Specific stock and distribution information
There are an estimated 12,085 health care workers in Zambia our of a total establishment of 22,608; this representing a shortfall of 11,304 (50%) (2008 Annual Health Statistical Bulletin, MoH). Of the total health care workers, the distribution by provinces loosely mirrors facilities and less so to population ratios (see table Table 3.7 below). However, the density of health workers (0.8 per 1,000 population) still falls short of the WHO recommended 2.5 health care workers per 1,000 population. This is higher in urban areas than in rural the rural areas.
The urban bias in the distribution of the human resources for health stock reflects the high density of health facilities in urban areas, coupled to health workers refusing to serve in rural areas due to poor socioeconomic infrastructure. The underlying factors to these geographical inequities in development outcomes are historical in nature and well beyond the control of the Ministry of Health acting alone.
The Ministry of Health has taken some measures to respond to this by firstly acknowledging the problems for what it is. In response, the 72 districts have been classified into 4 categories, namely A (Most urban), B, C, and D (most rural) (see Tables 3.7 and 3.8). Cash incentives are utilized for stimulating a voluntary reallocation of the staff to rural and disadvantaged areas (especially to category C and D districts). In addition to this, the forthcoming results-based financing approach (see Performance appraisal and non-financial incentive schemes) should provide a complementary tool to motivate and retain health workers in rural areas. The cumulative effects from these two initiatives will hopefully help to address inequitable imbalances in the Zambian health workforce.