A case study of government innovative programmes for increasing access to qualified Health Personnel in selected Rural District of Zambia

Objective: To document the experiences and lessons learnt from implementing innovative programmes that aim at increasing access to qualified health workers in Gwembe and Chibombo districts by Ministry of Health and participation of health workers.Methods: Qualitative analysis of the participation and satisfaction rates in retention and recruitment incentives for health workers in Gwembe and Chibombo Districts was conducted. Further document review of the current strategies implemented by the government was conducted with regards to them addressing the problems identified by the health workers based on a criterion that was developed. The study used primary and secondary data.Results: The findings indicated that there was high desire by the health workers to leave their current rural job postings and this was mainly due to issues related to their living and working conditions rather than the participation or satisfaction in the existing retention and recruitment schemes. There was substantial turnover in the health workforces in both districts over the five-year period from 2005-2009, with annual losses ranging from 2 percent to 16 percent of the professional health workforce in each district. These losses were dues to death, retirement and redirection. Overall, there was also very little evidence and the quality of much of what existed was weak hence the difficult to ascertain if these interventions were contributing to an increase in access to qualified health workers in rural areas.Conclusion:To retain staff in the rural areas remains a challenge because of the high desire to leave exhibited by health workers. Bundled interventions therefore coupled with strong national leadership, governance and information systemsare key in ensuring skilled, motivated and supported health workers at the right place and time. In addition, a strong monitoring and evaluation system should be establised to provide evidence and lessons to ascertain which interventions are or are not working and inform further policy decisions on health workforce.