Resource Allocation Management in Zambia’s Devolved Health System: A Comparative Study of Lusaka Province Before and After Devolution

Abstract

This study examined resource allocation management in Zambia’s devolved health
system before and after devolution in Lusaka Province. Conducted as a mixed-method
cross-sectional study in four districts of Chilanga, Chongwe, Rufunsa, and Lusaka,
between 2023 and 2024, the research combined quantitative analysis of funding data with
qualitative insights from interviews with 367 facility staff. Quantitative data were
sourced from government reports and Ministry of Finance records to assess funding
disbursements for Management Support Services (MSS) and Primary Health Services
(PHS). Paired t-tests using SPSS evaluated changes in funding pre- and post-devolution.
Results showed a statistically significant increase in PHS funding in the rural districts of
Chilanga, Chongwe, and Rufunsa. The paired t-test yielded a t-value of 11.13 (df = 2)
with a one-sided p-value of 0.003988, indicating an average funding increase of
approximately 52,435 units, with a 95% confidence interval confirming the increase was
at least 38,678 units. MSS funding remained stable in these districts, while Lusaka
District experienced funding variations attributed to constituency realignment, not
devolution. The study concludes that devolution positively impacted primary health care
funding by increasing program funds in rural districts. The uniform increase in PHS
funding aligned with population needs, likely reducing regional disparities and
improving equitable access to health services. These findings support the objective of
devolution to enhance resource allocation and service delivery at the community level.