Zambian Public Sector Nurses Incentives and Motivation In The Context of The Migration: How To Retai

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Zambian Public Sector Nurses Incentives and
Motivation In The Context of The Migration How
To Retain Zambian Nurses?

• Naomi Toyoshi-Hamada
• Supervisor Dr Jill Maben
• London School of Hygiene
• and Tropical Medicine

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The content of presentation

• Background
• Research protocol
• Key Findings - Factors likely to influence the
  out-migration of Zambian nurses
• 4. Recommendations

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Background Human Resource Problems in Africa

• Inadequate number
• HIV/AIDS
• Growing international markets
• High attrition of public health workers
• Lack of empirical base to guide their choice of
  intervention

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Research Design

• Setting One tertiary-level public hospital with
  the highest resignation rates (RN 53, RM 68)
  in Zambia during the period of 2001-2004
• Describe the migration trends
• Qualitative methods including in-depth interviews
  with remaining nurses in Zambia (n34)
• Analysis using principles of grounded theory
  (e.g. deviant case, constant comparison)

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Flexible framework for analysis
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Issuing Ethical Guidelines by the Department of
Health in England
Change of Immigration Policy in South Africa
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1. Economic factors influencing out migration

• Failure to secure living wages
• - high extended family demands
• Seeing the achievement of friends
• Malfunctioning pension

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2. Organizational factors influencing out
migration

• Poor administrative system
• Lack of support from supervisors
• Unfair organizational practices
• Poor quality care
• Lack of professional development opportunities

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3. Socio-demographic factors influencing out
migration

• Older age profile of migrated nurses age of
  children
• Widows and breadwinners - HIV/AIDS orphan carers

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4. Stick factors influencing out migration

• Costs of migration
• Family constraints
• Patriotism
• Expectation of sponsoring further education
• Hope

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Unfulfilled extended family demands

• You know my family is very important. At the
  moment, I am more concerned about my childrens
  education. My first daughter is in grade nine,
  my nephew and niece are in grade eight and the
  others are following behind. And very soon they
  will be finishingsecondary education they will
  be getting to college. But as I am now I can
  never dream of sending any of children to
  college So because of such pressuresif things
  will not work I cannot say I am a very unique
  person. I want to provide for my children and I
  may take an opportunity as it comes.
  (37-year-old clinical instructor with 7
  dependents)

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Low and late payment of pension

• That pensionis not enough, because if I retire
  today, when will I get that money may be seven to
  ten years. By that time that money has even lost
  value. So to me its not even attractive. Thats
  another reason why I cannot keep on working in
  the government to wait for the pension, because
  thats another disaster. (Registered Midwife)

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Lifelong wage structure
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Poor quality care

• This girl came in with a breech
  presentation...I was there struggling with the
  baby, in the end it diedI 'd want to help this
  or that onebut I can't manageI just said no one
  is going to question on anything because I am not
  supposed to work aloneI couldnt leave that
  patient! I had to finish! By the time I am
  finishing that side it's already too
  late...(Registered Midwife, Obstetrics and
  Gynaecology Department)

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Lack of support

• I do work those basic things but not with open
  heart since 1997 up to dateI was sick, thenI
  didnt get enough support during that hard time I
  was going throughThat was the saddest moment I
  have had at this hospital Not necessarily
  financial support, but psychological support, you
  know, feeling sympathybut at this hospital you
  find that there is nothing like that. (EN, a
  breadwinner of 11 children and unemployed
  husband)

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Unfair organizational practice (Lack of
professional development opportunities)

• At this hospital, whenever there is a seminar
  or workshop, us the nurses who are working are
  not taken to attend those seminars. It is the
  bosses, the managers, the matrons are the ones
  who go for those workshops especially if there is
  moneySo its very frustrating. Us nurses we
  remain, the same people go.
• (RN, Gynaecology Department)

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Expectation of sponsoring formal training (Stick
factors)

• If I really wanted to upgrade myself to go
  aheadI feel secured when I am in government.I
  can go ahead, unlike in the private sector
  because, if I had to join private sector, and if
  I really want to go to school, then the private
  sector has to terminate my contract.
  (27-year-old RN)

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Recommendations

• Need to pay more attention to nurses wage
  structures over their professional lives
• The perceived value of training should not be
  overlooked.
• The focus of the retention strategy should be on
  how to retain motivated workforce through
  improving their work and policy environment
  rather than just restricting migration.