The Human Resources for Health Crisis in Zambia An Outcome of Health Worker Entry, Exit, and Performance within the National Health Labor Market

by Herbst, Christopher; Vledder, Monique; Campbell, Karen; Sjöblom, Mirja; Soucat, Agnes

• ISBN13: 9780821387610
• ISBN10: 0821387618
• Edition: 1st
• Format: Paperback
• Copyright: 2011-04-26
• Publisher: World Bank Publications

Summary

Despite reporting some health gains since the 1990s, health outcomes remain poor in Zambia and it will be very challenging to achieve the health related MDGs by 2015. The Government of Zambia recognizes that the improvement of child and maternal health, and the reduction in mortality from HIV/AIDS and malaria require better access to an appropriate number of well performing health workers or human resources for health (HRH). This report compiles recent evidence on the Zambian health labor market and provides some baseline information on HRH to support the government address its HRH challenges. The report analyzes the national health labor market to better understand the available evidence related to the stock, distribution and performance of HRH in Zambia (i.e. the HRH outcomes). It aims to explain those HRH outcomes by mapping, assessing and analyzing pre-service education and labor market dynamics i.e. the flow of health workers into, within and out of the health labor market, as well as the core factors influencing these dynamics. The report finds that HRH stock in Zambia is low and indicators fall below national and international benchmarks. The low number of health workers in Zambia can in part be explained by low levels of inflow of health workers into the health labor market, in large part due to pre-service education capacity constraints. Aside from low levels of inflow, labor market exit, particularly of doctors, is another prime factor for low levels of stock in Zambia, and is primarily attributed to outmigration. The geographic distribution of health workers, particularly of higher level cadres, is highly uneven and biased towards urban, more prosperous areas. Dissatisfactions with rural conditions, or their perception of inadequacy, including both monetary and non monetary remuneration are primary reasons for low levels of inflow into, and high levels of exit out of, the rural labor market. Regarding health worker performance, data suggests that absenteeism in Zambia is high. Inadequate monitoring and accountability mechanisms, as well as coping mechanisms such as dual practice are attributed to these high levels of absenteeism. Another key performance issue identified to be problematic in Zambia is health worker competence. Weaknesses here are linked to training capacity, working conditions, skills substitutions and job satisfaction/motivation. The report finds that on the whole, the dynamics of labor market entry and exit (determining stock and distribution) and performance of HRH in Zambia is influenced by 4 overarching factors: 1) inefficient management arrangements and highly centralized decision-making on HRH 2) inadequate training capacity leading to low production of skilled workers 3) inadequate work environment and conditions of service'¬ ;including perceptions of low remuneration; and 4) HIV/AIDS related morbidity and mortality. At a more macro level, the fiscal environment is considered insufficient in its current form to adequately address the HRH crisis.