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CHAPTER 4

Geographical Distribution

H

ealth workers in Zambia are distributed across geographical divisions such as provinces, districts, and rural/urban areas. This section presents some existing evidence on the distribution of HRH, discusses needs-based and equity concerns, and offers possible explanations for the picture on distribution. Summary of main findings • Health workers, particularly doctors, are unevenly distributed across Zambia’s districts. • Higher cadres, particularly doctors, are concentrated in urban districts, something that cannot always be said about lower cadres. • There is a strong pro-rich gradient in the geographic distribution of human resources. • The disproportionate urban concentration of higher cadres can be explained by low inflows into the rural labor market, because of unfavorable monetary but particularly nonmonetary compensation. • Facility managers in rural areas may not possess the negotiating skills to attract centralized funding to fill vacancies. • High rates of exit from the rural labor market are also to blame for the maldistribution of HRH, largely because of dissatisfaction primarily of higher cadres with nonmonetary factors (living and working conditions).

Provincial and District Distribution (by Number) Health workers are unevenly distributed across provinces. Some provinces have nearly five times more health workers than others (Ferrinho and others 2008). Lusaka and Copperbelt provinces have by far the most health workers and Luapula and North-Western provinces have the fewest (figure 4.1). Uneven health worker distribution is even more pronounced across districts than across provinces. Analysis of data from the 2006 Health Facility Census (HFC) reveals distribution to range from 11 health workers in Chilubi to 2,224 in Lusaka (figure 4.2). More than half the districts have fewer than 100 health workers, with districts such as Milenge, Chilubi, Kaputa, and Chavuma having no more than 20. Only 10 districts have more than 300 health workers, and roughly 35 percent are found in only 4 of the 61 districts (Kabwe, Ndola, Kitwe, and Lusaka), which collectively have almost 4,300 health workers (Herbst and Gijsbrechts 2007).

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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...