Background: Death after an illness may be perceived as normal, especially after someone has sought care from institutions of care and they have done everything to save life and have failed, in Zambia, while others will die in hospital after such efforts have been made. Health Information System (HIS) records show that almost an equal number of people die outside and are Brought In Dead (BID). The un answered question one will ask is; why are there so many people dying outside health facilities?
Objective: To determine factors contributing to people dying outside health facilities.
Method: A cases-control study. Relatives to those who died outside health facilities were cases and of those who died in the hospital (UTH) were controls.Results: The results were that the majority of those who die outside health facilities were due to ime.\pected events/nature of illness which includes: Road Traffic Accidents (RTA). poisoning, murder and all such conditions that are medical emergencies and do not give someone chance to even go to the hospital. It also includes such conditions as are not curable like cancer and all HIV/.AIDS related conditions. Financial inacce>.sibilit\ constituted 14,7%. followed b> poor quality of care with 1.".()%. About 30.0" o of deaths among cases however, were due to non-attendance to health facilities. For those who died in the hospital on the other hand, nianv died due to nature of illness/unexpected events (60.0%) and negligence of staff (13.0%).
Conclusions: From these results it can be seen that educational level, inability to pay and poor qualitv of care are the most important determinants of people to die outside liealth facilities. For those who died in the hospital: unexpected events and /or nature of illness, lack of drugs in the hospital and negligence were the factors thev died from. In view of these results therefore, recommendations were made to government and health care prov iders in order to improve health care in the country. Public welfare assistance scheme (PWAS) is to be increased and publicised so that those who have problems of tlnanciai inaccessibility should be
helped; also to improve on the diagnosis and treatment of those that go to the health facilities.