Anyone can use Zambia's state health care facilities, often of poor quality. Photo: ALAMY
By Peter Pallot
Zambia offers the adventurous many attractions. It boasts features such as the Victoria falls, Zambezi river and exciting safari trips. Against that background, Zambia is a country of extreme poverty, very poor infrastructure and health care, save for those who can afford private medicine. That is limited to the major cities.
The World Bank records infant mortality at 86 per 1,000 live births. HIV prevalence is an estimated 14 per cent of the country’s 11 million inhabitants. These figures hardly need comparison with western data to point out how dismal is the situation.
Even so, Zambia has at least avoided inter-tribal strife that has cost so many lives in other parts of Africa. The scores of tribes (headed by the Bantu) appear to rub along without difficulty and are well disposed to the international community.
Expats – many from Britain and South Africa – number about 120,000 and are largely based in Lusaka and the mining belts. Most are working on assignment. Zambia’s tourist board records 60,000 British visitors a year.
State health care for all
Anyone in the country may use the health system but access for many is theoretical rather than realisable because doctors and nurses are overworked. Hospitals and clinics are underfunded.
The country has suffered the fate of many in the underdeveloped world – a skills drain of qualified medics to richer lands. Zambia is typical of those countries that have suffered, highlighted in a report published by theBritish Medical Journal in November 2011.
Severe doctor shortage
Different sources quote different figures on patient-to-doctor ratios. They average out about a wholly inadequate 10,000 patients for one practising doctor. The shortage of trained medical staff is most acute in rural Zambia where people might travel hundreds of miles for a hurried consultation.
Insurer Medicare International points up the consequences. Its senior executive, David Pryor, said: “Health care facilities are run by the Ministry of Health and are categorised in urban or rural health centres. However, by any measure they are regarded as very basic.
“With adult life expectancy of just 46 years, it’s easy to see why the only option in the vast majority of cases is to arrange emergency medical evacuation, which we would offer as a matter of course with all our policyholders. In all probability this will mean treatment taking place in one of the modern centres in South Africa, where facilities are generally excellent.”
The Foreign and Commonwealth Office describes health care in Zambia as “poor”. Rural areas are worst hit. The FCO adds: “You should know your blood group and carry a sterile medical kit including needles, dressings etc.”
It is not only expats, but wealthy Zambians too who go to South Africa, Europe, or North America for satisfactory treatment of any serious medical condition or sophisticated tests.
Most expatriate women go to the USA or Europe for pregnancy care and delivery. For minor ailments there are acceptable hospitals and clinics, but little in rural parts.
According to the insurer InterGlobal, the top hospitals in Zambia are CFB Medical Centre, Lusaka, Lusaka Trust Hospital and University Teaching Hospital, Lusaka.
Antony Brown, the provider’s regional general manager, said: “The best hospital is probably the government-run University Teaching Hospital, Lusaka, but it isn’t geared up to treat expatriates, so it isn’t always easy to get them to accept international insurance plans.”
However, it is still possible to gain access when it is the appropriate hospital for a particular case.
Among other hospitals used by the international community in Lusaka is the Corpmed Clinic, where the staff speak English.
Embassies or consulates in Zambia are worth consulting. They should give a steer on where is best for serious medical problems and may recommend a particular physician.
Dr Sneh Khemka, medical director of Bupa International, thinks the best hospitals – some “excellent” – are concentrated in the mining belt, especially the copper belt.
“Many of our clients use them,” he said. “Services are well catered towards industrial accidents there and the local hospitals provide fairly good levels of care.
“However, Zambia is a close neighbour to South Africa so by road or air transport a lot of people are taken to Johannesburg if there’s anything more than a minor complaint. Anything that requires inpatient treatment does tend to go to South Africa.”
For those with money, primary care provision is generally good in Zambia and with internationally qualified doctors, Dr Khemka said.
“It depends very much where you are located and it is very much a developing country and very rural in parts. But, if you are in one of the expat hubs or the big industrial mining communities, care provision is pretty good. Still, most inpatient treatment does still get done in South Africa.”
Evacuation cover essential
Of course, it’s only a serious case in which an insurer – or more likely, an assistance company acting for it – will seek to transport a patient outside Zambia. It is in this area of serious injury or illness that the country’s own health care is deficient. This makes international medical insurance with a good evacuation benefit essential.
Dr Khemka commented: “Patients used to go to Zimbabwe and there’s still some movement to Harare but there we’ve already seen costs escalate massively. Zimbabwean costs are greater than South African costs. And because of the political landscape [in Zimbabwe] the transition of members from Zambia to Zimbabwe is limited.”
Advice from the FCO is unequivocal. “You should take out comprehensive travel and medical insurance, which should include cover for medical evacuation by air ambulance. Check for any exclusions and that your policy covers you for the activities you want to undertake.”
Medical costs are so high in Zambia and fraudulent billing so prevalent that Aviva, a major UK-based insurer that entered the market in 2009, declines to cover expatriates there.
Among other UK-based providers recommended by Stephen Walker ofMedical Insurance Services in Brighton, AxaPPP and InterGlobal are among the most competitive. For a 25-year-old, Axa’s annual premium for comprehensive cover is £947. For inpatient budget cover it is £741.
InterGlobal’s premiums are £987 and £641 (budget) for the same person. Bupa’s Classic is £1,557 and for its budget plan, Essential, £826.
For a couple aged 34 and 31, IMG Global Select offers a 15 per cent starter discount, reducing the annual comprehensive premium to £2,198 (basic £1,311). Also competitive is AxaPPP at £2,264 for the couple (budget £1,770). Bupa International comes in at £3,706 and £2,015 (budget).
It should be noted that policies do not compare like for like but are broadly similar.
VAT on insurance
Zambia’s government abandoned an attempt in 2010 to impose VAT on insurers. However, Antony Brown (InterGlobal) believes the issue is far from dead. It could mean expatriates face another rise in medical insurance premiums.
'Holes’ in local schemes
Mr Brown warned about locally bought plans, which are generally much cheaper than international insurance. He said some employers were offering them to staff even though they gave very limited cover.
“We’ve seen one local scheme which claimed to offer evacuation cover, but on careful examination the policy covered evacuation only as far as Lusaka – which would be inadequate in the event of a serious illness or complex care requirements. Expats must make sure they carefully check the small print – even where a plan is provided by their employer as they could easily come unstuck with a local plan.”
Some over-the-counter drugs available in the UK are not legal in Zambia. You should check ingredients carefully and consider leaving non-essential items at home. You may be questioned by customs on arrival in Zambia about any medication you are importing. Visitpharmacy@pra.gov.zm
If medication is essential you are advised to contact Zambia’s Pharmaceutical Authority to request advance permission to bring the drugs into the country.
Malaria, rabies and tuberculosis (TB) are common. The FCO recently alerted travellers to an outbreak of measles particularly affecting the young. It advised: “You should take particular care if you are travelling with children.”
Among other health hazards, cholera and dysentery are common, particularly in the rainy season (November-April).
Boiled or bottled water should be consumed and ice in drinks avoided. Other hygiene rules include thorough cooking of food. Food from street vendors may not meet adequate hygiene standards. If you suffer from diarrhoea during a visit to Zambia you should seek immediate medical attention.
Watch out for…
Drug taking and smuggling are illegal and may attract severe punishment. Prison conditions are an extra deterrent. Courts make little distinction between soft drugs, such as marijuana, and more injurious illegal substances.
Also illegal and likely to lead to a jail sentence or deportation is possession of pornography. Homosexuality is illegal. Those caught engaging in homosexual acts can be sentenced to long terms of imprisonment. Also outlawed is drink-driving and using a mobile phone at the wheel.
Routine dental care is adequate in Lusaka, although advice is that more elaborate procedures such as crowns, periodontal work or oral surgery work should not be undertaken in Zambia.
Qualified opticians can be found but ophthalmologists are rare. Foreign nationals are advised to bring extra pairs of glasses, as well as a copy of their lens prescription, in case a replacement is needed. Extra contact lenses and cleansing solutions should be brought with you.
The curate’s egg
Zambia offers some of the world’s greatest natural attractions. But it is not the place, even for the adventurous, to forgo sensible precautions.
This article was originally published in the Telegraph Weekly World Edition
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