The Public Health Paradox.

• Position: Brief Article

Hon. Prof. Nkandu Luo, M.P.

The provision of effective acceptable and affordable health services is today a challenge for developing and developed countries alike. An effective public health services delivery system must be that which carefully balances the system's needs (in an environment of shrinking financial, human and material resources) with aspirations the system might have generated in an effort to reform itself over time.

The strategies which drive the reforms in Zambia are based on the following three principles: leadership, accountability and partnership, which are all sustainable. If it were possible to reduce all the strategies to the "lowest common factor", perhaps the most appropriate phrase would be "managing for quality in a decentralized system". This would mean creating leadership not only at the centre but throughout the system, particularly at the district level. The catch here is to decentralize the system without overburdening the districts.

In Zambia's Health Reform Vision Statement, the Government's aspirations on behalf of the consumers are dearly stated: "equity of access to cost-effective quality health care as close to the family as possible".

* Equity of access aspires to provide all Zambians with a public health system which fairly determines the availability of services according to need. In a situation where the developing needs, those developed along the way, place all members of the population at the same "need level", such as the need to provide HIV/AIDS services, it becomes almost impossible to talk about equitable access.

* Cost-effectiveness connotes the ability of the system to produce the desired effects at the least possible cost. However, we know that unless some minimum critical amount of resources are committed to the provision of public health services, getting the desired effect remains a dream. Our health care delivery system already functions at a level below the minimum required inputs, while the cost of procuring these inputs and the population's needs keep on rising.

Often, the absence of these minimum critical inputs impacts on health care providers and manifests as negative attitudes that, in turn, manifest as consumer dissatisfaction. Often, the continued rise in the cost of training health workers means that we never have them in adequate number to be able to provide quality services.

* Quality health care connotes the provision of the right type of care all the time. This is linked...