In 1964, responsibility for public health was transferred from the federation to Zambian authorities. Since then, the government has developed a health plan centered on specialist hospitals, with general and regional hospitals dealing with less complicated cases. At a lower level, district hospitals treat common medical and surgical cases. Rural health centers and clinics with outpatient facilities have been established throughout the country. Services to Zambian nationals are free at the rural health centers and clinics and at hospitals at the large urban centers. Due to government spending restrictions, the public health care sector has suffered from a severe shortage of doctors, medicine, and medical equipment and supplies. Health indicators have suffered since the advent of the AIDS epidemic, with earlier improvements reversed. For example, average life expectancy, which has been declining since 1984, was down to 38 years in 2000.
As of 1992, government records indicated nine hospitals and a few small outpatient clinics. Zambia produces locally 25% of the pharmaceuticals it consumes. As of 1999, there were an estimated 64 physicians and 78 hospital beds per 1,000 people. As of 1999, total health care expenditure was estimated at 6.9% of GDP.
Malaria and tuberculosis are major health problems, and hookworm and schistosomiasis afflict a large proportion of the population. In 1998, malaria accounted for 48% of outpatient visits by children under five years of age and 42% among the general population. In the same year, there was a serious outbreak of cholera. In addition, the HIV/AIDS epidemic has increased the incidence of tuberculosis. There were 495 cases of tuberculosis per 100,000 people reported in 1999. Other commonly reported diseases in Zambia were diarrheal diseases, leprosy, and measles.
Zambia has one of the highest rates of HIV infection, even in hard-hit sub-Saharan Africa. At the end of 2001, the number of people living with HIV/AIDS was estimated at 1.2 million (including 21.5% of the adult population) and deaths from AIDS that year were estimated at 120,000. HIV prevalence, which has remained stable since 1996, was 20 per 100 adults in 1999. It has been estimated that by 2000, about half a million Zambian children would have lost both parents to AIDS.
As of 2002, the crude birth rate and overall mortality rate were estimated at, respectively, 41 and 21.9 per 1,000 people. About 26% of Zambian married women used contraceptives in 2000. The maternal mortality rate was 649 per 100,000 live births in 1996. Between 1990–95, 32 of every 100 school-age children suffered from goiter. In 1997, children up to one year old were immunized against tuberculosis, 81%; diphtheria, pertussis, and tetanus, 70%; polio, 70%; and measles, 69%. The infant mortality rate in 2000 was 115 per 1,000 live births. In the same year, 42% of the all children under five were malnourished.
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