More than just Brain Drain: Zambia’a battle against the human resource crisis

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While millions of dollars of international aid are flowing into the country, Zambian doctors and nurses are exiting at a steady pace in hopes of opportunity elsewhere.  However, the migration of healthcare workers most often to more affluent countries commonly referred to as ‘Brain Drain,’ is not the sole aspect of the human resource crisis in this developing sub-Saharan country.  In 2010 Zambia’s Ministry of Health estimated a 46% health worker attrition rate, citing 23,676 of 51,404 vacant health positions in the public sector.  These vacant positions not only reflect the absence of physicians and nurses, but also include vital roles of pharmacists, midwives, and laboratory scientists as well.  And with ~14% of the population (documented) living with HIV/AIDS, 60,000 annual under-five deaths, and a 48 year life expectancy, changes to health worker education and retention are imperative.

The World Health Organization recommends a health worker ratio of 2.5 caregivers per 1000 persons in order to provide the most basic of medical care in a community.  With Zambia’s present workforce, there are 0.60 nurses for every 1000 persons and only 0.07 physicians per 1000 people.  Rural disparities are further heightened as even though over 70% of the nation’s population lives in a rural setting, only 23% of doctors work in these areas.   Rural health posts are often staffed with minimally trained community health workers, having insufficient supplies, equipment, and improved sanitation, and rely heavily upon the work of traditional birth attendants for maternal health needs.  The 2007 Zambian Demographic Health Survey reported an approximate 53% of all births attended in the absence of a skilled health provider.

Image In light of the upcoming 2015 target for the Millennium Development Goals, the Zambian Ministry of Health has partnered with the WHO to create a National Health Workforce Observatory in order to “assist in the management, monitoring and evaluation of the human resources of health situation.”  Developing a strategy in which to understand the complexities of the health system and its deficits begun in 2006 and the information collected highlighted several key areas contributing to the poor human resource management in the public health sector.  The obvious was the individual migration of workers due to international recruitment with the promise of higher pay and better working conditions.  But at a systems level, bigger issues identified were the insufficient financial allocations directed towards health services, the burden of disease on the health work force itself, the shortage of educational programs (with one national medical school), the maldistribution of existing human resources, competition from the private health sector, and the nation’s fragmented infrastructure, including issues of governmental accountability and corruption.

While individuals may always choose to explore life options elsewhere and should be privy to such a freedom, tackling these policy issues at community and national levels would not only positively impact the system, but may just incentivize health workers to be remain part of a developing and life-saving movement.

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4 Responses to “More than just Brain Drain: Zambia’a battle against the human resource crisis”

  1. sbfclk Says:

    This is such a difficult topic because ther are so many issues contributing to the problem. You have a government that doesn’t have enough schools to educate the number of healthcare workers needed to take care of the country’s population. The healthcare workers that are there are not being adequately paid for their services. In an ideal world, you would hope the healthcare workers would stay and work where they are needed. But in reality, these HC workers have their own families and their own needs to think of, and it is understandable why they are leaving. The government needs to step-up and invest more money into it’s healthcare system so that healthcare workers want to stay and take care of people in their own country.

  2. sidharthadeka Says:

    In order to combat the ‘brain drain’, the Zambian government and health sector should leverage novel solutions toward combating the astounding attrition rate. While the health sector does not have the capital to pay their workers through multiple sectors (national to community level), it must build perceived organizational support within key institutions: the health ministry, district-level hospital, community clinics, etc.

    Organizational support can include the building positive reinforcement from authority figures in the setting to low-ranking officers/practitioners. Zambian workers should be measured in the following criteria to determine the level of perceived organizational support in the health sector:

    1. My organization cares about my opinions.
    2. My organization really cares about my well-being.
    3. My organization strongly considers my goals and values.
    4. Help is available from my organization when I have a problem.
    5. My organization would forgive an honest mistake on my part.
    6. If given the opportunity, my organization would take advantage of me. (item is reverse-coded)
    7. My organization shows very little concern for me. (item is reverse-coded)
    8. My organization is willing to help me, if I need a special favor.

  3. sbfphc Says:

    My colleague, Michelle Wallon of Jhpiego’s Zambia office has this to say …
    “I think this is a pretty good picture of the problem. Rural health posts are the minority of facilities though – the poor staffing at rural health centers is the main problem. There’s often only one or two skilled providers and it seems the further you go out into a rural area, the more likely you are to find the lowest level of skilled provider (enrolled nurse) who is least equipped to deal with all the health problems of a community. In addition to the challenges to HR retention listed in the posting, major disincentives for working in rural areas also include the poor quality of life outside the workplace (e.g., poor housing options, lack of decent schools if one has children, lack of social life if one is single…). In terms of pay, the current administration has promised a 100% increase in health worker salaries. It hasn’t materialized yet though and people are getting restless.”
    Also, did you see this article? http://www.nytimes.com/2012/03/11/magazine/america-is-stealing-foreign-doctors.html?emc=eta1

  4. skclarke821 Says:

    This issue seems insurmountable. In one of my classes we discussed the issue of “brain drain” and my professor brought up the argument that one way to combat this problem would be to restructure the medical schools in the US. He argued that if the US had more medical schools, made them less expensive to attend, and focused more on primary health care physicians that more Americans would be able and willing to go to medical school, thus reducing the need for foreign doctors. However, the NY Times article says that even this wouldn’t prevent the U.S. from selecting top candidates from around the world. It is an extremely complex issue…

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