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Health Worker Visits WORLD BANK WORKING PAPER NO. 214 AFRICA HUMAN DEVELOPMENT SERIES The Human Resources for Public Disclosure Authorized Health Crisis in Zambia An Outcome of Health Worker Entry, Exit, and Performance within the National Labor Health Market Christopher H. Herbst Monique Vledder Karen Campbell Public Disclosure Authorized Mirja Sjöblom Agnes Soucat Public Disclosure Authorized Public Disclosure Authorized THE WORLD BANK WORLD BANK WORKING PAPER NO. 214 The Human Resources for Health Crisis in Zambia An Outcome of Health Worker Entry, Exit, and Performance within the National Health Labor Market Christopher H. Herbst Monique Vledder Karen Campbell Mirja Sjöblom Agnes Soucat Copyright © 2011 The International Bank for Reconstruction and Development/The World Bank 1818 H Street, NW Washington, DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org 1 2 3 4 14 13 12 11 World Bank Working Papers are published to communicate the results of the Bank’s work to the devel- opment community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally-edited texts. Some sources cited in this paper may be informal documents that are not readily available. This volume is a product of the staff of the International Bank for Reconstruction and Development/The World Bank. The fi ndings, interpre- tations, and conclusions expressed in this volume do not necessarily refl ect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judg- ment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this publication is copyrighted. Copying and/or transmi ing portions or all of this work without permission may be a violation of applicable law. The International Bank for Reconstruction and Development/The World Bank encourages dissemination of its work and will normally grant permission to reproduce portions of the work promptly. For permission to photocopy or reprint any part of this work, please send a request with complete information to the Copyright Clearance Center Inc., 222 Rosewood Drive, Danvers, MA 01923, USA; telephone: 978-750-8400; fax: 978-750-4470; Internet: www.copyright.com. All other queries on rights and licenses, including subsidiary rights, should be addressed to the Of- fi ce of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2422; e-mail: [email protected]. ISBN: 978-0-8213-8761-0 eISBN: 978-0-8213-8762-7 ISSN: 1726-5878 DOI: 10.1596/978-0-8213-8761-0 Library of Congress Cataloging-in-Publication Data has been requested. Contents Acknowledgments .................................................................................................................. vii Acronyms and Abbreviations ..............................................................................................viii Executive Summary ..................................................................................................................ix 1. Context and Introduction .....................................................................................................1 Health Outcomes Overview ..............................................................................................1 HRH in Context ...................................................................................................................3 Objective of the Report ....................................................................................................... 4 Using a Labor Market Angle to Analyze HRH ...............................................................4 Methods and Limitations to Analysis...............................................................................6 Organization of the Report ................................................................................................8 2. HRH Stock ...............................................................................................................................9 Stock and Profi les of HRH .................................................................................................9 Needs-Based Perspective .................................................................................................. 13 Explaining the Low Stock ................................................................................................. 16 3. Public/Private Sector Distribution .................................................................................... 25 Distribution by Sector .......................................................................................................2 5 Explaining Public/Private Sector Distribution .............................................................. 26 4. Geographical Distribution .................................................................................................2 9 Provincial and District Distribution (by Number) ....................................................... 29 Needs-based Perspective .................................................................................................. 33 Equity Concerns.................................................................................................................36 Explaining the Uneven Geographical Distribution ...................................................... 38 5. HRH Performance ................................................................................................................ 42 Health Worker Performance ............................................................................................ 42 Explaining Performance Outcomes ................................................................................ 47 6. Equity in Health Service Provision .................................................................................. 58 Provision of Antenatal Care ............................................................................................. 58 Delivery A endance .......................................................................................................... 59 Medical Treatment of Children with Diarrhea or Cough/fever ................................. 60 Health Worker Visits .........................................................................................................6 2 7. Core Factors Aff ecting Labor Market Dynamics ............................................................ 63 Centralized HRH Management Capacity ...................................................................... 63 Training Institution Capacity .......................................................................................... 67 Conditions of Service (Monetary and Nonmonetary Compensation) ....................... 69 HIV/AIDS ........................................................................................................................... 73 iii iv Contents 8. Available Financing for HRH ............................................................................................ 74 Appendixes ................................................................................................................................ 79 Appendix A. Economics of Health Labor Markets in Sub-Saharan Africa ............... 81 Appendix B. Ministry of Health Staff Levels against Approved Establishment (2004 and 2008) ........................................................................................................... 82 Appendix C. Composite Pre-tax Government Monthly Pay of Sample of Health Professionals (2005) ...................................................................................... 83 Appendix D. Budget Allocations to District Health Management Teams in Select Provinces (Chessore 2007) ............................................................................. 84 References .................................................................................................................................. 89 Boxes Box 3.1. Legislation hampering private sector practice .......................................................27 Figures Figure 1.1. Under-fi ve mortality rate: gaps between and within countries .......................1 Figure 1.2. Current and projected trends in maternal mortality .........................................2 Figure 1.3. Medically trained assistance during delivery by background and region (2007) ........................................................................................................................2 Figure 1.4. The fl ow of individuals into the health labor market .......................................5 Figure 2.1. The largest percentage of health workers are nurses (rounded) ....................11 Figure 2.2. Density (per 1,000 people) of doctors, nurses, and midwives across select Sub-Saharan African countries ............................................................................12 Figure 2.3. Gender divide among health workers (public and private) ...........................12 Figure 2.4. Vacancy rates (against 2006 establishment) in health facilities, by cadre (public sector only) ............................................................................................................14 Figure 2.5. Number of
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