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 .

In this analysis of the global workforce, the Joint Learning Initiative, a consortium of more than 100 health leaders, proposes that mobilization and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems everywhere. Worker shortage, skill mix imbalance, maldistribution, negative work environments, and weak knowledge bases challenge nearly all countries. Especially in the poorest countries, the workforce is under assault by a triple threat of HIV/AIDS, out-migration, and inadequate investment. Effective country strategies should be launched and backed by international reinforcement. These include urgently mobilizing one million more health workers for Africa, and focusing efforts on the unremunerated community-level health workers, the majority of whom are women. Ultimately, the crisis in human resources is a shared problem requiring shared responsibility for cooperative action. Alliances for action are recommended to strengthen the performance of all actors while expanding space and energy for new ones.

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.

Vanuatu is a traditionally male dominated and largely patriarchal society. Women have extremely low representation in parliament and in other decision making bodies. Despite this, women are increasingly involved in private sector development and in the market economy. Available statistics suggest that women own nearly 30 percent of all businesses and approximately 20 percent of small and medium-sized enterprises. Yet, government support for women's economic empowerment and women in business has been limited, and reforms are needed to the general legal framework to ensure gender equality.This v.

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.

The 2006 World Health Report focuses on the chronic shortages of doctors, midwives, nurses and other health care support workers in the poorest countries of the world where they are most needed. This is particularly true in sub-Saharan Africa, which has only four in every hundred global health workers but has a quarter of the global burden of disease, and less than one per cent of the world's financial resources. Poor working conditions, high rates of attrition due to illness and migration, and education systems that are unable to pick up the slack reflect the depth of the challenges in these crisis countries. This report considers the challenges involved and sets out a 10-year action plan designed to tackle the crisis over the next ten years, by which countries can strengthen their health system by building their health workforces and institutional capacity with the support of global partners.