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The 2012 national health policy is the overarching health policy framework in Zambia. The policy takes a human rights approach to health care provision, where all citizens are entitled to basic health care (Ministry of Health 2012). The policy is actualized through successive five-year national health strategic plans. Operationally, Zambia's health system is centralized, with delegated responsibilities from the center to lower levels of the health care delivery system. The Ministry of Health plays a dual role of policy formulation and strategic planning and delivery of health services, with provincial and district health offices being upwardly accountable to the Ministry of Health headquarters. Going forward, Zambia is in the process of launching two major reforms which will further affect the organization of the health sector. These are (a) implementation of the National Decentralization Policy, and (b) introduction of a National Health Insurance (NHI) scheme. The PHC function (including transfer of PHC staff to local government authorities) is among the front runner for decentralization. If national decentralization is fully implemented, it will affect the way health services are organized, delivered, and financed in the country. Thus, adequate preparations in the health sector are required to minimize challenges. Secondly, Zambia enacted the NHI Act in April 2018 which provides the legal mandate to establish the NHI management authority, and the NHI scheme. At the time of this study, it was envisaged that implementation of the NHI scheme will be done in a phased manner with a view of covering the entire population in the medium to long term. However, depending on the final design and implementation process, the NHI will have a substantial effect on the financing and delivery of health programs and services in Zambia. One of the immediate challenges will be providing insurance cover to the informal sector and indigent people in rural areas.

Finance --- History.

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The Zambian health care system continues to undergo various reforms. The system has experienced health financing and organizational reforms since 2006. Among the notable and common themes underpinning all the health reforms across the different timelines have been the following: the policy commitment continues to be associated with the desire to ensure that resources and health care services are distributed and provided as close to the household or family as possible; and access to quality and affordable health care services continues to be one of the central themes of the reform process. In this regard, health services are supposed to be generally available, adequate, and of reasonable quality and cost. Given that a number of health financing reforms have been implemented in Zambia over the years, this study provides an updated analysis on the extent to which government expenditures on health provide an effective intervention in redistributing health care resources in an equitable manner. The study looks at the health system holistically and does not look at each of the individual reforms.

Developing countries --- Zambia --- Developing countries. --- Zambia.

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Malawi's economic growth has been low and volatile for the past two decades, leading to stagnating high poverty levels. The Coronavirus (COVID-19) pandemic will negatively affected economic growth leading to lower government revenue. Despite low per capita growth, Malawi has made strong progress in many areas of human capital development since 2000. Notwithstanding the above, Malawi still faces considerable gaps in human capital, which will impede its ability to reduce poverty in the medium term. Malawi lags behind in some health and nutrition outcomes, including HIV and malaria prevalence. Strengthening human capital in Malawi will be critical to reduce poverty, increase inclusion in society, and create jobs. The World Bank launched a new Human capital index (HCI) in October 2018 as part of its broader Human capital project. One factor that contributes to low human capital outcomes is Malawi's adolescent fertility rate, one of the highest rates of in the world, with 132 births per 1,000 women aged 15-19. The main underlying cause for the high adolescent fertility rate is the high rate of child marriage. The government is making efforts to strengthen human capital. To strengthen human capital in the face of limited fiscal space, Malawi needs to improve the efficiency and effectiveness of government and donor spending on human capital. To address this problem, there is need to integrate financial reporting systems at district and central government levels. This will enhance government's ability to monitor and evaluate expenditure and program implementation across sectors.

Access To Health Services --- Health Economics and Finance --- Health Systems Development and Reform --- Health, Nutrition and Population --- Public Sector Development