Abstract
BackgroundThe Ministry of Health (MOH) in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH) strategic plan to address the crisis through improved training, hiring, and retention. However, the projected success of each strategy or combination of strategies is unclear.MethodsWe developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007), the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018.ResultsWith no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels.ConclusionsMeeting the minimum need for health workers in Zambia this decade will require an increase in health training school enrolment. Supplemental interventions targeting attrition, graduation and public sector entry rates can help close the gap. HRH modelling can help MOH policy makers determine the relative priority and level of investment needed to expand Zambia's workforce to target staffing levels.
Highlights
The Ministry of Health (MOH) in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services
The shortage of health workers is acute in resource-limited settings where it limits the provision of even basic health services like antenatal care and infant immunizations, and it prevents progress towards the health-related Millennium Development Goals (MDG) of
Of the 10 307 key health workers who leave the workforce during the 10 year period, 4073 (40%) leave to go back to school, 4239 (41%) leave for involuntary reasons, and 1995 (19%) leave for voluntary reasons
Summary
The Ministry of Health (MOH) in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH) strategic plan to address the crisis through improved training, hiring, and retention. The human resources for health (HRH) shortage is estimated at more than 4 million workers globally [1]. Underinvestment in training institutions has led to an inadequate supply of professional health graduates [5,6,7]. Policies to reduce HRH shortages include expanding training institutions and providing incentives to improve retention [14,15]. Such policies are being written into national multi-year, ministry-level HRH strategic plans [16]. Deciding among them or determining the most appropriate level of investments in them presents a significant challenge for decision-makers, as there is uncertainty around predicting the effects of interventions over time or the interplay between them [17]
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