SAP. The public health sector, which should have been the main health provider, experienced a decline in the attendees with the introduction of user fee system. Health become a luxury, negating the World Health Organization‘s objectives of making primary health care available especially to the developing world as stated in declaration of the WHO made in 1978 at Alma- Ata.38
However, it is worth mentioning that in rural areas and places where there are mission hospitals or church related health centers there was a hive of activities as they filled the gap that was created due to the introduction of user fees in public hospitals.39 Mission or church related health hospitals provide over 60% of health in the rural Zambia. According to Godfrey Biemba,
―current statistics indicate that the church provides 30% of overall healthcare and approximately 60% of rural health services. Church health institutions fill the gap where government health services are not available while at the same time co-existing side by side with government health facilities.‖40 Biemba also notes that these religious health institutions have a strong presence and are known to offer good services which has had proven reputation built on years of experience.41 The Copperbelt, which previously enjoyed relatively good health services through the mines, was one of the most affected. People lost jobs through SAP, so it was not just the health that was affected negatively, but the people‘s livelihoods as well.
2.6 Impact of Structural Adjustment Program (SAP) and privatization on livelihood of
role for the private sector was therefore seen as the key to stimulating economic growth.‖42 Clearly the goal of the IMF and the World Bank, who are behind SAP, was that the economic adjustment was a way to enhance peoples‘ livelihood and create an environment that would increase the wealth of a nation. However, the reality on the ground was the very opposite of the intended purpose. A number of people lost their jobs with the privatization of companies. Khor further makes an observation on SAP and its impact on people‘s livelihoods; he says ‗half the companies sold out of the state sector are now bankrupt. Over 60,000 people have lost their jobs as a direct result of the economic liberalization program introduced after 1991. With many mouths dependent on one breadwinner, this has thrown an estimated 420,000 into destitution 43 Emily Sikazwe a woman engaged in women and gender issues says, "SAPs cause poverty and poverty has a woman's face." Women shoulder the main burden of providing for families, and girl children are the first to be withdrawn from school when a father loses his job.44
It is clear that the impact of SAP added misery to a number of Zambians who were already living in poverty. It is important to note that at the time when these economic adjustments and reform programs where being implemented, the majority of people in Zambia were living in extreme poverty. The diagram below shows the levels of poverty indicators at the time of SAP.
Overall and extreme poverty in Zambia, in rural and urban areas, 1991-199845
Year Zambia Rural Urban
Overall Poverty
Extreme Poverty
Overall Poverty
Extreme Poverty
Overall Poverty
Extreme Poverty
1991 69.7 58.2 88.0 80.6 48.6 32.3
1993 73.8 60.6 92.2 83.5 44.9 24.4
1996 69.2 53.2 82.8 68.4 46.0 27.3
1998 72.9 57.9 83.1 70.9 56.0 36.2
42 Martin Khor, Structural Adjustment Explained , Structural Adjustment a major - cause of poverty- global issues- July 2005. htt://www.doublestandards.org/sapl.html #Zambia
43 Martin Khor, Structural Adjustment Explained , Structural Adjustment a major - cause of poverty- global issues- July 2005.
44 Martin Khor, Structural Adjustment Explained , Structural Adjustment a major - cause of poverty- global issues- July 2005.
45 Venkantesh Seshamani, Chris Ngenda Mwikisa, Zambia‟s Health Reforms, selected papers 1995- 2000.Department of Economics, University of Zambia, 2002.p57.
As can be seen from this table, the health reforms were implemented during a time when the social and economic life of the people was not sound. In 1993 when these policies took effect the table shows that the country poverty indicators were at 60.6%, implying extreme poverty.
Besinati Mpepo Phiri gives even more recent statistics that about 73% of Zambians live below the poverty line and that 71% of Zambians today live in abject poverty. Because of this poverty in Zambia, many people are prone to sicknesses and disease46.
The living conditions of the people during this period according to the Living Conditions Monitoring Survey of 199847 showed significant changes in the survival strategies employed by some of the people. Some women involved themselves in prostitution as a survival strategy which consequently compromised their health. The consequent result is seen in the increase of a crisis like HIV and AIDS during the same period of health reforms.
It‘s also worth noting the comments of Joseph Stiglitz, former World Bank chief economics, who observes that the IMF and World Bank admit that some of its policies do not work to alleviate poverty or improve people‘s livelihood. He says that, ―structural adjustment didn‘t benefit the poor, it is almost as though the Bank tries to subtly absolve itself by sort of blaming the poor for not benefiting from this. When structural adjustments have required cut backs in health, education and so on, then what would one expect? 48
The results of SAP on education are illustrated by Khors‘s observation in this quote, ―They are a direct result of cuts in public spending and the introduction of school fees. For example, whereas in 1991 the Zambian government spent about $60 per primary school pupil, it now spends just
$15. Cuts in public spending - the slimming down of a 'bloated' public sector - are a central plank of structural adjustment, as promoted by the World Bank and the IMF. In one of SAP's greatest ironies, the World Bank is now recasting itself as a 'Knowledge Bank' - at the same time as it
46 Besinati Mpepo Phiri, ‗The path away from poverty: an easy look at Zambia‘s poverty reduction strategy paper‘
(Lusaka: Civil Society for poverty reduction), 2004.
47 Venkantesh Seshamani, Chris Ngenda Mwikisa, Zambia‟s Health Reforms, selected papers 1995-
2000.Department of Economics, University of Zambia, 2002.p 61-62 The survey covered a number of areas such as demographics characteristics, migration, health, education, income, expenditure, child health and nutrition, food production, access to various facilities, household assets and poverty..
48 Joseph Stiglitz, Globalization and its Discontents, Penguin Books 2002. p40-41
condemns millions of children across Africa to a lifetime of ignorance and illiteracy‖. 49 Although the cutting on spending was a necessary move, it nevertheless demonstrated some of the negative impact of SAP on the livelihoods of people. It is also worth noting that the spending on the part of the government in order subsidize these services, had led the government to be indebted with continual borrowing.