Provider Purchasing and Contracting for Health Services_The Case

Table 5: Summary of health institutions by type, size, and ownership, 2002
Total Number Number of Facilities Owned
of
by
Facility Type
Number
of Units Beds Cots Government Private Mission
Percentage
of Units
Third level 5 3,802 452 5 - - 0.34
Second level 18 5,133 988 12 - 6 1.2
First level 74 6,795 1,166 36 17 21 5
Rural 973 8,077 570 889 23 81 66
Health
centers
Urban 237 1,632 325 163 74 - 16
Health posts
176 198 11 161 4 11 12
Total 1,478 25,637 3,512 1,266 118 119 10,944
Source: CBoH Report, 2002.
Table 5 shows providers of health services in Zambia by level of care. In 2002, it was
estimated that 1, 478 health facilities were formally registered in Zambia.
The government owns about of 86 percent of the health facilities: 100 percent of the tertiary
facilities, 67 percent of the second-level facilities, and 80 percent of the health centers.
Missionaries own 33 percent and 28 percent of the second- and first-level facilities,
respectively. These are mainly located in rural areas. Mission hospitals are mainly found in
rural areas that are not served by government facilities. The distribution reflects the historical
orientation of the various missionary organizations active in Zambia. In general, individual
denominations tend to take responsibility for different regions and have had a tendency to
favor the provinces least served by Ministry of Health facilities. The government provides
them with some subsidies, while the management rights are retained by the individual
denominations.
The data on the private sector in Zambia are very scant, and different sources give different
statistics. In 2002, the Ministry of Health and the Central Board of Health estimated that 118
private facilities were registered and run by doctors. These account for about 23 percent of
the first referral or district hospitals and 31 percent of the urban health centers in Zambia. The
private for-profit providers are concentrated in urban areas along the line of rail mainly for
profit motives. They are not subsidized by the government. Most of the first referral private
hospitals are owned by private individuals and corporations, especially the mining industry.
They are concentrated in Lusaka and the urban towns of the Copperbelt Province.
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