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Executive Summary

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espite 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 country has made considerable progress towards achieving MDG 4 (reduce child mortality), but under-five mortality remains high, at 119 per 1,000 live births in 2007, above the Africa region’s average. The main causes of illnesses and deaths in children under five years old in Zambia are preventable and/or treatable with low-cost and effective interventions. With regard to MDG 5 (improve maternal health), the maternal mortality ratio (MMR) may have declined in recent years; however, it would need to drop another 45 percent, from its current level of 591 per 100,000 live births, to reach the MDG target of a 75 percent reduction. The proportion of births a ended by a skilled birth attendant, one of the most effective interventions to reduce MMR, has remained virtually constant for almost two decades. Furthermore, infection and parasitic diseases are by far the largest causes of mortality in Zambia, with half of all mortalities a ributable to HIV/ AIDS, but also more easily treated illnesses like malaria and diarrheal diseases. The Government of Zambia recognizes that both the improvement of child and maternal health and the reduction in mortality from HIV/AIDS and malaria require be er access to an appropriate number of well-performing health workers, or human resources for health (HRH). So far, the government has demonstrated strong commitment to addressing the country’s HRH challenges, which is well reflected in Zambia’s Poverty Reduction Strategy Paper (PRSP), The Fifth National Development Plan 2006–2010 (GRZ 2006), the 2006–2010 National Health Strategic Plan (NHSP), and more specifically, in the 2006–2010 Human Resources for Health Strategic Plan (HRHSP) and the second HRHSP (2011 onwards) that is currently under development (MoH 2005a; MoH 2005b). This report compiles recent evidence on the Zambian health labor market and provides some baseline information on HRH to help the government address its HRH challenges. Rather than focusing on making policy recommendations, the report is designed to be a source book to benefit and fuel discussions related to HRH in Zambia. Most of the data presented in the report covers the period 2005–08. The report analyzes the national health labor market to be er understand the available evidence related to the stock, distribution, and performance of HRH in Zambia ( that is, the HRH outcomes). It aims to explain those HRH outcomes by mapping, assessing, and analyzing pre-service education and labor market dynamics, that is, 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. Stock is low particularly when compared to other countries in the developing world. Counting public and private sectors, as well as clinical and nonclinical cadres, Zambia has 1.05 health workers for every 1,000 people, which is less than Benin (1.11), Rwanda (1.22), Ghana (1.93), and India (1.95). Moreover, only a li le over half of the existing HRH stock in Zambia are clinical cadres. Of all clinical cadres, more than 60 percent are nurses, whereas the share of doctors is just over 7 percent. When set against international benchmarks, such as the recommended 2.3 health workers per 1,000 population, Zambia’s health worker numbers fall short of achieving the MDGs. Set against national benchmarks (the so called “establishment” in the public sector) the number of health workers is also highly inadequate. ix

The Human Resources for Health Crisis in Zambia  

Despite reporting some health gains since the 1990s, health outcomes remain poor in Zambia and it will be very challenging to achieve the he...

The Human Resources for Health Crisis in Zambia  

Despite reporting some health gains since the 1990s, health outcomes remain poor in Zambia and it will be very challenging to achieve the he...