

6
0

4
0

6
4

4
4

203

119

239

204

Process (1)

Input (1)
Output (1)

Input (1)

x
Input (3)

16

Input (4,
also
SWAp)

23

Input (1)

10

11

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

AnnexB

Indicatoranalysis

Maternal Mortality Ratio

Impact

(x)

(x)

Total Fertility Rate

Impact

% people living in extreme

hunger
Stunting prevalence in
underfives

Impact

Wasting prevalence in
underfives

Impact

Underweight prevalence in
underfives

Output,
Impact

Malaria incidence rate (per

1000)
HIV prevalence rate in 15-49
years

Impact

Impact

10
11

Syphilis prevalence rate in

15-49 years

Impact

Impact

(x)

Total score

Data quality

(x)

Measurable with current

data coll. Mechanims

Equity dimension present

Sensitive to change/
scaling-up

(x)

Good baseline info; target

can be set sensibly

Impact

Global estimates

Underfive Mortality Rate

12

Int. Reprod.
Health

Nutrition?

Child
Health,
Nutrition

Child
Health,
Nutrition

Child
Health,
Nutrition

14

Malaria

13

Child
Health
Child
Health
Int. Reprod.
Health

Criteria
GOZ, other than MoH

Other in MoH

HMIS, Prog.

(x)

Data source
Facility assessment

Impact

MDG

Infant Mortality Rate

PAF

Health
topics
Pop.-based survey

Targets

NHSP

IHP+ proposal

Documents

MTR

Indicator
type
(MoH)

NHSP

Indicators

HIV/AIDS &
STI

HIV/AIDS &
STI

x
x

12

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

TB

Impact

Comm.
diseases

Child
Health,
Basic
Healthcare
Package

Basic
Healthcare
Package

Health center utilization by

underfives

Outcome

15

Utilization rate of PHC

facilities

Output,
Outcome

16

OPD attendance rate

Output,
outcome

17

% fully immunized infant

Output,
Outcome

18

% infant immunized against

measles
% deliveries supervised by
skilled health workers

Outcome
Output,
Outcome

20

% births in a health facility

Outcome

(x)

(x)

Int. Reprod.
Health

21

% pregnant women receiving

at least 1 ANC visit

Outcome

(x)

(x)

Int. Reprod.
Health

x
x

Child
Health

Child
Health
Int. Reprod.
Health

Total score

Measurable with current

data coll. mechanims

10

10

13

14

Data quality

Equity dimension present

Global estimates

Criteria
GOZ, other than MoH

Other in MoH

HMIS, Prog.

Impact

14

19

Facility assessment

Data source
Pop.-based survey

MDG

NHSP

PAF

Health
topics

Sensitive to change/
scaling-up

13

TB incidence rate (per

100,000)
ARI incidence rate (per 1000)

Targets

Good baseline info; target

can be set sensibly

12

IHP+ proposal

Documents

MTR

Indicator
type
(MoH)

NHSP

Indicators

13

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

(x)

Int. Reprod.
Health

% pregnant women receiving

IPT for Malaria

Outcome

(x)

(x)

Malaria

(Hospital) Malaria CFR

among underfives
ART coverage

Outcome

Malaria

Output,
Outcome

HIV/AIDS &
STI

29

ART coverage, pregnant

women (PMTCT)

Output,
Outcome

(x)

(x)

HIV/AIDS &
STI

30

ART coverage, children

Output,
Outcome

31

Hospital Malaria CFR

Outcome

32

% population without
sustainable access to
improved water sources
% population without
sustainable access to
improved sanitation
ITN coverage (underfives,
pregnant women)

Outcome

Outcome

Contraceptive prevalence
rate (modern methods)

26

27
28

33

34

Output

Total score

(x)

25

Data quality

Outcome

Outcome

Measurable with current

data coll. mechanims

Int. Reprod.
Health

Maternal CFR

Equity dimension present

24

Sensitive to change/
scaling-up

(x)

Outcome

Good baseline info; target

can be set sensibly

Int. Reprod.
Health

% pregnant women receiving

at least 2 TT inj.

Global estimates

23

Criteria
GOZ, other than MoH

Int. Reprod.
Health

Outcome

MDG

Average ANC visits

PAF

(x)

22

Other in MoH

HMIS, Prog.

Data source
Facility assessment

Health
topics
Pop.-based survey

Targets

NHSP

IHP+ proposal

Documents

MTR

Indicator
type
(MoH)

NHSP

Indicators

x
x
x
3

11

10

HIV/AIDS &
STI

Malaria

(x)

Env. Health

(x)

Env. Health

Malaria

13

14

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

Output

36

TB cure rate

Output

TB

37

% smear+ TB case detection

rate / DOTS

Output

TB

38

Hospital Bed Occupancy

Rate

Output

(Health
Service
Delivery)

39

Number of CHWs/TBAs
implementing a defined
community health care
package (to be discussed
further)
% population within 5 km of a
public health facility; % rural
households within 5 kms of a
health facility
% districts submitting
complete HMIS quarterly
returns to MoH in time
Health center staff workload

Output

41

42

HRH

Process,
Outcome
; Output

Basic
Healthcare
Package

Process

HIS, M&E

Process

HRH

43

% drugs in stock (HC,

hospitals)

Process

Drugs/Med.
Supplies

44

Drugs kit opened / 1000

patients

Process

Drugs/Med.
Supplies

45

Percentage of GRZ budget

allocated to health sector

Input

Financing

46

Total public (GRZ+CPs)

allocated to health per capita

Input

Financing

Total score

Data quality

Measurable with current

data coll. mechanims

Equity dimension present

Sensitive to change/
scaling-up

Good baseline info; target

can be set sensibly

Global estimates

GOZ, other than MoH

Other in MoH

HMIS, Prog.

Facility assessment

Condom use at last high-risk

sex

HIV/AIDS &
STI

Criteria

35

40

Data source
Pop.-based survey

Health
topics

MDG

NHSP

Targets

PAF

IHP+ proposal

Dcuments

MTR

Indicator
type
(MoH)

NHSP

Indicators

13

15

12

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

MoH expenditure on PE

Input

Financing

48

Per capita GDP

Input

Financing

49

Exchange rates (ZMK vs

USD)
Per capita annual GRZ
expenditure on health

Input

Financing

Input

Financing

51

PE/GDP ratio

Input

Financing

52

% health facilities without any

stock-outs of tracer supplies
in a month; % facilities out of
stock of tracer drugs and
vaccines (HCs/hospitals)
% donated blood tested for
HIV, Hepatitis B & C, and
syphilis, in accordance with
national & WHO guidelines

Input

Input

53

Drugs/Med.
Supplies

Blood
transf.
services

Doctor/population ratio

Input

(x)

HRH

55

Nurse/population ratio

Input

(x)

HRH

56

Midwives/population ratio

Input

(x)

HRH

57

Input

(x)

HRH

58

Qualified HW/1000
population
Trained TBA/1000 population

Input

(x)

HRH

59

Active CHW/1000 population

Input

(x)

HRH

60

% HCs with 2 or more

professional health staff

Input

HRH

61

% JAR/MTR
recommendations fully
implemented

Input

Governanc
e

Total score

54

Data quality

Measurable with current

data coll. mechanims

Equity dimension present

Sensitive to change/
scaling-up

Good baseline info; target

can be set sensibly

Global estimates

Criteria
GOZ, other than MoH

Other in MoH

HMIS, Prog.

Facility assessment

Pop.-based survey

Data source

47

50

Health
topics

MDG

NHSP

Targets

PAF

IHP+ proposal

Documents

MTR

Indicator
type
(MoH)

NHSP

Indicators

16

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

64

65

66

% donor funds disbursed as

pooled funding, against the
total donor funds disbursed to
the health sector
% CP funded procurement in
the health sector that is
aligned to MoH procurement
plan and conducted using
GRZ system

Input

Financing/
SWAp

Input

Financing/
SWAp

MDG

17

Total score

Data quality

Financing/
SWAp

Measurable with current

data coll. mechanims

Equity dimension present

Input

Other in MoH

HIS, M&E

Financing

HMIS, Prog.

Facility assessment

Input

Pop.-based survey

NHSP

MTR

Input

Sensitive to change/
scaling-up

Criteria
Good baseline info; target
can be set sensibly

Data source

Global estimates

63

Health
topics

% MoH budget released to

district level (domestic, nondonor)
% CPs requesting MoH to
develop additional plans,
proposals and/or use
additional M&E indicators
sets separate from NHSPMF
% resources disbursed within
the intended year against the
total pledged disaggragated
for GRZ and CPs

NHSP
62

Targets

GOZ, other than MoH

Documents

PAF

Indicator
type
(MoH)

IHP+ proposal

Indicators

WHOandHMN,DRAFT,March2009
Zambia,CHeSS/IHP+

AnnexC

ExampleofDatafromDifferentSources(DHS,HMIS)

Skilled birth attendance, Zambia

70

60
50

HMIS

40
30

DHS2001-2002
DHS2007

20
10
2007

2006

2005

2004

2003

2002

2001

2000

1999

1998

Institutional deliveries, Zambia

60

50
40

HMIS

30

DHS2001-2002

20

DHS2007

10
2007

2006

2005

2004

2003

2002

2001

2000

1999

1998

Underweight prevalence among children under five years, Zambia

30
25
HMIS
DHS2001-2002

15

DHS2007

10
5
2007

2006

2005

2004

2003

2002

2001

2000

1999

0
1998

20

18