Zambia Human Development Report 2011

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Zambia Human Development Report 2011

Service Delivery for Sustainable Human Development


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As part o the poverty reduction and Millennium Development Goals local level eorts, the

United Nations Development Programme (UNDP) supports country programmes to develop

their capacity to increase access to basic public services or the poor and the potential

o multi-stakeholders partnerships to complement traditional public service delivery

approaches. (www.undp.org).

Copyright 2011

By the United Nations Development Programme

Alick Nkhata Road

P.O. Box 31966

Lusaka, 10101Zambia

The analysis and policy recommendations o the Report do not necessarily refect the views o

the United Nations Development Programme, its Executive Board, or its Member States. The

Report is an independent publication commissioned by UNDP Zambia. It is the product o

collaborative eorts by a team o independent consultants, the Zambia Human Development

Report Advisory Committee and UNDP.

All rights reserved. No part o this publication may be reproduced, stored in a retrieval system

or transmitted in any orm or by any means, electronic, mechanical, photocopying, recording

or otherwise, without prior permission rom the United Nations Development Programme.

Edited by Gretchen Luchsinger, Maryland, USADesigned by Content Design Limited, Lusaka, Zambia

Printed by New Horizon Printing Press, Lusaka, Zambia


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Service Delivery for Sustainable Human Development

United Nations Development Programme

P.O. Box 31966 Lusaka, ZambiaTel: +260-1-250800

E-mail: [email protected] / [email protected]

Website: www.undp.org.zm


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nDevelopmentReport2011

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Service Delivery or Sustainable Human Development


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Contents6 Message rom the Government7 Foreword

8 Acknowledgements

10 Zambias Human Development Balance Sheet

12 Overview: Service Delivery or Sustainable Development

16 Chapter 1: Service Delivery and Human Development

16 Conceptual Framework 19 Service Delivery and the Attainment o the Millennium Development Goals 22 Conclusions

23 Chapter 2: Zambias Policy Environment23 Policy context

24 Poverty Trends25 Macroeconomic Indicators

26 Economic Growth by Sector 26 Employment Creation

27 Government Revenues and Expenditures 28 Governance

28 Emerging Patterns in the Delivery o Services in Zambia28 Conclusions

30 Chapter 3: The State o Human Development in Zambia30 Long-term Trends in Zambias HDI32 Comparisons o the Human Development Index33 Explaining Developments in Human Development Status34 The Inequality-adjusted Human Development Index35 The Gender Inequality Index35 The Multidimensional Poverty Index36 Conclusions

38 Chapter 4: Agriculture38 Service Delivery Framework39 Policy and Institutional Context40 Budget Perormance40 Capacity Building or Service Delivery

42 Sector Perormance47 Cross-cutting Issues48 Conclusions and Recommendations

50 Chapter 5: Education50 Service Delivery Framework51 Policy and Institutional Framework52 Budget Perormance53 Sector Perormance


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55 Critical Gaps in Service Delivery

58 Cross-cutting Issues 61 Conclusions and Recommendations

62 Chapter 6: Health62 Service Delivery Framework

64 Budget Perormance66 Sector Perormance68 Perormance in the Delivery o Health Services73 Cross-cutting Issues76 Conclusions and Recommendations

77 Chapter 7: Water and Sanitation

77 Service Delivery Framework79 Budget Perormance81 Sector Perormance87 Cross-cutting Issues88 Conclusions and Recommendations

90 Chapter 8: General Conclusions and Way Forward92 General Policy Recommendations

94 Action Plan or Improving Service Delivery by Sector

97 Reerences107 Acronyms

108 Technical Annex 108 Technical Note 1: Calculating the Human Development Index 109 Technical Note 2: Calculating the Inequality-adjusted Human Development Index

111 Technical Note 3: Calculating the Gender Inequality Index 112 Technical Note 4: Calculating the Multidimensional Poverty Index

115 Appendix Tables 115 Appendix Table 1: MDG 1 Indictors 115 Appendix Table 2: MDG Indicators 115 Appendix Table 3: MDG Indicators 116 Appendix Table 4: MDG 4 Indicators 116 Appendix Table 5: MDG 5 Indicators 116 Appendix Table 6: MDG 6 Indicators

117 Appendix Table 7: MDG 7 Indicators 117 Appendix Table 8: GII Indices or Zambia and Provinces, 2008 118 Appendix Table 9: Indicators and the calculation o MPI, 2006

118 Appendix Table 10: Indicators and the Calculation o MPI, 2004 119 Appendix Table 11: Trends in Sector Employment Levels, 2004-2008 119 Appendix Table 12: Selected Competitiveness Indicators or Zambia, 2006-2010


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120 Appendix Table 13: Area Planted and Crop Production, 2006/2007 to 2007/2008 120 Appendix Table 14: Budget Allocations and Releases or Core Fith National

Development Plan Programmes, 2006-2008 (ZMK billion)121 Appendix Table 15: Agriculture Expenditures by Category

122 Appendix Table 16: Trends in the Budget and Fertilizer Allocations, and ExpectedProduction, 2002/2003 to 2009/2010

122 Appendix Table 17: Dropout Rate or Grades 1-7 by Province, 2008 123 Appendix Table 18: Teacher-Pupil Ratio by Grade and Province, 2005-2008 123 Appendix Table 19: Examination Pass Rates in Grade 9 by Gender and Province, 2005

and 2008 124 Appendix Table 20: Changes in Stang Levels between 2005 and 2009 125 Appendix Table 21: Clinical Health Workers per 1,000 People by Province,

December 2008 125 Appendix Table 22: Distribution o Health Workers by Size o Hospital, Type and

Ownership, 2008 126 Appendix Table 23: Total Number o Health Facilities by Population Size o Service

Users, 2008 126 Appendix Table 24: Perormance Indicators: Unaccounted or Water and Operation

and Maintenance Cost Coverage by Collection, 2006/2007 to 2009/2010 127 Appendix Table 25: Costs o Operation: Urban Water Supply and Sanitation, 2008-2010

Boxes

41 Box 4.1: Budget Patters and Implications or Service Delivery

51 Box 5.1: Non-state Actors and Public-Private Partnerships in Education54 Box 5 2: Free Primary EducationEmerging Issues78 Box 7.1: Challenges o the legal ramework reduce eectiveness o service delivery

institutions81 Box 7.2: Commercial Service Providers84 Box 7.3: Views o Some Service Providers86 Box 7.4: Low Demand Leads to the Underutilization o Water Facilities

Figures

17 Figure 1.1: Conceptual Framework: Linking Service Delivery to Human Development

18 Figure 1.2: The Accountability Triangle26 Figure 2.1: Trends in the Level o Employment26 Figure 2.2: Trends in Fiscal Revenues (in Percent o GDP), 2006-201027 Figure 2.3: Trends in governance indicators in Zambia, 1996-200831 Figure 3.1: HDI EvolutionZambia and Its Neighbours42 Figure 4.1: Percentage Contribution to Real GDP by Sub-sector51 Figure 5.1: Education Structure in Zambia59 Figure 5.2: Mean Score Trends or English and Mathematics, 1999-200665 Figure 6.1: Trends in Government Health Budget Allocations, 1995-200966 Figure 6.2: Actual Releases rom Donors through the Ministry o Health, 1997 to 200967 Figure 6.3: Trends in Under-ve Malnutrition Levels by Type, 1996-200768 Figure 6.4: Health Centre Sta-Patient Contact Ratio by Province, 2005-2008


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69 Figure 6.5: Percentage o Months or Which Drugs Were in Stock in Health Centres byProvince, 2006 to 2008

69 Figure 6.6: Percentage o Months or Which Drugs Were in Stock in Hospitals by Province,2006 to 200870 Figure 6.7: Hospital Bed Occupancy Rate by Province, 2005-200871 Figure 6.8: Review o Health Facility Eciency Studies in Selected Arican Countries82 Figure 7.1: Access to Sanitation Facilities in Urban and in Rural Areas

Tables

24 Table 2.1: Trends in Total Poverty, 1991-200624 Table 2.2: Trends in Selected Macroeconomic Indicators, 2000-201025 Table 2.3: Growth in GNP by Sector, 2001-201031 Table 3.1: Long-term trends in Zambias HDI, 1980-2010

32 Table 3.2: Comparison o developing regionsHDI and its components, 201032 Table 3.3: HDI values or Zambia and its provinces, 2000, 2004 and 200833 Table 3.4: HDI component indices or Zambia and its provinces, 200834 Table 3.5: HDI and IHDI component indices or Zambia and provinces, 200835 Table 3.6: GII values or Zambia and provinces, 200836 Table 3.7: Indicators and the calculation o the MPI, 2004 and 200639 Table 4.1: Allocations o the Agricultural Budget by Category by Percent, 2006-201040 Table 4.2: Breakdown o Allocations Under the Poverty Reduction Programmes, 2006-201043 Table 4.3: Food and Nutrition Key Perormance Indicators, 2005-200944 Table 4.4: Livestock Production, 2006-2009

45 Table 4.5: Fish Production Trends, 2005-200947 Table 4.6: Poverty Status o Households Headed by Men and Women by Percent, 200653 Table 5.1: Summary o Eciency Indicators in Schools80 Table 7.1: Budget Perormance or Water and Sanitation (ZK billion) 2006 -200880 Table 7.2: Percent o Population without Access to Water and Sanitation Services81 Table 7.3: Time to Obtain Drinking Water, Round Trip, 200882 Table 7.4: Changes in the Types o Sources o Water by Rural and Urban Areas, 1988-200883 Table 7.5: Water Supply and Sanitation Coverage o the Commercial Utilities in 201083 Table 7.6: National Urban Water Supply Coverage84 Table 7.7: Production and Financial Eciency o Commercial Utilities in 2009-2010

85 Table 7.8: Lost Revenues Due to Unaccounted or Water, 2010


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he 2011 Zambia Human Development

Reportcomes at a time when the people

o Zambia need to be inormed about adecade o progress in extending quality services,and expect improved eciency in delivery and ashit in the manner o implementation.

Te people o Zambia are and should be thereason or all national investments, developmentsand delivery o all public and private services.National policies and programmes in everysector, together with the relevant systems andmechanisms to reach intended beneciaries, are

o primary importance to peoples welare andhigher living standards.Tis report ocuses on services oered in the

agriculture, education, health, and water andsanitation sectors. As such, it touches on the basicso human well-being, which are undamental tohuman development and respect or human lie.Te countrys low perormance on the HumanDevelopment Index (HDI), despite a slightimprovement to 0.395 in 2010 rom below 0.35in 2000, calls or an immediate and real shit inpolicy choices. Tis situation requires reorm andrecommitment by all public sector implementingagencies signicantly concerned with each sector.

Messagerom the Government

A reorientation o ocus with regard to publicnancial resources, particularly those allocated tohealth and education services, needs to addressidentied gaps so that most people can attainneeded quality services. Furthermore, the privatesector is called upon to act in bringing substantialbenets to the people o Zambia.

I urge all institutions involved in servicedelivery to take time and consider the report inorder to learn and embrace its key values, and tomake advancements in upholding best practices,putting in place people-centred development,

emphasizing quality standards, and achievingeective and ecient programme implementation.Tese aspects need attention, and are part ogovernments top priority on the developmentagenda.

I look orward to the people o Zambia beingwell inormed by this report, and to making thenecessary changes in the way we do business inorder to build a better Zambia or us and ouruture generations.

Alexander B. Chikwanda, M.P.MINISER OF FINANCE


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Zambias Human Development Report

2011: Service Delivery or SustainableHuman Development in Zambia addresses

the gains, opportunities and challenges in oursectors critical to Zambias human developmentprogress: namely, agriculture, education, health,and water and sanitation. It is premised on globalevidence and widely accepted analysis that theprovision o public goods and services in theseour sectors is a prerequisite or the developmento human capabilities and enhanced well-being.Ensuring and even improving the provisiono services is not enough, however; it has to bedone on the basis o equal and aordable access,and sustained quality i the most vulnerablepopulations are to lit themselves out o poverty.Achieving this could deeply impact the course ohuman development in Zambia.

Previous Zambia human development reportsaddressed issues such as employment andsustainable livelihoods, eradication o extremepoverty and hunger, and household capacity to

respond to HIV and AIDS. Te 1998 reportreviewed the provision o basic social services, andthe ndings pointed to inadequate access or therural and urban poor, and a sharp deterioration othe quality o education, health, and water and, inparticular, sanitation services in most parts o thecountry. We now go back to look at these trendsand the picture more than 10 years later, and askwhat has changed, what works, and what still needsto be addressed to ensure acceleration o progressin these core areas o human development.

Te 2011 report documents a decade onoteworthy improvements in health and basiceducation services in Zambia. Inrastructure

development in these sectors has produced

more schools, hospitals and health clinics acrossthe country. Essential drugs or immunization,HIV, malaria and tuberculosis are more readilyavailable, including or those previously not ableto aord them. Desks and learning materials havebeen made available, including importantly tocommunity schools as an increasingly importantcatchment o school-goers. As a result o measureslike these, some health and education outcomemeasures have improved: maternal and child

mortality are on the decline, albeit slowly; primaryschool enrolment has reached universal coverage;and school completion rates are on the rise.Te agricultural sector has recently experiencedpositive growth rates ater a period o nearstagnation, especially in non-traditional exports.Progress has also been made in the provision obasic water services, with more people gainingaccess in both urban and rural areas.

Notwithstanding these improvements, gapsremain in the reach and quality o service delivery.

Tese hold back a stronger surge in overall humandevelopment. In 2010, Zambia ranked 150 out o169 countries on the global Human DevelopmentIndex. Mortality rates, school completion ratesand education, and literacy rates weigh heavily inthis measure, over and above the average incomelevels o a country. For a ull measure o humanwell-being, we have to look beyond incomeaverages, and ask who has reaped returns rom theeconomic growth that Zambia has been enjoyingor the past 10 years.

Te report points to secondary and tertiaryeducation alling short o catering to the learningneeds and skills demands o a young and growing

Foreword


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population. Tis requires a ocus on both qualityo learning and completion rom early childhoodlearning through grade 12, and on the ratio otrained teachers to students at each level, as key toboosting the relevance and impact o education.In health, the report looks closely at the stillunacceptably high rates o maternal mortality andmalnutrition, and the rising prevalence o bothcommunicable and non-communicable diseases.It considers the policy and investment choicesto address these concerns, based on lessons rom

within Zambia and rom other countries.In agriculture, inadequate public investmentshave limited eorts to combat poverty, enhanceood security and end malnutrition. Limitedresources have in particular hampered research,extension services, irrigation, support orlivestock and sheries, and the development omarket access and inrastructure. In water andsanitation, relatively low investments over thepast three decades have created service deliverygaps that will require a large boost in investments

over an extended period to sustain a level oservice coverage that enables Zambia to reach itsMillennium Development Goal targets in thesetwo elds.

Te report, i distilled to its essence, putsorward some o the key institutional andregulatory reorms that are needed to achievecurrent policies, so the country can see a bigpush in implementation. It recommends asignicant leap in human resource capacityinvestments, especially at local levels, to ensurethat skilled personnel with adequate means drivethe last mile o service delivery. And it looks atresponsible public-private partnerships that can

boost domestic resourcing in gap areas, with clearlines o accountability and quality assurance inplace.

Te content and scope o the 2011 reporthas been a while in the making. It has drawnon extensive research and consultations aroundthe country, with multiple stakeholders romstate institutions, civil society, the private sector,academia and independent experts. It traversedthe political milieu, as it delved into the issuesand debates that have impacted service delivery,

and as Zambians rom all segments o societysoul-searched, questioned and made their voicesheard on issues that so directly aect their dailylives. Te report has benetted immensely rombeing part o a wider public discourse, awarenessand articulation o what needs to be done toensure basic services reach all Zambians, withmore equity and justice. We hope the reportrefects this public debate, the eedback receivedand the recommendations made. We also hopethat this process, urther backed by national data

and analysis, will make the report a reerenceor national policy makers and programmeimplementers, or community groups andresearchers, as they all engage on the developmenttransormation processes underway.

Kanni WignarajaUNDP Resident Representative


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Acknowledgements

Iwish to acknowledge the valuable contributionso the large number o organizationsand individuals that contributed to theproduction o this report. At the top on this listis the National Human Development ReportAdvisory Committee under the leadership o

Chie Mumena, who guided the preparationprocess, starting rom choosing the theme toreviewing the drat versions to launching thereport. Te role played by the Central StatisticalOce o the Ministry o Finance and NationalPlanning in providing data is commendable.UNDP would also like to thank the ministries oEducation, Health, Agriculture and Cooperatives,Livestock and Fisheries Development, LocalGovernment and Housing, and the Departmento Water Aairs, which readily shared data and

inormation. I would also like to commendthe team o consultants that supported thepreparation o the report or their commitmentand proessionalism.

Te report beneted rom a series o reviewsand comments rom various national stakeholdersrom the Civil Society or Poverty Reduction;the University o Zambia; the EconomicsAssociation o Zambia; the National AIDSCouncil; the Programme Against Malnutrition;the National Water Supply and SanitationCouncil; traditional authorities; the GovernanceSecretariat; the echnical Education, Vocationaland Entrepreneurship raining Authority; the

Ministry o Finance and National Planning; theMinistry o Health; the Ministry o Agricultureand Cooperatives, the Ministry o Livestock andFisheries Development; the Ministry o LocalGovernment and Housing; and the Ministry oourism, Environment and Natural Resources.

I wish to acknowledge the valuable inputsrom external peer reviewers rom the Universityo Zambia, Mulungushi University, the UNDPRegional Service Centre or Eastern and SouthernArica and the UNDP Human DevelopmentReport Oce in New York. A Readers Groupwithin the UNDP Country Oce was constitutedto enhance the quality o the report, and I thankthem or their eorts in nalizing it. Specialthanks also go to all my other colleagues at UNDPwho contributed in one way or another to making

the production o the report possible.Finally, I would like to acknowledge the

contributions o ormer UNDP ResidentRepresentative Mr. Macleod Nyirongo andormer Economic Advisor Mr. John Wayem, whoinitiated the preparations o the report. Let mealso note with deep appreciation the invaluablesupport and inputs rom the current ResidentRepresentative, Ms. Kanni Wignaraja.

Viola MorganUNDP Country Director

List o preparation team members on page 128


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Zambias Human Development Balance Sheet

Progress Challenges

Overall human development

Zambias human development improved in the 2000s,ollowing the decline in the 1990s.

At 0.395, Zambias ranking on the Human DevelopmentIndex (HDI) is above the average o 0.389 or Sub-Sa-haran Arica, and slightly above the average o 0.393 orlow-HDI countries.

Te level o human development in Zambia is still low.

Income and poverty

Extreme poverty declined rom 58 percent in 1991 to 51percent in 2006.

Extreme poverty in rural areas declined rom 81 percentin 1991 to 67 percent in 2006.

Extreme poverty in urban areas declined rom 32 percentin 1991 to 20 percent in 2006.

Per capita income has increased rom US $635 in 2005 toUS $970 in 2009.

Te economy is stable with declining infation and eco-nomic growth averaging 5.5 percent in the recent past.

At 51 percent in 2006, overall extreme poverty is stillhigh.

At 67 percent in 2006, extreme poverty in rural areas isespecially high.

Economic growth is driven by capital-intensive sectors,and has limited impact on community welare.

Despite macroeconomic stability, interest rates have re-mained high, and in the last ve years, domestic debt hasbeen going up.

Education

Net enrolment rates or grades one to seven increasedrom 94.7 percent in 2005 to 101.4 percent in 2007.

Net enrolment rates or grades one to nine increased rom93.5 percent in 2005 to 99.5 percent in 2007.

At 1 to 57, the primary-teacherpupil ratios have re-mained above the recommended standard.

Te low proportion o domestic unding is a source oconcern.

Te low level o unding or tertiary education poses athreat to the development o science and technology.

Gender inequalityTe percentage o land titles issued to women increasedrom 5 percent in 2005 to 16.5 percent in 2009.

At 0.82, the ratio o girls to boys at secondary school levelremained below one to one in 2007 and 2008.

In 2007, the ratio o girls to boys in tertiary educationremained below the one-to-one benchmark.

Mainstreaming gender into the development process hasremained a challenge.

In the ormal sector, male employment accounted or 71percent, compared to 29 percent or emales.

Child mortality

Tere has been a reduction in under-ve mortality rom191 deaths per 1,000 live births in 1992 to 119 deaths per1,000 live births in 2007.

Te absolute level o child mortality is still high.Te impact o HIV and AIDS has kept child mortalityhigh.

Maternal mortality

Te maternal mortality ratio has declined rom 729deaths per 100,000 live births in 2002 to 591 deaths per100,000 live births in 2007.

Although declining, the absolute level o maternal mor-tality is still high.

Reproductive health services are worse in rural settings,where maternal mortality is higher.

Sae motherhood is not well integrated in reproductivehealth interventions.


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HIV and AIDS, malaria and other diseases

Te number o people tested or HIV increased rom234,430 in 2006 to 1,050,00 in 2008.

Te prevalence o HIV declined rom 16 percent in 2002

to 14.3 percent in 2007. In 2009, HIV incidence wasestimated at 1.6 percent or 82,000 new inections.

Te number o people on anti-retroviral treatment (AR)increased rom 30,112 in 2005 to 283,863 in 2009.

Te number o new malaria cases declined rom 412 in2006 to 252 in 2008.

Te tuberculosis notication rate decreased rom 419 per100,000 in 2007 to 408 per 100,000 in 2008.

Te high proportion o donor unding or both the HIVand malaria programmes is a source o concern withrespect to sustainability.

Te human resource crisis in the health sector has limitedattainment o health sector goals.

Water and sanitation

A higher proportion o the sector budget was allocated torural water and sanitation.

Tere is a high level o donor commitment to undingprogrammes in the sector.

Te proportion o households without access to sae waterdeclined rom 51 percent in 1991 to 40 percent in 2006.

Te percentage o people without sanitation increasedrom 26 percent in 1991 to 36.1 percent in 2006.

Te country has continued experiencing annual outbreakso cholera.

Te monitoring and evaluation systems or the sector areunderdeveloped.

Equity

Economic growth accelerated to 5.5 percent over the past10 years, compared to spells o decline and stagnation inthe previous decade.

Tere is wide interest in implementing pro-poor pro-grammes.

User ees were removed in health and education.

Tere was an introduction o sta rural retention schemes.

Accelerated economic growth was accompanied by highand increased income inequality, with the Gini index ris-ing rom 47.4 in 1996 to 52.6 in 2006.

Employment and sustainable livelihoods

imely government intervention ensured job protectionduring the 2008-2010 global nancial and economiccrises.

Male unemployment declined rom 18 percent in 2004 to13 percent in 2006.

Unemployment increased rom 9 percent in 2004 to 15percent in 2006.

Urban unemployment increased rom 21 percent in 2004to 32 percent in 2006

Environmental sustainability

Te national policy on environment was completed.Te national climate change adaptation programme oaction was launched.

As part o eorts to reduce deorestation, 500 hectareswere planted.

Environmental issues have not been ully integrated intodevelopment programmes.

Tere is a lack o national capacity or environmentalmanagement.

Te country lacks a comprehensive environmental rame-work that charts a pathway consistent with internationalinstruments.

Tere is limited inormation on the ull extent o environ-mental degradation and climate change.

Politics, governance and human rights

Te National Constitutional Conerence completed its

deliberations and prepared a drat Constitution.Sector advisory groups have been critical in guiding poli-cies and programmes.

Some major stakeholders have expressed dissatisaction

with the non-inclusion o important clauses in the dratConstitution.

Some sector advisory groups are not very active.


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Although the level o human developmentin Zambia is still low, there has been apositive and sustained change between theyears 2000 and 2010, compared to the situationbetween 1990 and 2000. In that period, thecountry witnessed a sustained decline, reaching itslowest-ever ranking on the HDI o 0.32 in 2000.

Since then, improvements have been observed inall key dimensions o the index: health, educationand material wealth. At 0.395 in 2010, ZambiasHDI ranking was above the average o 0.389 orSub-Saharan Arica and also slightly above theaverage o 0.393 or low HDI countries1.

Te recent resurgence o consistent economicgrowth gives hope that Zambia could improve itshuman development status to pre-1980 levels andhigher. Te attainment o human developmentlevels compatible with Zambias vision oreaching middle-income status by 2030, however,will require the removal o a number o structuralbottlenecks. Macroeconomic stability and positiveeconomic growth need to be translated intomarked declines in poverty, including throughbroad-based and pro-poor strategies that addresspoverty in all its dimensions.

Te change in the level o human developmenthas been analysed with reerence to the changes inservice delivery in our main sectors: agriculture,

education, health, and water and sanitation.Zambias service delivery perormance hasimproved on a number o ronts, but bottlenecks

slow the attainment o even better humandevelopment outcomes. Te main challenge liesin the skewed distribution o services acrossindividuals and regions in the country, vulnerabilityto climate change and the economic and nancialcrises, and the overlapping deprivations sueredby many. Interprovincial comparisons point to a

skewed economic and human development processbiased towards urban areas. Predominately ruralprovinces, such as Western, Northern, Luapulaand Eastern, are characterized by lower education,poor health outcomes, low lie expectancy andlower incomes.

Improving the coverage, eciency andeectiveness o essential services in agriculture,education, health, and water and sanitation may becrucial prerequisites or human development, butthis is not sucient. Te ability o people and theirinstitutions to participate in decisions that aectthem, and the power they possess to infuencechange are important or sustainability. Servicedelivery must go hand-in-hand with high levelso accountability, the guarantee o basic humanrights, and the empowerment o individuals andstate and non-state institutions at the rontlineo service delivery. For Zambia, this means thatall eorts should be directed towards avoidingunnecessary delays in the planned devolution o

decision-making to local authorities. It also entailsthe creation o space or the greater involvemento non-state actors in service delivery.

OverviewService Delivery or Sustainable Human Development

1The gures are based on the new methodology o calculating the HDI, as articulated in UNDPs 2010 global Human Development Report.


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Agriculture

Te growth o the agricultural sector has beenmostly positive, but on average lower than that oothers. Driven by good weather and supportivegovernment policies, crop production, especially

o maize and other cash crops, has been increasing,bringing some improvements in ood security.

Te sector remains highly vulnerable to globalmarket instability, however, and has suered amajor decline in exports. In the ace o rising ueland energy prices stemming rom the recent globalnancial and economic crises, the tilt in budgetallocations towards areas such as the FertiliserSupport Programme and the Food ReserveAgency has been costly, without the desiredeect o increased productivity. Allocations toother potential areas o growth, such as livestock,sheries, rural inrastructure, irrigation, researchand extension services, remain inadequate.Reorientation o government expenditures willbe crucial in better service delivery and strongersector perormance.

Agricultural extension services requiresubstantial improvements and better balancingbetween support or crops and livestock. Giventhe steady reduction in conventional extension

service provision, service delivery led by theprivate sector has been playing an increasinglyimportant role. Enhanced collaboration between

government and NGO providers oers somewin-win opportunities.

Achieving eective service delivery at thelocal level will require an enabling decentralizedstructure. Better-developed decentralizedagriculture operations could be improved throughcomplementary local structures or key line

ministries, such as the Ministry o Lands, and theMinistry o Works and Supply.

While production-targeted programmescould achieve desired agricultural output levels,marketing the output presents unique challenges,especially or small-scale armers. Resolvingmarket problems or rural armers will requirecapacity-building initiatives targeting bothindividuals and cooperatives.

Education

Reorms implemented in the educationsector starting in 1990 have resulted in notableimprovements in basic education, refected inhigher levels o access and participation. Girls,orphans and vulnerable children have achievedhigher enrolment rates, and there is greater equityin education.

Te quality o services remains poor, however.Beyond basic education, access and participation

have been lower than desirable, and genderand regional disparities remain high. Te slowpace o decentralization and the lack o a legal


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ramework or local institutions have resultedin limited local participation and accountability,which has hindered improvements in the qualityo education and skills necessary or sustainablegrowth and human development.

Pre-school education requires more attention.

Tere is a need to guarantee the rights o childrenat pre-school level and those o persons withdisabilities. Te recent reduction by hal in theparticipation o children with special educationneeds in high schools, and the decline in thenumber o emales receiving bursaries in basicschools, are examples o how such groups can belet unprotected in times o crisis.

Investments in school inrastructure andteaching sta have been impressive, butinsucient to meet demand and address braindrain and the challenges o HIV and AIDS.Te ragmented institutional ramework in theeducation sector could be reviewed, and variousprogrammes streamlined and rationalized toincrease the eciency, eectiveness and equity oservice delivery beyond post-basic education.

In line with its Sixth National DevelopmentPlan, Zambia could adhere to its target oincreasing access to post-basic and tertiaryeducation and improving quality at all levels by

developing innovative ways to encourage public-private partnerships in education, among otherstrategies.

Health

Over the past two decades, health servicedelivery has improved and attained positiveoutcomes. Child and maternal mortality rateshave declined; the spread o new HIV inectionsis halting; the incidence o tuberculosis has been

reversed; and the malaria incidence has beenreduced. More eort is required to accelerateprogress towards the Millennium DevelopmentGoals (MDGs) and achieve even better healthoutcomes. Child and maternal mortality are stillunacceptably high; epidemics are still a majorcause o chronic illness and death; and nutritionhas not improved since the early 1990s.

Accelerating investments and prioritizingpackages o high-impact interventions in scalingup health services is warranted. Tere is globalconsensus as to what constitutes such packagesor child mortality, maternal mortality, and HIVand other diseases. Te consistent implementation

o these, over a decade, could enable the countryto signicantly improve the health status o thepopulation and advance human development.

Zambias health workorce needs urgentexpansion and continuous upgrade o its qualityand perormance. Tis requires concertedmeasures to enhance the capacities o traininginstitutions, to motivate and retain sta inhealth acilities, particularly in rural areas, and toincrease productivity. Options may also need to beconsidered to shit the skills mix o health workersin avour o polyvalent sta at the communityand primary health care acility level, as close tothe amily as possible.

Access to adequate inrastructure, medicalequipment and essential drugs at all times isrequired or assuring quality care. argeted capitalinvestments and technical support at all levelscould strengthen health systems and improveservice delivery. Support rom the Global Fund orAIDS, uberculosis and Malaria has been critical

in that regard, and could be complemented bydomestic revenues or long-term sustainability.Hospitals in Zambia could benet rom

technical and managerial improvements related topatient management, quality assurance and otheroperational systems. Policy reorms in these areasare required to strengthen hospital capacities andimprove service delivery.

Specialist treatment abroad at the expense opublic unds is costly and inequitable. Te buildingo local capacities to handle most specialist

treatments and diagnostics, patient managementtools and other requirements could thereore beexplored.

Water and sanitation

Progress has been made in access to water inrural and urban areas over the recent past. Tis will


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A shortage o staaects the qualityo services and

partly accounts orthe low level ohuman develop-ment in Zambia.

Quality im-

provements inservice deliveryare crucial orensuring access tosae water.

Progresshas been made

in service delivery

in all our sec-tors.

Eective-ness and eciency

in the quality oservices is a missinglink or sustainablehuman develop-

ment.

Inadequatelyskilled human

resources are a seriousbottleneck or service

delivery, aggravated bylow motivation and

productivity.

likely be sustained in the coming years. Improvedinvestments in inrastructure and the capacitieso providers could urther expand coverage andenable access to clean water or the majority othe population.

Te policy, legislative and regulatory ramework

could be urther strengthened to increase thecommercial sustainability, eciency and qualityo water services.

Sanitation services remain unsatisactory.Solutions lie in options or enhanced nancing,the diusion o technologies that are appropriateand cost eective, and the adoption o approachesthat build on the participation o beneciaries inthe design, development and management o thesanitation acilities, as well as in drilling boreholesand investing in rainwater harvesting.

Insights rom the Sector Analyses

Agricultural production has increased andthe country has in recent years made progresstowards greater ood security. Te health sectorhas managed to reduce child mortality; maternalmortality; and the incidences o HIV, tuberculosisand malaria, although levels o morbidity andmortality rom these health hazards are stillunacceptably high. In basic education, accessand participation have improved. More people inboth urban and rural areas have access to cleanwater and sanitation, although the numbers arelow relative to population.

Zambia has cases o eective and ecientservice delivery. In all our sectors, progress hastended to emphasize growth, increased coverageand scale up o interventions. Te quality

dimension has lagged behind, and needs toimmediately appear on the policy agenda in orderto improve human development. Moresystematic dissemination o bestpractices and success stories, andthe introduction o perormance-

based contracting are steps thatcould increase peer learning whileocusing on achieving better quality.

All our sectors ace critical shortageso skilled sta, which compromisesservice delivery and humandevelopment. Te productivity oexisting sta is oten very low.More could be attained i thecurrent sta was better motivated,HIV and AIDS management was

eectively incorporated in workplaceprogrammes, tardiness was eliminatedand more managerial time was allocated towardsperormance management. Programmescould be enacted or enhanced toimprove the retention o skilledsta, particularly in rural areas.

Te private sector has thepotential to augment thepublic provision o services.Nonetheless, all our sectorsexhibit restraint in tapping intoit. Te recent approval o a Public-Private Partnerships Policy under the Ministryo Finance and National Planning has providedsome space or sectoral dialogue in this regard,creating an opportunity or initiatives to enhanceservices.


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Chapter 1Service Delivery and Human Development

Z

ambias Human Development Report2011: Service Delivery or SustainableHuman Development in Zambia covers

the period between 1990 and 2010. It presentsboth quantitative and qualitative data, mostlygathered through desk reviews and supplementedwith interviews o key inormants in Lusaka, andCentral and Southern provinces. In this chapter,basic concepts or assessing human developmentand its links to service delivery are dened andplaced within the context o the pursuit o theMDGs in Zambia. Detailed assessment o theMDGs, however, is beyond the scope o thisreport.

Chapter 2 discuses key policy developmentsover the stated period, and the role policy-makinghas played in shaping human development. Long-term trends in poverty and development areexamined using contemporary monetary measureso poverty and general indicators o development.Chapter 3 presents long-term trends in Zambiashuman development as measured by the HDIand other measures o human developmentintroduced in 2010. Tese include the Inequality-

adjusted Human Development Index (IHDI),the Gender Inequality Index (GII) and theMultidimensional Poverty Index (MPI). Teindices were compiled using data rom various

national surveys on poverty conducted by theCentral Statistical Oce. Further explanationsregarding the compilation and use o these indices

are given in the echnical Note and Annexes tothis report.Te rest o the report devotes a chapter each

to agriculture, education, health, and water andsanitation. Key dimensions o service deliveryare addressed, namely: the utilization o scarceresources to produce services equitably; eciencyin terms o the results-orientation o servicedelivery processes, as measured by accessibility,utilization and quality o services; and eectivenessor impact, in terms o tangible outcomes o service

delivery classied by economic and social eects atthe programme level, and ultimately made visibleat the level o human development. Te reportends with a presentation o general conclusionsand recommendations or uture action.

Conceptual Framework

Human development is dened as the process oexpanding peoples reedoms to live long, healthy

and creative lives; to advance towards other goalsthat they have reason to value; and to engageactively in shaping equitable and sustainabledevelopment on a shared planet (UNDP 2010, p.


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22). People are both beneciaries and drivers ohuman development, as individuals and in groups.Tis denition is underpinned by the philosophicalpremise that all human beings desire to enjoywell-being, security, empowerment, justice andreedom. Fundamental to enlarging their choices

is the building o human capacitiesthe range othings that people can do or be in lie. Investingin people will enable growth and empower people,thus developing human capacities.

According to the 2010 global HumanDevelopment Report, the most basic capabilitiesor human development are to lead long andhealthy lives, to be knowledgeable, to haveaccess to resources and social services neededor a decent standard o living, and to be able toparticipate in the lie o the community. Without

these, many choices are simply not available, andmany opportunities in lie remain inaccessible.

Te antithesis o human development is humanpoverty, dened by the United Nations as acondition o deciencies in human development,namely, the lack o a long and healthy lie, the lacko knowledge and the lack o a decent standard oliving. Poor households have the right to sustainthemselves by their labour, and to be reasonablyrewarded and aorded some protection rom

external shocks. Many people identiy water,education, health care and ood security as theirhighest priorities. Te delivery o basic services isthus central to reducing human poverty.

Service delivery is a problem-solvingprocess that provides the means by whichhuman development goals can be achieved ina systematic waythe delivery o inputs andoutputs leading to certain outcomes or resultsthat have socioeconomic impacts on individuals,households and communities. Service delivery

can be useully conceptualized as the relationshipbetween policy makers, service providers andconsumers o services, and encompasses bothservices and their supporting systems (Slaymakeret al. 2005).

Te term service delivery urther carries withit the connotation o groups o actors (state ornon-state) deriving income or livelihoods romproviding goods and services to the generalpublic, which in turn expresses appreciation bypaying or services or keeping governments inpower. Some services are delivered through costlyinrastructure, while others may have very highworking costs and are subject to externalities.

Conceptual ramework: Linking servicedelivery to human development

FIG

URE1.1

Although the provision o some basic servicessuch as education and health is largely theresponsibility o governments, the privatesector also has an important role to play. Sinceservice provision is subject to market ailures orexternalities, however, the private sector acting

alone is unlikely to be able to achieve the levelsbeneciaries expect. Tus, service delivery is botha technical and governance issue. Determininghow the government can assume this undamentalresponsibility in a satisactory manner is o criticalimportance.

Te conceptual ramework in Figure 1.1 showsa eedback relationship between service delivery,sustainability and human development. Teservice delivery process involves important policychoices that have several aspects, beginning with

which services to deliver, how and or whom. Tesechoices determine access, utilization and qualityo services, which are important determinantso the level o human development. Followingthe 2010 global Human Development Report, therichness o the human development concept hasbeen illustrated using three components: peoplesopportunities; process reedoms (aecting peoplesability to shape their lives); and key principles ojustice that shape processes and outcomes across

people, time and space.Several policy choices must be made. Te 2010global Human Development Report emphasizesthat these are not unconstrained. Some arebetter or poverty reduction, human rights andsustainability. Others are less eective becausethey avour elites, dismiss reedom o associationand deplete natural resources. When servicedelivery is ounded on the concepts o humandevelopment, it will embrace issues o justice,equity and sustainability, thus emphasizing some


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services and their modes o delivery over othersin an inormed and democratic way. In the UNcontext, equity is the idea o airness or everyperson; everyone has the right to an educationand health care. No one should be excluded romsuch services because o their inability to pay.

Figure 1.1 urther shows that service deliveryhas important socioeconomic impacts thatwill ultimately determine the level o humandevelopment and its sustainability. Tese willbe refected in various dimensions o socialand economic well-being, namely povertyreduction, knowledge, health and environmentalsustainability. Te link between service deliveryand the level o human development is notautomatic, and in poor economies quite otenrequires action on the demand side.

For example, a close link between the qualityo services in education and health and economicgrowth has been noted (Schweitzer 2007). Povertyand the absence o disposable income increasethe chances that children are malnourished, suerrom avoidable diseases and disabilities, developlearning disabilities and drop out o school, thusperpetuating a cycle o poverty. Te neglect osanitation has been cited as a leading cause odisease and learning disabilities in children (ibid).

Under these circumstances, improved access toeducation may not have the desired eect onknowledge. Service delivery needs to go hand-in-hand with investments in programmes thatincrease the income o the poorcommunitydevelopment, micro-credit, sel-help groups,etc.and measures to increase demand oreducation and health rom disadvantaged andmarginalized groups.

As successive human development reportshave shown, beyond income and basic services,

individuals and societies can be poorand tendto remain soi they are not empowered toparticipate in making decisions that aect theirlives. Poverty reduction is better measured interms o basic education, health care, nutrition,and water and sanitation, in addition to income,employment, and wages. Such measures mustserve as a proxy or other important intangibles,such as eelings o powerlessness and lack oreedom to participate.

Empowerment is the process o enhancingthe capacities o underprivileged individuals andgroups through democratic practices at dierentlevels. In accordance with the 2010 global Human

Development Report, empowerment involvespeople as being more than just beneciaries;their vision, ingenuity and strength are vitalto advancing their own and others well-being.Being empowered means that they are able tobring about change in their own lives, amilies

and communities, in part because supportiveinstitutional structures are in place.An important link between service delivery

and human development involves sustainability.According to the United Nations, sustainabledevelopment is development that meets the needso the present without compromising the abilityo uture generations to meet their own needs(Brundtland Commission). Te limits placed onsustainable development have been recognized.Civil strie, global economic and nancial crises,

gender inequality, amine, diseases such as HIVand AIDS, environmental disasters and climatechange have become common threats.

On the supply side, service delivery tends to beaected by governance, dened as the exerciseo economic, political, social, technological andadministrative authority to manage a countrysaairs at all levels. It comprises mechanisms,processes, and institutions, through whichcitizens and groups articulate their interests,

exercise their legal rights, meet their obligations,and mediate their dierences (UNDP 2001).A key measure o governance is the quality andavailability o essential services such as health careand primary education services, which comprise acore element o the social contract. Public accessto good services indicates that a society is wellgoverned and enables the political leadershipto draw continued support or its programs.Te relationship between service delivery andgovernance has been summarized in Figure 1.2.

Te accountability triangle

FIG

URE1.2

Source: World Bank, 2003


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From a political economy perspective, dierentgroups in society will have dierent visions aboutwhat makes good service delivery. Te result mayor may not involve the state providing servicesdirectly, as long as the services are in act delivered.Figure 1.2 shows that services can be delivered

through the long route o voice, compact andcentralization, or the shorter route o devolutionand empowerment, which brings rontline serviceproviders and clients more closely together.

A critical ingredient is accountability. Non-prot and civic organizations can in the shortterm deliver critical services such as healthcare by acting in parallel with government. Butlonger-term sustainability requires strengtheningaccountability linkages through mechanismso voice and compacts such as public-private

partnerships, and developing governmentcapacity so that the state can properly perorm itsdecision-making unctions.

Service Delivery and the Attainment o theMDGs

Achieving quality service delivery or the poorrequires global action to complement actions bycountries and local communities. At the global

level, a commitment to this aim is refected in wideacceptance o the human development paradigm,in which people are at the centre o development,bringing about development o the people, by thepeople and or the people. Over the last decade,this position has been strengthened by nationaland international commitments to achieve theMDGs. Te goals are essentially an agenda ortargeted improvements in the core areas o humandevelopmentto be knowledgeable, to haveaccess to essential resources and social services,

to acquire a decent standard o living and to beable to participate in the lie o the community.Eective service delivery is critical in realizingthe MDGs. Te rest o this chapter provides asynopsis o Zambias progress in this regard.

MDG 1: Eradicate extreme poverty andhunger

Between 1991 and 2006, Zambia achieveda modest reduction in extreme poverty o 7.5percent. o attain the MDG target on extremepoverty, Zambia needs to reduce the proportion

o people who live in extreme poverty by 21.5percent between 2006 and 2015 (UNDP and theGovernment o the Republic o Zambia 2011).

Te challenges militating against expeditedreduction o extreme poverty and hungerinclude the inecient allocation o resources in

the agriculture sector, which has hindered ruraldevelopment. Tere are severe income inequalities,poor access to business nance and capital, andhistorical public expenditure biases that avoururban areas. o the extent that women aredisproportionately represented among extremelypoor populations, interventions targeting thisgroup would yield better results, but womencontinue to ace constraints in accessing productiveresources and essential public services.

By contrast, good progress has been made in

reducing the national proportion o people whosuer rom hunger; only a reduction o twopercent is required to achieve the 2015 target.Declining infation and supportive social policiesare largely responsible or this.

o achieve the MDG on poverty and hunger,the Government could come up with a holisticapproach, which could be incorporated into thenational development plans. Specic interventionscould include rolling out careully targeted and

sustainable social cash transers, support orraising smallholder arm productivity, businessdevelopment services, small grants, micronanceor poverty reduction, the promotion o livestockproductivity and employment in labour-intensivesectors.

MDG 2: Achieve universal primary education

Good progress was made towards the attainmento this goal. Both net enrolment and the number

o pupils reaching grade seven grew steadily overthe years, and the targets have been achieved.Adult literacy rates, however, declined between1990 and 2004; no data are available to determinerecent trends. Factors explaining the otherwisepositive environment include promulgation o thenational educational policy, which allowed sub-sector policies and programmes to be articulated.Te Ministry o Education has implemented theree education policy enunciated in 2002, alongwith steps to reach the global Education or AllGoals adopted in 2000, which call or ensuringthat all boys and girls are able to attend school.


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Gender mainstreaming through the Programmeor the Advancement o Girls Education has alsohelped improve enrolment.

Remaining challenges include the poor qualityo education, and the loss o human capital,teachers in particular, due to HIV and AIDS.

Te poor conditions o service in the sectorhave resulted in teacher resignations. Indicatorso quality shortalls comprise poor achievementlevels, poor learning environments, a lack olearning and teaching materials, and highpupil-teacher ratios. Due to high poverty levels,especially in rural areas, some children ail to enrolin schools. Inconsistencies in the implementationo the ree basic education policy, such as boardingees, prohibit some children rom accessingeducation.

MDG 3: Promote gender equality and empowerwomen

Between 2005 and 2009, the ratio o girls toboys in primary school was airly stable, at a levelclose to the target ratio o one to one. But theratio o girls to boys in secondary school hasundergone a notable decline, rom 0.92 in 1990to 0.88 in 2009.

Important achievements include the adoptiono the Gender-based Violence Act, a modestincrease in the number o women with titles toland, and an increasing (albeit modest) proportiono women in leadership positions. Te proportiono girls in tertiary education has increased,although with marked fuctuations. In terms opolitical representation, the country is ar romreaching the Southern Arican DevelopmentCommunity standard o a minimum o 30 percentor women.

Factors accounting or partial achievements inattaining MDG 3 include the implementation othe Joint Gender Support Programme developedby the Government and cooperating partners tostrengthen the national capacity to mainstreamgender. Capacity-building activities at all levels othe Government have been stepped up. Furtherachievements are constrained by delays in enactingvital pieces o legislation, however, such as theull domestication o the UN Convention onthe Elimination o All Forms o Discriminationagainst Women.

Enhancing collaborative service deliveryamong government units would urther

improve the chances o attaining MDG 3, alongwith sustaining capacity building or gendermainstreaming. Early pregnancies and marriages,girls dropping out o school, the disproportionateimpact o HIV and AIDS on women, and thepersistence o attitudes and belies that rate men

as superior to women all adversely aect genderequality and womens empowerment.

MDG 4: Reduce child mortality

Tere has been a reduction in inant mortalityrom 95 per 1,000 live births in 2003 to 70 per1,000 in 2007, compared to the target o 30 per1,000 by 2015. Te under-ve mortality ratesimilarly ell rom 191 per 1,000 live births in1992 to 119 per 1,000 in 2007, compared to

the target o 63.6 per 1,000 by 2015. Improvedimmunization between 1992 and 1996 appearsto explain some o the decline in mortality rates.Progress in this area has remained stagnant at 84percent o all one-year-old children since 2002.

Among the interventions to achieve thesetargets are: the Reach Each District strategy,introduced to increase immunization coverage;National Immunization Days and annual ChildHealth Weeks; improved logistics, vaccines

and cold chain acilities; and the integratedmanagement o childhood illnesses. Furtherreduction in child mortality will require moreconcerted actions, especially those targetingHIV and AIDS. Signicant reductions in inantmortality will require reducing paediatric HIVinection levels and investing in the preventiono mother-to-child transmission. As with otherservices, over-dependence on donor unding inthis area is a major threat to sustainably achievingthe targets. Te human resource crisis continues

to exert a severe negative impact as well.

MDG 5: Improve maternal health

Tere has been a reduction in the level omaternal mortality rom 729 deaths per 100,000live births in 2002 to 591 deaths per 100,000live births in 2007. Te target is to reduce thematernal mortality ratio to 429 deaths per 100,000live births by 2015. Te main actors that havecontributed to progress comprised: the scalingup o long-term methods o amily planning to33 districts; the expansion in the provision oemergency obstetric care rom 18 to 50 districts;


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improved reerral systems; and the growth o saemotherhood groups rom 12 in 2008 to 43 by theend o 2009.

Tere are, however, some major actorshindering the attainment o this goal. Teseinclude inadequate access to health acilities,

which orces many women, especially in ruralareas, to deliver at home. Te scourge o HIV andAIDS is a urther constraint. Over-dependence ondonor unding and shortalls in human resourcesaect this goal as well.

MDG 6: Combat HIV/AIDS, malaria andother major diseases

With the recorded decline in the prevalence oHIV, rom 16 percent in 2002 to 14.3 percent in

2007, the target o keeping prevalence under 16percent has already been achieved. HIV incidenceis estimated at 1.6 percent or 82,000 newinections annually (Government o the Republico Zambia 2009).

New malaria cases, which had increased rom255 per 1,000 in 1990 to 412 per 1,000 in 2006,declined to 252 per 1,000 in 2008. Tis is in linewith the target o 255 by 2015.

Support or achieving this goal has come rom

the development and implementation o policiessuch as the National HIV/AIDS/SI/B Policy;the promotion o multisectoral coordination andcollaboration through a parliamentary act thatestablished the National HIV/AIDS/SI/BCouncil; the introduction o HIV and AIDSpolicies in work places; more partnerships amongmajor stakeholders; and the establishment omore AR centres countrywide. Other actorshave included: enhanced training o medicalsta to administer AR; recruitment and

retention o medical personnel; development ouniversal access initiatives; continued expansiono voluntary counseling and testing (VC);improved measures or provision o sae bloodtransusion services; paediatric initiatives toprovide ARs to children; and the identicationo six key drivers o the epidemic (i.e., multiple andconcurrent sexual partners, low and inconsistentcondom use, low levels o male circumcision inmost provinces, mobility and labour migration,high-risk behaviours among sex workers and inmale-to-male sexual relationships, and verticaltransmission rom mother to child).

Challenges remain related to negative culturalpractices and the poor economic status o womenand girls, which prevent them rom demandingsaer sex; a lack o comparative data orreporting and policy ormulation; adverse actorsimpacting VC uptake (such as ear, stigma and

discrimination, and inadequate privacy, space andcondentiality); health personnel inadequatelytrained to handle the increased disease burdenrelated to HIV and AIDS; human resourcesshortages due to mortality mostly attributed toAIDS-related complications and migration; lowcondom usage and low male circumcision.

MDG 7: Ensure environmental sustainability

Tis MDG requires that Zambia and other

countries integrate the principles o sustainabledevelopment into country policies andprogrammes, and reverse the loss o environmentalresources. Assessing perormance on reversals isdicult because o the absence o reliable data.Available data show that the area covered byorests has declined rom 59 percent in 1996 to38 percent in 2010, while the population usingsolid uels increased rom 86 percent in 1990 to88 percent in 2007. Te consumption o ozone-

depleting products declined rom 95.57 tons in1996 to 43 tons in 2004, but a lack o data since2005 makes it dicult to assess recent trends.

MDG 7 calls or halving the proportion opeople who do not have sustainable access tosae drinking water and sanitation by 2015.Te proportion o Zambias population withoutaccess to improved water sources declined rom53 percent in 1996 to 43 percent in 1998, but hasstagnated at around 40 percent in recent years.Te percentage o the population without access

to improved sanitation has increased since 1991,when it was at 26 percent, although it seems tohave stagnated at around 36 percent since 1998.Contributing to this poor perormance is thelack o overall investment in water supply andsanitation.

MDG 8: Developing a global partnership ordevelopment

Zambia has regained and sustained animpressive record o macroeconomic stability,achieved single-digit infation and consistently


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had growth rates over ve percent or the pastve years. Ocial development assistance (ODA)increased rom US $754 million in 2002 to US$918 million in 2009, and the Highly IndebtedPoor Country (HIPC) and Multilateral DebtRelie (MDR) initiatives reduced Zambiasdebt-servicing obligations. External public debtdropped rom US $6 billion in 1999 to US $934million in 2006, but subsequently increased to US$1.5 billion in 2009.

In 2010, Zambia was considered the sixth bestcountry in Arica or doing business. Signicantoreign direct investments have fowed in. From1995 to 2005, the country received an annualaverage o US $211 million. From 2006 to 2009,the gure rose to US $960 million annually. Teocus now must be on improving competitiveness,where Zambia ranks at 115 out o 139 countries(World Economic Forum 2011).

Policies should be targeted at easing supply-side constraints in transportation, storage,communications and the access o localentrepreneurs to open markets, particularlyor agricultural produce. Eorts to expand thedomestic revenue base through eective taxationpolicy and its ull administration are critical,as ODA shows greater volatility and may evendecline in coming years. Te use o scal space or

increased investments in human development isa strategy used eectively by countries that showsignicant progress on human development.Easing regional and global trade barriers throughcommon agreements will be key to a more robustand open trading regime that spurs balancedgrowth. At the same time, cooperating partnersmust also meet the agreed ODA target o 0.7percent o their gross domestic product (GDP) tosupport the achievement o the MDGs by 2015.

Conclusions

Service delivery is central to attaining humandevelopment. It is a technical and governanceissue, but it also impinges on peoples rights.Determining how the government, in partnershipwith private entities, can discharge its duties in asatisactory manner is o critical importance.

For Zambia, service delivery bottlenecks areamong the key actors slowing progress on anumber o the MDGs. Although the countryis making some progress, the magnitude andpace o change vary by goal. A more supportiveenvironment and more eective delivery oessential services is required to accelerate andmake coordinated progress on all eight MDGs.

Te University eachingHospital is an important centre

or sta development. Whilebeing a tertiary level healthcare institution, it has not beensupported by a district hospital

providing primary and second-ary level care or the people o

Lusaka.

Photograph: UNDP Zambia


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D

uring Zambias immediate post-independence period, most policyreorms placed people at the centre, as

the Government sought to address the inequitiesaecting its citizens through deliberate state-supported service delivery. Tere was widespreadstate ownership o assets and governmentintervention in production, marketing, anddistribution o goods and services in all sectorso the economy and society. Free access to healthcare, education and other social amenities helpedreduce some inequities between rural and urbanareas. Tis was consistent with what has currentlybeen termed the basic rights approach.

Over time, however, with a slump in thecopper mining industry in the 1980s and 1990s,and the slow pace o economic diversication,the Governments ability to provide servicesdeclined. Tis partly explains the rapid all inhuman development prior to 1996. While the

mining sector has been key in providingemployment opportunities and

contributing to export earnings,its tax contributions were less

than expected during the FithNational Development Plan,although they have increased in

recent years (Ministry o Finance

Chapter 2Zambias Policy Environment

and National Planning 2010). Partly as a result othe impact o mining rents on exchange rates, othersectors such as agriculture became internationally

less competitive and did not perorm accordingto potential, resulting in a development processbiased towards urban areas.

Beginning in 1992, comprehensive economicpolicy reorms were introduced, marked by statewithdrawal rom direct ownership o assets andthe curtailment o government interventions.Economic liberalization, commercializationand privatization o services, as well as greaterdemocratization o political, social and economicinstitutions came to constitute the main ocus opublic policy. Pluralism has allowed many actorsto enter the systems as agents, service providersand lobbyists. Te role o the state has changed,along with needs or publicly unded servicesand the types o institutions required to providethem. Te move towards decentralization hasbecome stronger, with increased demands orscal devolution and the provision o services bymunicipalities. Tese are among the major actorsprompting changes in service delivery over the

last 10 years.Owing in part to the long period o economicstagnation, however, and despite progress in keyareas such as privatization and budgetary reorms,

The econo-my remains depen-dent on the copper

mining sector, which hasweak linkages to therest o the economy.

Te Policy Context


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overall change has been slow. Economic eciencyand eectiveness have been less than desired.

Poverty rends

Poverty2 as measured in monetary terms haspreoccupied policy makers; all economic policiesand programmes implemented in recent yearshave poverty eradication as the recurring theme3.Noteworthy are the Poverty Reduction StrategyPaper (2002-2004), the ransitional National

Development Plan (2002-2005), the FithNational Development Plan (2006-2010) andthe Sixth National Development Plan (2011-

2016). Te outcome between 2004 and 2006 wasa modest decline in poverty at the national level,mostly avouring urban areas. According to able2.1, the level o poverty, estimated at 64 percent in2006, was still very high, although poverty reachedits peak in 1993 at 84 percent and has been onthe decline since then, reaching its lowest level in2006. Rural poverty increased rom 78 percent in2004 to 80 percent in 2006. At 84 percent in 2006,Western Province was experiencing the highestlevel o poverty. Te Eastern, Northern and

Southern provinces witnessed increases in overallpoverty rom 2004 to 2006, while poverty declinedin Lusaka and Copperbelt provinces.acTe 2006

Trends in selected macroeconomic indicators, 2000-2010

Indicator 2004 2005 2006 2007 2008 2009* 2010*

Annual infation 18 18.3 9.1 10.6 12.4 9.9 7.2

GDP growth rate 5.4 5.2 6.2 5.7 6.0 6.3 7.1

GDP per capita (purchasing power parity,PPP)*

1,060.78 1,127.0 1,208.5 1,295.6 1,364.8 1,428.6. N/A

Real GDP per capita growth 2.1 2.0 3.0 3.1 2.6 3.3 4.0

otal debt service (% o exports o goods,services and income)

22.1 11.1 3.4 2.5 3.1 3.8 N/A

Share o domestic debt to total debt 15 31 70 67 66 N/A N/A

otal scal debt to exports ratio -493 -271 -79 -70 -70 N/A N/A

otal scal debt to GDP ratio 148.6 87.9 29.8 25.8 26.8 28.6 26.9

Fiscal decit to GDP ratio -6.3 -8.3 -7.4 -4.8 -6.0 -6.7 -5.9

Income tax to GDP ratio 7.8 7.6 7.5 8.4 8.5 7.7 7.5

Consumption tax to GDP ratio 5.2 5.0 4.6 4.9 4.0 3.8 3.9

Source: Ministry o Finance and National Planning, International Monetary Fund World Economic Outlook dataset, April 2011.* Preliminary

N/A = not available.

Trends in total poverty, 1991-2006

Provinces 1991 1993 1996 1998 2004 2006 Change 2004-2006

1. Central 70 81 84 77 76 72 -4

2. Copperbelt 61 49 65 65 56 42 -14

3. Eastern 85 91 85 79 70 79 9

4. Luapula 84 88 87 82 79 73 -65. Lusaka 31 39 58 53 48 29 -19

6. Northern 84 86 87 81 74 78 4

7. North Western 75 88 90 77 76 72 -4

8. Southern 79 87 83 75 69 73 4

9. Western 69 69 69 69 83 84 1

otal 70 84 78 73 68 64 -4

Source: Central Statistical Oce

TA

BLE2.2

TA

BLE2.1

2At the time o research or this report, Zambias 2010 Living Conditions Measurement Survery was underway; the analysis in this section cannot use its nding.3This section ocuses on monetary poverty. The multidimensional aspects o poverty will be discussed in Chapter 3.


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Living Conditions Monitoring Survey (CentralStatistical Oce 2006) ound a large proportiono extremely poor people (51 percent) and a smallproportion o the moderately poor (14 percent).Eighty percent o poor people resided in rural

areas; o them, 67 percent were extremely poor.Tis situation has only slightly improved over theyears. In urban areas, the decline in poverty wasmore pronounced, exemplied by a phenomenalgrowth in the proportion o non-poor peoplerom 16 percent to 66 percent between 1996 and2006, compared to rom 11 percent to 20 percentin rural areas over the same period. Contributingto these trends were the eects o policies or tradeliberalization, oreign investment and the sale ogovernment housing, among others, that mostly

avoured urban areas. As the ensuing discussionwill show, these policies did little to encouragegrowth in agriculture, given the absence ocomplementary service delivery in the sector.

Macroeconomic Indicators

An examination o macroeconomic indicatorsin able 2.2 shows improvements in almost all othem. Te rate o infation has kept a consistent

downward trend, rom 18 percent in 2004 to 7percent in 2010. Over the 2001-2010 period,

the country registered consistent growth in realGDP per capita, rom 2.1 percent in 2004to approximately 4 percent in 2010.In light o long periods o limitedeconomic growth and high infation

levels in the 1990s, the recentachievements are commendable.Te ratio o debt servicing to

revenues has exhibited a negativetrend rom 2004 to 2008. Te country has beenmobilizing revenues at a rate o growth greaterthan it has been spending on debt servicing. Tisis an accomplishment in the implementation oprudent scal policies, given the long historyo indebtedness and crippling debt-servicingobligations. Te eort was well assisted by the

international community through the HIPCand MDR initiatives. Te ratios o total scaldebt to exports and GDP have also improved,where the rate o growth o exports and GDP ishigher than that o the total scal debt over thereerence period. Despite a welcome reductionin debt servicing, however, the ratio o domesticdebt to total debt has remained high, and actuallyincreased rom 15 percent in 2004 to 66 percentin 2008. Tis constitutes a major constraint on

the fexibility o the overall budget in terms oincreased resources or service delivery.

Growth in GDP by sector, 2001-2010

Kind o economic activity 2001 2005 2006 2007 2008 2009 2010* Period average

Agriculture, orestry and shing (2.6) (0.6) 2.2 0.4 2.6 7.2 6.6 2.34

Mining and quarrying 14.0 7.9 7.3 3.6 2.5 20.3 16.8 10.61

PRIMARY SECOR 1.9 2.5 4.1 1.7 2.5 12.4 10.9 5.18

Manuacturing 4.2 2.9 5.7 3.0 1.8 2.2 4.4 4.22Electricity, gas and water 12.6 5.4 10.5 1.0 (1.2) 6.8 4.7 3.33

Construction 11.5 21.2 14.4 20.0 8.7 9.5 7.2 15.20

SECONDARY SECOR 7.5 10.0 9.8 10.0 4.7 6.2 5.8 8.11

Wholesale and retail trade 5.4 2.4 2.0 2.4 2.7 2.3 4.3 3.76

Restaurants, bars and hotels 24.4 11.7 16.1 9.6 5.0 (13.4) 10.3 8.19

ransport, storage and communications 2.8 11.0 22.1 19.2 15.8 7.6 14.9 10.64

Financial institutions and insurance 0.1 3.3 4.0 4.1 8.7 5.2 3.9 3.98

Real estate and business services 3.5 3.2 3.2 3.1 3.0 2.8 3.0 3.42

Community, social and personal services 5.8 11.4 9.0 12.5 11.7 8.6 1.5 6.43

ERIARY SECOR 4.7 5.4 6.7 7.1 7.2 3.9 5.7 5.32otal GDP at market prices 4.9 5.3 6.2 6.2 5.7 6.4 7.1 5.56

Source: Central Statistical Oce 2010.* Preliminary

There hasbeen overall

improvement inmacroeconomic

indicators.

TA

BLE2.3


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Economic Growth by Sector

Tere have been substantial changes over timein the contributions o specic sectors to overallgrowth. All three major sectors o the economyas per broad classications o GDP (namely,

primary, secondary and tertiary) haverecorded growth in the period rom

2001 to 2010 (see able 2.3). Overthis period, GDP growth averaged5.6 percent per annum. Telowest growth was experiencedin agriculture at 2.3 percent;

consequently, the sectors share oGDP declined rom 16 percent in

2001 to 12.6 percent in 2010, along withits contribution to overall GDP growth. Teastest growth was in the construction sectorat 15.2 percent, ollowed by the mining and

manuacturing sectors, both averaging 10 percentgrowth per annum. In terms o contributions toGDP, the share o construction increased rom5 percent in 2001 to 11 percent in 2010; that omining rose rom 7 percent to 10.1 percent; andthat o manuacturing declined rom 10.4 percent

to 9.2 percent.For poverty reduction, the perormance o theagriculture sector is crucial. Although positive,agricultural sector growth has been sluggish,triggering a vicious cycle o slow growth, lowincome levels, enduring poverty, low productivityand slow growth. Registering a major impacton rural poverty will require sustained andhigher growth in the agriculture sector, giventhat the majority o the rural population derivetheir livelihoods rom agriculture, sheries and

orestry.Otherwise, or the short and medium term,

economic growth as experienced in the recentpast will continue to be driven by sectors thatbypass the rural areas and rural poor. o date,economic growth has been heavily biased towardsone province, Copperbelt, and largely driven bycapital-intensive sectors such as construction,mining, transport and telecommunication.

Employment Creation

Static levels o ormal employment stempartly rom the limited diversication o theeconomy. According to Labour Force SurveyReports (Central Statistics Oce 2005, 2008),the labour orce increased by 10 percent between2005 and 2008, while total employment grew by26.4 percent. Tese trends were largely attributedto inormal sector employment, which grew by29.3 percent between 2005 and 2008. Formal

sector employment grew by 5.3 percent, but itsproportion decreased rom 12 percent o totalemployment in 2005 to 10 percent in 2008. In theormal sector, male employment accounted or 71percent compared to 29 percent or emales. Televel o unemployment remained around 15.5percent o the total labour orce; 70 percent ounemployed people were in urban areas and 30percent in rural areas.

Figure 2.1 shows that most ormal employmentis in personal and community services. Tis sectorexperienced an upward swing in 2007 ollowingthe drive to recruit more teachers and health

Trends in scal revenues (in percent o GDP),2006-2010

Source: Ministry o Finance and National Planning.

Trends in the level o employment

FIGURE2.2

Source: Central Statistical Oce.

FIGURE2.1

Growthin the econo-

my was led by themining, construction,transport, storage and

communicationssectors.


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personnel. Employment levels have remainedstatic or the most part, however. In recent years,as trade has overtaken agriculture as the nextlargest employer, and employment opportunitiesin the latter have declined, Zambias growth hasbecome less inclusive and has ailed to reduce

poverty.Te 2006 Living Conditions MonitoringSurvey shows that most people nd employmentin the inormal sector, where the conditionso work are inadequate. In 2006, 82 percent othe labour orce was employed in the inormalsector, which is largely dominated by agriculture.In rural areas, 82 percent o people depend onthe inormal sector, and 90 percent o them arewomen. As will be discussed urther in Chapter4, better service delivery in agriculture is the most

prudent way to improve human development ormost people in Zambia.

Government Revenues and Expenditures

In the rst hal o the 1990s the ocus oscal policy was on expenditure containmentto redress the scal imbalances o the previousyears. Subsequently, in addition to sustainingmacroeconomic stability, scal policy was directed

at providing more resources to areas that enhanceservice delivery and promote private sectorgrowth.

Revenues and grants during the period o theFith National Development Plan (2006-2010)were generally around 23 percent o GDP, though

grants as a percentage o GDP were below targetin some years, fuctuating around 20 percent.

In the wake o increased scal space as aresult o the HPIC and MDR initiatives,expectations were that domestically nancedcapital expenditures would double between 2007

and 2010. However, partly as a result o the globalnancial and economic crises capital expendituresonly increased by 34 percent. Tis has made itdicult or the Government to provide qualityservices, as relevant inrastructure has not beenexpanded as envisaged. Nevertheless, in line withthe Fith National Development Plan objective oimproving service delivery, recruitment continuedin the health, education and public saety sectors.

Te absolute levels o tax revenues increasedor all categories, with direct taxes recording the

highest increase. But as shown in Figure 2.2, therelative contributions o various revenues haveremained largely unchanged rom 2006 to 2010.Te perormance o non-tax revenue has beenpoor over the period. In eect, Zambia has anarrow tax base drawing rom a ew workers inthe ormal sector.

Zambias tax revenues as a share o GDPhave generally been alling, rom 19.2 percentin 2000 to 16.8 percent in 2009, which has been

attributed to an erosion o the tax base throughthe prolieration o tax incentives and exemptionsacross and within sectors. Other actors are thenegative eects o tax competition in the regionand the poor perormance o the indirect tax, inparticular the domestic value-added tax.

FIGURE2.3

Source: Kaumann et al. 2009.

Trends in governance indicators in Zambia, 1996-2008


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Governance

Zambia has had a political system basedon multiparty democracy since 1991. Figure2.3 presents trends the countrys scores in theWorldwide Governance Indicators since 1996. Teindicators measure six dimensions o governance:voice and accountability, political stability andabsence o violence/terrorism, governmenteectiveness, regulatory quality, rule o lawand control o corruption. Tey are calculatedor 212 countries and territories, with a rangebetween -2.5 and 2.5. A higher score indicatesa better position. Zambias position is below theglobal average, but an overall improvement in alldimensions since 2002 is worth noting. Political

stability scores the highest, while control ocorruption and government eectiveness receivedthe lowest marks.

Tere are several actors that account orrelatively improved perceptions about Zambiasgovernance in recent years. Te currentadministration has declared zero tolerance orcorruption, and there have been several changesin the higher levels o the civil service. A numbero corruption cases were reported and someaddressed in 2009, on issues including nancial

improprieties in the health and roads sectors.Capacity challenges within the legal and judicialsystems, however, mean that not all higher-levelcases have been disposed o in court.

Despite some delay, the DecentralisationImplementation Plan ormulated in February2006 is expected to roll out in 2011, with theGovernment and stakeholders having reachedagreement on nancing. Dissemination oinormation by the Government and theparticipation o the private sector and civil societyin decision-making processes are improving. Oparticular relevance is the active participationo the private sector in sectoral advisory groups,which provide a orum or discussion amongstakeholders rom the Government, private sectorand civil society.

Emerging Patterns in the Delivery o Servicesin Zambia

Te 1998 Zambia Human Development Reportobserved that the country was not according ahigh priority to service delivery because o low

recognition o human rights, the misleadingimpression that social sectors are not productive,and a lack o incentives or private sectorinvolvement in the provision o services. Tecountry has gone through a number o changessince then, developing a better understanding

o the role o the social sectors and increasingbudgetary allocations or them. Tere has beengreater recognition o rights, especially orwomen, children and people living with HIVand AIDS, though not as much progress hasbeen made in saeguarding rights o people withdisabilities. More space in providing serviceshas been created or the private sector throughmarket mechanisms, and the role o NGOs indelivering services to the poor has increased.NGO involvement is mostly short-lived, however.

Building institutional capability should continuethrough the development o public-privatepartnerships.

Conclusions

Ater a protracted period o low and negativeeconomic growth, the recent resurgence ogrowth is commendable. Te perormance o theagriculture sector, a key sector or employment

creation and poverty reduction, remains low andinconsistent, however. Te continued dominanceo mining in the tradable goods sector, with itsweak linkages to other sectors, has limited theimpacts o employment creation and servicedelivery policies. High poverty levels, which havepersisted despite macroeconomic stability, conrmthat while macroeconomic stability is necessary, itis not a sucient condition or reducing povertyand improving human development. Acceleratinghuman development will require interventions

that go beyond mere economic growth andmacroeconomic stability, and that are groundedin inclusive, pro-poor strategies. Finding solutionsto deliver services to the large population o poorpeople is paramount.


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op: Te inormal sector is the mainsource o employment in Zambia.Right: Te Inrastructure challengesare an obstacle or human develop-ment.

Photographs: UNDP Zambia


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Chapter 3The State o Human Development in Zambia

his chapter presents trends in Zambiashuman development as measured by theHDI. As a composite index o human

development, the HDI measures a countrysaverage achievement on three basic dimensionso human development: a long and healthy lie,access to knowledge and a decent standard oliving. It is a partial measure; other dimensions,such as em

Zambia Human Development Report 2011

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