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Executive Summary

health workers surveyed in several cities in Zambia agreed that they had enough equipment and supplies to adequately carry out their tasks. Finally, the job satisfaction of health workers, and their motivation—their “willingness to exert and maintain an effort toward organizational goals”—may also be linked to competency issues. Evidence from a representative survey shows that while 44 percent of HRH report satisfaction with their job, 43 percent report dissatisfaction and 12 percent are indifferent. Staff dissatisfaction stems mainly from stressful workloads (42 percent) and low salaries (34 percent). Only 7 percent reported bad facility management while 17 percent cited “other reasons.” The report finds that the dynamics of labor market entry and exit (determining stock and distribution) and performance of HRH are influenced by four 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) morbidity and mortality related to HIV/AIDS. A closer assessment of each of these factors reveals that management on HRH is indeed highly centralized (after a brief and failed experiment with decentralization during the late 1990s), and evidence confirms that some aspects of management performance on HRH may be weak (such as monitoring and salary management). Pre-service education capacity, moreover, was also found to be poor in terms of physical, technical, and organizational capacity. In terms of work environment and conditions of service, closer analyses revealed that monetary compensation in the public sector is not as low as sometimes suggested when allowances are taken into account (although still lower than in the private sector). When benchmarking salaries and allowances against the average gross national income in Zambia as well as regional benchmarks doctors, remuneration compares relatively well in Zambia. A detailed assessment on nonmonetary factors beyond those discussed throughout this report is not available. Finally, HIV/AIDS constitutes a real problem in Zambia, and the country is one of only a handful that suffers simultaneously from HIV/AIDS and HRH crises. At the macro level, the report deems inadequate fiscal space to be an important parameter to the current HRH challenges. All of the factors discussed above and which influence labor market dynamics depend on adequate financing. The report finds that the budget allocated to the health sector (10 percent of `national budget) is below the Abuja target. About a third of all government spending for the health sector in 2007 came from donor funding. Donor funding is largely earmarked, restricting the actual budget for HRH. The wage bill (budget for personal emoluments) has actually declined over time largely due to this earmarking of donors funding. Finally, this report examines the issue of access and equity of HRH. It finds that even if health workers are available, in either urban or rural areas, and performing adequately, the wealthy in Zambia have be er access to services than the poor. This situation is found in most if not all other countries. The report finds that as far as access to health workers is concerned, the poor generally loose out. It also reveals that even if health workers are available, wealthier segments of the population often continue to have be er access to health workers than poorer segments. Wealthier women have the highest probability of receiving any antenatal care. There is an even steeper pro-rich gradient in delivery a endance in Zambia. In contrast to antenatal care, there is li le varia-

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...