Resource Library

Who Goes Where and Why? Examining HIV Counseling and Testing Services in the Public and Private Sectors in Zambia

Zambia is a small republic in Sub-Saharan Africa with a population of nearly 12 million. Unemployment and poverty levels are significant concerns: 80 percent of Zambians live on less than US $2 per day. Of the nine provinces in Zambia, two—Lusaka and Copperbelt—are predominantly urban, while the remaining seven are primarily rural. The urban population is 4.5 million. HIV/AIDS prevalence is significant, with an adult prevalence rate of 14.3 percent (16.1percent among women and 12.3 percent among men), according to the most recent Zambian Demographic and Health Survey (ZDHS 2007). People living in urban areas are more likely to be infected than those in rural areas (20 percent versus 10 percent). HIV prevalence among adults ranges from just under 7 percent in the Northern and Northwest provinces (6.8 percent and 6.9 percent, respectively) to 20.8 percent in Lusaka province. The country faces a severe shortage in human resources for health. In 2006, Zambia recorded only 646 doctors—just 28 percent of its target of 2,300 (Schatz 2008). The same year the country recorded only 6,096 nurses, well below the national target of 16,732 nurses. Currently, the Zambian government finances 46.8 percent of total health expenditures, while private sources—including donor-funded NGOs, private firms, and households—finance the remaining 53.2 percent (WHO 2008). The private sector, including the private for-profit sector, plays an important role in providing HIV and other health care services to Zambians. More information is needed, however, about why clients utiliize the private for-profit sector for HIV services and the quality of those services. The role of the private for-profit sector in offering VCT services is of particular interest for the Private Sector Partnerships-One (PSP-One) project. PSP-One is the United States Agency for International Development's (USAID) flagship global project to increase the private sector's provision of high-quality reproductive health, family planning, and HIV products and services in the developing world.