Serious Health Workforce Shortage in Zambia

Shortage of staff in the health care sector

Zambia continues to have one of the fastest growing populations in the world. The UN predicts that the population will grow from 18 million to 39 million by 2050. This rapid growth significantly increases the demands on the health sector. Despite remarkable investment and commitment, Zambia still lacks about 40 percent of its estimated health workforce needs. In 2019, only 13 nurses and midwives provided care to 10,000 people, compared to 175 in Switzerland. The challenge of insufficient numbers is compounded by inequalities in the geographical distribution. In 2017, about 90 percent of the trained health workers were located in urban areas, while more than half of the population lives in rural areas. To meet the healthcare needs of its growing population, the country needs to increase the number of healthcare workers from 26,000 to 73,000. Professional health training therefore required new innovative models to meet these challenges.

Decentralised nurse training model

In 2012, SolidarMed developed and successfully piloted such a new approach with the decentralised nurse training model. The main goal is to increase the number of nurse students while maintaining a high quality of training. Furthermore, the focus was on rural settings to increase the likelihood of retaining the trained HCWs (Health Care Workers) in rural health facilities. In this way, SolidarMed sought to address the imbalance of the rural versus urban distribution of HCWs.

The old model is based on the collaboration of one nursing school with one hospital. All nurse students at that school undergo their practical training in the attached hospital. The focus of the decentralised nursing model is to deliver high quality theoretical and decentralised practical training. Increasing the number of practical training sites that are linked to the school thus allowed to have more students at the same time.

Key components of this model are decentralisation and increase of number of training sites, clinical mentoring of nurse students, rotation between the sites, combined teaching and blended learning. The model has been accredited by the Ministry of Health and is currently being rolled out.

Accomplishments

The pilot was carried out in partnership with the Ministry of Health and St. Luke’s School of Nursing and Midwifery where the project started and where it was implemented. The Nursing and Midwifery Council of Zambia was involved in the project from the outset, to support both the pilot and the roll-out.

The decentralised nurse training model has proven to be effective in doubling the number of graduated nurses. By the end of 2018, 469 nurses finished their training in the new model.In addition, a 2018 review showed that 61 percent of St. Luke’s graduates were posted to a rural health facility (General Nursing Council of Zambia, 2019). The success of the pilot has been recognised by the Ministry of Health and the NMCZ. St. Luke’s School of Nursing and Midwifery, as well as the decentralised partner hospitals were accredited by the NMCZ thereby acknowledging that the quality standards for the students’ training are met.

This recognition has boosted interest in the model from other training institutions. In 2019, SolidarMed initiated support of two additional nursing schools to implement the decentralised model. These two nursing schools have begun implementation, while several others are currently planning to implement the model even without SolidarMed support but using the developed guidelines. For more information, please feel free to read the article by Amélie Gottier and Beatrice Zulu in the current Medicus Mundi Bulletin:

Medicus Mundi Switzerland Bulletin #156