The Human Resources for Health Crisis in Zambia

Herbst, Christopher H.; Campbell, Karen; Soucat, A.; Sjöblom, Mirja; Vledder, Monique

doi:10.1596/978-0-8213-8761-0

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…For attrition, we observed lower turnover for administrators in the PBF group compared to either of the control groups. Incentive schemes may not have the same effect on HRH outcomes in another national context, which differ on labor market conditions including changes in staff salaries, retirement age, transfers within and across districts, and education status [ 32 , 33 ]. 21…”

Section: Discussionmentioning

confidence: 99%

Incentives to change: effects of performance-based financing on health workers in Zambia

et al. 2017

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BackgroundPerformance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers’ job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before–after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group.MethodsMixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion seeks to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program.ResultsEconometric analysis shows that PBF led to increased job satisfaction and decreased attrition on a subset of measures, with little effect on motivation. The C1 group also experienced some positive effects on job satisfaction. The null results of the quantitative assessment of motivation cohere with those of the qualitative assessment, which revealed that workers remain motivated by their dedication to the profession and to provide health care to the community rather than by financial incentives. The qualitative evidence also provides two explanations for higher overall job satisfaction in the C1 than in the PBF group: better working conditions and more effective supervision from the District Medical Office. The PBF group had higher satisfaction with compensation than both control groups because they have higher compensation and financial autonomy, which was intended to be part of the PBF intervention. While PBF could not address all the reasons for attrition, it did lower turnover because those health centers were staffed with qualified personnel and the personnel had role clarity.ConclusionsIn Zambia, the implementation of PBF schemes brought about a significant increase in job satisfaction and a decrease in attrition, but had no significant effect on motivation. Enhanced health financing also increased stated job satisfaction.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-017-0179-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Incentives to change: effects of performance-based financing on health workers in Zambia

et al. 2017

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“…In Zambia, laboratory technicians’ salaries in the public sector were more than three times lower than those in the private sector and between 23% and 46% of those paid by non-governmental organizations [24]. This different salary scale probably contributed to the deficiency of laboratory technicians in the public sector in Zambia.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of Sub-Saharan Africa

Marinucci

Majigo²,

Wattleworth

et al. 2013

Hum Resour Health

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Effective implementation and sustainability of quality laboratory programmes in Sub-Saharan Africa relies on the development of appropriate staff retention strategies. Assessing the factors responsible for job satisfaction and retention is key for tailoring specific interventions aiming at improving the overall impact of health programmes. A survey was developed to assess these factors among 224 laboratorians working in the laboratory programme the University of Maryland implemented in seven Sub-Saharan African countries. Lack of professional development was the major reason for leaving the previous job for 28% of interviewees who changed jobs in the past five years. Professional development/training opportunities was indicated by almost 90% (195/224) of total interviewees as the most important or a very important factor for satisfaction at their current job. Similarly, regular professional development/opportunities for training was the highest rated incentive to remain at their current job by 80% (179/224). Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector (P = 0.002). The findings were used for developing specific strategies for human resources management, in particular targeting professional development, aiming at improving laboratory professionals within the University of Maryland laboratory programme and hence its long-term sustainability.

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“…The remainder work in the for-profit sector. In Zambia it is reported elsewhere that 80% of health workers worked in the public sector in 2006 [ 53 ] and in Zimbabwe, it has been estimated that 45% of doctors work full-time in the private sector [ 54 ].…”

Section: Case Studiesmentioning

confidence: 99%

Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health

et al. 2013

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BackgroundThe last decade has seen widespread retreat from user fees with the intention to reduce financial constraints to users in accessing health care and in particular improving access to reproductive, maternal and newborn health services. This has had important benefits in reducing financial barriers to access in a number of settings. If the policies work as intended, service utilization rates increase. However this increases workloads for health staff and at the same time, the loss of user fee revenues can imply that health workers lose bonuses or allowances, or that it becomes more difficult to ensure uninterrupted supplies of health care inputs.This research aimed to assess how policies reducing demand-side barriers to access to health care have affected service delivery with a particular focus on human resources for health.MethodsWe undertook case studies in five countries (Ghana, Nepal, Sierra Leone, Zambia and Zimbabwe). In each we reviewed financing and HRH policies, considered the impact financing policy change had made on health service utilization rates, analysed the distribution of health staff and their actual and potential workloads, and compared remuneration terms in the public sectors.ResultsWe question a number of common assumptions about the financing and human resource inter-relationships. The impact of fee removal on utilization levels is mostly not sustained or supported by all the evidence. Shortages of human resources for health at the national level are not universal; maldistribution within countries is the greater problem. Low salaries are not universal; most of the countries pay health workers well by national benchmarks.ConclusionsThe interconnectedness between user fee policy and HRH situations proves difficult to assess. Many policies have been changing over the relevant period, some clearly and others possibly in response to problems identified associated with financing policy change. Other relevant variables have also changed.However, as is now well-recognised in the user fee literature, co-ordination of health financing and human resource policies is essential. This appears less well recognised in the human resources literature. This coordination involves considering user charges, resource availability at health facility level, health worker pay, terms and conditions, and recruitment in tandem. All these policies need to be effectively monitored in their processes as well as outcomes, but sufficient data are not collected for this purpose.

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The Human Resources for Health Crisis in Zambia

Cited by 9 publications

References 8 publications

Incentives to change: effects of performance-based financing on health workers in Zambia

Incentives to change: effects of performance-based financing on health workers in Zambia

Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of Sub-Saharan Africa

Removing financial barriers to access reproductive, maternal and newborn health services: the challenges and policy implications for human resources for health

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