Hum Resour Health. 2010 Jun 30;8:15.

Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia.

Tjoa A, Kapihya M, Libetwa M, Schroder K, Scott C, Lee J, McCarthy E.

Source

Clinton Health Access Initiative, Boston, USA. atjoa@clintonfoundation.org.

Abstract

BACKGROUND:

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. However, the projected success of each strategy or combination of strategies is unclear.

METHODS:

We 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.

RESULTS:

With 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.

CONCLUSIONS:

Meeting 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.

PMID:: 20591143; [PubMed]
PMCID: PMC2914658

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Figure 1

Minimum changes in training enrolment, attrition, graduation, and public sector entry by 2010 that will achieve staffing targets for each cadre by 2018. *the increase in training enrolment is described as a multiplier of current training enrolment, i.e. 1× implies no change in enrolment, 2× implies a doubling of enrolment or 100% increase in enrolment, etc; please note that these multipliers were rounded up to the nearest integer. ¹This assumes that the number of midwives trained each year remains at 2008 levels through 2018. ²This axis is the graduation rate multiplied by the public sector entry rate. This figure highlights the factor by which current training enrolment must increase by 2010 in order to reach staffing targets by 2018, for each change in attrition, graduation, and public sector entry that is achieved by 2010. The x-axis represents the percent enrolment into the public sector from training institutions (graduation rate multiplied by the public sector entry rate) and the y-axis represents percent attrition. A 1× means that training enrolment remains at current levels, while a 2× signifies the need for a doubling of current training enrolment, and so on. A bold box indicates the current rate of attrition, graduation, and public sector entry and the corresponding necessary increase in training enrolment if these other variables remained constant. For example, if 80% of graduating doctors entered the public sector, and attrition were 10% (both of which are close to current rates), then training enrolment would need to increase 13-fold in order to produce enough doctors to meet the targets set for 2018. If there were an increase in graduation and public sector entry and a reduction in attrition, the factor by which training enrolment would need to increase could be brought down as low as three.

Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia

Hum Resour Health. Hum Resour Health;8:15-15.