Between 2006-2011, the Zambian Ministry of Health has put in place a number of strategies aimed at meeting the goals of the 2006 –2010 Human Resources for Health (HRH) Strategic Plan. These include systematic surveys, censuses of HRH staffing and distribution, and expansion of the capacities of training institutions. In addition, strong partnerships have been established with key stakeholders in the health sector, including other government ministries and departments, local communities, private sector, faith-based institutions, civil society organizations (CSO), and Co-operating Partners (CPs) (MOH JAR, 2009).
Despite these recent strategies however, the country has less than half the required WHO recommended HRH workforce in all categories (Zambia MOH, 2010). Currently there are 0.06 physicians, 0.77 nurses and midwives per 1000 persons (AHWO, 2010). 80% of health workers in Zambia work in the public sector. There is high staff turnover at public health facilities, especially in rural areas where there is a net negative migration, despite the annual pool of graduates from training institutions. This is attributed to dissatisfaction with compensation and non-monetary factors such as occupational hazards, physical and psychological violence, and unreasonable workloads (World Bank, 2011; WHO, 2010).
Current HRH challenges in Zambia include (World Bank, 2011):
- inefficient management due to highly centralized decision making;
- high attrition rates from pre-service training;
- fewer graduates and deterioration in the overall quality of health workers as a result of inadequate funding of training institutions and lack of teaching staff; and
- high health worker morbidity and mortality due to HIV/AIDS.
COUNTRY COORDINATION AND FACILITATION (CCF) IN ZAMBIA:
The CCF process was introduced in Zambia with support of the Global Health Workforce Alliance (the Alliance) in 2009-2010. This facilitated the MOH to pursue the multi-stakeholder approach to promoting greater levels of understanding and trust among HRH partners, and establish an HRH-Technical Working Group (HRH Committee) for stakeholder coordination. This committee serves as a negotiation platform to resolve differences among stakeholders and the government, and creates a commonly agreed upon managerial road map that sustains the HRH partnership and shared ownership of HRH action in Zambia.
Achievements through CCF include the development of an evidence-based, fully costed, second-generation HRH strategic plan with a strong monitoring and evaluation framework that is actively supported and endorsed by the national and international partners, and incorporates the best aspects of the first HRH strategic plan as well as new developments and requirements in healthcare. Other achievements through the support of the Alliance include the exploration of avenues for alleviating bottlenecks in training and production of HRH, introduction of government initiatives for a community health workers’ program, including support of a case study tour to Ethiopia for senior management; a midwifery training initiative for accelerated production of midwives; and opportunities for senior policy makers from the MOH, accompanied by members from cooperative partners, to participate in regional and global HRH conventions and consultation avenues.
The new HRH strategic plan (2011-2016) has identified the following broad strategies to address HRH issues:
- scale up the recruitment, and improve distribution and retention of human resources for health;
- strengthen HRH management, in order to improve efficiency and effectiveness in utilization of existing staff; and
- strengthen training and staff development.
The HRH objectives formulated by the MOH for 2011 covered the following areas (Zambia MOH, 2011):
- development of HRH information systems;
- increased number of skilled health workers on staff;
- improved health worker productivity and performance;
- continued implementation of the Zambian Health Workers Retention Scheme Scale-up Plan;
- increased training output from health colleges;
- increased training of community health workers and lay health care providers; and
- provision of in-service and pre-service training.
HEALTH WORKFORCE DATA
HUMAN RESOURCES FOR HEALTH PLAN
REPUBLIC OF ZAMBIA: National Human Resources for Health Strategic Plan 2011 – 2015
- Republic of Zambia Human Resources for Health Strategic Plan (Draft): 2006 - 2010
HEALTH SECTOR STRATEGIES / PLANS
COUNTRY CASE STUDIES AND OTHER DOCUMENTS
- The Zambia Country Case Study: Positive Practice Environments: Quality Workplaces for Quality Care (2010)
- Health workforce responses to global health initiatives funding: A comparison of Malawi and Zambia (2010)
Zambia: Improving Coordination Process with CCF Principles
ALLIANCE MEMBERS WORKING IN ZAMBIA
- Afro-European Medical and Research Network (AEMRN)
- Afya Mzuri, Lusaka, Zambia
- Clinton Foundation HIV/AIDS Initiative
- Initiatives Inc.
- Johns Hopkins Center for Clinical Global Health Education
- School of Public Health, University of the Western Cape
- Teesside University, School of Health and Social Care
- University of Cape Town School of Public Health
- University of Edinburgh, School of Clinical Sciences and Community Health, Edinburgh, UK
- USAID Health Care Improvement Project (HCI)
- Wemos Foundation, Netherlands
- Zambia UK Health Workforce Alliance
- Zambian International Health Alliance (ZIHA)