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Executive Summary

The number of doctors in Zambia is only 42 percent of the approved establishment, the number of nurses 46 percent, and the number of midwives 48 percent. 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. Low production of health workers, particularly of higher-level cadres, is a significant supply problem linked to capacity limitations of health training institutions. Zambia produces around 50–60 medical doctors a year, which is low when compared to such countries as Rwanda (97), Tanzania (200), Ghana (265), or Ethiopia (481). Some funded vacancies are not filled in Zambia, potentially pointing to extremely low production levels. In 2007, for instance, the Ministry of Health (MoH) managed to fill only 1,400 of approximately 1,700 funded positions in the budgetary timeframe. At the same time, the inability to fill funded vacancies also seems to be linked to highly centralized management of HRH. Which factor plays the larger role will need to be assessed further. Another issue is that even if health worker production were scaled up, it is not clear whether the “established” public sector vacancies would be funded, which means that the absorption capacity for an increased supply of graduates is not fully known. Indeed, in 2008 close to 40 percent of the established posts were not funded. And the not-for-profit and for-profit private sectors in Zambia remain small (see discussion below) and at present unlikely to absorb a large number of health workers. Aside from low levels of inflow, labor market exit, particularly of doctors, is another prime factor for low numbers of health workers in Zambia, and is primarily a ributed to outmigration (due in part to dissatisfaction with low pay and, until recently, aggressive recruitment strategies). Data by Clemens and Pe ersson (2006) found that the fraction of Zambian-trained doctors working abroad was close to 60 percent, staggering next to an average of 28 percent for all Sub-Saharan African countries combined. Aside from outmigration, premature death due to HIV/AIDS is also considerable in Zambia. In terms of sectoral distribution of HRH, the report finds that the overwhelming majority of health workers in Zambia work in the public sector (close to 80 percent in 2006) although the private sector is growing. The not-for-profit sector employs li le less than 20 percent of HRH, whereas the for-profit sector is extremely small, at less than 1 percent. Health workers are a racted to higher salaries in the private sector. The forprofit sector is underdeveloped and current regulations make it difficult to open a private practice. The geographic distribution of health workers, particularly of higher-level cadres, is highly uneven and biased towards urban, more prosperous areas. Health workers, particularly doctors, are extremely unevenly distributed in Zambia, particularly when benchmarking against international standards. Whereas Livingstone for example is home to 2.7 health workers per 1,000 population, a district like Chilubi is only home to 0.13 per 1,000. Higher-level cadres are predominantly concentrated in urban districts, something that cannot always be said about mid- or lower-level cadres (a larger proportion of health officers, for example, are located in rural areas). On the whole, perhaps not surprisingly given that a large proportion of the poor live in rural areas, there is a strong pro-rich gradient in the geographic distribution of human resources in Zambia. The disproportionate urban concentration, particularly of higher-level cadres, can be explained by low levels of inflow into, and high levels of exit out of, the rural labor market. A study found that in rural health centers, out of 688 staff in 2006, 69 were “in-

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...