Vulnerability and Resilience Determinants of under-five mortality changes in Zambia

Trends in under-five mortality were favorable in Zambia in the twelve years following independence (1964-1975), as a result of favorable political and economic context and generous health, education and social policies, largely financed by the exports of copper minerals, the main economic resource of the country. In 1975, the international prices of copper decreased suddenly, and exports of copper continued to diminish in volume. This created a tremendous economic shock to the country, and seriously affected both the state budget and private income. During the long-lasting economic crisis, income per capita was strongly reduced, and most economic indicators collapsed or were strongly reduced as well: imports, agricultural production, private and public consumption, savings, and industrial investments. The health sector was also affected: health expenditures declined, imports of medical drugs and supplies declined, and as a result of declining salaries some physicians left the country. School attendance was reduced somewhat later, in the 1980’s, and had long term effect on the mean level of education of adult women. Under-five mortality increased in the years following the copper crisis, up to a maximum in year 1992, after which under-five mortality went down again, despite a significant impact of HIV/AIDS. A regression model indicates that most of the increase in mortality after discounting for the effect of HIV/AIDS is attributable to the direct and indirect effects of the copper crisis and the declining income. Both trend analysis and regression analysis indicate that mortality in 1992 was more than double what it should have been in the context of a regular health transition and positive economic development. The mortality decline after 1992 seems to be due to the resumption of the health transition, the implementation of new health policies, and continuous investments in health personnel and health infrastructure. These changes occurred in the context of structural adjustment policies. Issues about vulnerability and resilience are discussed in light of economic and political choices made in the earlier periods and recent changes in policies. Key Words: Under-five mortality, Mortality trends, Economic crisis, Copper price, Economic policies, Health policies, Structural adjustment policies, Education, Nutritional status, HIV/AIDS, Malaria, Developing countries, sub-Saharan Africa, Zambia.