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Targeting Specific Diseases vs. Health System Strengthening in Zambia

By Tara Newton, Communications Associate, BID Initiative

Apr 16, 2015

Posted in

Photo: Humanosphere

Photo: Humanosphere

As we work towards increasing immunization coverage rates in Zambia through increased data collection, quality, and use, we take a moment to review a recent study in BMC Medicine by Institute for Health Metrics and Evaluation, USAID, among others. The results beg the question, are routine health services, such as child immunizations, suffering as the focus grows towards disease specific interventions? The following excerpts are from an article originally published on Humanosphere, authored by Tom Paulson.

A new study reveals that while Zambia has made great progress against malaria over the past decade or so it was losing ground on many other health needs like basic child immunizations and maternal health care.

The findings, though limited to evaluating select health trends in one African country, may well become fodder in the long-running – but, lately, increasingly intense – debate over whether the global health community should continue favoring targeted or disease-specific interventions or shift its emphasis to more fundamental “health systems” improvements.

“Zambia has been recognized worldwide for its successes in improving childhood survival and tackling many deadly diseases, including malaria and HIV/AIDS,” said one of the lead authors, Emmanuela Gakidou, a researcher at the University of Washington’s Institute for Health Metrics and Evaluation. The study is published today in BMC Medicine.

“At the national and district level, Zambia achieved greater successes in newer, rapidly scaled-up interventions while gains in routine services delivery either stalled or declined,” the study authors report. Put simply, Zambia’s much-celebrated success against malaria may have come at the expense of de-emphasizing some aspects of basic primary care. 

Insecticide-treated net ownership or indoor residual spraying to combat malaria, 2000-2010. (Red is low numbers; greener is higher). IHME

Insecticide-treated net ownership or indoor residual spraying to combat malaria, 2000-2010. (Red is low numbers; greener is higher). IHME

Polio immunizations stagnated or, in some cases, declined between 1990-2010. IHME.

Polio immunizations stagnated or, in some cases, declined between 1990-2010. IHME.

Did targeting malaria or other specific diseases contribute to neglect of other basic health services in Zambia? Many in the ‘health systems’ camp – those who argue for funding basic care and infrastructure rather than targeting specific problemsmake that case. Or are these contradictory trends operating independent of each other?

Read the entire article and learn more on Humanosphere.

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