Zambia like most countries in Africa has a private and public health sector. The private health sector has earned a reputation for providing good quality health services and specialized care, while the public health care sector is controlled by the government. Zambia offers universal healthcare to all its citizens but this healthcare is very basic. The health system is heavily stretched at the moment, and only a critical injury will elicit immediate help in a government hospital. Many Zambian doctors leave the country or work only for the private health system, meaning that public health is subject to a skills drain.

People decide where to seek medical care, but mostly choose the public sector because it is more affordable. In terms of diabetes, the majority seek certain public hospitals because the government pays for some of the costs.

What happens if you need to see a doctor?
When a person needs to see a doctor, they have to make an appointment with their hospital. The private sector is more concerned with this strategy but the public sector has a different approach. They have certain days in the week on which they see patients, mostly with chronic conditions like diabetes, etc. When a person makes an appointment in the public hospital, they have to be at the hospital at 4 AM because of the wait time to see the doctor. Most doctors in public hospitals are general doctors so people living with diabetes would never learn some things about diabetes and may never know about tests that they are supposed to do, like HBA1c. For private hospitals you can visit the hospital on any day and make appointments but you would have to be a member of a private hospital to make an immediate appointment.

Who decides what doctors can prescribe?
The Zambia National Formulary (ZNF) seeks to provide a list of drugs suitable for use in Zambia together with essential information about their use, courtesy of the Ministry of Health (MOH) in Zambia. It is in charge of all medical facilities and health care systems.

Practically, what is it like to live with type 1 diabetes in Zambia?
Living with type 1 diabetes in Zambia is a huge challenge due to the fact that people lack education about the condition and believe in several myths about diabetes. Children up to a certain age receive the basics for free from the government like insulin, glucometer test and ketone testing, but private hospitals that prescribe different types of insulin come with high costs. These high costs of test strips, syringes, glucose meters, insulin etc. can use up a lot of a family’s income, often the amount needed is twice their salary. With all these obstacles, people mostly fail to cope with the condition and suffer many complications. Most people with diabetes in Zambia do not know what it means to check their blood sugar levels regularly or how important it is to manage diabetes. If they wanted to check regularly by the end of the month the strips would have used up their whole salary.

What about getting admitted to hospital?
The different health sectors have a different ways of operating. The private sector is way more costly if one is admitted compared to the public, although some parts are free. At a private hospital you are required to provide your own food, pay for any supplies, and buy the prescribed medicine after being discharged. In the case of diabetes it is basically the same situation, although sometimes insulin is provided during your stay. For public sector one is admitted for free and given the basics like insulin and syringes. Blood sugar is checked but other tests must be paid for.

How does diabetes care vary throughout Zambia?
Zambia’s public healthcare system is chronically underfunded and only 50 percent of rural people have access to a facility (often only a mission hospital), compared to 99 percent access for people in cities. Zambia has 10 provinces and each has a different health care set up. The most common set up is the public sector in most of its provinces, but not all public hospitals provide free insulin for their patients in the provinces. Some people find it hard to access insulin. This situation is mostly in rural areas. Overall the prices of insulin and diabetes materials like test strips, syringes etc. also varies widely from one place to another and is unaffordable for almost everyone.

A big thank you to our friends Chip Chisanga and Florence Banda in Zambia for providing this information.