title: Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions.
abstract: BACKGROUND
  The rapid evolution in disease burdens in low- and middle income countries is forcing policy makers to re-orient their health system towards a system which has the capability to simultaneously address infectious and non-communicable diseases. This paper draws on two different but overlapping studies which examined how actors in the Zambian health system are re-directing their policies, strategies and service structures to include the provision of health care for people with chronic conditions.
  
  
  METHODS
  Study methods in both studies included semi-structured interviews with government health officials at national level, and governmental and non-governmental health practitioners operating from community-, primary health care to hospital facility level. Focus group discussions were conducted with staff, stakeholders and caregivers of programmes providing care and support at community- and household levels. Study settings included urban and rural sites.
  
  
  RESULTS
  A series of adaptations transformed the HIV programme from an emergency response into the first large chronic care programme in the country. There are clear indications that the Zambian government is intending to expand this reach to patients with non-communicable diseases. Challenges to do this effectively include a lack of proper NCD prevalence data for planning, a concentration of technology and skills to detect and treat NCDs at secondary and tertiary levels in the health system and limited interest by donor agencies to support this transition.
  
  
  CONCLUSIONS
  The reorientation of Zambia's health system is in full swing and uses the foundation of a decentralised health system and presence of local models for HIV chronic care which actively involve community partners, patients and their families. There are early warning signs which could cause this transition to stall, one of which is the financial capability to resource this process.
authors.affiliation: VU University Amsterdam, Faculty of Earth and Life Sciences: Athena Institute, De Boelelaan 1085, Amsterdam, HV 1081, The Netherlands. c.j.aantjes@vu.nl.
authors.forename: Carolien J
authors.initials: CJ
authors.lastname: Aantjes
authors.forename: Tim K C
authors.initials: TK
authors.lastname: Quinlan
authors.forename: Joske F G
authors.initials: JF
authors.lastname: Bunders
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D017598:Efficiency, Organizational; D005260:Female; D005380:Financing, Government; D017144:Focus Groups; D006078:Government Programs; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D018166:Health Care Reform; D006285:Health Planning; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D008297:Male; D011785:Quality Assurance, Health Care; D015024:Zambia / Q000453:epidemiology