Migration, Retention and Return of Health Professionals The Zambian Case

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Migration, Retention and Return of Health
Professionals The Zambian Case
The Challenge of Managing a Health Care System in
Crisis
Dr. S.K Miti Health in Foreign Policy Forum 2006
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Presentation Overview

• Introduction
• Face of the Crisis
• Migration of Health Professionals
• Impact of the crisis on health service delivery
• Current Initiatives to Address the Crisis
• Country Level Solutions to Address the Crisis
• Challenges to implement the HRH Strategic Plan
• Options to mitigate the HR Crisis in Developing
  Countries at the Global Level

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Introduction

• There is a human resource for health crisis in
  Zambia.
• The Zambian public health sector is operating at
  50 capacity
• Causative factors are both exogenous and
  endogenous
• Exogenous factors - austere fiscal measures (HIPC
  conditionalities) introduced by IMF and World
  Bank and a growing global labour market for HRH
• Endogenous factors poor conditions of service
  and work environment coupled with low training
  outputs

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The Face of the Crisis
RECRUITMENT
ATTRITION

• -Low training outputs
• Restrictions on recruitment to maintain the PE to
  GDP ratio
• Establishment not consistent with demand
• Core vs Support Staff

• Death mostly due to HIV
• Resignations
• Brain drain
• -Retirement age at 55

DISTRIBUTION

• Rural vs urban imbalances
• -Critical Cadres vs Support Staff
• Central vs Service delivery
• Public vs Private

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Migration of Health Professionals as an Example
of an Exogenous Factor

• Migration is the highest cause of attrition for
  all heath cadres, more for Nurses
• Records reveal resignations in Zambia's health
  sector could be explained by recruitment in
  developed countries
• Zambia is losing more nurses to the UK, and other
  countries compared to its production
• Between 2003 2004, General Nursing Council
  processed 1222 applications for Nurses/Midwives
  to work abroad compared to 994 graduates

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Impact of the Crisis on Health Service Delivery

• The HR crisis entails that Zambia cannot
  guarantee the provision of the basic health care
  package.
• The MDG targets will not be attained, if nothing
  is done to resolve the crisis.
• Zambia has inadequate staff to administer the
  HIV/AIDS programmes. This has affected our
  efforts to scale up ART program for instance
• In these circumstances, retention is of utmost
  importance

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Current Initiatives to address the Crisis
Retention of Health Professionals

• Action at National Level to meet the
• Abuja targets
• Increase in govt budget to the health sector from
  9 in 2004 to 12 in 2005
• US9.4 million allocated to the Ministry above
  the normal PE budget for recruitment and
  retention of 1,800 employees
• Loan scheme for public health workers

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Current Initiatives to address the Crisis
Retention of Health Professionals Cont.

• Action at District Level includes
• Provision of staff transport,
• Group performance incentive schemes,
• Top-up salaries for staff in remote areas,
• Renovation of accommodation
• Electrification using solar in remote areas

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Current Initiatives to address the Crisis
Retention of Health Professionals Cont.

• Support from Cooperating Partners as
• Zambia Health Workers Retention Scheme for
  medical doctors in rural areas - Royal
  Netherlands Govt
• Recruitment of 9 provincial Clinical Care
  Specialists - USAID
• Top-up allowances for members of District Health
  Management Teams
• Renovation construction of houses for medical
  staff in Luapula Province - USAID

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Current Initiatives to address the Crisis
Retention of Health Professionals Cont.

• Support from Cooperating Partners as
• Institutional scholarship support for the
  training of Zambia Enrolled Midwives in North
  Western Province - UNFPA.
• WHO salary supplementation for lecturers at the
  School of Medicine, University of Zambia
• SIDA support for training of nursing tutors,
  curriculum review general strengthening of
  training institutions

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Country Level Solutions to Address the Crisis

• All the above initiatives were implemented in a
  fragmented manner hence the need for a holistic
  approach to resolving the crisis.
• The extent of the crisis prompted the President
  of the Republic of Zambia to demand for a
  comprehensive plan to address the crisis.
• This demonstrates commitment at the highest
  political level
• In response to the presidential directive the
  Ministry of Health has since developed an HRH
  Strategic Plan 2006 2010.
• The HRH Strategic plan will provide an
  implementation framework for all efforts towards
  resolving the HR crisis in Zambia.

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Country Level Solutions to Address the Crisis
Contd

• In recognition of Zambia's initiatives a proposal
  has been made which is being considered
  positively by my Government to host the launch of
  the World Health report and commemorate the World
  Health Day
• Theme of the 2006 World Health Day is Health
  Workforce Crisis

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Country Level Solutions to Address the Crisis-HRH
Strategic Plan

• The HRH Strategic Plan will serve as an entry
  point for all Government and Co-operating Partner
  support for HRH
• The plan costed at USD313m for the first three
  years
• The Ministry using the plan as a tool to mobilise
  resources for HRH
• Commitments from the EU, CIDA, Sida, USAID and
  DGIS

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Country Level Solutions to Address the Crisis-HRH
Strategic Plan Cont.

• The key Strategic Interventions HRH Strategic
  Plan Are the Following
• A coordinated approach to HRH planning across the
  sector e.g MoE, MoFNP, MSTVT
• Increased numbers of trained staff through
  expansion of capacity of training institution and
  equity in distribution of staff
• Improved productivity and performance of health
  workers through improved work environment and
  performance based management
• Strengthened HR systems in planning, management,
  and development at all levels

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Challenges to implement the HRH Strategic Plan

• Zambia now faces the challenge of mobilizing
  enough resources to implement the HRH Strategic
  Plan.
• Mobilizing donor to shift from pilots and project
  mode of supporting HRH to an integrated and
  holistic sector wide approach to support HRH

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Policy Options to Mitigate HR Crises in
Developing Countries Global Perspectives
(Conclusions)

• International agreements for destination
  countries of third world migrant to invest in
  increasing pre-service training outputs to
  compensate for loss of staff
• Encourage Public Private Sector Partnership in
  human resources for health service delivery
• Multilateral Organizations to allow some fiscal
  space and waive the Health Sector from
  conditionalities imposed on developing countries

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• THANK YOU VERY MUCH