The Human Resources for Health Crisis in Zambia
47
Percent of women who received antenatal care
Figure 5.7. Quality of antenatal care 100 90 80 70 60 50 40 30 20 10 0
94
91
80
80
73 59
56
61
48 28
Informed of signs of pregnancy complications
Weight measured
Zambia 2007 Namibia 2006–07
30
Height measured
DRC Tanzania 2004–05
23
Blood pressure measured Malawi 2004 Zimbabwe 2005–06
Urine sample taken
Blood sample taken
Mozambique 2003 Regional Average
Source: DHS 2007; World Bank 2010.
Low HRH productivity may also be an issue in Zambia. A study of a sample of Zambian hospitals found that they operate at 67 percent technical efficiency. It found further that inefficiencies were no more pronounced in government hospitals than in those owned by private NGO and faith-based organizations, suggesting widespread inefficiencies in both the public and private sectors (Masiye 2007). Furthermore, according to the PETS, MoH staff members’ self-reported late arrivals in the month preceding the survey was 37 percent among rural health center staff, 47 percent among urban health center staff, and 47 percent among hospital staff, yielding 43 percent overall. The average number of days late the previous month was three for rural health center staff, four for urban health center staff, and three for hospital staff, yielding four days late overall (Picazo 2008).
Explaining Performance Outcomes Many performance problems can be explained by capacity weaknesses and health worker coping mechanisms in complex and adverse environments (Ferrinho, Omar, Fernandes, Blaise, Bugalho, and Lerberghe 2004; Ferrinho and Van Lerberghe 2002; Serneels 2005). Performance problems can be linked to:
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Weaknesses in pre-service and in-service training (explaining issues with competence). Inadequate management and accountability structures including an effective performance appraisal and merit based promotion (explaining absenteeism). Unfavorable working environments such as high workload (explaining problems of productivity, responsiveness, and competence). Coping mechanisms such as dual practice, coping with lack of skills sets (explaining competence and absenteeism problems). HIV/AIDS (also explaining high rates of absenteeism and inadequate competence and productivity). Lack of motivation and satisfaction (explaining productivity, responsiveness, and other performance problems).
Each of these factors will be discussed below.