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Efforts to improve HRH in Zambia are made in a context where HRH management structures are highly centralized, the private sector is relatively small, and the fiscal space for HRH is limited. As this report will show, decision-making on public sector HRH is almost the exclusive role of the central government, with the sub-central level (districts or facilities) unable to hire and fire specific health workers as they deem fit (see chapter 7). In addition, the private sector, although growing in recent years, continues to be extremely small and unable to compensate for the insufficient number and performance of heath workers in the public sector (see chapter 3). HRH policies and programs moreover have to be designed in a context of limited fiscal space on HRH. Although fiscal space on health until recently was considered to be substantial, a significant proportion of it consists of donor contributions tied to specific non-HRH expenditures (see chapter 8). On the whole, such a context may make any rapid improvements on HRH particularly challenging.

Objective of the Report The report aims to be a diagnostic analysis of the health labor market in Zambia. Rather than emphasizing and focusing on policy recommendations, the report is designed to be a source book to benefit and fuel discussions on HRH in Zambia. Until now, the full story of the consequences and causes of health workers entering, performing in, and leaving the labor market has not been told comprehensively in Zambia. Available evidence and discussion focus on piecemeal analyses of different aspects of the health labor market. Not a single report or book has reviewed the HRH picture in its entirety. That has made it impossible to obtain a full picture on labor market outcomes and dynamics and difficult to prioritize one problem over another and develop targeted interventions to correct labor market imbalances. The report addresses this knowledge gap by consolidating all the evidence currently available on HRH to paint a coherent and comprehensive picture of the health labor market in Zambia. It not only provides an up-to-date assessment and understanding of HRH in Zambia, but also identifies and highlights practical levers that can help policymakers improve the functioning of the Zambian labor market toward be er availability and performance of HRH. Some of the data and findings of the report have already informed HRH discussions, including the development of the HRH chapter in the 2010 Country Status Report on Health in Zambia, as well as a Policy Note on HRH. Currently the report provides the evidence base for integrating HRH into the next health planning cycle, including the 2011–2015 National Health Strategic Plan and the second Human Resources for Health Strategic Plan (the current strategy, 2006–2010 is coming to an end in January).

Using a Labor Market Angle to Analyze HRH This report uses a labor market angle to analyze and try to understand the picture related to the stock, distribution, and performance of HRH in Zambia (HRH outcomes). It aims to explain HRH outcomes by mapping, assessing, and analyzing the flow of health worker into, within, and out of pre-service education and the HRH labor market. The movement into, within, and out of health training and labor market institutions is determined by a number of supply-side factors (for example, the number of willing

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...