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Box 8.1 (continued) But in Zambia, between 2000 and 2004 the public sector wage bill was expanded. And in 2002 a hiring freeze was introduced to contain the wage bill, although doctors and nurses were excluded, favoring the health sector. MoH data indicated that the health sector’s share of the public sector wage bill had declined significantly, suggesting that this legislative favoritism did not translate to practice. Also, some of this decline could have resulted from the CBoH hiring additional staff from its block grants during decentralization, thus insulating the health sector from the wage bill ceilings and the ensuing hiring freezes. So the accounting methodology may not have captured wage bill and staffing increases under this decentralized structure.3 And while this decentralization may have funneled more money into salaries than MoH data indicate, it may also have come at the expense of essential health services (Vujicic and others 2008). The public service salary scale review approved by the Zambian cabinet in 2002 led to fewer salary grades and hence to a decompression of salaries. The resulting higher allowances and increases were not anticipated and resulted in overruns to the 2003 budget.4 In reaction, another hiring freeze was put in place, and the IMF introduced measures to keep the wage bill within the agreed limit of 8 percent of GDP (Vujicic and others 2008). Source: Authors.

Notes 1. The Abuja target requires Sub-Saharan African countries to increase their health spending to 15 percent of total public spending by 2015. 2. Anecdotal evidence indicates that vertical funds are being used by health facilities to incentivize health workers at the district level. 3. Key informant interview with the PSMD cabinet oďŹƒce, Government of Zambia, April 7, 2008. 4. Key informant interview with former PSMD.

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...