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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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Many rural households in low and middle income countries continue to rely on small-scale agriculture as their primary source of income. In the absence of irrigation, income arrives only once or twice per year, and has to cover consumption and input needs until the subsequent harvest. We develop a model to show that seasonal liquidity constraints not only undermine households' ability to smooth consumption over the cropping cycle, but also affect labor markets if liquidity-constrained farmers sell family labor off-farm to meet short-run cash needs. To identify the impact of seasonal constraints on labor allocation and agricultural production, we conducted a two-year randomized controlled trial with small-scale farmers in rural Zambia. Our results indicate that lowering the cost of accessing liquidity at the time of the year when farmers are most constrained (the lean season) reduces aggregate labor supply, drives up wages and leads to a reallocation of labor from less to more liquidity-constrained farms. This reallocation reduces consumption and income inequality among treated farmers and increases average agricultural output.

Zonder onderwerpscode: economie

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Small-scale farming remains the primary source of income for a majority of the population in developing countries. While most farmers primarily work on their own fields, off-farm labor is common among small-scale farmers. A growing literature suggests that off-farm labor is not the result of optimal labor allocation, but is instead driven by households' inability to cover short-term consumption needs with savings or credit. We conduct a field experiment in rural Zambia to investigate the relationship between credit availability and rural labor supply. We find that providing households with access to credit during the growing season substantially alters the allocation of household labor, with households in villages randomly selected for a loan program selling on average 25 percent less off-farm labor. We also find that increased credit availability is associated with higher consumption and increases in local farming wages. Our results suggest that a substantial fraction of rural labor supply is driven by short-term constraints, and that access to credit markets may improve the efficiency of labor allocation overall.