Hospitalizations and costs incurred at the facility level after scale-up of malaria control: pre-post comparisons from two hospitals in Zambia.

There is little evidence on the impact of malaria control on the health system, particularly at the facility level. Using retrospective, longitudinal facility-level and patient record data from two hospitals in Zambia, we report a pre-post comparison of hospital admissions and outpatient visits for malaria and estimated costs incurred for malaria admissions before and after malaria control scale-up. The results show a substantial reduction in inpatient admissions and outpatient visits for malaria at both hospitals after the scale-up, and malaria cases accounted for a smaller proportion of total hospital visits over time. Hospital spending on malaria admissions also decreased. In one hospital, malaria accounted for 11% of total hospital spending before large-scale malaria control compared with < 1% after malaria control. The findings demonstrate that facility-level resources are freed up as malaria is controlled, potentially making these resources available for other diseases and conditions.

The impact of AIDS on government service delivery: the case of the Zambia Wildlife Authority.

BACKGROUND: The loss of working-aged adults to HIV/AIDS has been shown to increase the costs of labor to the private sector in Africa. There is little corresponding evidence for the public sector. This study evaluated the impact of AIDS on the costs and service delivery capacity of a government agency, the Zambia Wildlife Authority (ZAWA). METHODS: Data were collected on workforce characteristics, mortality, costs, and number of days spent on patrol between 2003 and 2005 by 76 current patrol officers (reference subjects) and 11 patrol officers who died of AIDS or suspected AIDS (index subjects). The impact of AIDS on service delivery capacity and labor costs and the net benefits of providing treatment were estimated. RESULTS: Reference subjects averaged 197.4 patrol days per year. After adjustment index subjects patrolled 68% less in their last year of service (P < 0.0001), 51% less in their second to last year (P < 0.0001), and 37% less in their third to last year (P < 0.0001). For each employee who died, ZAWA lost an additional 111 person-days for management, funeral attendance, vacancy and staff replacement. Each death also cost ZAWA the equivalent of 3.3 years' annual compensation for care, benefits, recruitment, and training. In 2005, AIDS reduced service delivery capacity by 6.0% and increased labor costs by 9.3%. CONCLUSION: Impacts on this government agency are substantially larger than observed in the private sector. AIDS is constraining ZAWA's ability to protect Zambia's parks. At a cost of US $500/patient/year, antiretroviral therapy (ART) would result in service improvements and net budgetary savings to ZAWA.

AIDS and agriculture in Zambia.

BACKGROUND: Because agriculture is the livelihood base for the majority of people affected by AIDS in sub-Saharan Africa, the interactions between AIDS and agriculture, and their implications for policy and programming, are of fundamental importance. OBJECTIVE: This paper summarizes evidence from three RENEWAL (Regional Network on AIDS, Livelihoods, and Food Security) research studies and one policy review on the interactions between AIDS and agriculture in Zambia and their implications for future policy and programming. METHODS: The unit of analysis adopted for each study varies, spanning the individual, household, cluster, and community levels, drawing attention to the wider socioeconomic landscape within which households operate. Results. This paper identifies the ways in which livelihood activities, within the prevailing norms of gender, sexuality, and perceptions of risk in rural Zambia, can influence susceptibility to HIV and how the nature and severity of the subsequent impacts of AIDS are modified by the specific characteristics and initial conditions of households, clusters, and communities. CONCLUSIONS: The findings demonstrate the importance of studying the risks, vulnerabilities, and impacts of the AIDS epidemic in the context of multiple resource flows and relationships between and within households-and in the context of other drivers of vulnerability, some of which interact with HIV and AIDS. The paper addresses several factors that enable or hinder access to formal support programs, and concludes by highlighting the particular importance of engaging communities proactively in the response to HIV and AIDS, to ensure relevance, sustainability, and scale.