BackgroundNon-communicable diseases (NCDs) are an emerging global health concern. Reports have shown that, in Zambia, NCDs are also an emerging problem and the government has begun initiating a policy response. The present study explores the policy response to NCDs by the Ministry of Health in Zambia using the policy triangle framework of Walt and Gilson.MethodsA qualitative approach was used for the study. Data collected through key informant interviews with stakeholders who were involved in the NCD health policy development process as well as review of key planning and policy documents were analysed using thematic analysis.ResultsThe government’s policy response was as a result of international strategies from WHO, evidence of increasing disease burden from NCDs and pressure from interest groups. The government developed the NCD strategic plan based on the WHO Global Action Plan for NCDs 2013–2030. Development of the NCD strategic plan was driven by the government through the Ministry of Health, who set the agenda and adopted the final document. Stakeholders participated in the fine tuning of the draft document from the Ministry of Health. The policy development process was lengthy and this affected consistency in composition of the stakeholders and policy development momentum. Lack of representative research evidence for some prioritised NCDs and use of generic targets and indicators resulted in the NCD strategic plan being inadequate for the Zambian context. The interventions in the strategic plan also underutilised the potential of preventing NCDs through health education. Recent government pronouncements were also seen to be conflicting the risk factor reduction strategies outlined in the NCD strategic plan.ConclusionThe content of the NCD strategic plan inadequately covered all the major NCDs in Zambia. Although contextual factors like international strategies and commitments are crucial catalysts to policy development, there is need for domestication of international guidelines and frameworks to match the disease burden, resources and capacities in the local context if policy measures are to be comprehensive, relevant and measurable. Such domestication should be guided by representative local research evidence.
Introduction{Fazel, 2011 #25}Worldwide, the rates of infectious and non-infectious diseases in prisons is generally higher than that of the general population. Although Zambia has adopted international and local guidelines to address prisoners’ health, the disease burden remains high in Zambian prisons. This study therefore explored barriers to translation and implementation of the legislative acts and guidelines that deal with health for inmates in correctional facilities. MethodsThis was a case study. Data was gathered through key informant interviews with stakeholders supporting inmates’ health in Zambia. These included the Ministry of Home Affairs, Ministry of Health (MoH), Ministry of Justice, Zambia Correctional Service, NGOs and UN agencies. The policy triangle was used to guide data collection, organization and analysis. Data was analysed using thematic analysis. Nvivo software version 12 was used for data coding. ResultsContext: There was political will and commitment to address inmate’s health in Zambia but was constrained by inadequate resources, infrastructure and trained Health Care Workers. Actors: Many key actors were not aware of key policy documents and guidelines addressing inmates’ health in Zambia. Coordination among partners was poor and efforts were underway to address lack of coordination in providing good health services to inmates. The role of the Ministry of health, as the lead partner, was emphasised going forward. Process: It was revealed that the policy development and implementation process was not consultative. There was weak inter-ministerial collaboration and lack of completion of the domestication process of the international guidelines, and this resulted in poor coordination and implementation of legal provision on inmates’ health.ConclusionDespite the existence of key legal and policy guidelines to address prisoners’ health in Zambia, there remain several barriers to implementation. These include lack of resources, lack of awareness and poor coordination among partners working in this sector. It will be important for the Ministry of Health to provide leadership and resources to raise awareness about prisoners’ health and a policy provision to support this process. Resources and infrastructure will be key to addressing the current challenges related to providing quality care for inmates in Zambia.
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