External shocks, state management and under-five mortality in Zambia

Michel Garenne, Institut de Recherche pour le Développement (IRD)
Eneas Gakusi, Centre D'Etudes et de Recherches sur le Développement International (CERDI)
Christopher Grigoriou, Centre D'Etudes et de Recherches sur le Développement International (CERDI)

Trends in under-five mortality were favorable in Zambia in the 11 years following independence (1964-1975), as a result of favorable political and economic context and generous health, education and social policies. In 1975, the international prices of copper, which represented 95% of exports and 55% of government revenue, went down dramatically. This created a tremendous economic chock to the country, which depended almost entirely on copper exports for financing economic development and social policies. As a result of a long-lasting economic crisis, income per capita was strongly reduced, and most economic indicators collapsed or were strongly reduced: imports, agricultural production, private and public consumption, savings, investments. The health sector was also heavly 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 later, in the 1980’s, but did not have any effect on the mean level of education during the crisis years. Under-five mortality increased dramatically 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 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 many aspects of the copper crisis are discussed in light of economic and political choices made in the earlier periods.