Page 39

The Human Resources for Health Crisis in Zambia

23

Table 2.13. Estimates of premature mortality in selected countries in the WHO Africa region Crude death rate per 1,000 active health workers Physicians

Nurses and midwives

Central African Republic

Country

25

21

Democratic Republic of Congo

23

19

Côte d’Ivoire

25

22

Ethiopia

23

20

Kenya

23

23

Liberia

24

20

Madagascar

21

20

Rwanda

25

19

Sierra Leone

26

22

Tanzania

24

22

Uganda

26

22

Zambia

28

22

Zimbabwe

28

24

Total

24

21

Source: Kinfu and others 2006.

countries in the region. Of 13 African countries, Zimbabwe and Zambia together have the highest crude death rate of doctors per 1,000 active workers and the third highest crude death rate of nurses and midwives (table 2.13). Because Zambia produces only 50 to 60 doctors per 1,000 people annually, the crude death rate of roughly 28 per 1,000 cripples the country’s capacity to expand its health labor market. HIV/AIDS is the leading cause of premature death among health workers in Zambia and is responsible for high mortality rates throughout the country. An early landmark study on mortality among female nurses at two hospitals between 1980 and 1991 showed that the observed increase in mortality was due largely to HIV infection. The mortality rate of nurses in the hospitals increased from 2 per 1,000 between 1980 and 1985 to 7.4 per 1,000 between 1986 and 1988 to 267 per 1,000 between 1989 and 1991. (Note, however, that this was before ART were made available to the general population.) The World Bank (1997) estimated that a country with a stable HIV prevalence of 20 percent would experience an annual loss of between 2.1 percent and 4.4 percent of the health sector workforce due to death from AIDS. The loss of health workers from HIV/AIDS varies not only by province and facility but also by cadre, with clinical officers and nurses more affected than doctors. For doctors, mortality is not the most common reason for a rition. But it is for clinical officers and nurses. In the 12-month period ending in October 2003, deaths made up a significant proportion of all “terminations” (20 percent in Lusaka, 33 percent in Kasama, and 26 percent at the University Teaching Hospital). Death rates were 0.4 percent for doctors, 2.8 percent for clinical officers, and 3.5 percent for nurses working at the study sites. On average, clinical officers die with 57 percent of their expected career term remaining, and nurses die halfway through their normal career term. The current output of clinical officers would have to increase by 80 percent to offset observed AIDS mortality, and that of graduating nurses would have to grow by 50 percent (Feeley and others 2004).8

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...