This report compiles recent evidence on the Zambian health labor market and provides some baseline information on human resources for health (HRH) to help the government address its HRH challenges. Rather than focusing on making policy recommendations, the report is designed to be a source book to benefit and fuel discussions related to HRH in Zambia. Most of the data presented in the report covers the period 2005-08. The report analyzes the national health labor market to better understand the available evidence related to the stock, distribution, and performance of HRH in Zambia (that is, the HRH outcomes). It aims to explain those HRH outcomes by mapping, assessing, and analyzing pre-service education and labor market dynamics, that is, the flow of health workers into, within, and out of the health labor market, as well as the core factors influencing these dynamics. Finally, this report examines the issue of access and equity of HRH. It finds that even if health workers are available, in either urban or rural areas, and performing adequately, the wealthy in Zambia have better access to services than the poor. This situation is found in most if not all other countries. The report finds that as far as access to health workers is concerned, the poor generally loose out. It also reveals that even if health workers are available, wealthier segments of the population often continue to have better access to health workers than poorer segments. Wealthier women have the highest probability of receiving any antenatal care. There is an even steeper pro-rich gradient in delivery attendance in Zambia. In contrast to antenatal care, there is little variation across socioeconomic quintiles among those seeking medical treatment for children with diarrhea or cough and fever. The poor are slightly more likely to be visited by a health worker and receive certain services during visits. The factors linked to these variations in use of services remain to be examined (they could be linked to expense, fear of receiving care from an individual belonging to a higher social stratum, or different gender, and so forth). Either way, they should be taken into consideration when planning to improve access for the poor to health care services and providers.

'The Human Resources for Health Crisis in Zambia' is part of the World Bank Working Paper series. These papers are published to communicate the results of the Bank’s ongoing research and to stimulate public discussion.Despite reporting some health gains since the 1990s, health outcomes remain poor in Zambia and it will be very challenging to achieve the health-related Millennium Development Goals by 2015.The Government of Zambia recognizes that the improvement of child and maternal health and the reduction in mortality from HIV/AIDs and malaria require better access to an appropriate number of wellperforming health workers or human resources for health (HRH). This paper compiles recent evidence on the Zambian health labor market and provides some baseline information on HRH to support the government as it addresses its HRH challenges. In addition, the paper analyzes the available evidence on the national health labor market to better understand the number, distribution, and performance of HRH in Zambia.The paper also explains HRH outcomes by mapping, assessing, and analyzing pre-service education and labor market dynamics and well as the core factors influencing these dynamics.This working paper was produced as part of theWorld Bank’s Africa Region Health Systems for Outcomes (HSO) Program.The Program, funded by the World Bank, the Government of Norway, theGovernment of the United Kingdom, and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems inAfrica to reach the poor and achieve tangible results related to Health, Nutrition, and Population.The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharmaceuticals, Governance and Service Delivery, and Infrastructure and ICT. More information as well as all the products produced under the HSO program can be found online at www.worldbank.org/hso .

This book portrays the performance of the health sector in Zambia using quantitative techniques. While there have been a number of health sector assessments in the country, they have relied on qualitative and anecdotal evidence for the most part. For the first time, this pubic expenditure review of the health sector brings together the results of three separate but related analytical efforts: multi-year national health accounts, a public expenditure tracking and quality of service delivery survey, and resource and impact modeling using the Marginal Budgeting for Bottlenecks software. These exercises combine to yield more powerful findings on the weaknesses and prospects of the Zambian health system.

Achieving universal health care requires understanding health labor markets dynamics to overcome constaints in human resources for health. This book helps to understand how key elements in health labor markets interact and how these interactions can help or hinder significant progress in health care coverage.

Sub-Saharan Africa has only 12 percent of the global population, yet this region accounts for 50 percent of child deaths, more than 60 percent of maternal deaths, 85 percent of malaria cases, and close to 67 percent of people living with HIV. Sub-Saharan Africa, however, has the lowest number of health workers in the world-significantly fewer than in South Asia, which is at a comparable level of economic development. The Labor Market for Health Workers in Africa uses the analytical tools of labor markets to examine the human resource crisis in health from an economic perspective. Africa's labor markets are complex, with resources coming from governments, donors, the private sector, and households. Low numbers of health workers and poor understanding of labor market dynamics are major impediments to improving health service delivery. Yet some countries in the region have developed innovative solutions with new approaches to creating a robust health workforce that can respond to the continent's health challenges. As Africa grows economically, the invaluable lessons in this book can help build tomorrow's African health systems.

Afro-Eurasia: Assessing Sustainability focuses on the geographic area where humans originated and first began to make use of the natural world - Earth's largest landmass, stretching from Portugal in the west across the steppes of Russia and south across Africa to the Cape of Good Hope. By examining the history of human expansion, as well as 21st century pressures to address ecosystem damage across the region, international scholars and regional experts weave sustainability into core curricular subjects. The interdisciplinary coverage includes national and regional environmental histories, as well as business and commerce, migration, educational institutions, law and government, and the lifestyles of diverse populations.

The human resources crisis in the health sector has been gathering attention on the global stage. To date, however, most of this attention has focused on shortages of health human resources (HRH) at the national level. At least as important are problems at the sub-national level. Massive geographic and skill mix imbalances are reflected in the perilous undersupply of HRH in most rural areas. Virtually all Sub-Saharan African countries suffer from significant geographic imbalances. Very little substantive information or documentation exists on the problem. Even less is known about the lessons from policies aimed at addressing urban-rural human resource imbalances, let alone experiences of Sub-Saharan Africa countries, with such policies. There also appears to be a disconnect between the objectives and efforts of policymakers on the one hand and the functioning of national health labor markets and labor market behavior on the other hand. This disconnect hinders policy effectiveness and the efficient utilization of resources intended to narrow urban-rural inequities. In Sub-Saharan Africa government policies, often limited to the management of public sector vacancies, appear to be elaborated, prescribed, and implemented independently of labor market considerations. Partly as a result, they are unable to effectively address urban-rural imbalances, which are an outcome of labor market dynamics. This report discusses and analyzes labor market dynamics and outcomes (including unemployment, worker shortages, and urban-rural imbalances of categories of health workers) from a labor economics perspective. It then use insights from this perspective as a basis for elaborating policy options that incorporate the underlying labor market forces. The goal of the study is to address undesirable outcomes (including urban-rural HRH imbalances) more effectively. The book is thus suitable for researchers, policy analysts and policy makers with an interest in understanding and improving the allocation of human resources for health in the developing world.