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REPUBLIC OF ZAMBIA MINISTRY OF HEALTH

National Human Resources for Health Strategic Plan 2011 – 2015

Ministry of Health Lusaka December 2011

MESSA AGE FROM THE MINIS STER Since 19 992, the Zambian Gove ernment has remained committed to improvin ng the healtth status off the Zambia an population n by implem menting healtth sector refforms aimed d at improvin ng health se ervice delive ery. The mis ssion of the Ministry of Health H is to provide equ uitable accesss to cost-e effective, quality health services ass close to th he family ass possible. The Ministry recognise es that an equitable e disstribution of a adequately skilled s and ssupported health workers is critical to providing g quality hea althcare. The Zam mbian health sector face es an inadeq quate distrib bution and ssevere shorta age of skille ed healthcarre workers. To address this issue e, the Minisstry has devveloped this s Plan, whicch prioritizess the needs and activitie es that relate e to the hum man resource es for health crisis. This is the second National Human Re esources for Health Stra ategic Plan (NHRH ( SP).Covering th he period off 2011 to 2015, 2 it attempts to pro ovide a clea ar, feasible, affordable and a coherent framework for addresssing the ne eeds of the Z Zambian hea alth workforcce. I am awa are of the en normity of the e challengess we may face in the imp plementation n of this Plan. Howeverr, I am confident that – with the collective efforts and ssustained su upport of ou ur Governm ment, manag gers and sta aff at all levvels – we will w indeed ssucceed. Th he Ministry of o Health and the Gove ernment of Zambia Z are sincerely co ommitted to completing the activitie es outlined in i this plan and a to ensurring improve ed health serrvice deliveryy for all Zam mbians. I invite ou ur Cooperating Partnerss and stakeh holders to su upport our en ndeavours by contributin ng to the successful imp plementation n of this plan n.

Hon. Dr. Joseph Ka asonde Minister of Health Lusaka Decembe er, 2011

ACKNO OWLEDGEM MENTS The deve elopment of the second National Hu uman Resou urces for He ealth Strategic Plan 20112015 wa as successful due to the active ssupport and dedication of multiple e consultants, individua als, and stak keholders. I wish to reco ognize the dedication d o all those involved, botth of directly and a indirectlyy, whose co ontributions a and insights helped to ensure e that this t Plan is of o the highe est quality. This Pla an was de eveloped th hrough a p participatory and conssultative ap pproach, witth contributions and insight from managemen nt and staff across all levels of th he Ministry of o Health; public p and private health h training insstitutions; pu ublic health facilities; f me embers of th he various regulatory r bodies; b the Churches H Health Asso ociation Zam mbia; the He ealth Unions; Cooperating Partners; variouss Civil Society Organizzations; and d Village/Ne eighbourhoo od Health Committees. C In total, 350 0-400 people e were conssulted during g the develo opment in this Plan, as part of a tw wo-fold proc cess: (i) to review r the previous p NHRH SP for 2006-2010 to t draw critical lessons from it; and (ii) to provid de recomme endations forr the new Plan. We than nk all of you u for the tim me, expertise e and suppo ort provided. My sincere e gratitude is s extended to t the members of the NHRH N SP Committee C fo or managing the develop pment process. On beha alf of the Min nistry of Hea alth, I also w wish to ackn nowledge th he financial and technical support of o the Deleg gation of the European Union U in Zam mbia, the W World Health Organisation, the Global Health Workforce W Alliance, Cana adian Interna ational Deve elopment Ag gency, Clinto on Health Access A Initia ative, the Za ambian Integ grated Systtems strengtthening Pro ogram and all a other Cooperating Pa artners. Finally, I wish to ackknowledge and a thank alll who contrib buted to making this Pla an a success, but who could c not be e individuallyy mentioned here.

Dr. Peterr Mwaba Permane ent Secretary Ministry of Health Lusaka Decembe er, 2011

TABLE OF CONTENTS MESSAGE FROM THE MINISTER ...................................................................................................... 2 ACKNOWLEDGEMENTS .................................................................................................................... 3 TABLE OF CONTENTS ....................................................................................................................... 4 LIST OF TABLES ................................................................................................................................ 6 LIST OF ACRONYMS .......................................................................................................................... 7 1.

INTRODUCTION .................................................................................................................... 10

1.1. 1.2. 1.3. 1.4.

Background Information .......................................................................................................... 10 Links to National Policy Documents ........................................................................................ 10 Development Process ............................................................................................................. 11 Overview of Objectives ........................................................................................................... 12

2.

SECTOR PROFILE ................................................................................................................ 12

2.1. 2.2. 2.3. 2.4.

The Definition of Health Workers ............................................................................................ 12 Demographic Profile ............................................................................................................... 13 Health Profile .......................................................................................................................... 13 The Health System ................................................................................................................. 15

3.

SITUATIONAL ANALYSIS ..................................................................................................... 15

3.1. 3.2. 3.3. 3.4. 3.5. 3.6.

NHRH SP 2006-2010.............................................................................................................. 15 Health Workforce Capacity and Distribution ............................................................................ 16 Training ................................................................................................................................... 20 Performance Management...................................................................................................... 22 HRH Management Functions .................................................................................................. 23 SWOT Analysis ..................................................................................................................... 255

4.

VISION, MISSION, GOAL, OBJECTIVES AND GUIDING PRINCIPLES ............................... 27

4.1. 4.2. 4.3. 4.4. 4.5.

Vision ...................................................................................................................................... 27 Mission ................................................................................................................................... 27 Overall HRH Goal ................................................................................................................... 28 Objectives ............................................................................................................................... 28 Guiding Principles ................................................................................................................... 28

5.

OBJECTIVES AND INTERVENTIONS ................................................................................... 29

5.1. 5.2. 5.3. 5.4.

Objective A: Increase number of employed and equitably distributed health workforce with appropriate skills mix .............................................................................................................. 29 Objective B: Increase training outputs harmonized to the sector’s needs ............................... 31 Objective C: Improved performance and productivity of HRH ................................................. 34 Objective D: Strengthen systems and structures to support HR expansion and performance. 36

6.

IMPLEMENTATION AND MONITORING FRAMEWORK ...................................................... 38

6.1. 6.2. 6.3.

Coordination Structures .......................................................................................................... 38 Critical Success Factors ......................................................................................................... 38 Monitoring Frameworks and Indicators ................................................................................... 39

7.

COSTING OF NHRH SP 2011-2015....................................................................................... 40

7.1. 7.2. 7.3.

Resource Envelope................................................................................................................. 40 Costs for the NHRH SP 2011-2015 ........................................................................................ 42 Financing Options ................................................................................................................... 43

8.

ANNEX A: RESULTS FRAMEWORK AND COSTED ACTIVITY PLAN ................................ 44

9.

ANNEX B: GRADUATES BY CADRE ................................................................................... 66

10.

ANNEX C: ENROLMENTS BY CADRE ................................................................................. 67

11.

ANNEX D: TRAINING PROGRAMS AND ENROLMENTS BY TRAINING INSTITUTION..... 68

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12.

ANNEX E: ENTRY REQUIREMENTS AND DURATION OF NURSING AND MIDWIFERY PROGRAMS ........................................................................................................................... 71

13.

ANNEX F: NURSING AND MIDWIFERY GRADUATES ........................................................ 72

14.

ANNEX G: MAP OF TRAINING INSTITUTIONS.................................................................... 73

15.

ANNEX H: PEOPLE CONSULTED ........................................................................................ 74

16.

REFERENCES ....................................................................................................................... 80

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LIST OF TABLES Table 1: Health workforce classification by sector

12

Figure 1: Population distribution by province, Zambia, 2010

13

Table 2: Number of health staff employed by the MoH, 2005 and 2010 verus the approved MoH Establishment.

16

Figure 2: Physicians per 1,000 population and nurses and midwives per 1,000 puulation for selected SADC countries. 17 Figure 3: estimated number of inflows and outflows of MoH healthcare workers, 2010-2020

18

Table 3: Provincial Distribution of the Health Workforce in 2005 and 2010

18

Table 4: Retirement Projectsions - Health workforce

19

Table 5: Voluntary and involuntary attrition of MoH health workers by geographic category, 2007-2009 19 Table 6: Health workers on the ZHWRS, as of December 2010

20

Table 7: Health workers on the ZHWRS, as of December 2010

20

Table 8: Qualifications offered in Zambia, as of Decemebr 2010

21

Table 9: Proposed targets for funded establishment of health workforce positions, 2011-2015

30

Table 10: Cumulatative new positions within the MTEF financial space

31

Table 11: Proposed target for annual enrolments of clinical cadres

33

Table 12: Allocated resources to the MoH in the SNDP (in mn ZMK)

40

Table 13: MTEF projections for the MoH, 2011-2013 (in mn ZMK)

41

Table 14: Estimated resource envelop for HRH Plan, 2011-2015 (in mn ZMK)

41

Table 15: Summary of costs by HRH SP objective (in USD)

42

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LIST OF ACRONYMS Acronym BA BSc CBoH CDE CHA CHAI CHAZ CHW CO CP CPD CSO DCC&DS DfID DHRA DPH&R DP&P DTSS DIP DMO EHT EM EN ERP EU FBO FNDP FMIS GAP GHWA GNC GRZ HC HCM HCW HMIS HPCZ HQ HR HRA HRD HRDC HRH NHRH SP HRM HRIS HR TIMS HRTWG

Definition Bachelor of Arts Bachelor of Sciences Central Board of Health Classified Daily Employee Community Health Assistant Clinton Health Access Initiative Churches Health Association of Zambia Community Health Worker Clinical Officer Cooperating Partner Continuing Professional Development Civil Society Organisation Directorate of Clinical Care and Diagnostic Services Department for International Development (UK) Directorate Human Resources and Administration Directorate Public Health and Research Directorate of Planning and Policy Directorate of Technical Support Services Decentralisation Implementation Plan District Medical Officer Environmental Health Technologist Enrolled Midwife Enrolled Nurse Enterprise Resource Planning European Union Faith Based Organisation Fifth National Development Plan Fleet Management Information System Governance Action Plan Global Health Workforce Alliance General Nursing Council Government of the Republic of Zambia Health Centre Human Capital Management Health Care Worker Health Management Information System Health Professions Council of Zambia Headquarters Human Resources Human Resources and Administration Human Resources Development Human Resource Development Committee Human Resources for Health National Human Resources for Health Strategic Plan Human Resources Management Human Resources Information System Human Resources Training Information Management System Human Resources Technical Working Group

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Acronym HTCC IFMIS JAR LAMU L&M Programme MBB MDD MDG MDR M&E MEPI ML Mimed MoAC MoD MoE MoFNP MoH MoJ MoLG MoSTVT MoU MoWS MPH MTEF MTR NDP NEPI NGOs NHIS NHSP NIPA NRDC NTD NTOP OPD OTN PA PCS PE PEPFAR PHC PMEC PMO PMP PPP PSC PSMD PSRP PSTDP

Definition Health Training Coordinating Committee Integrated Financial Management Information System Joint Annual Review Lusaka Apex Medical University Leadership and Management Programme Marginal Budgeting for Bottlenecks Management Development Division Millennium Development Goals Multi-Drug Resistance Monitoring and Evaluation Medical Education Partnership Initiative Medical Licentiates Master of Medicine Ministry of Agriculture and Cooperatives Ministry of Defence Ministry of Education Ministry of Finance and National Planning Ministry of Health Ministry of Justice Ministry of Local Government Ministry of Science, Technology and Vocational Training Memorandum of Understanding Ministry of Works and Supplies Master of Public Health Medium Term Expenditure Framework Mid-Term Review National Development Plan Nursing Education Partnership Initiative Non Governmental Organisations National Health Insurance Scheme National Health Strategic Plan National Institute for Public Administration Natural Resources Development College Neglected Tropical Diseases National Training Operational Plan Out- Patients Department Operating Theatre Nurse Performance Assessment Public Service Commission Personal Emoluments President’s Emergency Plan for AIDS Relief Primary Health Care Payroll Management and Establishment Control Provincial Medical Officer Performance Management Package Public Private Partnerships Public Service Commission Public Service Management Division Public Sector Reform Programme Public Service Training and Development Policy

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Acronym QA RBF RHC RM RN SADC SAG SIDA SoM SNDP SWAp SWOT TA TB TBA TEVETA THET TI TIMS TNA TNDP ToR TQM TWG UHC UNZA USAID USD UTH WHA WHO WOM ZAU ZDHS ZHWRS ZISSP ZMK

Definition Quality Assurance Results-Based Financing Rural Health Centre Registered Midwife Registered Nurse Southern African Development Community Sector Advisory Group Swedish International Development Agency School of Medicine Sixth National Development Plan Sector Wide Approach Strengths, Weaknesses, Opportunities and Threats Technical Assistance Tuberculosis Traditional Birth Attendant Technical Education, Vocational and Entrepreneurship Training Authority Tropical Health and Education Trust Training Institution Training Information Management System Training Need Assessment Transitional National Development Plan Terms of Reference Total Quality Management Technical Working Group Urban Health Centre University of Zambia United States Agency for International Development United States Dollar (currency) University Teaching Hospital World Health Assembly World Health Organisation Workforce Optimisation Model Zambia Adventist University Zambia Demographic and Health Survey Zambia Health Workers Retention Scheme Zambian Integrated Systems Strengthening Program Zambian Kwacha (Zambian currency)

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1.

INTRODUCTION

1.1. BACKGROUND INFORMATION The performance of a health system is influenced significantly by the size, distribution, and skill set of its health workforce. Although the 2007 Zambian Demographic Health Survey showed that Zambia has achieved progress in reducing maternal and child mortality, further progress is necessary if the country is to achieve the Millennium Development Goals. This is, to a large measure, dependent upon the alleviation of the human resource shortage within the health sector. Planned interventions within the health sector have not been successfully implemented due to staff shortages, which have been driven by multiple factors, including poor conditions of service, unsatisfactory working conditions, inequitable distribution of staff between urban and rural areas, weak human resources management systems, and inadequate training systems, amongst others. To address these issues, the Zambian health sector has recognized that health workforce planning is a critical component of a comprehensive health strategy. In this vein, the sector developed its first National HRH Strategic Plan for the period 2006-2010 with the overall objective of ensuring an adequate and equitable distribution of appropriately skilled and motivated health workers to provide quality health services. The second National Human Resources for Health Strategic Plan (NHRH SP), 2011-2015, will build on the key lessons from the first Human Resources for Health Strategic Plan and attempt to address all constraining factors, while providing a comprehensive, coherent, and feasible Health Workforce Plan. 1.2. LINKS TO NATIONAL POLICY DOCUMENTS This Plan derives its mandate from various national policy and planning documents, such as the Vision 2030 Declaration, the Sixth National Development Plan (SNDP), the National Health Policy and the National Health Strategic Plan (NHSP), as well as area-specific policy documents. In the Vision 2030 Declaration, which has an overarching goal statement of “A Prosperous Middle Income Nation by 2030,” Zambia reaffirmed its commitment to achieving the Millennium Development Goals (MDGs). The improvement of health worker to population ratio is a key means of improving key health outcome indicators. The SNDP for 2011-2015 (SNDP) provides the overall development framework and contains a summarised version of the NHSP within its health chapter. In the health chapter, the third objective is to improve the availability and distribution of qualified health workers in the country through the expansion of training capacity, reduction of health worker retention, improvement of HR management, and implementation of the Community Health Worker Strategy. The National Health Strategic Plan 2011-2015 is built from six primary building blocks, each with specific objectives, as outlined below. No.

Program

1

Service Delivery Primary Health Care Services

Hospital and Referral services 2

Human Resource for Health

Objectives

To provide cost-effective, quality and gender sensitive primary health care services to all as defined in the Basic Health Care Package To increase access to and quality of advanced referral medical care services To improve the availability of and distribution of qualified health workers in the country

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No.

Program

3

Medical Products, Vaccines, Infrastructure, Equipment and Transport Medical Commodities & Logistical Systems Infrastructure

Equipment, Transport and ICTs

Specialised Support Services 4

Health Management Information System (HMIS)

5

Health Care Financing

6

Leadership and Governance

Objectives

To ensure availability and access to essential health commodities for clients and service providers To provide sustainable infrastructure conducive for the delivery of quality health services at all levels of the health care system To ensure the availability of adequate, appropriate and wellmaintained medical equipment and accessories in accordance with service delivery needs at all levels To strengthen and scale up other medical support services, to ensure efficient and effective support To ensure availability of relevant, accurate, timely and accessible health care data to support the planning, coordination, monitoring and evaluation of health care services To mobilise resources through sustainable means and to ensure efficient use of those resources to facilitate provision of quality health services To implement accountable, efficient and transparent management systems at all levels of the Health Sector

The NHRH SP 2011-2015 is therefore not a standalone document, but an integral part of the overall national development and Ministry of Health planning framework. It supports the health policy vision of “a nation of healthy and productive Zambians” and builds upon the NHSP by elaborating on the planned activities and targets within the human resources for health sector. It provides a more detailed analysis of the HRH situation, priorities, proposed strategies and expected results. The MoH has also attempted to align this Plan with several other important international agreements and documents that impact on the health sector, including: ƒ

The Abuja Declaration

ƒ

The African Union Ministers of Health reports

ƒ

The Global Health Workforce Alliance reports

ƒ

The World Health Organization reports

ƒ

The Africa Health Strategy 2007-2015

ƒ

The World Health Assembly resolution WHA57-19

ƒ

The decisions and reports of the two GHWA Forums, and

ƒ

The Kampala Declaration 2008

1.3. DEVELOPMENT PROCESS This Plan was developed through a participatory and consultative approach, with contributions and insight from 350-400 people representing various Government agencies, regulatory bodies, civil society organization and cooperating partners.

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1.4. OVERVIEW OF OBJECTIVES To support the National Health Strategic Plan 2011-2015, the following four national Human Resources objectives have been developed: 1. Increase the number of employed and equitably distributed health workforce with appropriate skills mix 2. Increase training outputs harmonised to the sectors needs 3. Improve performance and productivity of health workforce 4. Strengthen systems and structures to support HR expansion and performance

2.

SECTOR PROFILE

2.1. THE DEFINITION OF HEALTH WORKERS The definition of health workers is not straightforward. The World Health Organization (WHO) defines ‘health workers’, or human resources for health (HRH), as “all people whose main activities are aimed at promoting, protecting and improving health”.1 Yet, the WHO makes the following classifications: “those who are working within the health sector and those who work in other sectors”. Within the health sector, the following sub classifications have been identified: health service providers (including ‘professionals’ like Medical Doctors and ‘other community providers’ like traditional practitioners) and health management and support workers. This latter sub-classification also includes craft and trade workers that support the health system, as reflected in the table below. Table 1: Health workforce classification by sector All Economic Sectors Health sector Health service Health management and providers support workers Professionals: Professionals: e.g. Accountants in health e.g. Medical Doctors, facilities Nurses,

Associates: e.g. Laboratory Technicians Other community providers: e.g. Traditional Practitioners

All other sectors Health service All other providers occupations Professional and associates: e.g. Medical Doctors employed by mining company, Nurses working in schools and Nurse Tutors in training institutions not owned by the MoH

Associates: e.g. Administrative professionals in health centres Support staff: e.g. clerical workers, Ambulance Drivers Craft and trade workers: e.g. Gardeners in hospital Source: Based on WHOM 2007: 3.

1

WHO 2006.

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Thus, the WHO includes within HRH each of the following: (i) people who provide health services, such as Medical Doctors, Nurses, Midwives, Clinical Officers, Pharmacists and Laboratory Technicians; (ii) health related training staff, such as Lecturers and Tutors who work in health training institutions; (iii) management and support workers, such as Accounts Officers, HR staff, and MoH directors; and (iv) support staff, such as cooks, drivers and other classified daily employees (CDEs). All of these health workers may work in the public sector, non-governmental organizations (NGOs), Faith-Based Organizations (FBOs), and/or privatefor-profit facilities and institutions. 2.2. DEMOGRAPHIC PROFILE The population count from the Preliminary Results of the 2010 Census of Population and Housing for Zambia is 13,046,508, as of October 2010. Of the 13,046,508 persons, 6,394,455 were male and 6,652,053 were female. The regional distribution of the population is as depicted in the map below. Zambia’s population grew at an average annual rate of 2.8 percent during the 2000-2010 inter-census period, compared to a growth of 2.4 percent in the 1990-2000 period.2 Figure 1: Population distribution by province, Zambia, 2010

2.3. HEALTH PROFILE The country is facing an epidemiological transition toward a dual disease burden. Although communicable diseases, such as HIV/AIDS, Tuberculosis and Malaria, have had a major impact on the health of the population, an increasing prevalence of non-communicable diseases has been reported, predominantly due to changes in demographic, behavioural, and social trends, as well as large-scale population shifts from rural to urban areas.

2

CSO, 2011

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The Zambia Demographic and Health Survey (ZDHS) of 2007 provided evidence that investment in primary health care programs has begun to yield positive results, with a drop in infant, under-five, neonatal and maternal mortality rates between 2002 and 2006: for every 1000 live births, the infant mortality decreased from 95 to 70, under-five mortality from 168 to 119, neonatal mortality from 37 to 34, and maternal mortality from 729 to 591.3 However, the neonatal death rate did not decrease significantly over this period, leading to concerns of poor peri-natal care in the country. Malnutrition is the primary cause of under-five deaths in Zambia, attributable to up to 52%. The stunting rate in under-five children is 45%, with 5% acutely malnourished (wasted) and 15% underweight. The rates of micronutrient deficiencies are also high: 53% of children have a vitamin A deficiency, 4% of school-age children have an iodine deficiency disorder, and 46% have iron deficiency anaemia.4 Malaria accounts for over 40% of all visits to health facilities and poses a severe social and economic burden on communities living in malaria endemic areas. Malaria is a key driver of morbidity and mortality rates. In 2009, 3.2 million cases of malaria (confirmed and unconfirmed) were reported countrywide, of which 4,000 resulted in death. The annual malaria incidence was estimated at 246 cases per 1,000 population in 2009, a slight drop from 252 cases per 1,000 population in 2008. Expanded use of rapid diagnostic tests may explain this slight drop, among other explanations. Zambia has a generalized HIV epidemic fuelled by structural factors such as genderinequality, social norms that encourage multiple concurrent sexual partnerships for men and unequal distribution of wealth between men and women. HIV/AIDS ranks high as a key cause of morbidity and mortality for both women and children. Females (16.1% prevalence rate) are more likely to be HIV positive than males (12.3%) due to biological, economic and social factors. Urban-rural differentials exist, with urban areas having a higher prevalence (20%) than rural areas (10%). Partly as a consequence of HIV/AIDS, tuberculosis (TB) continues to be a major public health problem in the country. In addition, the prevalence of Multi-Drug Resistant (MDR) for TB has increased.5 Zambia also experiences seasonal epidemics, like cholera, which are driven by inequitable access to improved water sources, safe sanitation and insufficient hygiene practices. According to the 2007 ZDHS, only 41% of the households have access to improved sources of water and 25% of households have no toilet facilities.6 The country’s huge disease burden is partly attributable to poverty, inequity, inadequate food, poor environmental health and sanitation, and limited promotion of healthy lifestyles and prevention techniques. Non-communicable diseases include heart disease, stroke, cancer, diabetes, mental illness, consequences of alcohol and substance abuse, tobacco-smoking related illnesses, epilepsy, trauma, asthma, oral health problems and nutrition problems. Against this background, the Government of the Republic of Zambia (GRZ) has taken non-communicable diseases as a crucial component of primary health care, the referral system and the overall health service delivery reform strategy.7

3

CSO et al., 2009. MoH 2011. 5 CSO et al., 2009. 6 CSO et al., 2009. 7 MoH 2011. 4

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2.4. THE HEALTH SYSTEM In the formal health sector, the main providers of health care services include public health facilities under the MoH, the Ministry of Defence (MoD) and the Ministry of Home Affairs. CHAZ is a faith-based umbrella organisation with many clinics and hospitals, spread over the entire country, predominantly in rural and hard-to-reach areas. The majority of its workforce is on the payroll of the MoH. Other providers in the formal system include privatefor-profit clinics, drug stores, diagnostic centres and hospitals. The informal health sector is large and unregulated. It consists of numerous trained and untrained traditional birth attendants and traditional healers, and a wide range of community health workers. Some people in rural and remote areas consult informal health service providers. Yet, even some urban people with formal education also consult them for specific health concerns. In the formal health sector, the lowest level facility is a health post, intended to cater for populations of 500 households (3,500 people) in rural areas and 1,000 households (7,000 people) in the urban areas, or to be within reach within a 5 kilometre radius for sparsely populated areas. The next level is the health centre (HC). Urban HCs are intended to serve a catchment population of 30,000 to 50,000 people. Rural HCs are intended to serve a catchment area of a 29 kilometre radius or a population target of about 10,000 people. Basic level health care facilities are supported by the following referral structure: Level Level 1

Level 2

Level 3

3.

Description Hospitals serve a population of between 80,000 and 200,000 with medical, surgical, obstetric and diagnostic services, including all clinical services to support HC referrals. Most of the 72 districts have a level 1 or a district hospital. Although CHAZ has level 1 hospitals, these do not (yet) serve as district hospitals, thus possibly causing duplication of services within the same catchment area. The country has 85 level 1 hospitals. Hospitals, or general hospitals, at provincial level, have a catchment area of 200,000 to 800,000 people, with services in internal medicine, general surgery, paediatrics, obstetrics and gynaecology, dental, psychiatry and intensive care services. These hospitals also function as referral centres for the first level hospitals, including the provision of technical back-up and training functions. The country has 21 level 2 hospitals. Hospitals, or central hospitals, serve a catchment population of 800,000 people and above. These facilities are referral centres for level 2 hospitals and have subspecializations in internal medicine, surgery, paediatrics, obstetrics, gynaecology, intensive care, psychiatry, training and research. The country has 6 level 3 hospitals.

SITUATIONAL ANALYSIS

3.1. NHRH SP 2006-2010 In preparation for the creation of this Plan, the NHRH SP 2006-2010 and its implementation was reviewed by independent consultants in early 2011. The review found that the NHRH SP 2006-2010 had been implemented to a limited extent and, as a result, Zambia continues to face a severe skilled health workforce shortage. The two primary variables that contributed to the limited implementation of the NHRH SP 2006-2010 were: (i) limited funding, approximately 17% of the required funding was received, and (ii) limited output from health-related training institutions.

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Other factors that negatively impacted the implementation of the NHRH SP 2006-2010 included the restructuring of the Ministry and the migration of the Ministry to a new Establishment, which consumed time and administrative capacity. Additionally, the withdrawal of funding by several Cooperating Partners in 2009 due to allegations of misappropriation of funds resulted in significant delays in programme implementation. 3.2. HEALTH WORKFORCE CAPACITY AND DISTRIBUTION 3.2.1.

Health Workforce Baseline 2010 and future needs

Although there has been an increase in the number of health staff employed by the Ministry over the past five years, there is still a serious shortage of staff as compared to the Establishment in all health staff categories except pharmacy. Further, although the recommended ratio of clinical to administrative staff is 60-65% to 35-40%, respectively, the existing ratio is 53% clinical to 47% administrative. Table 2: Number of health staff employed by the MoH, 2005 and 2010 versus the approved MoH Establishment. Staff category

Clinical Officer Dentistry Doctors Nutrition Lab Services Pharmacy Physiotherapy Radiography Midwives Nurses Environmental Health Other health workers Total clinical Administration Overall Total

Number of staff 2005 1,161 56 646 65 417 108 86 142 2,273 6,096 803 320 12,173 11,003 23,176

Number of staff 2010 1,535 257 911 139 639 371 239 259 2,671 7,669 1,203 363 16,256 14,457 30,713

Net Increase 374 201 265 74 222 263 153 117 398 1,573 400 43 4,083 3,454 7,537

Establish ment 2010 4,000 633 2,391 209 1,560 425 300 233 5,600 16,732 1,640 5,865 39,588 12,054 51,642

Gap to Establish ment, No. 2,465 376 1,480 70 921 54 61 -26 2,929 9,063 437 5,502 23,332 -2,403 20,929

Gap to Establish ment % 62% 59% 62% 33% 59% 13% 20% -11% 52% 54% 27% 94% 59% -20% 41%

Source: MoH 2010.

The Establishment that is presented above represents the number of clinical and administrative positions that have been approved by Cabinet Office. However, positions in the Establishment can only be filled when Treasury Authority is granted. The funded establishment represents positions with Treasury Authority from the MoFNP. In this regard, the head count in the table represents the number of funded positions in that particular year. Funded positions on the establishment increase depending on funds allocated in the national budget for net recruitment each year. The “gap in the Establishment” represents positions that were not funded. The approved Establishment was initially developed during the restructuring process of the MoH in 2006 and has been adjusted on an annual basis based on approvals of structures for new health facilities. Over the years, the MoH has observed that the distribution of positions in the current Establishment may not meet the requirements for effective service delivery. In an attempt to develop a demand-based staffing tool, the MoH developed the Workforce Optimization Analysis (WOM) in 2009, which identifies the health facilities and districts that have greatest need of additional health staff. The WOM uses Health Management Information System

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(HMIS) data regarding patient admissions, health worker productivity, and activity time standards to define the “optimal” number of health staff, by cadre, required at each public health facility in the country.8 The WOM has been utilized by the MoH since 2009 to inform the deployment methodology. As compared to its regional neighbours, Zambia is in the middle of the ranking for the Nurses per 1,000 population ratio (7th out of 14th countries), while it fares relatively worse than its neighbours on the physicians per 1,000 population ratio (10th out of 14th countries). Although the WHO recommends a proxy ratio of two medical doctors and 14.3 nurses per 1,000 population to achieve the MDGs, none of the Southern Africa Development Community (SADC) countries have met that benchmark.9 Figure 2: Physicians per 1,000 population and nurses and midwives per 1,000 population for selected SADC countries.

Source: MoH/ World Bank African Region Human Development 2010

To mitigate the shortage of public health staff, health facilities are supported by expatriate and volunteer staff. As the current annual production of medical officers is too low to meet the country’s need, the MoH has appointed expatriate doctors throughout the country to alleviate the shortage. Approximately 30% of the doctors serving in Zambian health facilities are expatriates (PMEC data). Untrained volunteer health workers also play an important role in the provision of community level health services. In the past, untrained volunteer health workers have been provided short-term (two weeks to three months) training by CPs and employed throughout the country. In an effort to formalise this health cadre and provide Government oversight and standardization, the MoH has developed and begun the implementation of the Community Health Assistant Strategy. The strategy will be rolled out in phases, the first of which is a pilot phase. The pilot will generate evidence and learnings to inform a national scale up. Despite the increase in health staff since 2005 and the support of expatriate and volunteer health workers, a gap remains between the number of available health staff and the needs of the health sector. A Workforce Review was conducted by the MoH in December 2010, which included an analysis of the inflows and outflows of health workers employed in the public health workforce over a 10-year period.10 This analysis, illustrated below, was based on the projected student enrolments at each TI, the 2010 graduation rate, the 2009 attrition rate, and the 2010 absorption rate of 80%.

8

MoH/DHR&A 2009: 6. WHO/AHWO 2010. 10 MoH 2010d. 9

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Figure 3: Estimated number of inflows and outflows of MoH healthcare workers, 2010-2020 60,000 

Inflow

Preventable Outflow Non‐Preventable Outflow

Healthcare workforce gap

50,000  3,471  6,476 

40,000 

2,617  4,273 

31,940 

30,000 

Voluntary attrition is not  a leading driver.  

20,000 

12,996  4,994 

39,360  26,364 

10,000 

16,255 

‐ Sept. 2010 #  Student  Did Not  of HCWs in  Enrollments Graduate public  health  workforce

Graduated  Voluntary  but not  Attrition entering  public  health  workforce

Retiring

Other  Involuntary  Attrition

Total in  2020

Gap

Target

Source: MoH Workforce Review, Dec. 2010

As illustrated above, if the rates of inflow and outflow of health workers in the public sector remain the same over the next ten years, Zambia will suffer from a shortage of 12,996 health workers in the 2020, as compared to the Recommended Establishment staffing-level of 39,360 clinical health workers. This estimate assumes that Zambia will maintain an annual increase of 1,000 health workers per year net of attrition. To reach the establishment of 39,360 health workers, the public health sector will need to more than double its annual increase of health workers per year, net of attrition, to 2,300. This may be achieved by increasing the number of graduates per year from health training institutions, increasing the percentage of health workers that are absorbed into the public health workforce, and/or decreasing annual attrition. 3.2.2.

Distribution of Health Workforce

Although there has been an improvement during the last five years, Zambia continues to suffer from an inequitable distribution of health workers, at the disadvantage of rural provinces. Table 3: Provincial Distribution of the Health Workforce in 2005 and 2010

Northern Luapula Eastern Western Central Southern

Population

2005 Clinical health staff

1,445,730 903,746 1,530,118 863294 1,180,124 1,407,433

559 545 1,119 720 1,126 1,625

Clinical staff to 1,000 pop 0.39 0.60 0.73 0.83 0.95 1.15

Population

2010 Clinical health staff

1,759,600 958,976 1,707,731 881,524 1,267,803 1,606,793

1,191 807 1,385 984 1,442 2,477

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Clinical staff to 1,000 pop 0.68 0.84 0.81 1.12 1.14 1.54

5-year Change

+0.29 +0.24 +0.08 +0.29 +0.19 +0.39

2010 5-year Clinical Clinical Change Clinical Population health staff to staff to staff 1,000 1,000 pop pop Northwestern 683,367 870 1.27 706,462 1,033 1.46 +0.19 Copperbelt 1,820,443 2,899 1.59 1,958,623 3,260 1.66 +0.07 Lusaka 1,579,769 2,665 1.69 2,198,996 3,648 1.66 -0.03 Total 11,441,461 12,128 1.06 13,046,508 16,227 1.24 +0.18 Sources: 2005 population – CSO Population Projections; 2010 population - the Preliminary Report for the 2010 Census; staffing: MoH PMEC Population

2005 Clinical health staff

As illustrated above, many of the provinces that suffered from the greatest shortage of clinical health workers in 2005 benefited from the largest increase in clinical staff to population during the 2005 and 2010 period, notably Northern, Luapula, and Western. Similarly, Lusaka Province saw a reduction in its clinical staff to population ratio in an effort to the benefit of rural provinces. However, there still exists a great discrepancy between the clinical staff to population ratio among the various provinces: the clinical staff to population ratio in Lusaka is more than double to that of Northern Province. Further discrepancies exist among districts within each province. Table 3 illustrates that the equitable distribution of health workforce must be considered throughout the implementation of HRH initiatives. 3.2.3.

Attrition Rate

The total attrition rate of health workers is 3.6% as of 2009, signifying that attrition is not a significant factor on the size of the health workforce in Zambia. According to the MoH’s Workforce Review, and illustrated in figure 2 above and table 5 below, ‘preventable’ or ‘voluntary’ attrition within the public health sector, which is predominantly resignation, has had a limited impact on the public health workforce, suggesting that increasing training outputs would be a rational approach to increasing the size of health workforce. ‘Nonpreventable’ or ‘involuntary’ attrition is predominantly caused by death or retirement. The statutory retirement age of 55 years has caused a high turnover of public health workers. However, this is mitigated by the provision for MoH to rehire retired health workers on a three-year contract that may be renewed twice. Table 4: Retirement Projections - Health workforce Gender Female Male Total

2011 405 279 684

2012 278 240 518

2013 369 280 649

2014 289 262 551

2015 420 347 767

Table 5: Voluntary and involuntary attrition of MoH health workers by geographic category, 2007-2009

Involuntary Voluntary Total

Urban 3.7% 1.7% 5.4%

2007 Rural 2.9% 0.7% 3.5%

Total 3.4% 1.3% 4.7%

Urban 3.7% 1.3% 5.1%

2008 Rural 3.4% 0.8% 4.2%

Total 3.6% 1.2% 4.7%

Urban 3.0% 1.0% 3.9%

2009 Rural 2.6% 0.5% 3.1%

Total 2.8% 0.8% 3.6%

Source: MoH 2010d: 5.

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3.2.4.

Strategies to Retain Health Workers

Although the Government of Zambia has incorporated incentives within its salary schedule to attract and retain staff in the Public service (i.e. Recruitment and Retention allowance for degree holders, which is 20% of basic salary; Rural and Remote Hardship allowance of 2025% of basic salary), these allowances have not been sufficient to attract a suitable number of health workers. In 2003, the Zambian Health Workers Retention Scheme (ZHWRS) was initiated to attract Medical Officers to work in the rural and remote areas of the country. In 2007 the ZHWRS was expanded to include other health workers, as reflected below in Table 6. The award payments of the ZHWRS range from 30-75% of the healthcare worker’s basic salary per year, based on the level of remoteness of the health facility to which the healthcare worker has been placed. In addition, Health workers on the ZHWRS who successfully complete the three-year contract are awarded with a bonus payment of an amount nine times their monthly allowance. Table 6: Health workers on the ZHWRS, as of December 2010 2006 103

Year Health Workers

2007 89

2008 659

2009 860

2010 961

Source: MoH – Zambian Health Workers Retention Scheme database 2010 Table 7: Health workers on the ZHWRS, as of December 2010 Cadres Medical Doctor Medical Consultant Medical Licentiate Clinical Officer Tutor/Lecturer Nurse & Midwife Environmental Health Technologist Total

Participants 144 20 39 36 231 352 140 961

Source: Zambian Health Workers Retention Scheme database 2010

3.3. TRAINING 3.3.1.

Training outputs

During the 2005-2010 period, the MoH and its CPs have implemented several initiatives that have successfully increased the annual number of graduates from health-related training programmes from 1,101 in 2005 to 2,311 in 2010 (a 110% increase). These figures include graduates from public, mission, and private Training Institutions (TIs). A detailed breakdown of these figures is contained in Annex B.. Although, the annual number of graduates from these programmes is envisaged to continue to increase, a large gap still remains between the available number of health workers and the needs of the sector. In 2010, MoH developed a National Community Health Workers Strategy. The strategy defines training of “Community Health Assistants” (CHAs) for a period of one year. The strategy will be rolled out in four phases, which commenced in June 2011, with the intake of a pilot class of 311 CHAs with a planned expansion of up to 5,214 in phase 4. The pilot will inform decision-making for the national scale up. The first pilot training programme is being hosted by the newly established Ndola Community Health Assistant Training School, hosted on the grounds of Ndola Central Hospital.

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3.3.2.

Training programmes

As of 2011, there were 22 pre-service, 7 post-basic and 16 post-graduate training programmes available within the country. The table below shows the qualifications provided by TI’s in Zambia. Annex D contains a list of the training programmes available for health workers in the country. Table 8: Qualifications offered in Zambia, as of December 2010 Qualification Certificate Diploma Advanced Diploma Bachelors Degree Masters degree

Duration 1 to 2 years 3 years 2 years 4 years 1 ½ to 4 years

Number of TI’s 24 20 1 2 1

During the period 2005-2010 the number of programmes at degree-level increased. However, for some programmes, training is only available at diploma level. See Annex E for a brief description of the current programmes available for different workers. 3.3.3.

Training institutions

During the period 2005-2010, there were thirty-seven health training institutions in Zambia, offering various programmes. The TI’s are in three categories as shown below: ƒ

Public institutions: The public TIs are owned, operated, and funded by either the MoH, Ministry of Education (MoE), Ministry of Science, Technology and Vocational Training (MoSTVT), the Ministry of Defence (MoD) or the Ministry of Agriculture and Cooperatives (MoAC). Apart from the nursing schools, TIs are located along the line of rail. Annex D contains a list of the TI’s by ownership and programme, while Annex G provides a map illustrating the location of TIs.

ƒ

Mission institutions: The mission TIs are owned and operated by the Churches Health Association of Zambia (CHAZ) institutions, with funding by MoH. The tutors of mission TIs are employed by the MoH and students are partially sponsored by the MoH. Additionally funding to support mission TIs is received from CHAZ and missionfocused organizations. All graduates of mission TIs are expected to be recruited into the public health sector.

ƒ

Private for-profit institutions: A number of private-for-profit TIs have opened between 2005 and 2010. The private TIs are primarily located in Lusaka and Copperbelt. The private sector is still highly dependent on the public health sector for tutors. Graduates of private TIs may be employed in the public, private, or international organisations.

In an effort to quantify the infrastructure needs of Zambia’s TIs, a comprehensive assessment of the 39 public, mission, and private training institutions in Zambia was completed by MoH in June 2008. Based on the findings, the 2008 National Training Operational Plan was developed. The Plan defined the infrastructure, faculty, and equipment needs of each TI. The NTOP estimated that the annual enrolment of health-related students could be increased from 1,900 to 3,700 by 2012 could be achieved through substantial funding support from MoH and its CPs. However, due to limited funding, the 2008 NTOP has not been fully implemented and TIs continue to face considerable infrastructure constraints impeding the ability to increase intakes. A number of TIs have commenced with new programmes and increased on the numbers of student enrolment. However, the increase in enrolments and programmes has far outpaced

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the number of teaching staff. The average lecturer-to-student ratio is 1:35 and the clinical instructor-to-student is 1:105, against the recommended 1:20 and 1:10, respectively. 3.4. PERFORMANCE MANAGEMENT 3.4.1.

Performance assessment and performance management

The MoH has implemented several processes for monitoring and assessing the performance of its workforce, including bi-annual Performance Assessments (PAs), bi-annual Technical Supportive Supervisions, and annual Joint Annual Reviews (JARs). Further, the PSMD has developed relevant guidelines, procedures and codes to guide managers in encouraging good performance and handling offences within the public service.11 The Disciplinary Code, or ‘Red Book’, has identified eight major categories of offences.12 All categories deal with offences that directly or indirectly affect the performance of the workforce. However, there is no system for rewarding good performance, such as a performance-based reward and remuneration system. In an effort to improve the performance management system, the Public Service has developed the Performance Management Package (PMP), which represents a move away from annual individual confidential assessments. In collaboration with the PSMD, the MoH has commenced the roll-out of a training programme on PMP, including a training of trainers programme for PMO senior staff on the use of the PMP tools. Although performance management systems (PMP, PA, Technical Supportive Supervision) are in place for monitoring and assessing performance, there is need to strengthen enforcement of the regulations and standards as well as action on issues raised during assessments. 3.4.2.

Leadership and management

After the re-structuring of the MoH in 2006, it was decided that only Medical Doctors and Medical Specialists may be hired for senior management positions, such as Provincial Medical Officers, District Medical Officers and Medical Superintendents. However, many of the Medical Doctors assigned with managerial and administrative responsibilities have limited or no training in management.13 In support of the need for Management and Leadership training, the Zambia Integrated Systems Strengthening Programme (ZISSP) is providing the management training for senior positions in conjunction with local academic institutions, including the National Institute for Public Administration (NIPA). 3.4.3.

In-service training

The Public Service Training and Development Policy (PSTDP) and the Procedures and Guidelines for Human Resource Development in the Public Service provide the framework for the training and development of civil servants. This framework defines a systematic training cycle and the procedures concerning in-service training (i.e. health professionals wishing to upgrade their skills). It also clarifies the roles and responsibilities of various actors and provides a link between performance and in-service training as well as training and career development. According to this framework, the annual number of health professionals that may begin in-service training is based on the needs of the MoH, as an organisation. To determine the needs of MoH, each district, hospital, and province develops an ‘Annual 11

These include the Terms and Conditions of Service, Code of Ethics and Disciplinary Code for the Public Service. 12 GRZ 2003: 3-9. 13 Some health training programmes have included management modules, including for RNs, RMs and COs.

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Training and Development Plan,’ which outlines its in-service training requests and submits it to MoH Headquarters annually. The MoH compiles the requests and develops a ‘Ministerial Training Plan,’ which highlights the programs that are of greatest need and the number of health professionals that may enter in-service training. According to the PSTDP, the Government is expected to provide sponsorship to public professionals to undertake training that is relevant to the Public Service, within the constraint of available monetary resources. In addition to MoH sponsorships, CPs, including FBOs, NGOs, and other private institutions, also provides scholarships. Although in-service training provides an opportunity for the public health sector to upgrade and improve its skills, there is need to strengthen coordination and control mechanisms to avoid temporary depletion of health workers and to ensure strategic staffing and need-based decisions are made regarding the cadres that are sent for training from each facility. 3.5. HRH MANAGEMENT FUNCTIONS Human resource (HR) management in the public service is governed by the procedures and processes of the Public Service Management Division (PSMD). Prior to the restructuring of MoH in 2006, the Central Board of Health (CBoH) held significant power to manage human resources decisions.14 However, since the restructuring of the MoH, the Public Service Commission (PCS) has normalised all HRH ‘cases,’ requiring that PSMD approve all HRH management decisions. Consequently, major HR functions have become more centralised, resulting in additional, labour-intensive work for the MoH headquarters. The description below presents different aspects of key MoH HR management functions. 3.5.1.

Governance and regulatory functions

In accordance with the Sector Wide Approach (SWAp), the MoH with its partners have established the Human Resource Technical Working Group (HRTWG), which provides strategic direction and support for the programs and processes related to human resources for health. The membership of the HRTWG includes representatives from MoH, CPs, the Ministry of Finance and National Planning (MoFNP), PSMD, MDD, the health unions and the regulatory bodies. There are plans to include the Ministry of Education (MoE) and the Ministry of Science and Technology. The HRTWG has ‘Task Groups’ that are responsible for managing, implementing, and reporting on projects within a particular sector of human resources. In an effort to reduce the burden on the MoH headquarters, a national decentralisation strategy has been developed and implementation has begun. Delegation of certain duties to lower levels of MoH will enable the DHRA to concentrate on other aspects of their mandate, including policy and strategic issues, M&E, capacity strengthening, mentoring and coaching of HR officers, and assessing workforce performance. Since 2009, the MoH has recruited approximately 230 HR officers, each with a minimum qualification of a Bachelor of Arts (BA) degree, that have been deployed to the MoH central level, larger hospitals, the PMOs, and the District Medical Offices (DMOs). There are three primary regulatory bodies for the health sector: 1. The Technical Education, Vocational and Entrepreneurship Training Authority (TEVETA), which regulates the teaching staff and training programs offered under TEVETA, 2. The General Nursing Council (GNC), which regulates the nursing and midwifery, teaching staff and training programs, and; 14

The boards were in place between 1995 and March 2006.

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3. The Health Professions Council of Zambia (HPCZ), which regulates all other health professions, teaching staff, and training institutions. Additionally, HPCZ is responsible for inspecting and accrediting public, private, and mission health facilities. These regulatory bodies are responsible for approving training programs in both public and private training institutions, including approving curricula, setting quality standards, and accrediting training institutions and sites for internships and practical training. However, all of the regulatory bodies are facing challenges in the fulfilment of their roles and responsibilities. 3.5.2.

Recruitment

With the dissolution of the Central Board of Health, the PSC was given the sole responsibility for the recruitment of professional staff. Therefore, although MoH may recommend an individual to be recruited for a particular position, the final authority is given by PSC. The MoH holds recruitment and induction programmes at appropriate times annually, where recent health-related graduates and qualified professions who wish to enter the public health sector are inducted and posted to available funded, vacant positions in the country. 3.5.3.

HRH Planning

The health sector has a comprehensive planning framework that includes human resource issues and runs from the district and provincial levels to the national level. The NHSP 20112015 will be implemented through a series of Mid-Term Expenditure Frameworks (MTEF) that will give expenditure ceilings for the various sectors of the Ministry of Health. The MoH will ensure that the activities proposed in this Plan will be included within the MoH’s Annual Action Plan and budgets. Furthermore, in 2008, the MoH established a Planning Unit within the DHRA responsible for human resource planning and information. It is expected that this Unit will function as a ‘Think Tank’ for the Directorate, focusing on strategic issues. 3.5.4.

Human Resources Management Information System

For monitoring and evaluation, the MoH and its partners have introduced a common results framework, which presents a set of selected key indicators for joint monitoring and evaluation (M&E) of the sector’s performance against the NHSP and the health related MDGs. In addition, the Joint Annual Reviews (JARs) have served as mechanisms for monitoring the NHRH SP since 2006. However, the JAR tools for HRH will need to be aligned with the new NHRH SP to ensure standardization and alignment with the bi-annual Performance Assessments (PAs) tools. The Public Service has a comprehensive human resources management information system. The system is the SAP-based Enterprise Resource Planning (ERP) model within the software-suite called Human Capital Management (HCM). GRZ has purchased the Payroll Management and Establishment Control (PMEC) module of HCM for managing the payroll and administrative issues of all GRZ ministries. Although the system is centrally housed at the PSMD offices, plans are in place to provide direct access to PMEC to each line ministry by December 2011. This will allow MoH to generate its own reports and have direct access to payroll data. However, the health sector in Zambia also lacks a comprehensive HRIS database to provide a national picture on health workforce trends.

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3.6. SWOT ANALYSIS Strengths

Weaknesses

Overall ƒ GRZ has demonstrated strong commitment to addressing the country’s HRH crisis ƒ Large numbers of dedicated health staff are working at all levels of MoH

Overall ƒ Funding constraints throughout MoH limit its ability to implement effective improvements ƒ Programme planning, implementation, and monitoring is limited by weak systems throughout MoH

Training ƒ The capacity for training of HRH has increased substantially in recent years ƒ The 2008 National Training Operational Plan (NTOP) for scaling-up the production of additional health staff has been developed, with clearly defined infrastructure, equipment and teaching staff requirements ƒ New training programmes have been and continue to be developed and implemented, including the Community Health Assistant training programme

Training ƒ Weak coordination mechanisms are in place for collaboration among stakeholders, TIs, and the MoH ƒ Insufficient funding is available from MoH to support the training of critical cadres ƒ Training for certain health professions and specialties is not available in country ƒ Newly developed training programmes do not meet the needs of the country nor correspond to available positions in the Establishment ƒ An urban-biased geographical distribution of health training institutions has reduced rural retention ƒ There exists shortages of faculty and student accommodation, classroom infrastructure, and transport to practical sites ƒ MoH has substantially decreased its funding to support the MoH in-service scholarship programme ƒ No bonding system in place for graduates of pre-service training programs and enforcement of the bonding scheme for graduates of in-service training is weak

Planning ƒ Comprehensive planning framework is in place ƒ Workforce Optimization Model is in use for determining staffing needs and deployment methodologies ƒ Decreased attrition rate among health workers ƒ Data metrics have provided for improved planning and management of human resources ƒ Two payroll verification exercises have been conducted across more than 90% of the public health facilities

Planning ƒ Only 60% of the positions provided on the approved Establishment are filled, resulting in continued shortages of health staff ƒ The approved Establishment does not represent the needs on the ground ƒ There is an inequitable distribution of health workers between provinces and districts; rural areas are particularly affected ƒ HR functions are not well articulated within the planning framework ƒ Inadequate harmonization of planning between the various Directorates of MoH for new infrastructure, new equipment, and additional staffing ƒ Centralised HR functions No direct access to the PMEC system within MoH, as PMEC is housed in the PSMD

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Strengths

Weaknesses

Management ƒ Many relevant procedures and guidelines for guidance of HR management are in place ƒ Opportunities to monitor and assess performance of human resources through integrated tools, such as the PMP, PAs and JAR ƒ Zambia Health Workers Retention Scheme (ZHWRS) in place to increase retention of health workers in rural and remote areas

Management ƒ No consistent enforcement of the PSMD’s guidelines, including monitoring of absenteeism and tardiness ƒ HR functions not well articulated within the monitoring tools for PAs and JARs ƒ Inadequate human resource documentation and information management systems ƒ Leave schedules are not well managed ƒ Limited leadership and management competencies among managers, supervisors, and HROs ƒ Lack of efficient communication structures throughout the various levels of MoH ƒ Inadequate career development/progression opportunities for medical cadres ƒ Performance-based remuneration is not part of the Performance Management Package, resulting in reduced morale and productivity ƒ Inadequate staff houses in rural and remote areas ƒ Job descriptions for certain positions are missing

Opportunities

Threats

Overall ƒ Zambia is a signatory to a number of international declarations and conventions, including the Abuja and Kampala Declarations ƒ The political will to address the HRH crisis is clearly articulated both in the SNDP and the NHSP 2011-2015

Overall ƒ Inadequate, irregular and consistently decreasing funding for the health sector ƒ Restriction on overall public wage bill (i.e. the PE/GDP ratio) ƒ Poor governance structures exist, allowing for improper fund management ƒ Donor fatigue for pooled funding mechanisms after the ‘funding freeze’ of 2009-2010 ƒ Uncoordinated CP financial incentives to health workers working on donor-supported interventions, resulting in disinterest in conducting MoH responsibilities ƒ The threat of multi-drug resistance affecting the MoH health workers ƒ Increased numbers of health workers becoming sick or dying prematurely ƒ Very lenient annual sick leave allocation of 180 days per year ƒ Poor management of performance throughout the MoH with a lax attitude to poor performers

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Opportunities

Threats

Training ƒ CPs support the design and implementation of new training programmes and the strengthening and scaling up of the training capacity ƒ The potential to offer new training programmes that are currently not offered in the country ƒ The private for-profit sector of health training is growing

Training ƒ The high cost of scaling up of training capacity relative to the quality of the training ƒ Poor overall management of in-service training ƒ No control over how many health workers from the same facility attend training, resulting in a depletion of the available workforce

Planning ƒ The GRZ’s commitment to annually increase the number of funded positions through the ‘net recruitment fund’ ƒ An active HRTWG, with representatives from relevant stakeholders and CPs; a revised HRTWG ToR to facilitate funding, implementation and monitoring of the NHRH SP 2011-2015

Planning ƒ Severe funding constraints with a shrinking health sector budget

Management ƒ Establishment of “Restructuring Report Review and Technical Committee”, the “Salaries Review Commission” and the “Job Review Commission” to review the establishment, public servants salaries and the jobs required for service delivery ƒ Training in PMP rolled out to provincial level on a ‘train the trainer’ basis ƒ Increased collaboration with non-state actors private-for-profit and private not-for-profit ƒ Decentralisation Implementation Plan (DIP) provides opportunities for a de-centralised health sector and advocates for using a multisector approach

Management ƒ Slacking of professional ethics and ineffective management of poor and unethical performance ƒ Unclear devolution process in the DIP on how centralized HR functions like recruitment, placements, promotions, leaves and retirements will be addressed within the DIP

4.

VISION, MISSION, GOAL, OBJECTIVES AND GUIDING PRINCIPLES

4.1. VISION The national vision for health, as expressed in the National Health Policy (NHP, 2011) is: A Nation of healthy and productive Zambians. 4.2. MISSION The Ministry’s mission statement, stipulated in the NHSP 2011-2015, reads as follows: To provide equity of access to cost-effective quality health services as close to the family as possible.

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4.3. OVERALL HRH GOAL To have an adequate, competent, well-supported and motivated health workforce to ensure provision of safe, ethical, cost effective and quality health services. 4.4.

OBJECTIVES

To achieve the goal, the following specific objectives have been defined: 1. Increase the number of employed and equitably distributed health workforce with appropriate skills mix 2. Increase training outputs harmonized to the sector’s needs 3. Improve the performance and productivity of health workers 4. Strengthen systems and structures to support HR expansion and performance 4.5.

GUIDING PRINCIPLES

The following are the guiding principles for the NHRH SP 2011-2015: Equity: reduction of inequities in access to health services through the equitable distribution of competent, supported and well-motivated HRH at all levels of the health system. Feasibility and sustainability: interventions are designed to be achievable within the expected resource envelope and integrated within the overall health sector planning and monitoring framework, taking into account other external factors. Cost effectiveness: the selected strategies and interventions have been designed to produce the best value for money. Health system approach: strategies and interventions will be mainstreamed and integrated with other components of the health system. Gender equality: selected strategies promote activities that favour equal opportunities for both women and men. Accountability and transparency: accountability and transparency to the political administrative system and clients will be maintained throughout the implementation of the plan. Coordination: The plan recognises contributions by key stakeholders and will strengthen coordination mechanisms to achieve the objectives.

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5.

OBJECTIVES AND INTERVENTIONS

5.1. OBJECTIVE A: INCREASE NUMBER OF EMPLOYED AND EQUITABLY DISTRIBUTED HEALTH WORKFORCE WITH APPROPRIATE SKILLS MIX 5.1.1.

Rationale

By all metrics, Zambia suffers from a shortage of clinical health staff within its public health sector: ƒ The current number of doctors, clinical officers, midwives and nurses of 12,786 is only 43.0% of the WHO recommended staffing level of 2.28 health workers per 1,000 population.15 ƒ The existing ratio of population to nurses is 2.2x the target set in GRZ Vision 2030 Plan. ƒ The existing ratio of population to doctors is 2.7x the target set in the GRZ Vision 2030 Plan. ƒ The current clinical health workforce of the six main cadres16 of 13,574 is 66.6% of the “optimal number of health workers,” as determined during the 2008 Workforce Optimization analysis. ƒ The existing clinical health workforce of 16,256 is 41.1% of the MoH Recommended Establishment of 39,360.17 Due to this shortage, the accessibility and quality of Zambia’s health service provision has been compromised. Whilst the shortage of staff is a national phenomenon, the situation is particularly dire in the rural and remote areas. Further, Zambia still needs to determine the optimal staffing requirements for adequate health service delivery. 5.1.2.

Interventions

To achieve this objective, the health sector will pursue the following strategies for the attainment of the objectives set out in the NHRH SP 2011-2015: Intervention A.1 Increase the number of the health workforce. While recognising the expansion in the private sector, the public sector will continue to advocate for an increased share of the budget to meet the human resource needs of the health sector. While it is recognized that an expansion of the general workforce is likely and welcome, the result at present is related to the number of funded positions for the public sector. Over time, the introduction of more effective health workforce information systems will enable the sector to set expansion targets to meet the needs of the health workforce. Intervention A.2: Redefine staff posting and establishment based on need. The MoH will develop a needs-based model to determine the number of health staff required at each health facility, providing data-based evidence to inform the funding and distribution of the health workforce. Further, the health workforce expansion will be harmonised with the expansion of health facility and training institution infrastructure.

15

Sources: the health workforce figure was taken from Table 2; the 2010 population figure was taken from the 2010 Census of Population and Housing, Preliminary Population Figures Report; and the WHO recommended staff level was taken from the the WHO World Health Report 2006, pg 11, and was specified for these four cadres only. 16 The six key cadres, as defined by the 2008 Workforce Optimization Analysis, are doctors, clinical officers and medical licentiates, midwives, nurses, laboratory staff, and pharmacy staff. 17 Table 2 of this Plan.

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Intervention A.3: Distribute human resources equitably and ensure appropriate skills mix for achieving the MDGs. Considerable imbalances in the distribution of health service providers exist between urban and rural areas, to the disadvantage of rural and remote districts and provinces. A concerted effort needs to be made to improve the working conditions and incentives for health workers in the rural and remote areas of the country. Intervention A.4: Implement and enforce bonding scheme for all pre- and in-service trainees. Work with key stakeholders to ensure a rights-centred policy document to enforce compulsory service and ensure that a documentation system with enforcement guidelines is in place to manage the bonding scheme. Intervention A.5: Improve conditions of service to attract and promote retention of health service providers in rural and remote facilities. The MoH will continue to actively participate in committees working to improve remuneration packages and working conditions to promote the importance of health workers and the services they deliver. 5.1.3.

Targets

Scenario 1: Based on Full Funding for Approved Establishment The table below indicates the requirement of the public sector for health professionals per cadre, assuming funds were available to fill the approved establishment. It should be noted that these numbers are indicative and should be reviewed and revised on an annual basis, and will be based on the findings of an upcoming study geared to assess Zambia’s optimal workforce requirements. This assessment will make use of the WHO tool for workload indicators of staffing need (WISN), and will be undertaken by the MoH in 2012.

Table 9: Proposed targets for funded establishment of health workforce positions, 2011-2015 SN

Cadre

1 Clinical officers 2 Dentistry 3 Doctors 4 Nutrition 5 Biomedical Sciences 6 Pharmacy 7 Physiotherapy 8 Radiography 9 Midwives 10 Nurses 11 Environmental Health 12 Other Health workers 13 Administrative Total

Approved Establishment 4,600 833 2,891 309 1,960 997 400 448 5,900 16,732 1,840 5,865 13,846 56,621

Head Count August 2011 1,461 263 1,076 159 637 743 258 268 2,745 7,795 1,293 1,683 13,581 31,962

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Gap 3,139 570 1,815 150 1,323 254 142 180 3,155 8,937 547 4,182 265 24,659

Cost to fill the Gap (ZMK million) 76,765 18,439 226,738 2,273 34,482 1,821 2,260 3,155 96,744 230,600 10,763 287,263 8,726 1,000,029

Scenario 2: Based on Medium-Term Economic Framework Financing Projections The current Midterm Economic Framework 2011-2013 allocates just above ZMK 200 billion over two years to finance an increase of the health workforce. Assuming that this increase can be maintained over the following two years, close to ZMK 360 billion will be available for health workforce expansion per year over the 2011-2015 period. This would allow for the expansion of the health workforce with 9,675 additional health staff over the next five years. The table below presents a tentative staff-category distribution. Table 10: Cumulative new positions within the MTEF financial space Cadre Clinical officers Dentistry Doctors Nutrition Lab sciences Pharmacy Physiotherapy Radiography Midwife Nurses Environmental Health Other clinical Total clinical Administration Overall Total Net recruitment budget (ZMK billion)

2011 87 17 68 2 39 55 14 7 126 706 82 63 1,266 487 1,753

2012 216 42 169 5 97 136 35 17 312 1,750 203 156 3,138 625 3,763

2013 342 67 267 8 153 216 55 27 495 2,773 322 247 4,973 761 5,734

2014 468 91 366 11 210 296 75 38 678 3,797 441 339 6,809 896 7,705

2015 594 116 464 14 266 376 96 48 860 4,820 560 430 8,644 1,032 9,675

52.7 130.5 206.8 283.2 359.5 Note: Depending on the findings of evaluation of the CHA pilot, additional targets for CHAs may need to be added to the above establishment expansion targets.

5.1.4.

Critical success factors

The following issue is critical for achieving the objective and the targets, but is not fully controlled by MoH: Financing. Without adequate financial resources to both expand the Funded Establishment and the capacity of training institutions nationwide, the targets outlined in this Plan cannot be achieved. 5.2.

OBJECTIVE B: INCREASE TRAINING OUTPUTS HARMONIZED TO THE SECTOR’S NEEDS 5.2.1.

Rationale

Despite a substantial increase in the number of graduates during the 2005 to 2010 period, a large gap still exists between what is required and what is available. This is specifically notable for Nurses and Midwives, Medical Doctors, Medical Licentiates, Clinical Officers, Laboratory staff, and Pharmacy staff. These needs have been identified through the application of 2008 Workforce Optimization Model (WOM), which indicated that the current workforce has a 44.4% vacancy rate as compared to the optimal staffing level. To close this gap, the training capacity of the various health training institutions needs to be expanded.

NHRH SP 2011-2015 Page 31

Furthermore, the training capacity of health sector should be updated on an annual basis to reflect the required skills for effective and efficient service delivery. Training programs should continually be adjusted to meet future health challenges. New and specialist programs should be created in clinical and basic sciences. All programmes for the training of health professionals need to include education in leadership and management. 5.2.2.

Interventions

To achieve this objective, the health sector will pursue the following interventions: Intervention B.1: Strengthen the coordination among the key actors in training of health workers. A National Health Training Coordinating Committee (HTCC) is in place, with representation by key stakeholders, and will be responsible for the coordination of training in accordance to the revised Terms of Reference of the HTCC. Intervention B.2: Expand the national training capacity for production of HRH. To accommodate the planned expansion of the health workforce, the training capacity needs to be increased. For this, the expansion of the public sector must be in-line with the revised and updated National Training Operational Plan to reflect the current infrastructure needs and other related investments that should be made. Investments in new training institutions should also be considered, such as expanding training for medical officers, clinical officers and registered nurses. Intervention B.3: Improve access to pre-service programmes for candidates/ students from rural and remote areas. There is evidence that students from rural and remote areas are more likely to remain in rural and remote regions. However, the majority of the TIs offering programmes for health practitioners are located along the line of rail or in urban areas, which has hampered potential students from rural areas from applying to the health programmes. . Programs that promote rural and remote students, such as positive discrimination practices and quota systems, should be explored and implemented. In addition, the Community Health Assistant training programme should be supported, as it recruits students from rural and remote communities to serve within their community. Depending on the findings of the evaluation of the CHA pilot, CHA training facilities will need to be expanded to reach the MoH’s vision of 5,000 CHAs. Intervention B.4: Review existing training programmes and certification of health workforce and develop new ones to respond to the sector’s needs. The MoH should work with the regulatory bodies and relevant training institutions to develop new and innovative training programs that respond to the sector’s needs. For example, in response to the need for additional anaesthesia and psychiatric specialists, the UNZA School of Medicine introduced degree programmes providing a Master of Medicine in Psychiatry and Anaesthesia. The sector also needs to prepare for the increasing number of patients suffering from non-communicable diseases. Training programmes must prepare students for the new health needs of communities. New masters programmes will, therefore, need to be developed as well as upgrading some training institutions into colleges or universities.

NHRH SP 2011-2015 Page 32

Further details on the implementation of these strategies are presented in the Results Framework and Costed Activity Plan that appears as Annex A. 5.2.3.

Targets

The interventions mentioned above will facilitate the achievement of the annual enrolment targets, as defined in the table below. The targets are subject to yearly reviews through MoH annual action plans. Table 11: Proposed target for annual enrolments of clinical cadres No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

Projected Annual Enrolments Programme 2011 2012 2013 Clinical Officer General 296 230 400 Clinical Officer Psychiatry 14 20 20 Environmental Health 212 150 150 Technologist Registered Mental Health Nurse 27 30 30 Medical Licentiate 25 54 64 Ophthalmic Clinical Officer 4 10 10 Clinical Officer Anaesthetist 21 80 80 Ophthalmic Nurse 8 10 10 Optometry Technologist 13 15 15 Counselor 94 50 50 Medical Laboratory Technologist 103 50 50 Pharmacy Technologist 168 50 100 Physiotherapy Technologist 79 50 50 Radiography Technologist 103 50 50 Dental Therapist 82 30 82 BSc. Nursing 70 70 70 Registered Nurse 571 685 700 Registered Midwives 177 263 280 Operating Theatre Nurses 33 75 75 Enrolled Nurses 561 533 535 Enrolled Midwives 142 170 205 HIV Nurse Prescriber 29 35 35 Certified Midwives 101 110 110 Critical Care Nurses 0 30 40 Medical Doctors 160 200 200 Physiotherapists 24 24 24 Pharmacists 52 52 52 Environmental Health Sciences 16 16 16 Biomedical Sciences 51 51 51 Internal Medicine 8 8 8 Obstetrics and Gynaecology 7 7 7 Psychiatry 3 3 3 Orthopaedics 6 6 6 Urology 0 0 0 Paediatrics and Child Health 10 10 10 HIV Medicine 7 7 7 Surgery 15 15 15 Anesthesia 8 8 8 Nursing 9 9 9

NHRH SP 2011-2015 Page 33

2014 400 20 150

2015 400 20 150

Total 1,726 94 812

30 64 10 80 10 15 50 50 50 50 50 30 70 700 280 75 540 205 35 110 40 200 24 52 16 51 8 7 3 6 0 10 7 15 8 9

30 64 10 80 10 15 50 50 50 50 50 82 70 715 280 75 550 205 35 110 40 200 24 52 16 51 8 7 3 6 0 10 7 15 8 9

147 271 44 341 48 73 294 303 418 279 303 306 350 3,371 1,280 333 2,719 927 169 541 150 960 120 260 80 255 40 35 15 30 0 50 35 75 40 45

No Programme 40 Ophthalmology 41 Pharmacy 42 Pathology 43 Microbiology 44 Parasitology 45 Public Health 46 Nutritionist Total

Projected Annual Enrolments 2011 2012 2013 2 2 2 22 22 22 19 19 19 7 7 7 5 5 5 0 30 30 40 40 40 3,404 3,391 3,752

2014 2 22 19 7 5 30 40 3,655

2015 2 22 19 7 5 30 40 3,732

Total 10 110 95 35 25 120 200 17,934

Source: UNZA and other training institutions Note: Depending on the findings of evaluation of the CHA pilot, additional targets for CHAs may need to be added to the above projected training targets.

5.2.4.

Critical success factors

The following issues are critical for achieving the above objective and targets. 1. Financing: without resources to complete the listed interventions, the objective and targets may not be achieved. 2. Availability of teaching staff: without sufficient supply of adequately trained teaching staff, quality and scale-up of training cannot be guaranteed. 3. Support from government institutions and other stakeholders: without collaboration with relevant government institutions and stakeholders, successful implementation of interventions cannot be assured. 5.3. OBJECTIVE C: IMPROVED PERFORMANCE AND PRODUCTIVITY OF HRH 5.3.1.

Rationale

Improving health workforce performance and productivity requires multifaceted interventions. An enabling working and learning environment with the right tools is crucial for increasing motivation, performance and utilization of the health workforce. Among others, these include the provision of water, sanitation, electricity, medical equipment, drugs, and surgical and other supplies. For improved performance and productivity there is need for continuous professional development. Management of absence from work due to illness is critical to ensuring adequate health service delivery. There is need to support prevention, treatment and care for communicable and non-communicable diseases. Further, strengthening the management and leadership skills of managers to ensure adequate supervision of HCWs will facilitate efficient and effective utilisation of resources. Finally, the competence of the existing health workforce will require continued maintenance through a combined set of interventions that aim at developing and maintaining its competence and capacity to ensure appropriate delivery of services.

NHRH SP 2011-2015 Page 34

5.3.2.

Interventions

To achieve the objective, the sector will pursue the following strategies: Intervention C.1: Strengthen the leadership and management capacities of managers and supervisors at all levels. The MoH will implement a comprehensive leadership and management (L&M) package, designed to strengthen systems and structures at all levels, including supervision and governance training. Intervention C.2: Provide enabling and supportive learning and working environments for all health workforce in all health institutions. Initiatives focused on establishing and maintaining conducive learning and working environments at all health facilities will be supported by the MoH through ensuring the provision of medical and surgical equipment supplies, utility vehicles, housing, water and electricity for health facilities and staff housing. The sector will explore and implement initiatives to improve health and safety in the work environment. Intervention C.3: Strengthen performance management for improved productivity and quality of work of health workforce. Consistency in monitoring of staff behaviours will be key to the success of this intervention. The MoH will ensure that PMP and job descriptions are disseminated at all levels. In addition to this, measures for regular coaching, mentorship, and in-service training will be put in place. Initiatives for rewarding performance, such as performance-based incentives, will be encouraged at all levels. The dissemination and sensitisation, enforcement of MoH’s “Code of Ethics and Conduct, the “Disciplinary Code,” and “Terms and Conditions of Service” will be undertaken to improve productivity in performance at all levels. The performance of the health care workforce will be monitored through the implementation of the PMP at various levels as well as PAs, JARs and TWGs. Intervention C.4: Increase number of service-oriented and client-centred facilities. To avoid and minimise the perceived or alleged negative attitudes and poor service delivery by staff members at health facilities, the MoH will give high priority to client and employee satisfaction. To assess reasons for unmet client needs, elaborate on ways to improve customer care, and assess job satisfaction among the health workforce, research will be conducted to design and implement client and job satisfaction programmes. Intervention C.5: Strengthen organisational needs.

planning

of

In-service

Training

according

to

In-service training18 is necessary to ensure that staff are adequately trained, have up-to-date competencies for providing quality services and are prepared for career progression. A computerized Training Information Management System (TIMS) for the sector will be developed to ensure a more coordinated and professional approach to in-service training. To meet the sector needs, the management of scholarship programmes needs to be strengthened at all levels.

18

In-service training means training and development organized and conducted by a Ministry, Province or other Government Institution to upgrade the skills of exisiting health workers.

NHRH SP 2011-2015 Page 35

Further details on the implementation of these strategies are presented in the Results Framework and Costed Action Plan that appears in Annex A. 5.3.3.

Targets

Due to the qualitative character and the complexity in achieving this objective, results will be more qualitative than quantitative and the measurable indicators are input- or processoriented. The Results Framework in Annex A provides indicators in relation to the proposed interventions. 5.3.4.

Critical success factors

The following issues are critical for achieving the objective and the targets: 1. Dialogue with and support from the Public Service Management Division: the MoH is an integral part of the Government of the Republic of Zambia and must, therefore, adhere to the overarching rules and regulations. Some of the strategies discussed above, however, may require adjustments in government policy, which is outside the jurisdiction of the MoH. Solutions must therefore be sought through dialogue and collaboration with PSMD 2. Financing: without financial resources to complete the listed interventions, the objective and targets may not be achieved. 3. Collaboration with all stakeholders within the sector: many of the interventions are multi-disciplinary and require cross-functional collaboration within the sector to be adequately implemented. It is crucial that planning and implementation is completed jointly and not regarded as the responsibility of the MoH alone. 5.4. OBJECTIVE D: STRENGTHEN SYSTEMS AND STRUCTURES TO SUPPORT HR EXPANSION AND PERFORMANCE 5.4.1.

Rationale

As a consequence of restructuring in the MoH, a number of functions have been centralised. To make the systems and structures at various levels of the health sector responsive to the demands for effective and efficient service delivery, there is a need for strengthening planning and management systems at all levels. The absence of a comprehensive HRIS in the sector has, over the years, posed a challenge for evidence-based planning and decision making. Apart from the Ministry of Health, the regulatory functions of the sector must be strong enough to set and enforce the standards required for both training of health workers and for the delivery of health services. 5.4.2.

Interventions

To achieve the objective, the sector will pursue the following strategies: Intervention D.1: Strengthen information systems.

human

resources

planning,

management

and

The sector will strive to promote evidence-based planning and decision making. To achieve this, there is need for the sector to establish functional, comprehensive HRIS. It is critical to ensure that planning tools and guidelines reflect the priorities of the NHRH SP at all levels annually. There is also need to undertake an assessment of the workload at all levels in

NHRH SP 2011-2015 Page 36

order to establish the appropriate number of health workers required at different levels of care. To improve efficiency in the management of health workers, continuous capacity assessment and development of HR’s at various levels is necessary. Intervention D.2: Develop and implement a harmonised communication strategy. There is a need to develop and implement an effective communication strategy with clear guidelines. This will alleviate frustration among stakeholders, health workers, and communities due to lack of information. The communication strategy will emphasize the need for conducting regular meetings at all levels, institutions and facilities with staff and with representatives of health unions and associations to share information, hear concerns, and develop strategies for working towards a common goal. Email communication should be encouraged, as it is a rapid means of written communication. Intervention D.3: Strengthen functions and roles of regulatory bodies. There is need to improve the capacity of regulatory bodies to ensure quality service delivery in the sector. Further, regulatory bodies are a reliable source of data on the activities in training and service delivery in both public and private institutions. They also have the mandate to ensure that standards are adhered to for each cadre.

Intervention D.4: Accelerate implementation of the national gender policy. The MoH will adhere to the National Gender Policy to redress gender imbalances and attain gender equality in all aspects of the workplace environment, including health worker training, recruitment, deployment and promotion. Further details on the implementation of these strategies are presented in the Results Framework and Costed Action Plan that appears in Annex A. 5.4.3.

Critical success factors

The following issues are critical for achieving the objective: 1. Delegation of routine activities to lower levels of the MoH is necessary to allow the MoH headquarters to provide strategic vision, policy guidance, and oversight. The MoH headquarters must free itself from many of the less strategic activities that it is currently occupied with. 2. Dialogue with and support from the Public Services Management Division (PSMD). The MoH must adhere to the overarching government-wide rules and regulations. Therefore, some of the strategies discussed above may require dialogue and collaboration with PSMD to find appropriate solutions. 3. Financing: without adequate resources to complete the listed interventions, the objective and its targets may not be achieved.

NHRH SP 2011-2015 Page 37

6.

IMPLEMENTATION AND MONITORING FRAMEWORK

6.1. COORDINATION STRUCTURES The NHRH SP 2011-2015 will be implemented, monitored and coordinated through the existing health sector organisational and management structures, including the Health Sector Advisory Group (SAG), the MoH at central level, the PMOs, the DMOs, the Hospital Management Teams, the public and private-for-profit health training institutions, the regulatory bodies, and other stakeholders, including CHAZ, health NGOs, private-for-profit facilities, health unions and civil society. The MoH, through the DHRA, assisted by the HRTWG, will be responsible for the overall coordination and monitoring of the NHRH SP 2011-2015. Additional mechanisms for consultation and supervision will be established as needed, e.g. experts’ ad hoc technical working groups with input from relevant stakeholders. The CPs will be requested to support the NHRH SP by aligning and synchronising their interventions with the MoH priorities and timelines, as specified in the NHRH SP 2011-2015. As a subset of the NHSP, it is expected that the implementation of the NHRH SP will fall within the scope of the Memorandum of Understandings signed between stakeholders and the government in regard to the implementation of the NHSP. Many stakeholders are instrumental to achieving the objectives of the plan. A list of the key stakeholders is provided in Annex H. 6.2. CRITICAL SUCCESS FACTORS Experiences in other countries have shown that four factors are instrumental for the successful and timely funding, implementation and monitoring of HRH strategic plans: ƒ

Sound leadership: The HRTWG will be the coordinating body for the implementation and monitoring of this Plan, with the DHRA acting as the focal point, serving as secretariat to carry out the required routine coordination, communication and facilitation. To improve the capacity of the HRTWG, its ToR will be reviewed and membership adjusted to ensure stakeholders and senior officials from all relevant government institutions are present.

ƒ

Strong partnerships: To promote effective collaboration with its stakeholders, partners and beneficiaries, the MoH, will: (i) promote effective communication with stakeholders and beneficiaries in the implementation and monitoring of the NHRH SP 2011-2015, clearly outlining the division of labour and the targets to be met, and (ii) write and share annual action plans with partners, stakeholders and beneficiaries to promote accountability, transparency and collaboration.

ƒ

Evidence-based and cost-indicative annual action plans: to facilitate the financing, implementation, and monitoring of this Plan, the DHRA will develop cost-indicative Annual HRH Action Plans that reflect realistic targets based on a reliable baseline that are fully integrated within the MoH’s general Annual Action Plans.

ƒ

Sound and feasible M&E system using measurable indicators against an established baseline. Please see Section 6.3 for additional information regarding the M&E structures for this Plan.

Based on these structures, the MoH believes it is well-positioned to successfully implement and monitor this Plan within the given targets and deadlines.

NHRH SP 2011-2015 Page 38

6.3. MONITORING FRAMEWORKS AND INDICATORS 6.3.1.

M&E systems and structures:

A lesson learned from the previous NHRH SP is that there should not be a separate monitoring system or process for HR, but it should be properly integrated in the MoH general M&E system. Data for the specific indictors proposed for the NHRH SP 2011-2015 should be collected as part of the general M&E system. The following are important parts of the M&E system: ƒ

Performance Management Package system: Training in the PMP will be cascaded to assess the performance of individual workers, using job descriptions and individual work plans.

ƒ

Quarterly and annual narrative and financial progress reports: these reports are required for the overall management of joint financing of the health sector. The DHRA will prepare quarterly reports concerning the implementation of the NHRH SP to be presented to the HRTWG.

ƒ

Facility-based performance assessments: This assessment is conducted twice a year using semi-structured questionnaires in all health facilities. The assessments follow a Total Quality Management (TQM) approach and are one of the monitoring instruments of the NHRH SP to improve planning and management of the health workforce.

ƒ

Technical Supportive Supervision: Visits to the sites addressing the weaknesses found in the facility-based performance assessments.

ƒ

The Joint Annual Reviews: The reviews aim to assess the progress made in implementing the Annual Action Plans, with an emphasis on key thematic areas. During the review, various stakeholders at all levels participate in the assessment. The JAR should follow-up on agreed indicators of the NHRH SP.

ƒ

The Mid-Term Review (MTR) and final evaluation of the implementation of the NHRH SP 2011-2015 and annual action plans: the implementation of the NHRH SP 2011-2015 will be assessed through a midterm review and a final evaluation.

ƒ

Financial reporting: financial management software (IFMIS) should be urgently put in place so that the MoH Annual Action Plans, including the NHRH SP, may be mapped against the budget (the Yellow Book). The system should enable the production of monthly, quarterly and annual financial reports on the implementation and expenditure for the NHRH SP.

6.3.2.

Indicators

Defined indicators to measure MoH’s success in implementing this Plan and monthly PMECreports generated by the HR Planning Unit in the DHRA will be evaluated. The Results Framework and Costed Action Plan in Annex A provide key indicators for the NHRH SP. 6.3.3.

Reporting

Reporting on activities to achieve the objectives in the NHRH SP will be done using the routine information systems from the sector, both existing and those intended to be introduced as part of this plan’s implementation. The DHRA will ensure that the reporting mechanisms will be appropriate to report on progress in plan implementation. Reporting will be done quarterly to the MoH, who will brief the SAG on progress made through the HRTWG. The DHRA Planning Unit will amalgamate the Quarterly Reports.

NHRH SP 2011-2015 Page 39

These reports will highlight problem areas and suggest actions to be taken to resolve the problems. Monthly reporting will follow the process below and feed into the quarterly reports: ƒ

The HRIS Committee will set the parameters of the monthly reports to be generated from the Payroll Management and Establishment Control (PMEC) system

ƒ

The DHRA Planning Unit will generate the required reports on a monthly basis and present the information to the Director HRA and devise ways to resolve some of the pertinent issues

ƒ

The Director of the DHRA will present the information to the Senior Management Meeting, when required

ƒ

The HRIS reports will be provided to the members of the Human Resources Technical Working Group (HRTWG)

ƒ

The HRTWG Task Group leaders will take the information to their relevant task groups for discussion, solutions and recommendations which are to be made at the main HRTWG

ƒ

The Directorate HRA will provide updates on progress at the Human Resources Technical Working Group monthly meetings. In addition, regular monthly and quarterly reports on the NHRH SP indicators, referred to above, will be provided to senior management.

7.

COSTING OF NHRH SP 2011-2015

7.1. RESOURCE ENVELOPE The Zambian government recognises health as one of the sectors that greatly contributes to the well-being of the nation and, therefore, remains committed to providing quality health services to all of its citizens. In this regard, the government has gradually increased its share in the national budget towards the attainment of the Abuja target of 15 percent. Growth in overall national budget, specifically the health budget, has in part been due to a very impressive economic national growth rate, averaging 6 percent in the past decade. During 2011-2015, a total of ZMK 132,200,000 million is estimated to be available for the implementation of the SNDP. Most Government resources are already committed to personal emoluments and other constitutional expenditures, but a total of 48,004 billion is available for the implementation of the programmes of the Sixth National Development Plan (SNDP), of which 7,111,000 million is earmarked for development programmes of the health sector, including human resources for health, as shown in the table below. These resources correspond to the non-personal emoluments in the MoH budget and do not include grants from CPs. Table 12: Allocated resources to the MoH in the SNDP (in mn ZMK) Health sector HRH

2011 802,000 125,100

2012 1,288,000 200,700

2013 1,418,000 229,400

2014 1,755,000 273,600

2015 1,848,000 288,100

Total 7,111,000 1,116,900

Source: GRZ 2010a

NHRH SP 2011-2015 Page 40

The SNDP will be implemented though the Medium Term Expenditure Framework (MTEF) and associated annual activity based budgets. In 2011-2013, the Government states its intention to direct more financial resources to the health sector, especially in the wake of the reduced sector support by a number of the Cooperating Partners. For this period, the allocation to the sector is expected to increase by 58.4% compared to the 2008-2010 MTEF. This will compensate for the reduced support from CPs and ensure that that the sector maintains a funding level of at least 10.5% of total Government expenditure. Table 13: MTEF projections for the MoH, 2011-2013 (in mn ZMK) Budget 2010 Personal emoluments Other programs Total MoH Net Increase Percent Increase

669,191 702,501 1,371,692

Projection 2011 956,149 802,443 1,758,592 386,900 28.2%

Projection 2012 1,134,791 1,287,450 2,422,241 663,649 37.7%

Projection 2013 1,327,624 1,471,658 2,799,282 377,041 15.6%

Source: MTEF 2011-2013

The allocation in the MTEF for 2011-2013 will continue to address challenges of the double disease burden, inadequate clinical staff and equipment and the erratic supply of essential drugs. The MTEF 2011-2013 is also providing financial space for the recruitment of 1,700 health workers per year 2011-2013. Actual funds received by the entire health sector from CPs, 2006 – 2009 averaged 265,000 million ZMK per year.19 Based on the estimates in the Sixth National Development Plan and the projected allocation of funds to the health sector, and from within the health sector to the development of HRH, the following estimates can be made regarding the available resources for the NHRH SP 2011 – 2015 (see table below). Table 14: Estimated resource envelop for HRH Plan, 2011-2015 (in mn ZMK) SNDP funds for HRH CP contributions Total

2011

2012

2013

2014

2015

Total

125,000

201,000

229,000

274,000

288,000

1,117,000

50,000

52,500

55,125

57,881

60,775

276,282

175,000

253,500

284,125

331,881

348,775

1,393,282

Source: Costing data from Annex A.

After the alleged misuse of funds in 2009, a number of major CPs have reduced or suspended their funding to the health sector. There is thus a high level of uncertainty when attempting to estimate the contributions from CPs in the coming years. . In Table 17, it is estimated that CPs will return to earlier levels of contribution at around 250,000 million ZMK annually to the health sector in 2012 , that about 30% of this will be allocated to the NHRH SP 2011-2015, and that the funds will increase by approximately 5% annually. Zambia has traditionally had four main sources of financing for health. These include Government funding, donor funding, household contributions, and “other,” which are mainly private sector (employer) contributions to the health sector. Future funding from CPs will depend on the successful implementation of the MoH Governance Management and 19

CSO et al., 2009.

NHRH SP 2011-2015 Page 41

Capacity Strengthening Plan. The NHRH SP highlights areas of the HRH sector that require support from the CPs. 7.2. COSTS FOR THE NHRH SP 2011-2015 The estimated costs (excluding the baseline costs estimated to be around USD 300 million for salaries and other recurrent costs) for the NHRH SP 2011-2015 translate to K1.56 trillion, only slightly above the estimated resource envelope of K1.39 trillion, with the following breakdown by objective: Table 15: Summary of costs by HRH SP objective S/ N A

Objective/Intervention Increase number of employed and equitably distributed health workforce with appropriate skills mix

1

Increase the number of the health workforce

2

Redefine staff posting and establishment based on need Distribute human resources equitably and ensure appropriate skills mix for achieving the MDGs

3 4 5 B

Amount (ZMK Mn)

Amount (USD 000)

1,348,947

269,789

1,032,700

206,540

200

40

80,023

16,005

Implement and enforce bonding scheme for all pre- and in-service trainees Improve conditions of service to attract and promote retention of health service providers in rural and remote facilities

789

158

235,235

47,047

Increase training outputs harmonized to the sector’s needs

182,571

36,514

1

Strengthen the coordination among the key actors in training of health workers

240

48

2

Expand the national training capacity for the production of HRH Improve access to pre-service programmes for candidates/students from rural and remote areas Review existing training programmes and certification of health workforce and develop new ones to respond to the sector’s needs

171,783

34,357

83

17

10,465

2,093

24,256

4,851

7,200

1,440

1,835

367

3

Improved performance and productivity of HRH Strengthen the leadership and management capacities of managers and supervisor at all levels Provide enabling and sportive learning and working environment for all health workforce in all health institutions Strengthen performance management for improved productivity and quality of work of the health workforce

10,931

2,186

4

Increase number of service-oriented and client-centred facilities

4,290

858 -

5

Strengthen planning of in-service training according to organizational needs Strengthen systems and structures to support HR expansion and performance

0

-

6,889

1,378

3 4 C 1 2

D

683 1

Strengthen human resources planning, management, and information systems

2

Develop and implement a harmonised communication strategy

3

Strengthen functions and roles of regulatory bodies

4

Accelerate implementation of the national gender policy

Grand Total

NHRH SP 2011-2015 Page 42

3,414

-

150

30

3,325

665

0

-

1,562,663

312,533

CP contributions for financing the plan are suggested to be as follows: ƒ

For objective A, the Government has earmarked funds for the recruitment of 1,700 health workers per year within the medium term expenditure framework. CPs are expected to contribute approximately about 40% to this objective which translates to approximately USD 107 million for the strategic plan period.

ƒ

For objective B, CPs are assumed to contribute 35-40%, or USD 13.7 million, of estimated costs of implementing the revised National Training Operational Plan (NTOP 2011) (Result A.3). The difference amounting to USD 22.8 million is expected to come from GRZ

ƒ

For objective C, CPs are expected to contribute up to USD 3 million towards the financing of the L&M programme. One of the CPs, USAID, through ZISSP, has funds available for L&M training through a sub-contractor BRITE.

ƒ

For objective D, CPs are expected to contribute up to 50 percent towards the financing of the planning and management systems strengthening.

Total contributions from CPs towards the financing of the NHRH SP 2011-2015 would be about 100 million US dollars over the five years. 7.3. FINANCING OPTIONS The NHRH SP 2011-2015 is within the estimated resource envelope, but if more resources become available for the second half of the plan period, it is suggested that the midterm review revisit the plan and propose amendments based on progress made and the situation at that time. Activities that can be added to the plan during the latter half of the plan period are: ƒ

Increasing the funded establishment for clinical cadres,

ƒ

Increase the training capacity and diversify training institutions

ƒ

Increasing the budget for scholarships,

ƒ

Building more staff houses and other improvements of staff conditions (DP&P)

NHRH SP 2011-2015 Page 43

8.

ANNEX A: RESULTS FRAMEWORK AND COSTED ACTIVITY PLAN

8.1. OBJECTIVE A: INCREASED NUMBER OF EMPLOYED AND EQUITABLY DISTRIBUTED HEALTH WORKFORCE WITH APPROPRIATE SKILLS MIX 8.1.1.

Results Framework

Result Result A.1: Increased health workforce

Result A.2: Redefine staff posting and establishment based on need

Indicators # of filled clinical positions

Baseline 16,256 clinical positions

Target by 2015 24,900 clinical positions

# of filled administrative positions

14,457 administrative (Table 2) Plans not aligned

15,488 administrative (Table 10) Annual action plans are fully harmonised and priorities set jointly

Staffing needs for different health facilities according to a revised health workforce optimization model

Source of Verification − PMEC

Assumptions − Financing provided − Adequate output from training institutions





− Expansion of (i) health workers; (ii) health facilities; and (iii) medical equipment harmonised in the annual operational plans

Minutes on file of joint biannual Directorates’ planning and review meetings NHSP 2011-2015 Annual Operational Plans.

− − − −

Result A 3: HRH with appropriate skills mix equitably distributed





% of rural HCs with at least 1 midwife, 1 clinical officer, 1 EHT

# of health facilities with a staffing structure that matches its workload

To be obtained

0 health facilities

All RHCs have clinical, reproductive and environmental health core competence 75% of health facilities have a rationalised staffing structure.

NHRH SP 2011-2015 Page 44

− − − −

PMEC Annual District Health Profiles Reviewed and adjusted WOM/WisN Annual recruitment and (re)deployment schedules based on adjusted WOM

− − − −

Effective collaboration between Directorates SMART and cost and timeindicative plans in place MoFNP and CPs committed to finance the implementation of plans National Training Operational Plan is based on an assessment of the sector’s needs Funding is predictable and regular Functional HRTWG with revised ToRs and membership WOM reviewed and adjusted every one years Effective collaboration with other Directorates DHRA produces timely comprehensive narrative and financial annual reports

Result Result A 4: Bonding system for pre- and in- service students in place

Result A 5: Improved attraction and retention levels of health service providers in rural and remote facilities

Indicators − Revised legal framework − % of students signed RRBS prior to entering health training programme − % of temporal registrations successfully changed to full registration after serving the RRBS for agreed period − % of full adherence to bonding scheme of inservice graduates − # of staff houses built / renovated near remote or rural HCs by MoH − # of staff houses built – using MoH design and standards – by privatefor-profit sector for renting − % of clinical staff retained for at least 3 years in rural and remote facilities − % of competent retired HRH provided with contract to be working in remote or rural HCs − More sustainable retention scheme in use − Compulsory service policy signed and implemented

Baseline Only temporal registration for Medical Doctors - No RRBS Bonding scheme for in-service not enforced

Target by 2015 RRBS fully implemented and posting based on a rationalised staffing structure

Source of Verification − Concept Paper with guidelines on RRBS − Revised GNC Act − PMEC

Assumptions − Effective collaboration with other Directorates − Significant scaling up of training outputs of multiple training programmes − WOM reviewed, revised and consistently used for optimal RRBS recruitment and deployment of new graduates

To be obtained

To be obtained





− − − − −

DP&P’s Infrastructure Development Plan PMEC Annual District Health Profiles DMO’s annual reports DHRA annual reports Revised ZHWRS

− − − −

NHRH SP 2011-2015 Page 45

Effective collaboration with other Directorates Significant scaling up of training outputs Adjusted WOM consistently used for optimal deployment of HRH Retired professionals with scarce competences contracted to work on in D and C districts Affordable ZHWRS in place to allow for expansion of selected clinical cadres working in facilities in D and C districts

8.1.2.

Costed Indicative Activity Plan

Objective A: Increase number of employed and equitably distributed health workforce with a appropriate skills mix Intervention / Result

Resp.

Timeframe 2011

A.1 A.1.1

A.2

2012

2013

Cost Items

2014

MoH/ MoFNP

X

X

X

X

X

Cost of salaries and benefits, average ZMK44 mn per health workers, scenario 2 with total 9675 additional health workers: Additional cost over 5 years

Redefine staff posting and establishment based on need

A.2.1

Expand the annual action plans to include (i) Expansion of Funded establishment (ii) finalized health infrastructure, and (iii) medical equipment.

MoH DPP/ DHRA, DHCC

X

X

X

X

X

External workshops, 2 x 2 days

A.2.2

Monitor the implementation through quarterly reports.

MoH Mgmt

X

X

X

X

X

No cost

A.3 A.3.1

Distribute human resources equitably and ensure appropriate skills mix for achieving the MDGs Purchase the end-user license fees for the ‘Talent management’ module of the ERP HCM system Finalize negotiation with PSMD to provide expanded access to the PMEC within the MoH

DHRA/ HRTWG/ PSMD/ MoFNP/ CPs

A.3.3

Fund training - provided by PSMD – to all newlyappointed HR officers at all levels in using relevant modules of the SAP-ERP-HCM

DHRA/ PSMD/ CPs

A.3.4

Provide briefings to managers on use of PMEC and linkages with other databases

A.3.5

Conduct annual 4-day refresher courses for all HR Officers already trained in PMEC and provide training on expanded use of PMEC and linkages with other databases

DHRA/ PSMD/ PMOs/ DMOs/Med Superintendents / HRO DHRA/ PSMD/ DHRA/ HR Officers

A.3.6

Update PMEC monthly and submit regular reports to MoH

A.3.2

X

Purchase license and installation of system existing on the market, 3,500 USD per license x 120 users No cost

DHRA/ HR Officers

X

X

4 external workshops, 3 days

X

X

10 internal workshops, 1.5 days

X

X

X

X

5 external workshops, 4 days

X

X

X

X

No cost

NHRH SP 2011-2015 Page 46

Cost ($'000)

2015

Expanded number of funded positions Increase the number of the health workforce

Cost (ZMK mn) 1,032,700

206,540

1,032,700

206,540

200

40

200

40

0

0

80,023

16,005

21,000

4,200

0

0

1,066

213

656

131.2

2,633

527

0

A.3.7

Conduct annual (independent) payroll audits and WOM audits

DHRA/ HR Officers / M&E Unit of DPP

X

X

A.3.8

Produce, distribute and use comprehensive HR reports, including staff returns

DHRA/ HR Officers

X

X

A.3.9

Conduct research into the type and quality of services provided and workload at each level of the referral system

X

A.3.1 0

Conduct research into unmet need at community level and fund this activity

X

A.3.1 1

Conduct research to assess which activities could/ should be task-shifted and what training and supportive supervision would /should be required

A.3.1 2

Review/adjust the Establishment, using findings from reports above

DHRA/ HRTWG/ Research Unit of DPHR/ CPs/ University/HCs DHRA/ HRTWG/ Research Unit of DPHR/ University / Neighborhood Health Committees / Civil Society/ communities/CPs DHRA/ HRTWG’s Task Group 8/ DPHR/ Research Unit of the DPHR/ University /facilities at all levels/regulatory bodies/ training institutions DHRA/ PSMD/ CHAI

A.3.1 3

Advocate for approval of a needs-based establishment, including increased # of funded positions and increment of annual ‘net recruitment budget’ from Treasury

DHRA/ Senior management/ HRTWG/ MoFNP/ Cabinet Office

X

X

A.3.1 4

Review and adjust the WOM, using findings from previous activities

DPHA/ CHAI/ DPP

X

X

A.3.1 5

A.3.1 6

Use revised WOM for optimal recruitment and (re)deployment, bi-annual recruitment and (re)deployment schedules, including requirements for foreign trained professionals with scarce skills Recruit and redistribute HRH in line with agreed schedule as defined in B.2.14

A.3.1 7

Budget for and provide reallocation allowances in line with GRZ benefits for redistributed HRH

DHRA/ regulatory bodies/ Committee at SoM responsible for screening foreign applications DHRA/ PSMD/ PMOs /DMOs/ HR Officers DHRA/ PMOs/ DMOs

Travel and per diem costs etc X

118.6

25

5

X

Producing report is regular work at no extra cost. Printing 500 copies x 50,000

X

X

Procure 2 studies annually x 100 million

1,000

200

X

X

Procure 2 studies annually x 100 million

1,000

200

Procure 2 studies annually x 100 million

1,000

200

150

30

X

External workshop: Audiovisuals, Stationery, Transport/Fuel, Secretarial, Photocopying, Consultancy, Venue, Lunch/teas, 1 workshop x 2 days, annually Internal work, no cost

0

0

X

Local consultant, 4 weeks

100

20

300

60

X

X

X

593

X

X

X

X

X

X

X

External workshop: Audiovisuals, Stationery, Transport/Fuel, Secretarial, Photocopying, Consultancy, Venue, Lunch/teas, 2 workshops x 1.5 days, annually

X

X

X

Recruitment cost, 5 million per recruitment

25,500

5,100

X

X

X

Reallocation allowances, 25 million per person x 1000

25,000

5,000

NHRH SP 2011-2015 Page 47

A.4 A.4.1

A.4.2

A.4.3 A.4.4

A.5 A.5.1

A.5.2

A.5.3

A.5.4

A.5.5

A.5.6

Implement and enforce bonding scheme for all pre- and in-service trainees Investigate the different types of bonding schemes, including the proposed RRBS and RRCSS, write concept paper and present to the MDD and Unions Develop policy and legal documents in a consultative process involving all relevant stakeholders

DHRA/ HRTWG/ Research Unit of the DPHR/ MDD/ Health Unions/ Regulatory bodies/ training institutions

X

789 X

Internal work, no cost

X

Local consultant to develop the campaign and material, 2 weeks, fees and material

Implement the designed bonding scheme Carry out a formative evaluation of the effects of the bonding scheme and adjust according to results

X

X X

Improve conditions of service to attract and promote retention of health service providers in rural and remote facilities Advocate for improved allowances DHRA/ HRTWG/ Senior X X and provide free ‘high cost’ medical management/ MoFNP scheme to public sector HRH Advocate for infrastructure development in health facilities and for newly built and /or renovated staff houses near rural and remote HCs Conduct a research study to assess GRZ’s hardship and retention allowances/ schemes from other sectors and review their impact Review the ZHWRS, identify funding mechanisms to promote its sustainability of attracting and retaining clinical cadres Implement a multi-media campaign to improve attraction to and retention of working in rural and remote facilities Establish an effective system for contracting and deploying qualified, competent and committed HRH with scarce skills

6.6

10 internal workshops, 1.5 days

656

131.2

consultant

100

20

235,235

47,047

In relation to social health insurance

X

DHRA/ Research Unit of DPHR/

X

Cost of study

DHRA/ Research Unit of the DPHR

X

DHRA/ HRTWG/ CPs/ regulatory bodies/ media firms

X

X

X

X

X

X

X

X

X

NHRH SP 2011-2015 Page 48

0

33

DHRA/ DPP/PMOs / DMOs/ CPs

DHRA/ HRTWG/ Regulatory bodies/ PMOs and DMOs

X

157.8

Construction of 500 houses x 90 million (DPP budget)

0

45,000

9,000

100

20

External workshops, 2 x 2 days

60

12

Local consultant to develop the campaign and material, 2 weeks, fees and material

25

5

Local consultant 6 weeks

50

10

A.5.7

Pay allowances to HRH participating in the ZHWRS

DHRA

X

X

X

X

X

Target 1,350 health workers. 270 doctors with annual gross benefits of ZMK 56,000,000 per doctor including housing amount and 1,080 other clinical staff with annual gross benefits of ZMK 19,200,000 per clinical staff. Calculations also include 9 months extra salary to be received after fulfillment of the contract, ZMK 42,000,000 per doctor and ZMK 14,400,000 per other staff

Subtotal A

190,000

38,000

1,348,947

269,789

8.2. OBJECTIVE B: INCREASE TRAINING OUTPUTS HARMONIZED TO THE SECTOR’S NEEDS 8.2.1. Result Result B1: Effective coordination between the key actors in training of HRH

Results Framework Indicators National Health Training Coordination Committee (HTCC) meetings

Baseline To be obtained

Joint planning

Result B:2: Training programmes and certification of HRH reviewed and new ones developed in response to sector’s needs and to facilitate career progression

# of programme reviewed # % of training programmes for clinical cadres that include non-clinical subjects, including leadership, management, M&E, HMIS and reporting components

# of new progression programmes developed for programmes with no clearly outlined progression

To be obtained

Target by 2015 Functional HTCC in place

National Training operational plan developed. All existing programmes evaluated by end 2013 All curricula for training of clinical cadres include leadership, management and M&E modules

Source of Verification ToR, minutes .,Plan document.

Assumptions Interest by the key actors to collaborate

− − −



− −

Reports Revised curricula Approval of programme/curriculum by regulatory bodies Curricula Programme career progression structures

All programmes with clear and cost effective progression paths

NHRH SP 2011-2015 Page 49

− −



Capacity at the MoH to conduct/ spearhead the activities Capacity at the TIs and regulatory bodies to participate in the activities CPs supporting the activities (CHAI, MEPI, NEPI, DfiD, USAID, Strengthening training and education of health workers etc.) TIs and Regulatory bodies engaged in redefining progression alternatives

Result Result B.3: Expanded national capacity for production of HRH

Indicators # of graduates/enrolments # of TIs meeting the required standards Approved updated NTOP % of students from rural and remote areas

Baseline 2,981 Enrolments and 2,311 Graduated Annually. See Annexes B and C for # per cadre

Target by 2015 3626 enrolments

Result B.4: Improved access to HRH training programmes (pre-service) for students from rural and remote areas



To be obtained

Minimum of 30 % of students accepted on HRH training programmes are from rural and remote areas





8.2.2.

GNC Act revised and approved to allow for temporal registration for Nurses before December 31, 2012 % of newly graduates for each cadre deployed in rural and remote HCs with temporal registration % of temporal registrations successfully changed to full registration after serving the RRBS for agreed

Source of Verification − Registers/ − Records at regulatory bodies. − MoH graduates tracking tool − Assessment reports/Records by regulatory bodies − Plan document − − MoH Annual Review Report − Records of students accepted

3200 graduations See training output targets in Table in main plan



Concept Paper with guidelines on RRBS Revised GNC Act in place Health Councils Data bases Health training institutions’ annual reports District annual reports DHRA annual reports PMEC

− − −

RRBS implemented st from 1 of January 2012 onwards for all new students in clinical professionals

− − −

Assumptions − The MoH investment plan is facilitating implementation of the NTOP 2011 and investments in new TIs − Capacity available at the MoH to conduct/ spearhead the activities − CPs willing to support the activities (CHAI, MEPI, NEPI, DfID, USAID) Strengthening training and education of health workers etc.) − TIs and regulatory bodies open-minded to innovation and revision − Effective collaboration with other Directorates − Significant scaling up of training outputs of multiple training programmes − WOM reviewed, revised and consistently used for optimal RRBS recruitment and deployment of new graduates

Costed Indicative Activity Plan

Objective B: Increase training outputs harmonized to the sector's needs Intervention / Result

Resp.

Timeframe 2011

B. 1

2012

2013

Strengthen the coordination among the key actors in training of health workers

NHRH SP 2011-2015 Page 50

2014

Cost Items

Cost (ZMK mn)

Cost ($'000)

240

48

2015

B.1.1

Establish a National Health Training Coordinating Committee (HTCC)

HRH committee

B.1.2

Strengthen the link between the MoH and private TIs for training of HRH by: a) Create a forum , and b) Establish MoUs with private Ties

Private TIs

B.1.3

Review and update to year 2015 the NTOP 2008

DHRA, DPP, CHAI, HRTWG

B.2

X X

X

X

X

Internal work, no cost

0

0

Internal work, no cost

0

0

240

48

171,783

34,357

33

6.6

20,000

4,000

24,000

4,800

27,700

5,540

16,000

3,200

Local consultant 12 weeks. Travel costs, consultant and 2 HR officers from MOH, 3 travels for regional verification meetings

X

Expand the national training capacity for production of HRH

B.2.1

Implement and monitor the revised and updated NTOP 2011

DPP, CHAI, CPs, HRTWG

X

B.2.2

Establish a new TI for training of Medical Doctors and Dental Surgeons (Ndola School of Medicine)

DPP, CBU, NCH, HPCZ

X

B.2.3

Establish training sites for Clinical Officers in two additional provinces,

Chainama College

B.2.4

Provide training of Registered Nursing in Western Province and North Western Province

Nursing Dep., GNC, PMOs

B.2.5

Re-open Chitambo Nursing School for training of Enrolled Nurses

Nursing Dep, DHRA, DCC&DS, DTSS

X

X

X

X

NHRH SP 2011-2015 Page 51

X

X

X

X

X

X

HTCC meetings coordinating, internal workshop 2 x 1 day annually. Additional 360 staff , Recurrent costs New infrastructure and equipment for capacity of 1000 students Salaries and other recurrent costs New infrastructure and equipment for 2 schools, each with capacity of 100 graduates annually New infrastructure and equipment for 2 schools, each with capacity of 100 graduates annually. Salaries and other recurrent costs Renovation of existing and some new infra structure for 100 graduate capacity. Salaries and other recurrent costs

B.2.7

Increase the use of non- traditional forms of training e.g. open and distance learning

CPs, NEPI, MEPI programmes, TIs abroad

X

X

X

B.2.8

Review and update the organizational structures of the public TIs

MoFNP

X

X

X

B.2.9

Increase the # of trained Nursing and Midwifery tutors, Basic Science Lectures and Clinical Sciences Lectures

NEPI, MEPI, UNZA, MOE

X

X

X

X

X

150 staff (in addition to 360 staff included in NTOP)

B.2.10

Increase # of funded positions for Nursing and Midwifery Tutors, Basic Science lectures and clinical sciences Lectures and Clinical Instructors to respond to the increased # of students

MoE, MoFNP, UNZA

X

X

X

X

X

B.2.11

Create positions for BSc Nurses and Midwives in health facilities to improve clinical instruction and quality of health services

MoH, MoFNP, PSMD

X

X

X

X

B.3

Improve access to pre-serve programmes for candidates / students from rural and remote areas Conduct a study to determine the current X number of students from rural and remote areas accepted on training programmes for HRH

B.3.1

B.3.2

B.4

Explore options to actively favor enrolment of students from rural and remote districts to be accepted on training programmes for HRH.

MoE, Ties, HPCZ, GNC

X

X

Review existing training programmes and certification of health workforce and develop new ones to respond to the sector's needs

Page 52

Local consultant 6 weeks

50

10

0

0

84,000

16,800

Internal work, no cost

0

0

Internal work, no cost

0

0

83

16.6

Local consultant 2 weeks

33

6.6

Local consultant 6 weeks

50

10

10,465

2,093

Internal work, no cost

X

NHRH SP 2011-2015

X

B.4.1

Review training programmes for HRH to determine how they: a) respond to the needs of the sector; b) correspond with positions in the establishment, and c) facilitate career progression

B.4.2

Develop and establish new programmes in line with sector needs including: clinical instructors, dental surgeons, medical masters degree, ML degree biomedical engineers etc

B.4.3

Create new relevant diploma and degree training programmes to:

B.4.4 B.4.5

MOH HQ, TIs, GNC, HPCZ, CPs

Local consultant, 4 weeks. HTCC meetings coordinating

35

7

329

65.8

10,000

2,000

Local consultant, 4 weeks

35

7

International consultant 4 weeks, fees, per diem and travel

66

13.2

182,571

36,514

X

X

X

X

X

X

Local consultant, 4 weeks x 10 programs

MoH, Colleges/ regulatory councils

X

X

X

X

Costs cannot be calculated, but a ceiling estimated HTCC meetings coordinating

Evaluate the CHAs training after the first year of implementation

MoH, HPCZ, CHAI, DfID

X

Amend curricula for clinical cadres to include non-clinical subjects such as leadership and management, planning, M&E, HMIS, performance management and reporting

MoH, TIs, GNC, HPCZ, CPs

X

X

X

Subtotal B

NHRH SP 2011-2015 Page 53

8.3. OBJECTIVE C: IMPROVED PERFORMANCE AND UTILIZATION OF HRH 8.3.1.

Results Framework

Result

Indicators

Baseline

Result C.1: Supervisors and managers at all levels and institutions possess L&M capacities to assure a professional, serviceoriented, clientcentered and ethical workforce



No courses in L& M offered to target groups

Result C.2: Enabling and supportive learning and working environments for all students and HRH in all facilities and institutions

% of planned supervisors and managers participated in the 2-year comprehensive L&M training/coaching and mentoring package − Criteria for annual awards for best-performing team in district, hospital, training institutions and HRH (per cadre?) developed and communicated to all HRH − % of health facilities which are appropriately constructed, furnished and equipped − % of facilities in D and C districts with safe and adequate supply of water and electricity − % of facilities with adequate medical equipment according to set standards −

To be obtained

Target by 2015 360 supervisors and managers trained through L&M package approach

Source of Verification

Assumptions





To be obtained

− Infrastructure inventory − PA tool includes these indicators − Bi-annual PA reports − Annual narrative and financial reports from DMOs, PMOs and DHRA

− − − − −

National Annual Training Plan (NTOP 2011) NTA report Comprehensive training report List of participants for each training session Financial report Criteria for annual awards visibly displaced in each facility

NHRH SP 2011-2015 Page 54

− − −

Investment in training package in L&M yields intended results DHRA lead by example Managers and supervisors trained in L&M lead by example Annual awards motivates HRH to become better performers

− MoH commitment to concentrate on increasing access to services in D and C districts − MoH committed to improve staffing levels and skills mix for facilities in D and C districts − MoH committed to promote continuous learning of HRH − Effective collaboration with other directorates − Plans with other directorates are fully harmonized − Construction firms ready to construct staff near facilities in D and C districts for renting to HRH

Result

Indicators

Baseline

Result C.3 All facilities and institutions have healthy and safe learning and working environments for students and HRH



− National Health and Safety Act in place − MoH’s HIV/AIDS workplace policy in place −





− Result C.4: Productivity and quality of work of HRH significantly increased

− − −

% of facilities implementing the national programme on occupational health, safety, security, and harm and risk reduction in line with the National Health & Safety Act % of facilities enforcing implementation of the MoH’s HIV/AIDS workplace policy (2008) % of districts with budget allocations for protective wear used for selected cadres % of general staff meetings conducted Effective daily attendance registry in place PMP implemented at all levels and facilities Best performing facilities (teams) and HRH (per cadre) annually publicly and timely awarded

− No daily attendanc e registry in place − HC level services provided at higher levels of the health pyramid (ineffective referral System)

Target by 2015 Each district and major facilities/institu tion has functional Committee in place

Source of Verification

Assumptions

− PSMD booklets − PSC booklets − PA and JAR tools on HRH issues − Bi-annual PA reports − Annual narrative and financial reports from DMOs, PMOs and DHRA − Minutes of ‘general staff meetings’ on file

− Effective collaboration with other directorates − Plans with other directorates are fully harmonized

− 90% of all facilities have functional registers

− Daily attendance registries − PMP reports − HRH personal files − PA and JAR tools on HRH − Bi-annual PA reports − JAR reports − Research report − Annual HRH’s performance appraisals − Annual narrative and financial reports from DMOs, PMOs and DHRA − Assessment reports to asses best performers based on set criteria

− Managers and supervisors lead by example − Funds available for rolling out PMP to all levels and facilities

NHRH SP 2011-2015 Page 55

Result

Indicators

Baseline

Result C.5: Number of service-oriented, client-centred and gender sensitive workforce significantly increased



− Codes in place but not enforced





Result C.6: In-service training strengthened

8.3.2.

− −

% of facilities with Code of Ethical Conduct in English and local language visibly exhibited % of Neighbourhood Health Committees briefed on Code of Ethical Conduct and Disciplinary Code % of districts, institutions and larger facilities with functional Grievance Handling Committees % increment to the MoH scholarship programme % of provinces with decentralized in- service programme

− Budget figure 2011 − No guidelines in place − 0%

Target by 2015 To be obtained

Doubling of the current MoH scholarship programme

Source of Verification

Assumptions

− PA tool − Bi-annual PA reports − Annual narrative and financial reports from DMOs, PMOs and DHRA − Grievance Handling Committee reports − Research reports on client satisfaction and job satisfaction of HRH

− Managers and supervisors are conversant with Code of Ethics and Disciplinary Code and lead by example − Strong team spirit in facilities − HRH have confidence in Handling Committees have con

− − − −

− MoH Action Plan facilitate increased funding to scholarship programme − HRH/HRD capacity at PMO level available − Capacity at the MoH to spearhead and monitor the activities

MoH Annual Action Plan NTOP Guidelines Decisions by the MoH (PSMD)

MoH training guidelines in place 100% of the provinces

Costed Indicative Activity Plan Intervention / Result

Resp.

Timeframe

2011

C.1

2012

2013

Strengthen the leadership and management capacities of managers and supervisors at all levels

NHRH SP 2011-2015 Page 56

2014

Cost Items

Cost (ZMK mn)

Cost ($'000)

7,200

1,440

2015

C.1.1

Develop and implement a comprehensive modular L&M ‘package’ for a cohort of managers, supervisors and HR officers at all levels, institutions and major facilities

DHRA/ HRTWG/ NIPA/ regulatory bodies/ PSMD/ Procurement unit/ CPs/ ZISSP/ BRITE

X

X

X

C.1.2

Conduct bi-annual L&M induction programmes for newly recruited managers and supervisors at all levels and institutions,

DHRA/ HRTWG /CPs/ NIPA/ BRITE/ CPs

X

X

X

X

C.1.3

Conduct quarterly three-day meetings for all managers: PMOs, DMOs, In- Charges of facilities, and HR officers at PMO and DMO level to discuss L&M issues, provide ongoing coaching, mentoring and training

All Directorates/ PMOs/ DMOs/ medical superintendents / HR Officers/PSMD

X

X

X

X

C.2 C.2.1

Provide enabling and supportive learning and working environments for all health workforce in all health institutions Purchase and distribute lockable files, computers and DHRA/ PMOs/ DMOs/ X X printers for offices of HR Officers Medical superintendents

International consultant(s) 12 weeks

200

40

X

External workshops, 2 x 5

500

100

X

External workshops with 200 participants, 4 times per year during 5 years, total of 20 meetings. Cost per meeting is 300 million

6,500

1,300

1,835

367

X

Equipment for 120 offices, ZMK 7.5 per office

900

180

C.2.2

Provide paid study leave and financial support for attending national professional events/conventions

All Directorates/ Professional organizations/ PMOs/ DMOs

X

X

X

X

X

10 national convents annually. Cost covering travel, lodging, per diem and registration fees

485

97

C.2.3

Participate in PSC tours

DHRA/ PSMD/ HR Officers

X

X

X

X

X

Costs for transport, lodging and per diem for 2 persons

450

90

C.2.4

Offer internal attachments at the DHRA to HR Officers working at PMO, hospitals and DHOs for continuous learning opportunities

DHRA/ PMOs/ DMOs

X

X

X

X

X

No cost

0

0

C.2.5

Promote shared learning and synergy between MoH staff and TA’s/CP’s to increase relevance of Technical Support to sector needs

CPs/ all Directorates/ PMOs/ DMOs/ Medical Superintendents

X

X

X

X

X

No cost

0

0

10,931

2,186

C.3

Strengthen performance management for improved productivity and quality of work of the health workforce

NHRH SP 2011-2015 Page 57

Local consultant 2 weeks for development of assessment guidelines, assessment by HR officers

35

7

External workshops with consultant and stakeholders. 4 workshops x 2 days

200

40

X

Indicative implementation costs, awaiting the programme development

70

14

X

X

Regular work, no cost

0

0

X

X

Indicative cost

8,000

1,600

X

Local consultant 6 weeks for writing booklets, printing and distribution

50

10

X

X

Local consultant for planning, 12 weeks and resource persons for lecturing

100

20

X

X

regular work, no cost

0

0

C.3.1

Assess all learning and working environments on prevalence of safety measures

DPH&R/ PMOS/ DMOs/ Medical Superintendents

X

X

C.3.2

Develop a national MoH policy on occupational health and safety in line with the Health and Safety Act

DPH&R

X

X

C.3.3

Establish national programme on occupational health, safety, security, and harm and risk reduction at all levels and institutions into their annual action plans

DPH&R

X

X

X

X

C.3.4

Enforcement of the implementation of the HIV/AIDS workplace policy

DCCDS/ all HR Officers

X

X

X

C.3.5

Provide protective wear to all eligible workers on a regular basis

Administrative and Logistic Unit

X

X

X

C.3.6

Request the PSMD to provide copies of the Disciplinary Code and Procedures for handling offences in the Public Service to all facilities at all levels; provide briefing to HR officers on the ‘Red Book’ during quarterly meetings and equip them with the skills to brief their workers on the issue

DHRA/ PSMD/ all HR officers

X

C.3.7

Provide in-service training to all HR Officers in providing services in accordance with their job descriptions

DHRA/ PSMD/ ZISSP

X

X

X

C.3.8

Conduct regular ‘general staff meetings’ at all levels

All Directorates/ PMOs/ DMOs/ Heads of training institutions/ Medical Superintendents

X

X

X

NHRH SP 2011-2015 Page 58

X

X

X

X

C.3.9

Continue with the roll-out of the Trainer-training training of PMP to all levels and institutions

DHRA/ PSMD/ PMOs/ DMOs / Heads of training institutions/ Medical Superintendents / HR Officers

C.3.10

Ensure that the PMP is implemented at central and at all levels and institutions and collate all completed and signed Performance Agreements

DHRA/ PMOs/ DMOs/ HR Officers

C.3.11

Provide any outstanding job descriptions and ensure that new employees are given their copies

DHRA/ PSMD/ HR Officers

C.3.12

Provide opportunities for regular coaching, mentoring of and in-service training to HR officers on PAs and technical supportive supervision, during their quarterly meetings

C.3.13

C.3.14

X

X

Funded

0

0

X

X

X

X

Part of regular work when institutionalized

0

0

X

X

X

X

X

Part of regular work

0

0

Snr. HR Officers

X

X

X

X

X

Resource persons from MoH and internal meeting costs

1

0.2

Incorporate HR officers in PAs and Technical Supportive Supervision teams

DTSS/ PMOs and DMOs

X

X

X

X

X

Development of tools internal by HRH specific working group. Costs for travel and 4 external workshops

400

80

Request the PSMD to provide copies of PSMD policies, codes and guidelines to senior managers and use quarterly meetings to discuss and agree on strategies for consistent enforcement of adherence to codes and guidelines

DHRA/ SMD/ DTSS/ PMOs/ DMOs/ medical superintendents/ HR Officers

X

X

X

X

X

Cost for printing of 500 copies of 5 documents

250

50

NHRH SP 2011-2015 Page 59

C.3.15

Develop performance-based reward system, and submit it to MDD for approval, and to MoFNP for funding; Once approved, communicate criteria for excellent performance of individuals and teams; institute the annual special recognition award event at all levels and facilities to publicly reward good performance

DHRA/ MDD/ DTSS/ PMOs/ DMOs/ medical superintendents/ HR Officers

X

X

X

X

X

Local consultant 12 weeks for development and support to implementation

C.3.16

Enforce adherence to PSMD policies, guidelines and codes at all levels and institutions

DHRA/ HR Officers

X

X

X

X

X

regular work, no cost

C.3.17

Conduct policy research on productivity and quality of care provided at health facilities

DPH&R

X

X

X

X

X

Procure 2 studies annually x 100 million

C.3.18

Develop a national policy on Task-shifting

DHRA/ Task Group 8/ Research Unit of DPH&R/ all Directorates/ regulatory bodies/ training institutions/

C.3.19

Implement the Task shifting Policy and provide regular in-service training, coaching, mentoring and supportive supervision to those lower

DHRA/regulatory bodies/ training institutions/ PMOs/ DMOs

C.4

Increase number of service-oriented and client-centered facilities

X

X

C.4.1

Sensitize Civil Society Organizations (CSOs), Neighborhood Health Committees (NHC) and Village Health Committees on the Code of Ethics for the Public Service to enable them to assert their rights to be treated with respect and dignity by all HRH

DHRA/ DMOs/ In-charges of HCs/ HR Officers

X

C.4.2

Conduct research into the public’ perception of the health facilities and services, client satisfaction and job satisfaction of HRH

DPH&R /CPs

X

NHRH SP 2011-2015 Page 60

X

X

X

X

X

100

20

0

0

1,000

200

Establish working group to define task-shifting and plan for the implementation, w external workshops

125

25

Consultancy for Development of implementation plan & training modules, external 2 day workshop, training costs

600

120

4,290

858

0

0

100

20

X

Should be brought up in regular meetings, no extra cost

X

Research study

C.4.3

Establish client satisfaction / customer care programmes at all facilities

All Directorates/ Senior management / Hospitals and HCs

X

X

X

X

X

Ceiling estimated

C.4.4

Provide easy and comfortable access to facilities

DPP/ Medical Superintendents/ Incharges of HCs

X

X

X

X

X

Since based on assessments, costs cannot be calculated, but a ceiling estimated

C.4.5

Train HR Officers in setting set up and supporting Grievance Handling Committees

PSMD/ DHRA

X

X

X

X

Local consultant 4 weeks

C.4.6

Develop an Employee Wellness Programme and provide training in stress management and encourage HRH to take vacation leave at least every 24 months to be able to relax and recuperate and return to work reenergized

All managers

X

X

X

X

This is a management issue, no extra cost

X

Strengthen planning of in-service training according to organizational needs C.5.1

Enforce the implementation of the Public Service Training and Development Policy and the Procedures and Guidelines for Human Resource Development in the Public Service at all levels

PSMD, HR officers at PMOs

X

Subtotal C

NHRH SP 2011-2015 Page 61

X

X

X

X

Internal work, no cost

650

130

3,500

700

40

8

0

0

0

0

0

0

24,256

4,851

8.4. OBJECTIVE D: STRENGTHEN SYSTEMS AND STRUCTURES TO SUPPORT HR EXPANSION AND PERFORMANCE 8.4.1.

Results Framework

Results Result D.1: Functional planning and management systems and procedures in place at all levels and institutions

Result D.2: Gender mainstreamed in all aspects of planning, development and management of HRH

Result D.3: Effective communication and collaboration between and within levels, institutions and communities practiced

Indicators − HRTWG works in line with its revised ToR and NHRH SP 20112015 − Realistic cost-and time indicative annual action plans and reports timely developed and distributed − % of eligible women entering into nontraditional health professions − % of eligible women in management positions per level

Baseline − HRTWG did not work in line with NHRH SP − No narrative and financial annual reports − JAR for HRH not aligned − No midterm review but final review conducted

Target by 2015 − HRTWG works in line with its ToR and NHRH SP − Annual time and costindicative plans and reports timely available

Source of Verification − HRTWG ToR − HRTWG agenda and minutes on accessible file − Time and costindicative annual action plans − Narrative and financial reports

Assumptions − HRTWG has committed members who serve key ministries and other major stakeholders in influential positions

− 1 female director − No female PMOs − # of female DMOs?

To be obtained





Insufficient systems in place to promote effective communication and collaboration

To be obtained

− PMEC − Annual narrative and financial reports from DMOs, PMOs and DHRA − Reports on selection of new students and recruitments − MoH website updated on HRH issues − Accessible and updated files with agendas and minutes of meetings

− 2011 budget figures

100 % increment by 2015

− # of funded positions 2011

New funded positions 2015





Result D.4: Functions and roles of the regulatory bodies (GNC and HPCZ) strengthened

− −

Communication strategy implemented as planned % of meetings at each level/ facility/ ward/ conducted using effective meeting management principles % of major facilities with Internet connectivity Grant given to GNC and HPCZ # of funded positions

NHRH SP 2011-2015 Page 62

− MoH Action Plans and annual reports − Regulatory bodies reports

Managers and supervisors are conversant with content of National Gender Policy and act accordingly

− Managers and supervisors lead by example regarding effective communication and collaboration − Principles of time management and effective meeting management consistently practiced − Zero - tolerance for adhoc activities

8.4.1.

Costed Indicative Activity Plan

Objective D: Strengthen systems and structures to support HR expansion and performance Intervention / Result

Resp.

Timeframe 2011

D.1

2012

2013

Cost Items

2014

Cost (ZMK mn)

Cost ($'000)

2015

Strengthen human resources planning, management and information systems

3,414

683

0

0

423

84.6

0

0

Hire 20 extra staff, working under guidance for 4 months

110

22

80

16

D.1.1

Develop guidelines for effective meeting management, provide training to senior managers at lower levels and lead by example

DHRA/ DTSS/ Directorates/ PMOs/ Medical Superintendents/ DMOs

X

D.1.2

Conduct TNA and train senior HR officers in ‘coaching’, conducting PAs, supportive supervisory skills and in conducting Technical Supportive Supervision

DHRA/ PSMD/ DTSS/ DPP

X

D.1.3

Prepare annual planning guidelines - to be used during the annual planning launches – to guide the ‘translation’ of the HRHSP’ interventions for each level and support HR officers in developing annual action plans

DHRA /DP&P

X

D.1.4

Clear backlog of ‘HR cases’ at DHRA to enable the Directorate to allocate time to strengthening HRH planning and management systems and procedures at all levels and institutions

DHRA/ PSMD/ PMO/ DMO/ HR Officers

X

D.1.5

Review and adjust the HRHSP 2011-2015 monitoring framework: indicators, baseline and targets and incorporate it into NHSP 2011-2015

DHRA/ HRTWH/ DPP

X

X

X

X

X

External workshop, 3 days

D.1.6

Review and adjust MoH planning guidelines, the PA monitoring tool for HR and make it relevant to and in line with the objectives of HRHSP 2011-2015

All Directorates

X

X

X

X

X

Internal work, no cost

0

0

D.1.7

Review and adjust the JAR tool in line with the HRHSP objectives and participate in the annual reviews

DHRA/ DPP/ WHO/ JAR team

X

X

X

X

X

Internal workshop

1

0.2

X

X

X

X

NHRH SP 2011-2015 Page 63

X

X

X

X

Internal work, no cost

X

Local consultant for 12 weeks, 4 external MOH workshops annually

X

Internal work, no cost

D.1.8

Review and adjust ToR and membership of HRTWG and Task Groups to strengthen their performance

DHRA/ HRTWG/ Task Groups

X

D.1.9

Establish a linkage system that allows for following up on the activities of the HRHSP 20011-20015 and the financing report system once the links are available with Navision and IFMIS

DHRA/ DPP/ MoFNP

X

X

D.1.10

Develop HRH Annual Actions Plans and annual narrative and financial reports

DHRA/ PMOs/ DMOs/ Medical Superintendents/ HR Officers

X

X

D.1.11

Conduct an independent mid-term review and a final evaluation of HRHSP 2011-2015, including an assessment of performance of HRTWG and Task Groups, draw lessons learned and make recommendations for the next phase

DHRA/ DPP/Research Unit of DPHR/ CPs

D.1.12

Adjust HRHSP 2011-2015 based on findings and recommendations of mid-term review and distribute copies to all stakeholders

DHRA/ HRTWG

D.2

Develop and implement a harmonized communication strategy

Internal work, no cost

X

Internal work, no cost

0 0

0

2,500

500

X

Internal workshop, 4 days, annually

X

X

Team of 3 local consultants x 6 weeks

150

30

X

X

External workshop, 3 days

150

30

150

30

150

30

X

X

D.2.1

Develop and implement a communication strategy for the sector to promote effective communication and feedback across and within levels, institutions and with representatives of relevant stakeholders and CPs

Administrative Unit of DHRA/ CPs/ UNZA / NIPA

X

X

X

X

X

Local consultancy for 8 weeks, 4 external MOH workshops annually

D.2.2

Collaborate actively with representatives of communities with the catchments areas of facilities

DHRA/ DPP/ DTSS

X

X

X

X

X

Regular work, no cost

0

0

D.2.3

Conduct regular Joint Labour Management Committee Meetings to facilitate harmonious labour and industrial relations and submit labour issues to PSMD

DHRA/ PMOs/ DMOs / HR Officers / PSMD

X

X

X

X

X

Regular work, no cost

0

0

3,325

665

3,000

600

D.3 D.3.1

Strengthen functions and roles of regulatory bodies Increase the grant and # of funded positions at GNC and HPCZ

DPP, HPCZ, GNC, CHAI, other CPs

X

NHRH SP 2011-2015 Page 64

X

X

Double grant to GNC, 400 million and 1/3 increase to HPCZ, 200 million

D.3.2

Support decentralization of some functions of GNC and HPCZ to provincial level

HPCZ, GNC, PMOs

D.3.3

Clarify the roles and responsibilities between the regulatory bodies

HPCZ, GNC, TEVETA

D.4

X

X

X

Training for PMO staff Internal work, no cost

X

Accelerate implementation of the national gender policy

325

65

0

0

0

0

D.4.1

Encourage young women to enter non-traditional health professions, including health management training

Training institutions / DHRA

X

X

X

X

X

This is a management issue, no extra cost

0

0

D.4.2

Encourage eligible women to apply for management positions within health sector, in particular for positions like Director, Deputy Director, Assistant Director, PMO, medical superintendent and DMO

PSMD/ Senior management

X

X

X

X

X

This is a management issue, no extra cost

0

0

D.4.3

Brief managers on content and implications of National Gender Policy for major HR functions

PMOs/ Medical Superintendents/ DMOs/ HR Officers

X

X

No extra cost

0

0

D.4.4

Enforce National Gender Policy to redress gender imbalances and attain gender equality in all aspects of training, recruitment, deployment and promotion

HR Officers at all levels

X

X

This is a management issue, no extra cost

0

0

6,889

1,378

X

X

Subtotal D

NHRH SP 2011-2015 Page 65

X

X

9.

ANNEX B: GRADUATES BY CADRE

Number of graduates by cadre and year Cadre Biomedical Scientist Clinical Officer Anesthesia Clinical Officer General Clinical Ophthalmology Officer Clinical Officer Psychiatry Dental Technologists Dental Therapy Direct Entry Midwife Enrolled Midwife Enrolled Nurse Environmental Health Officer Environmental Health Technologist Medical Officer Medical Laboratory Technologist Medical Licentiate Nutritionist Operating Theatre Nurse Ophthalmology Nurse Pharmacist Pharmacy Technologist Physiotherapist Physiotherapy Technologist Post Basic Nurse – Bsc Radio Technologist Registered Mental Health Nurse Registered Midwife Registered Nurse Total

2006

2007

2008

2009

2010

16 0 95 0 2 0 0 0 131 259 38 65 44 48 0 * 31 0 25 Na 6 38 26 32 0 134 315

12 12 104 0 0 0 0 0 119 285 62 75 60 94 26 * 34 0 35 35 11 34 29 38 0 130 357

4 0 123 8 37 8 20 0 103 327 63 74 67 76 0 * 36 7 38 42 7 41 21 41 39 143 377

36 10 134 6 39 0 29 80 109 413 85 89 50 81 17 35 4 35 129 12 30 24 23 33 138 435

31 3 59 7 20 6 22 80 136 445 54 28 48 127 1 42 30 11 42 144 17 33 29 42 27 126 701

1,305

1,552

1,702

2,076

2,311

*

* Figures not available. Source: MoH graduates tracking tool, May 2011. Graduate information for all nursing and midwifery cadres provided by GNC. Graduate information for all non-nursing and midwifery cadres gathered from Chainama College, Evelyn Hone College, UNZA and HPCZ.

NHRH SP 2011-2015 Page 66

10. ANNEX C: ENROLMENTS BY CADRE Enrolments by cadre, 2010 Cadre

2010

Biomedical Scientist

171

Clinical Officer Anaesthesia

16

Clinical Officer General

113

Clinical Officer Psychiatry

28

Dental Technologists

22

Dental Therapy

8

Direct Entry Midwife

101

Enrolled Midwife

128

Enrolled Nurse

512

Environmental Health Officer

30

Environmental Health Technologist

120

Laboratory Technologist

80

Medical Doctor

118

Medical Licentiate

24

Nutritionist

56

Operating Theatre Nurse

32

Ophthalmology Clinical Officer

7

Ophthalmology Nurse

11

Pharmacist

59

Pharmacy Technologist

103

Physiotherapist

23

Physiotherapy Technologist

79

Post Basic Nurse – BSc

72

Post Basic Nurse – MSc

19

Radiography

96

Registered Mental Health Nurse

28

Registered Midwife

140

Registered Nurse

785

Total

2,981

Source: Ministry of Health - Enrolment Tracking Tool 2010. Enrolment information for all Nursing and Midwifery cadres was provided by TI forms. Graduate information for all non-Nursing and Midwifery cadres was gathered from Chainama College, UNZA and Evelyn Hone College. Chainama total of January and June Intakes, UNZA- Pharmacist and Physiotherapy have totals of 2nd and 3rd year enrolments. Evelyn Hone in 2010 introduced Extension programmes Biomedical Scientist used synonymously with Biomedical Scientist.

NHRH SP 2011-2015 Page 67

11. ANNEX D: TRAINING PROGRAMS AND ENROLMENTS BY TRAINING INSTITUTION Training institutions by province, ownership, training programs offered and enrolments, 2010 Training Institution

Province

Ownership

Cadre

Jan 2010 Enrolment

Jun 2010 Enrolment

Total 2010 Enrolment

Agape School of Nursing Chainama Hills College

Central Lusaka

Private GRZ

Registered Nurse Clinical Officer General Clinical Officer Ophthalmology Clinical Officer Psychiatry

29 55 7 0

35 58 0 28

64 113 7 28

Environmental Health Technologist

29

41

70

0

24

24

Ophthalmology Nurse

11

0

11

Registered Mental Health Nurse

28

0

28

Medical Licentiate

Chikankata School of Biomedical Sciences

Southern

Mission

Laboratory Technologist

30

0

30

Chikankata School of Nursing

Southern

Mission

Registered Nurse

83

0

83

Chilonga Nursing & Midwifery

Northern

Mission

Enrolled Midwife

0

36

36

0 26 0 22 8 16 0 0 0 0 0 0 0

28 0 50 0 0 23 50 125 103 79 96 17 15

28 26 50 22 8 39 50 125 103 79 96 17 15

Enrolled Nurse Certified Midwife Registered Nurse Dental Technologists Dental Therapy Registered Nurse Environmental Health Technologist Biomedical Scientist Pharmacy Technologist Physiotherapy Technologist Radiography Enrolled Midwife Enrolled Nurse

Chipata School of Nursing & DEM

Eastern

GRZ

Dental Training School

Lusaka

GRZ

Dovecot College of Nursing Trust Evelyn Hone College

Lusaka Lusaka

Private GRZ

Kabwe School of Nursing & Midwifery

Central

GRZ

Kafue College of Health Sciences and Research Kalene School of Nursing

Southern

Private

Clinical Officer

Northwestern

Mission

Enrolled Nurse

NHRH SP 2011-2015 Page 68

30 0

54

54

Training Institution

Province

Ownership

Cadre

Kasama School of Nursing Kitwe School of Nursing & Midwifery

Northern Copperbelt

GRZ GRZ

Lewanika Nursing & Midwifery School

Western

GRZ

Livingstone School of Nursing Lusaka Health Institute Nursing School Lusaka Nursing Institute Lusaka Schools of Nursing, Midwifery, & Operating Theatre

Southern Lusaka Lusaka Lusaka

GRZ Private Private GRZ

Macha School of Nursing Makeni School of Nursing Mansa School of Nursing Monze School of Nursing & Midwifery

Southern Lusaka Luapula Southern

Mission Private GRZ Mission

Mufulira School of Nursing & Midwifery

Copperbelt

GRZ

Mukinge School of Nursing

Mission

Mwami 7th Day Adventist School of Nursing Nchanga School of Midwifery Ndola School of Nursing & Midwifery

Northwestern Eastern Copperbelt Copperbelt

Mission GRZ GRZ

Ndola School of Community Health Ndola School of Biomedical Sciences Roan Antelope School of Midwifery School of Anaesthesia School of Medicine at UNZA

Copperbelt Copperbelt Copperbelt Lusaka Lusaka

GRZ GRZ GRZ GRZ GRZ

School of Medicine at UNZA / DNS

Lusaka

GRZ

Jan 2010 Enrolment

Jun 2010 Enrolment

Total 2010 Enrolment

Registered Nurse Registered Midwife Registered Nurse Enrolled Midwife Enrolled Nurse Registered Nurse Registered Nurse Registered Nurse Operating Theatre Nurse

52 29 52 34 0 70 15 30 32

0 0 0 0 65 0 15 13 0

52 29 52 34 65 70 30 43 32

Registered Midwife

37

0

37

Registered Nurse Enrolled Nurse Registered Nurse Registered Nurse Enrolled Midwife Enrolled Nurse Registered Midwife Registered Nurse Enrolled Nurse

29 0 36 0 0 0 32 60 0

0 43 41 78 18 33 0 0 55

29 43 77 78 18 33 32 60 55

Enrolled Nurse Certified Midwife Registered Nurse, Registered Midwife Community Health Assistants

0 0

45 35

45 35

Certified Midwife Clinical Officer Anaesthesia Biomedical Scientist Medical Doctor Environmental Health Scientist Physiotherapist Pharmacist Post Basic Nurse - BSc 2 Post Basic Nurse - Msc

40 16 0 0 0 0 0 0 0

0 0 46 118 30 23 59 72 19

40 16 46 118 30 23 59 72 19

NHRH SP 2011-2015 Page 69

Training Institution

Province

Ownership

Cadre

Solwezi School of Nursing

North Western Eastern

GRZ

Enrolled Nurse

Mission

Enrolled Midwife

0

9

9

Enrolled Nurse

0

50

50

0

40

40

14

0

14

St. Francis / Katete School of Nursing & Midwifery

Jan 2010 Enrolment

Jun 2010 Enrolment

Total 2010 Enrolment

54

0

54

St. Luke's School of Nursing

Lusaka

Mission

Enrolled Nurse

St. Paul’s School of Nursing & Midwifery

Luapula

Mission

Enrolled Midwife Enrolled Nurse

0

30

30

Western School of Nursing, Livingstone

Livingstone

Private

Registered Nurse

0

15

15

Source: Data compiled by CHAI, May 2011

NHRH SP 2011-2015 Page 70

12. ANNEX E: ENTRY REQUIREMENTS AND DURATION OF NURSING AND MIDWIFERY PROGRAMS Types of Nursing and Midwifery cadres and the prerequisite training required for each cadre Programme

Description / Qualification

Enrolled Nursing

Pre-service Certificate Programme. Prerequisites: completion of Grade 12 and O-levels Pre-service Diploma Programme. Prerequisites: completion of Grade 12 and O-levels In-service Diploma Programme for Enrolled Nurses Pre-service Certificate Programme Prerequisites: Grade 12 and Olevels In-service Certificate Programme for Enrolled Nurses. Requirements: 2 years of Enrolled Nursing, 2 years of work, 1 year Midwifery In-service Diploma Programme for Registered Nurses. Requirements: 3 years of Registered Nursing, 2 years of work experience, 1 year Midwifery Pre-service Diploma Programme, comprised of 3 years of Registered Nursing, 2 years of work, followed by 1 year of Mental Health Nursing Prerequisites: Grade 12 and 6 O-levels

Registered Nursing

Certified Midwifery Enrolled Midwifery

Registered Midwifery Registered Mental Health Nursing

Operating Theatre Nursing Ophthalmology Nursing HIV Nurse Practitioner BSc in Nursing

MSc in Nursing

Duration of Study 2 years 3 years 2 years 2 years 1 year

1 year

3 years

In-service Diploma Programme (for Nurses who already hold a Diploma)

1 year

In-service Diploma Programme (for Nurses who already hold a Diploma)

1 year

In-service Diploma Programme (for Nurses who already hold a Diploma)

1 year

In-service Diploma Programme (for Nurses who already hold a 1 year Certificate) In-service Diploma Programme (for Nurses who already hold a Diploma) 1 year Pre-service Bachelor’s Degree Program, comprised of 3 years of 4 years Registered Nursing, 2 years of work, 2 years of post-graduate studies Prerequisite: 1 year of study in the Department of Natural Sciences In-service Bachelor Degree Programme for Nurses who already hold a 3 years diploma In-service Master Degree Programme for Nurses who already hold a BSc 18 months degree Source: Data compiled by CHAI, May 2011

NHRH SP 2011-2015 Page 71

13. ANNEX F: NURSING AND MIDWIFERY GRADUATES Number of graduates from Enrolled Nursing and Enrolled Midwifery programmes by year, training institution, province and owner Training Institution

Province

Owner

Jun 2009 Graduates

Dec 2009 Graduates

Jun 2010 Graduates

Dec 2010 Graduates

Southern

Mission

32

4

0

0

Northern

Mission

30

0

32

2

Central

GRZ

26

0

29

10

Northwestern Western

Mission

0

21

6

0

GRZ

14

29

48

3

Southern

Mission

25

4

38

2

Southern

Mission

29

0

29

18

Northwestern Eastern

Mission

28

1

30

10

Mission

32

9

36

7

A. Enrolled Nursing 1. Chikankata School of Nursing 2. Chilonga Nursing & Midwifery 3. Kabwe School of Nursing & Midwifery 4. Kalene School of Nursing 5. Lewanika Nursing & Midwifery School 6. Macha School of Nursing 7. Monze School of Nursing & Midwifery 8. Mukinge School of Nursing 9. Mwami 7th Day Adventist School of Nursing 10. Solwezi School of Nursing 11. St. Paul’s School of Nursing & Midwifery 12. St. Francis / Katete School of Nursing & Midwifery 13. St. Luke's School of Nursing Total

Northwestern Luapula

GRZ

13

21

11

30

Mission

34

0

46

5

Eastern

Mission

51

21

52

1

Lusaka

Mission

0

0

0

0

314

110

357

88

B. Enrolled Midwifery 1. Chikankata School of Nursing 2. Chilonga Nursing & Midwifery 3. Kabwe School of Nursing & Midwifery

Southern

Mission

8

1

5

1

Northern

Mission

35

1

35

0

Central

GRZ

24

0

21

0

4. Lewanika Nursing & Midwifery School 5. Monze School of Nursing & Midwifery 6. St. Francis / Katete School of Nursing & Midwifery 7. St. Paul’s School of Nursing & Midwifery Total

Western

GRZ

14

29

0

29

Southern

Mission

18

0

18

0

Eastern

Mission

18

4

10

3

Luapula

Mission

0

0

0

14

117

35

89

47

Source: Table compiled based on raw data from CHAI; dated February 2011.

NHRH SP 2011-2015 Page 72

14. ANNEX G: MAP OF TRAINING INSTITUTIONS

The 37 Health Training Institutions in Zambia COPPERBELT PROVINCE

LUAPULA PROVINCE

NORTHERN PROVINCE

1.

1.

Nchelenge District-St. Paul’s School of Nursing-Mission

1.

Kasama District-Kasama School of Nursing-GRZ

2.

Mansa District-Mansa School of Nursing-GRZ

2.

Mpika District-Chilonga Nursing-Mission

Kitwe District-Kitwe School of Nursing & Midwifery-GRZ

Note: All Mission Schools: a. receive funds from GRZ; b. receive HR support from GRZ and; c. the students are supported by GRZ. *The five schools that do NOT teach nursing or midwifery have been marked with a *

2.

Chingola DistrictNchanga School of Midwifery-GRZ

3.

Ndola District-Ndola College of Biomedical Sciences*-GRZ

4.

Ndola District-Ndola School of Nursing & Midwifery-GRZ

5.

Mufulira DistrictMufulira School of Nursing & Midwifery-GRZ

6.

Luanshya District-Roan Antelope School of Midwifery-GRZ Ndola DistrictCopperbelt RN PolytechPrivate

LUSAKA PROVINCE & DISTRICT

7.

CENTRAL PROVINCE 1.

Kabwe District-Kabwe School of Nursing-GRZ

2.

Kabwe District-Agape School of Nursing-Private

EASTERN PROVINCE 1.

Chipata District-Chipata School of Nursingand Midwifery - GRZ

2.

Chipata District-Mwami 7th Day Adventist School of Nursing-Mission

3.

Katete District-St. Francis/ Katete School of Nursing-Mission

1.

Chainama Hills College-GRZ

NORTH WESTERN PROVINCE

2.

Dental Training School*-GRZ

1.

Mwinilunga DistrictKalene School of Nursing-GRZ

3.

Lusaka Schools of Nursing, Midwifery, & Operating TheaterGRZ

2.

Kasempa DistrictMukinge School of Nursing & MidwiferyMission

4.

School of Anesthesia*-GRZ

5.

Defense School of Nursing-GRZ

6.

Evelyn Hone College*-GRZ

7.

School of Medicine at UNZA-GRZ

8.

Dovecot College of Nursing TrustPrivate

9.

Lusaka Health Institute Nursing School-Private

3.

Solwezi District-Solwezi School of Nursing-GRZ

SOUTHERN PROVINCE 1.

Choma District-Macha School of Nursing-Mission

2.

Livingstone District-Livingstone School of Nursing-GRZ

WESTERN PROVINCE

3.

Monze District-Monze School of Nursing-Mission

1.

4.

Mazabuka District-Chikankata College of Biomedical Sciences*-Mission

Mongu District-Lewanika Nursing School-GRZ

5.

Mazabuka District-Chikankata School of Nursing & Midwifery-Mission

10.

Lusaka Nursing Institute-Private

6.

Livingstone District-Western School of Nursing-Private

11.

Makeni School of Nursing-Private 1

NHRH SP 2011-2015 Page 73

15. ANNEX H: PEOPLE CONSULTED Lusaka Ministry of Health Ms. Karen Campbell, Technical Advisor, ZISSP, DHRA Mr. Collins Chansa, Chief Planner, DPP Ms. Emily Chipaya, Chief Nursing Officer, Management, DCCDS Dr. Elizabeth Chizema, Director of Technical Support Services Ms Namataa P. Kalaluka, Chief Accountant, DHRA Mr. Chipalo Kaliki, Acting Deputy Director (ME), HMIS, DPP Mr. Henry Kansembe, Deputy Director, Planning, DPP Mr. Adam Lagerstedt, Technical Advisor, Sida, DPP Mr. Mubita Lubalelwa, Deputy Director Donor Coordination, DPP Mr. Robbson Manda, Snr. HRD Officer, DHRA Ms. Ndubu Milapo, Chief Nursing Officer, Education, DCCDS Mr. Trust Mufune, Snr. ME Officer, DPP Mr. Lazarous Mulenda, Acting Chief Human Resources Management Officer, Planning, DHRA Dr. Dennis Mulenga, Deputy Director, DTSS Ms. Evelyn Muleya, Chief HRD Officer, DHRA Ms. Namasiku Mulikita, HR Officer, DHRA Ms. Mutinta Musonda, Assistant Director - HRMD, DHRA Dr. Peter Mwaba, Permanent Secretary Mr. Jere Mwila, Director, DHRA Mr. Lawrence Njovu, Chief Human Resources Management Officer, DHRA Ms. Patricia Sikaala, Administrative Officer, DHRA Ms. Patricia Sikada, Accounting Officer, DHRA Ms. Brivine Sikapande, Snr. ME Officer, DPP Dr. Christopher Simoonga, Director, DPP Mr. Nchebe Chitashi, Chief Medical Imagining Dr. Miriam Libetwa, Deputy Director Nursing Services, DCCDS Mr. Cleto Mweemba, Chief Physiotherapist Mr. Davy Namduba, Dep. Director Pharmaceuticals Mr. Clement Phiri, Biomedical Scientist Mr George Sampa, Prosthetics and Orthotics Dr. Gardner Syakantu, Director, DCCDS Dr. Edgar Wamuwi, National Clinical Care Specialist Ms. Mary Wiyenda, National Eye Care Coordinator Ms. Muzala Kanyanga, Epidemiologist Mr. Lubinda, MHR Mr. Sackson Mayuni, CDT Dr. Itone Muteba, DDPHR.OH Ms Sandra Sakala, PSRO Mr. Vichael Silauwe, Chief IMCI Officer Mr. Wamunyima, SMHO Dr. Tackson Lambart, Provincial Medical Officer, Lusaka Dr. Dandi Malawo, Senior Medical Superintendent, Ndola Central Hospital Ms. Charity Chirwa, Senior HR Development Officer, Mr. Kapembwa, Senior HR Management Officer, Eastern Province Ms. Florence Kashita, Senior HR Officer, Copperbelt Province Dr. V. Lubinda, Medical Doctor at PMO, Solwezi Ms. Fridah Mashandi, HR Officer, Central Province Mr. Akabando Mbeha, HR Management Officer, Western Province Mr. Bupe Mutanya, Senior HR Officer, Arthur Davidson Children’s Hospital Ms. Cleopatra Ngandu, Senior HR Officer, Southern Province Mr. Simon Mulenga, Senior HR Management Officer, Lusaka Province Mrs. Sandra Zulu, Senior HR Officer, MoH University Teaching Hospital and School of Nursing, Midwifery and Theatre Dr. Lackson Kasonka, Senior Medical Superintendent Mr. Isaac Kasaro, Chief Hospital Administrator Mrs. Mary Jaramba, Principal Education Officer, Lusaka School of Nursing Mrs. Ester M Maseke, A/Principal Tutor, Lusaka School of Midwifery Mrs. Prisca S Mukonka, Acting Principal Tutor Mrs. Universe Mulenga, A/principal Tutor, School of Theatre Nursing Mrs. Tolosi Mwinga, Chief Nursing Officer NHRH SP 2011-2015 Page 74

Chainama Hills College Hospital Dr. Welani Chilengwe, Senior Medical Superintendent Mr. A.C. Bowa, Head of Training, Chainama College of Health Science Mr. Mandume Kakukwena, Chainama College Mr. Peter Mukelabai, Human Resource Management Officer Mr. Evans Mulaba, Principal Hospital Administrator Dr. Joseph Wapabeti, Acting Head Clinical Care Mr. John C. Zimba, Acting Registrar Dr. Dolors Castello, Technical Advisor, Sida Ministry of Defence Col. A. Akapetwa, CND Col. R. Chibale, DDN (Army) Col. E. Malyangu, Commandant (DSHS) Dr. (Col.) A. Mulela, DHS-2NS Dr. F. Sinyangwe LTCOL. R. Zulu, Pharmacist MSMH Ministry of Education Mr. Mattheos Chirusa, Principal Education Standards Officer Ms. Hilda B. Chisala, Senior Education Standards Officer Ms. Veronica Silungele, Senior Education Standards Officer Ministry of Finance and National Planning Mr. Davies K. Chisenda, Director of Budget Mr. Mwaka Mukubega, Principal Budget Analyst Public Service Management Division Mr. Alfonso Banda, Director HRD Ms. Peggy Chirwa, Director – Recruitment and Placement Ms. Cathy Mkala, Director HRIP Mr. Felix Mushabati, Research and Policy, Technical Service Department Ms. Vivien Ndhlovu, Personal Administration Specialist Ms. Joyce Nyama, Asst. Director Research and Policy Mr. Ackim Sakala, Director PMEC Health Professional associations Ms. Mercy Chaipampe, Vice President of the Radiological Society of Zambia Dr. Grace Karenna, Vice National Chairperson of the Biomedical Society of Zambia Mr. Bonaventura Kasama, President of the Pharmacologist Society of Zambia Dr. Whyson T. Munga, President of Resident Doctors Association of Zambia Dr. Robin Mwewa, President of the Zambia Dental Association Mr Cleto Nweemba, President of the Zambia Society of Physiotherapists Dr. George B. Sampa, Zambia Prosthetics and Orthotics Association Mr. Vincent Zulu, President of the Dental Therapists Society of Zambia Civil Society Ms. Dorothy Charity Brolund, Project Director, Flame Home-Based Care Mr. Geoffrey N. Chikunjiko, E.O, CBPC Mr. Henry Kaimba, Programme Manager, PPAZ Mr. Paul Kasonkomona, Civil Society Health Reform Ms. Prudence Michelo-Haimbe, Programme Officer, Sightsavers Ms. Grace Banda Mushibwe, Breast Feeding Association of Zambia Mr. Wiscot M. Mwanza, Project Manager, Plan International Mr. Felix Mwanza, Country Coordinator, TALC Mr. Drinan Banda Nyirenda, Nutrition Association of Zambia Others Prof. Sekelani S. Banda, Deputy Vice Chancellor, Head of School of Medicine, Cavendish University Mrs. Bertha Chipepo, Acting Registrar, GNC Mrs. Stella Chisunka, M & E specialist, GNC Dr. Bona Chitah, Independent Consultant Ms. Linsey Crumbaugh, HR Specialist, Clinton Health Access Initiative Ms. Angela Dunbar, Consultant, WHO-HQ Dr. Kathrin Furrer, Tecnical Advisor, SolidarMed Dr. Fastone Goma, Dean of School of Medicine NHRH SP 2011-2015 Page 75

Ms. Tracy Rudne Hawry, Programme Manager HRH, CHAI Dr. Peter Herzig, Head Social Sector and Governance, EC Delegation Mrs. Elizabeth Jere, Human Resources Specialist, ZISSP Prof. Dick Jonsson, SIDA, the University of Zambia Dr. Patrick Kadama, Medical Doctor, Dep. For Health Systems Governance and Service Delivery, WHO Mr. Solomon Kagulula, Programme Officer - Health Systems, WHO Dr. Paul Kalinda, Health Advisor, European Union Dr. William Kanekwa, Health Advisor, USAID Zambia Dr. Randy Kolstad, Director Population, Health & Nutrition Director, USAID Zambia (PhD) Mr. Sitali Liseli, General Secretary, Zambia Union of Nurses Organisation Dr. John Mudenda, Director of Medical Education, LAMU Mr. Lewis Mukosha, General Secretary, Health Workers Union of Zambia Ms. Audrey Mwendapole, NPO, Swedish Embassy Mr. Anthony Okoth, Country Director, Clinton Health Access Initiative Mr. Gregory Saili, Development Officer, High commission of Canada (Gregory) Ms. Angela Spilsbury, Health Advisor, DFID Dr. Chris Zielinski, Coordinator, African Health Observatory, WHO Dr. M. M. Zulu, Registrar, Health Professions council of Zambia Mr. Stanford Zulu, Human Resources Manager, CHAZ Dr. Robert Zulu, General Secretary, Zambia Medical Association Mr. Mwangala Liomba, Deputy Permanent Secretary, Western Province PMO, Western Province Mr. Harrison A. Anseli, Senior Health Education Officer Mr. Elias C. Luhana, Principal Medical Equipment Officer Mr. Akabondo Mbeha, Human Resources Management Officer Mr. Peter Macniellage, Administrative Officer Mr. Mukololo Mnbita, Environmental Health Technologist Mr. Mubita Mubita, Planning Officer Mr. Joseph Mudenda, Principal Nutritionist Mr. Mwango Mutale, Senior Health Information Officer Mr. Musendabai Muyunda, Senior Human Resources Management Officer Ms. Njahi M. Sitali, Principal Nursing Officer Mr. Emeldah K. Sikaale, Principal Dental therapist Dr. Albert Sitali, PMO Lewanika Hospital Mr. Kalangwa Charles, Assistant Hospital Administrator Mr. Dungani Chembo, Accounts Assistant Mr. Bilali Hassan, Information Officer Ms. Thandiwe L. Lubasi, Principal Nursing Officer Mr Alfred Mandina, Principal Tutor Ms. Inonge Mboo, Nursing Officer Ms. Minyoi Mooka, Assistant Accountant Mr. Banny Sampa, Assistant Human Resources Management Officer Dr. Andrew Silumesi, Medical Superintendent Lewanika School of Nursing and Midwifery Ms. Pelena P. Chibanye, Nurse Tutor Mr. Esnart M. Juunza, Coordinator Midwifery School Ms. Hiram Kariuki, Nurse Tutor Mr. Alfred Mandona, Principal Tutor Ms. Klinnie Mwgnda, Assistant Accountant Mr. Mumbuwa Silumbu, Nurse Tutor Lui River Rural Health Centre Mr. Nyambe Akafumba, Watchman Mr. Sitali Mufalo, Environmental Health Technician Mr. Charles Kayawe, CDE Ms. Mwieumwa Sililo, Enrolled Nurse Senanga District Medical Office Mr. Ngombo Chikote, CCO Mr. Ewans Chiroya, PSO Mr. Fabian Habeenzu, Assistant Accountant Mr. Fabian Kaingu, DHIO Mr. Francis Lyemba, Accountant Assistant NHRH SP 2011-2015 Page 76

Ms Kufuna Seke, Planner Mr. Haggai Silumbwe, PSA Ms. Mubita Siyanga, Registry Clerk Senanga District Hospital Mr. Bilali Hassan, Dental Therapist Mr. Mnlumbensi K. Malijani, HA Mr. Lennox Moonga, Pharmacy Technologist Ms. Mubiawa Kamayoyo, Nursing Sister Mr. Muyunda, Laboratory Technician Ms. Mary Phiri, Nurse Mr. Kaluwa Raston, PSA Mr. George Sigwioi, PCO Mooyo Rural Health Centre Mr. Chinkama Mutinta, Environmental Health Officer Ms. Charity Akantu, CO Ms. Grace Hamatika, Enrolled Nurse Mr. Monge Mulella, CE Mr. David M. Kapusi, Watchman Mr. Wasa Nyambe, Watchman Mooyo Advisory Committee Mr. T.Malai, Prison Clinic Mr. Mazeko, Mulanga Clinic Mr. F. Muteio, Mulanga Clinic Mr. B. Nguhibe, Prison Clinic Mr. Chomba Phiri, Mulanga Clinic Mr. Ndalda Sinate, CO Mr. S. Smungole, Prison Clinic Health Workers’ Unions Ms. Muata Mnyangana, Shop Steward, Zambia Union of Nurses Organization Ms. Shelary M. Munbia, Vice Chairperson, NUPWS Ms. Mubita Nawa, Branch Trustee, ESUAKS Upperland Family Clinic Mr. Geffrey Kantumoya, Director Ms. Eddah Kantumoya, Enrolled Nurse Mr. Kahilu Sinbuwa, CE Ms. Patra Zulu, CE PMO, Copperbelt Mr. Chibongele Chirwa, Stores Officer Ms. Mupeta Deusmeius, Assistant Accountant Mr. Edwin Gwai, DMS Mr. Joackim Longwes, Infrastructure Officer Ms. Florence Kashita, Senor HR Management Officer Ms. Mulenda Kingsley, Registry clerk Ms. Munloa Leffert, Registry Officer Mr. Lubasi Lubasi, Senior Internal Auditor Ms. Catherine Mutenga, Ass. Executive Officer Ms. Rhoda Mukemwembo Ms. Frusam Mymosaw Dr. Chandwa Ngambi, PMO Ms. Benedict Tembo, PP District HR Officers Ms. Yvonne T. Banda, HRMO Ndola Mr. Abdon Champo, SHRMO Kitwe Ms. Ruth Filumba, Ass. HRMO Mr. Komgata Golden, HRMO Masaiti Ms. Clara Kanyemba, HRMO Kawiushi Mrs. Florence Kasita, SHRMO, PMO Mr. Haggai Kwesa, Ass. HRMO Ndola Central Hospital Ms. Mushili Mukobe, HRMO Mufulira Mr. Bupe Mutanya, SHRMO Ndola NHRH SP 2011-2015 Page 77

Ms. Elisabeth L. N. Ngiawdu, HRMO Lufwanyama Ndola Central Hospital Mr. Janken Banda, Chairperson HWUZ Mr. Jacob C. Chilufia, Principal Hospital Administrator Ms. Lynette M. Hampande, Ass. Principal Nursing Officer Mr. Haggai Kwesa, Ass. HRMO Mr. Alex Mambute, Ass. Senior accountant Dr. Charles C. Masase, Head of Clinical Care, Hospital Director Ms. Chresentia Mumba, Chairperson SCAWUZ DMO Chingola Mr. H. Chewo, HRMO Mr. Chima Chima, Senior Clinical Care Officer Mr. Hamakuku, Administration Manager Mrs. R. Lupulwe, Nursing Officer Dr. C. Sakulanda, DMO Health Workers Unions Mr. Janken Banda, HWUZ Mr. F. Chewe, HR Officer Ms Crescentia M. Kajimalwendo, CSAWUZ Ms. Haggai Kwesa, Ass. HRMO Ndola Central Hospital Ms. Jane Mwale, ZUNO Ms. Mutinta Mweemba, HWUZ Mr. Lewis Mukesho IPAFU RHC Rev. Sister Florence Chibale, Midwife Rev. Sister Angelina Kaoma, Acting In-Charge Officer Nchanga South Hospital Dr. Eib Chilegwa, Medical Superintendent Dr. J Banda Sikasote, Manager of Community Medicine Ndola School of Nursing, Midwifery and Theatre Ms. Jaclyn Chileshe, Nurse Tutor Ms. Kapulu K. Chishimba, Nurse Tutor Ms. Janness Chitumba, Principal Tutor Ms. Kabelenga Elijah, Clinical Instructor Ms. Lynette M. Hampande, Nursing Services Manager Ms. Vivian M. Hatonsola, Principal Tutor Ms. Cynthia Lukwesa Mukowica, Nurse Tutor Ms. Joyce N. Musenga, Clinical Instructor Ms. Mutinta Musonda, Ass. Director Ms. Julia S. Mwyumba, Senior Nurse Tutor Ms. Annie N. Mwale, Senior Nurse Tutor Mr. Felix Nsama, Ass. Accountant Ms. Ireen K. Nyamvwala, Clinical Instructor Mr. Loveness M. Silumbwe, Registry clerk Ms. Grenda Shatamuka, House Keeper Copperbelt Nursing Polytechnic Mr. Bruce Luvweyi, College Accountant Ms. Sulinda, Principal Nurse Tutor

NHRH SP 2011-2015 Page 78

16. REFERENCES Africa Health Workforce Observatory. 2010 Human Resources for Health Country Profile: Zambia. WHO: Geneva. Sept. 2010. Bowa, K.,F. Goma, Y. Mulla and S. Banda. Undated Postgraduate medical training in Zambia, a Tool to Reduce External Brain Drain. Brugha, R., J. Kadzandira, J. Simbaya, P. Dicker, V. Mwapasa and A. Walsh. 2010 Health Workforce Responses to Global Health Initiatives Funding: A Comparison of Malawi and Zambia. Human Resources for Health Journal, 2010. Vol. 8, Issue 19. Central Statistical Office of Zambia. The Zambia Demographic and Health Survey 2007. CSO and Macro International Inc, Calverton, MD. 2009. Central Statistical Office of Zambia. Population and Housing Census Preliminary Report. CSO, 2011. Chabot, J. 2008 Report of the Mid Term Review of the Zambia National Health Strategic Plan NHSP IV, 2006–2010. MoH, Lusaka. Chessore, Wemos. 2008 Human Resources for the Delivery of Health Services in Zambia: External Influences and Domestic Policies and Practices. A Case Study of Four Districts. Centre for Health, Science and Social Research, Lusaka. Chitah, M. 2005 Expenditure Ceiling, Human Resources and Health: The Case of Zambia. CHAZ, Lusaka. CIA World Fact Book. 2011. Dal Poz, M., Y. Kinfu, S. Drager and T. Kunjemen. 2007 Counting health workers: definitions, data, methods and global results. WHO, Jan. 2007. Dambisya, Y. A Review of Non-Financial Incentives for Health Worker Retention in East and Southern Africa. Equinet Discussion Paper, No. 44 with ECSA-HC. University of Limpopo, South Africa. 2007. Directorate of Human Resources and Administration. 2008 HRH Operational Plan. Government of Zambia: Lusaka. April 2008. Directorate of Human Resources and Administration. Zambian Health Workers Retention Scheme Guidelines. Government of Zambia: Lusaka. August 2010. Directorate of Policy and Planning, Monitoring and Evaluation Unit. Annual Health Statistical Bulletin 2006. Government of Zambia: Lusaka. Feb. 2007. Directorate of Policy and Planing, Monitoring and Evaluation Unit. Annual Health Statistical Bulletin, 2008. Government of Zambia: Lusaka. 2009. Directorate of Policy and Planning, Monitoring and Evaluation Unit. Annual Report 2008. Government of Zambia: Lusaka. Feb 2010. Dolea, C., L. Stormont, P. Zurn, D. Shaw and J. Braichet. 2009 Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention. WHO: Geneva. 2009.

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Global Health Workforce Alliance. 2010: Country Coordination and Facilitation (CCF), Principles and Process. GHWA/WHO: Geneva. 2010. Global Health Workforce Alliance. From Kampala to Bangkok: Reviewing Progress, Renewing Commitments: Outcome Statement of the Second Global Forum on Human Resources for Health. WHO: Geneva. 2011. Grépin K. and W. Savedoff. Ten Best Resources on Health Workers in Developing Countries. Health Policy and Planning Journal. 2009. Vol 24, pg. 479-482. Grobler, L., B. Marais, S. Mabunda, P. Marinda, H. Reuter and J. Volmink. Interventions for Increasing the Proportion of Health Professionals Practising in Rural and Other Underserved Areas (Review). The Cochrane Library, Issue 2. John Wiley and Sons. 2009. Government of the Republic of Zambia. Fifth National Development Plan 2006-2010. 2006. Government of the Republic of Zambia. Broad Based Wealth and Job Creation Through Citizenry Participation and Technological Advancement ( Summary). Ministry of Finance and National Planning, Lusaka. Government of the Republic of Zambia. Organization Structure Report for the Ministry of Health. MoH and Management Development Division, Cabinet Office, Lusaka. 2006. Government of the Republic of Zambia. Vision 2030: A prosperous Middle-income Nation by 2030. December, 2006. Government of the Republic of Zambia. Workforce Audit: Results of Payroll Verification Exercise. MoH, Lusaka. Oct. 2009. Government of the Republic of Zambia. Act No. 24 of 2009: The Health Professions Act. 2009. Government of the Republic of Zambia. Sixth National Development Plan 2011-2015: Sustained economic growth and poverty reduction. 2010. Government of the Republic of Zambia. 2011-2013 MTEF and 2011 Budget. GRZ: August 2010. Government of Zambia. Public Service Training and Development Policy. GRZ: Lusaka. 2007. Global Health Workforce Alliance, World Health Organization. Scaling Up, Saving Lives. WHO: Geneva. 2008. Global Health Workforce Alliance, World Health Organization. The Kampala Declaration and Agenda for Global Action. WHO: Geneva. 2008. Global Health Workforce Alliance, World Health Organization. Health Workers for All and All for Health Workers. WHO/GHWA: Geneva. 2008. Global Health Workforce Alliance, World Health Organization. What Countries Can Do Now: Twenty-Nine Actions to Scale-Up and Improve the Health Workforce. GHWA/WHO: Geneva. 2009.

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Global Health Workforce Alliance, World Health Organization. Financing and Economic Aspects of Health Workforce Scale-up and Improvement: Framework Paper. GHWA/WHO: Geneva. 2009. Hamada, N. J. Maben, B. McPake and K. Hanson. International Flow of Zambian Nurses. Human Resources for Health Journal. 2009, Vol. 7, Issue 83. Hanefeld, J. and M. Musheke. What Impact do Global Health Initiatives have on Human Resources for Antiretroviral Treatment Roll-out? A Qualitative Policy Analysis of Implementation processes in Zambia. Human Resources for Health Journal. 2009, Vol 7: Issue 8. Human Resources Information System. Expanding on the existing Human Capital Management and PMEC systems. Government of Zambia: Lusaka. March, 2011. Health Professions Council of Zambia. Annual Report 2009. Health Professions Council of Zambia, 2010. Horstman, R. Zambian Health Workers Retention Scheme: Measuring the effect on health system deliverables. Consultancy Mission Report, Dec. 2010. Horstman, R. and Th. Ngulube. Global Fund Proposals: Meeting Health Work Force Constraints in Zambia. PowerPoint Presentation, May 2009. Joint Learning Initiative. Human Resources for Health: Overcoming the Crisis. Harvard University Press, Cambridge, MA. 2004. Kandimaa Matterson, A. Human Resources for Health, Report. SIDA: Stockholm. 2010. Koot, J. and T. Martineau. Mid-Term Review. Zambian Health Workers Retention Scheme (ZHWRS) 2003-2004. MoH: Lusaka. 2004. Matsiko, Ch. Positive Practice Environments in Uganda: Enhancing Health Worker and Health System Performance. GHWA: Geneva. 2004. Ministry of Health of Zambia. National Health Strategic Plan 2006-2010: Towards Attainment of the Millennium Development Goals and National Health Priorities. Government of Zambia: Lusaka. 2006. Ministry of Health of Zambia. Human Resources for Health Strategic Plan (2006-2010). Government of Zambia: Lusaka. 2006. Ministry of Health of Zambia. Joint Annual Review, 2007, Prelimiary Report. Government of Zambia: Lusaka. 2008. Ministry of Health of Zambia. Action Plan 2008. Government of Zambia: Lusaka. 2008. Ministry of Health of Zambia. National Training Operational Plan 2008: Field Assessments, Analysis and Scale-up Plans for Health Training Institutions. Government of Zambia: Lusaka. July 2008. Ministry of Health of Zambia. Technical Planning for the 2009-2012 MTEF Plans, Planning Documents Technical Paper No. 1. Government of Zambia: Lusaka. May 2008.

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Ministry of Health of Zambia. 2008 Annual Training and Development Plan. Government of Zambia: Lusaka. 2008. Ministry of Health of Zambia. Joint Annual Review Report, 2008. Government of Zambia: Lusaka. 2009. Ministry of Health of Zambia. Action Plan 2009. Government of Zambia: Lusaka. 2009. Ministry of Health of Zambia. Technical Planning for the 2010-2012 MTEF Plans, Planning Documents, Technical Paper No. 1. Government of Zambia: Lusaka. July 2009. Ministry of Health of Zambia. Joint Annual Review Report, 2008. Government of Zambia: Lusaka. 2009. Ministry of Health of Zambia. 2010 Action Plan. Government of Zambia: Lusaka. 2010. Ministry of Health of Zambia. Workforce Optimization Analysis: Optimal Healthcare Worker Allocation for Healthcare Facilities Across Zambia. Government of Zambia: Lusaka. September 2009. Ministry of Health. Health Workforce Review. Government of Zambia: Lusaka. December 2010. Ministry of Health. Technical Planning Updates for the 2011-2013 MTEF Plans. Planning Documents Technical Paper No. 1. Government of Zambia: Lusaka. May 2010. Ministry of Health. National Workforce Accessment 2010, Preliminary Results. Government of Zambia: Lusaka. December 2010. Ministry of Health. National Community Health Worker Strategy. Government of Zambia: Lusaka. 2010. Ministry of Health. Annual Training and Development Plan. Government of Zambia: Lusaka. 2010. Ministry of Heatlh. Draft National Health Strategic Plan 2011-2015. Government of Zambia: Lusaka. 2010. Ministry of Health. Draft National Health Strategic Plan 2011-2015. Government of Zambia: Lusaka. 2010. Ministry of Health. Human Resources Information System. Expanding on the existing Human Capital Management and PMEC systems. Governmetn of Zambia: Lusaka. March 2011. Ministry of Health, Directorate of Human Resources and Administration. Workforce Optimization Analysis. Optimal Healthcare Worker Allocation for Healthcare Facilities across Zambia. Government of Zambia: Lusaka. 2009. Ministry of Health. Human Resources for Health Strategic Plan 2006-2010, Review Report. Government of Zambia: Lusaka. May 2011. Ministry of Health. Action Planning Handbook for District Health Teams, 5th Edition. Government of Zambia: Lusaka. April 2009.

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Ministry of Health. Action Planning Handbook Hospitals, 5th Edition. Government of Zambia. April 2009. Ministry of Heatlh. Action Planning Handbook for Training Institutions, 5th Edition. Government of Zambia: Lusaka. 2009. Ministry of Health. Action Planning Handbook Health Centres, Health Posts and Communities, 5th Edition. Government of Zambia: Lusaka. April 2009. Mongu District Health Management Team, Ministry of Health. Strategic Action Plan and Budget (2009-2011). Government of Zambia: Lusaka. 2009. Mwale, H. Health Systems Strengthening Program 2009: Human Resources for Health Innovations in Zambia: A Case Study of the Zambia Health Workers Retention Scheme. PowerPoint Presentation, November Mwale, H and S. Smith. Health Services and Systems Programme. MOLGH, Decentrlization Secretariat. Decentralization Implementation Plan 2009-2013., Government of Zambia: Lusaka. Dec. 2009. Neupane, R. and H. Njie. Zambia Health Sector Support: Mapping Report. DFID Health Resource Centre: London. 2006. Ngulube, Th. The Zambia Country Case Study on Positive Practice Environments (PPE). Quality Workplaces for Quality Care. PPE Campaign Secretariat, International Council of Nurses: Geneva. 2010. Office of the Secretary to Cabinet. Code of Ethics for the Public Service. Government of Zambia: Lusaka. Office of the President, Cabinet Office. The National Decentralisation Policy. Government of Zambia: Lusaka. 2002. Omaswa, F. Health Worker Migration: Perspectives from an African Health Worker. Strengthening Health Care Systems Journal. WHO: Geneva. 2006. Picazo, O. and S. Kagulura. The State of Human Resources for Health in Zambia: Findings from the Public Expenditure Tracking and Quality of Service Delivery Survey (PET/QSDS). 2005/06. Secretary to the Cabinet. Terms and Conditions of Service for Public Service. Government of Zambia: Lusaka. June 2003. Schatz J. Zambia’s Health Worker Crisis. The Lancet 371. Feb 23, 2008. Pg. 638-9. Sunkutu, K. and N. Nampanya-Serpell. Searching for Common Ground on Incentive Packages for Community Workers and Volunteers in Zambia. National HIV/AIDS/STI/TB Council: Lusaka. 2009. Tjoa, A., M. Kapihya, M. Libetwa, J. Lee, C. Pattinson, E. McCarthy and K. Schroder. Doubling the Number of Health Graduates in Zambia: Estimating Feasibility and Costs. Human Resources for Health Journal. Vol. 8: Issue 22. 2010.

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Van den Broek, A., G. Gedik, M. Dal Poz and M. Dieleman. Policies and Practices of Countries that are Experiencing a Crisis in Human Resources for Health: Tracking Survey. WHO: Geneva. 2010. World Health Organization. WHO Global Code of Practice on the International Recruitment of Health Personnel. WHA63. 16. Agenda Item 11. 5. A63/8. WHO: Geneva. 2010. World Health Organization. The World Health Report 2006: Working Together for Health. WHO: Geneva. 2006. World Health Organization. Report of the Global Consultation on an Implementation Framework for Scaling Up Nursing and Midwifery Capacity. WHO: Geneva. 2008. World Health Organization. Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention, Background Paper. WHO: Geneva. 2009. World Bank. African Region Human Development Report: Zambia, Country Health Status Report. World Bank: New York. June 2010. World Health Organization. Human Resources for Health, Country Profile: Zambia. WHO: Geneva. September 2010. Global Health Workforce Alliance, World Health Organization. Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals. A Systematic review, Country Case Studies, and Recommendations for Integration into National Health Systems. WHO/GHWA: Geneva. World Health Organization. Policies and Plans for Human Resources for Health, Guidelines for Countries in the WHO African Region. WHO: Brazzaville. 2006. World Health Organization. Framework for the implementation of the Ougadougou Declaration on Primary Health Care and Health Systems in Africa. WHO: Brazaville. 2010.

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