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ZambiaHealth Profile and HRH Crisis Zambia is ranked at number 165 in the 2006 Human Development Index. In terms of HNP outcomes, the table below clearly shows that life expectancy and infant mortality and under 5 mortality have improved insignificantly or not at all over the last 5 years. Zambia’s Minister of Health Sylvia Masebo stated recently that “the biggest problem facing the country's health sector, and the biggest bottleneck to improving HNP outcomes and achieving the health MDGs, is the human resources crisis, which is characterized by insufficiency of health workers, high level brain drain, low salary plus poor working environment and the imbalance in the distribution of health workers between urban and rural areas”.
Addressing HRH The “amount of money and technical assistance needed to address the HRH crisis is "colossal" and requires the cooperation and support of all the stakeholders." (President Levy Mwanawasa). “I wish to urge our cooperating partners to continue supporting my government technically and financially, particularly to ensure that the strategies in the human resources for health plan are operationalized and implemented in order to address the human resources crisis in the health sector," the president said. The WB HRH program is working in tandem with Government activity, other Donor activity, and NGO activity to address the Human Resources for health crisis. The following activities are organized and funded by the Banks HRH program, and are currently ongoing or have been completed. Activities are centered around 1) obtaining baseline information on HRH 2) developing strategy, policy and programs on HRH, 3) implementing strategy, policy and programs on HRH. Baseline Information and AnalysisThe State of Human Resources for Health in Zambia: Findings from the Public Expenditure Tracking and Quality of Service Delivery Survey (PET/QSDS), 2005/06: A Public Expenditure Tracking and Quality of Service Delivery survey (PET/QSDS) was undertaken in mid-2006 to provide a quantitative assessment of the state of health service delivery in the country. One component of the survey focused on the management of health personnel, including staff availability, vacancy, absenteeism, and tardiness; staff turnover; staff workload, use of time, and morale; and staff salary and benefits. The PETS survey adopted a multistage sampling frame involving provinces, districts, and health facilities, and within them, health workers and patients. In addition, the survey also interviewed patients and health workers. The study was lead by Oscar Picazo. Adequacy and Accuracy of Information on health worker Stock, Profiles and Distribution: Analysis of the Health Facility Census data in Zambia. This paper analyzed the HRH related data of the Zambia national health facility census conducted in 2006 discussing 1) the extent to which the derived indicators may be considered sufficient for HRH policy and program development, 2) the extent to which they may be considered accurate, and 3) key recommendations on how to update this data in the future. (Led By Chris Herbst) Health Worker Productivity in Zambia:Information on the productivity of existing health workers is crucial for managing the current stock of health workers in Zambia. A worker productivity analysis is planned and modeled on a methodology and similar exercise carried out by Marko Vujicic in Ghana in May 2006. The study will allow the government to understand the factors explaining the variations in health worker productivity so that facilities or districts with lower staff productivity can benefit from lessons from the better performers. Productivity estimates will be adjusted for a number of variables and will be defined as the amount of output produced for a given level of inputs used in a production process. In the context of health workforce productivity, the relevant output is a measure of health care services provided to the population (number of patients seen) and the relevant input is some measure of the quantity of human resources for health (HRH). Marko Vujicic, Christopher Herbst and Ottar Mestaed will work together to conduct the analysis in Zambia. Study to map bottlenecks to scaling up health worker production: A crucial piece of baseline information required to manage health worker inflows is information on the capacity in Zambia to produce health workers. This study plans to assess quantitatively and qualitatively the current capacity of production of qualified health workers in Zambia (doctors, nurses, dentists, pharmacists, technicians, and allied providers), and the factors which influence it. The proposed work will look at the following dimensions of the production of health workers: policy environment, the regulation and functioning of training institutions, planning practices (i.e how many health workers can be employed in the public and private sectors), actual health worker training programs and locations, educational institution infrastructure, actual student population, quality of training, outputs (graduation rate, course development rate etc), and institutional ownership and funding (public and private), etc. The study will be lead by Gaston Sorgho under the overall direction of the Africa Health Workforce Team. Study on Wage ceilings: This study looks at health workers’ wage ceilings and the process determining the budgeted wage bill for health workers, contracting arrangements, and external funding of health worker salary and remuneration in Zambia. Such information is important both for designing policies programs to manage outflows as well as for increasing the productivity of the existing stock of health workers. This proposed study will collect, analyze, and map out information on wage bill conditionalities and the process determining the budgeted health worker wage bill, public sector contracting arrangements, and donor funding of salaries in Zambia. This process will identify problems and help “make the case” and pave the road for investments to improve health workforce performance and adequately manage and deal with outflows. Marko Vujicic will lead this study with general guidance from the Africa Health Workforce Team. Study of the Effectiveness of Rural Retention Incentives: The Bank Booster project in Zambia is financing rural retention incentives for health workers (motorcycles, electrification of health worker homes, etc). The study will evaluate the effectiveness of various forms of incentives in posting health workers to rural clinics and in their retention. The evidence from this study will be used to design nation-wide retention incentives. (Led by Rosemary Sunkutu and Aly Sy) A Qualitative and Quantitative Study on Community Health workers in Zambia: It is estimated that, for developing countries to reach the health-related Millennium Development Goals (MDGs), scaling up the coverage of community-based health interventions is crucial. Yet, there has been strikingly little research on comprehensive assessments of the CHW system. While some early studies looked at what types of individuals would be best to choose for such positions and how to most successfully train such individuals in the initial phase of their careers, evidence on the incentives and sustainability of the CHW system are almost non-existent. The WB HRH program commissioned a study, both quantitative and qualitative in nature, that aims at (i) improving the understanding of the key issues surrounding CHW’ s, including incentives, sustainability, workload, accountability, reporting, and dynamics at the community level; and (ii) providing evidence to inform the decision-making process in strengthening community-based services in Zambia. Feng Zhao, is leading the study. Development of National HRH Strategic Plans, Policies, and ProgramsHuman Resources for Health Research Conference, 7-8 June, 2007, Lusaka, Zambia. With significant funding from the World Bank, The Ministry of Health, through the office of the Director of Public Health, held a National Research Conference on Human Resources For Health from 7th to 8th June 2007 at Mulungushi International Conference Centre organized by the National Health Research Advisory Committee (NHRAC). The Theme of the Conference was “Transforming Research into Action: Providing Evidence for HRH Policy development, Program Design and Implementation.” The Participants were drawn from; District Health Management Teams, Provincial Health Offices, Ministry of Health Headquarters, Health Training Institutions, Health Professional bodies, Trade Unions, Traditional Healers, Researchers, Cabinet Office, Parliamentarians, and Cooperating Partners. The overall objective of this conference was to gather and review all existing evidence that would contribute towards moving the National HRH Agenda forward by informing policy development and implementation of the HRH Strategic Plan in Zambia. The HRH program team attended the conference, presented and discussed preliminary AHRH program research findings, and moderated key break off group discussions. Implementing Policies and Programs TBA |
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