The human resources for health crisis in Zambia: Deaths, departures, demoralising conditions of service and disinterested diaspora.

Abstract

For over a decade, the health sector in Zambia has given us a 91 impse of the night mare unfolding in the sub-Saharan region,a consequence of not investing in the training of staff to man our hospitals and care for our people. Zambia is facing a human resources for health (HRH) crisis that threatens the attainment of the millennium development goals (MDGs). In our lead article, Miti elucidates the issue of HRH that is neglected and yet critical to combating the health crisis . We add our voice to the numerous voices that have been raised, both local and international, in addressing the imbalances that exist in health care delivery in the developed north and developing south. It does not require a mathematical genius to realise that a Zambian nurse's salary of 110 pounds per month compares poorly to her colleagues working in the United Kingdom and earning over twenty times as much. Yet the donor community has placed a ceiling on how much must go to personal emoluments (PEs). It is paradoxical that these very donors, with the endorsement of our government, have set very ambitious MDGs. What happened to the "Health for all by the year 2000" campaign? Is it not the same international community that are signatories to the Alma-Ata Declaration, which clearly spells out health as a basic human right. There are however indications that there is a change in donor thinking. This is evident in their support of financial and non-financial incentives to keep our doctors in the rural parts of the country. Needless to say, it is easy to lash out at the donors when some of the problems we are faced with are self-inflicted. At the centre of this unfolding crisis has been our government's policies and attitude towards indigenous health staff. Previous government programmes have undermined the delivery of health in Zambia. Such actions have included the ill-conceived voluntary separation package (VSP) that led to the exodus of many Zambian nurses and the early retirement of resident doctors in 2000 following an industrial dispute. The United Kingdom and Botswana were beneficiaries of the exodus of our nurses and doctors respectively. Suffice it to say, departures and demoralising conditions of service have not been the only factors at play in this nightmare,death has accounted for a large number of health staff lost during this difficult period in our history. As Miti rightly points out, a local factor for the high attrition rates that should not be underplayed is the high mortality and morbidity among health workers from HIV/AIDS related illnesses. It has become increasingly apparent that workplace programs have overlooked hospital workers even though they too are at risk. for HIV infection, both from occupational and nonoccupational factors. What is even more of a paradox is that most of our health institutions do not have HIV/AIDS workplace policies whilst other government departments such as Education have had these in place for years. Are we living in a cocoonordenial? Why should the mortality be so high among health workers when antiretroviral drugs (ARVs) have been free for the last five years and we are the prescribers and distributors of these drugs? The consequence of all these factors that have a negative impact on health has been quite evident. We are grappling with an infant mortality rate of 95 per 100,000, matemal mortality rate of 749 per 100,000 and an HIV prevalence of 16% among adults. Gloomy as this may appear to be, lessons may be leant from countries like Cuba. This island state now boasts of sturming health achievements with many national health indicators, such as infant mortality rate, comparable to the United States and yet their econony has been struggling for decades. Under a well-structured technical assistance programme, Zambia has benefited from Cuban health personnel who have gone back to their country upon completion. Can't Zambia export its doctors and nurses in an orderly manner so that their foreign earnings are deposited in the Bank of Zambia? For example, three quarters of Egyptian foreign exchange earnings is from the export of its human resource to neighbouring oil-rich countries. The disorderly export of our human resource has led to a failure of our people to invest their earnings in Zambia and in a Diaspora disinterested in their country of birth. If only we could learn from Uganda, which makes a fortune from the foreign earnings reinvested in the country from the hundreds of thousands of Ugandans spread all over the globe. With conviction as a nation, creative management that seems to finally be in place and strategic engagement of the donor community, attainment of the MDGs may still be a reality. We all have to rise to the challenge.