PHA-Exch> EQUINET Discussion Paper 65: Retention incentives for health workers in Zimbabwe

[Rene Loewenson]

EQUINET Discussion Paper 65: Retention incentives for health workers in
Zimbabwe,
MJ Chimbari, D Madhina, F Nyamangara, H Mtandwa, and V Damba; National
University of Science and Technology
Cite as: Chimbari MJ, Madhina D, Nyamangara F, Mtandwa H, Damba V (2008)
'Retention incentives for health workers in Zimbabwe'  EQUINET Discussion
Paper Series 65. EQUINET, National University of Science and Technology in
co-operation with UNAM, U Limpopo and ECSA-HC, Harare.

Available online at:
http://www.equinetafrica.org/bibl/docs/DIS65HRchimbari.pdf 
This paper investigates the impact of the framework and strategies to retain
critical health professionals (CHPs) that the Zimbabwean government has put
in place, particularly regarding non-financial incentives, in the face of
continuing high out-migration. The study investigated the causes of
migration of health professionals; the strategies used to retain health
professionals, how they are being implemented, monitored and evaluated and
their impact, in order to make recommendations to enhance the monitoring,
evaluation and management of non-financial incentives for health worker
retention. The field survey results showed that Zimbabwe is losing the most
experienced CHPs, but even newly qualified staff aspire to migrate to gain
experience. Migration was found to be taking place at all levels (primary,
district, provincial, central and private sector) of the health delivery
system. Most CHPs from Zimbabwe migrate to South Africa, Botswana, Namibia,
Australia, United Kingdom and New Zealand.The major factor driving
out-migration was economic hardship that CHPs face due to the deterioration
of the country's economy. Other factors identified include poor
remuneration, unattractive financial incentives and poor working conditions.
Hyper-inflation has rapidly eroded the value of the financial retention
incentives awarded by the ZHSB, while  negative economic growth rate  and
funding limitations have limited their application. Some practices added to
falling morale: These include bonding staff, the selective award of
allowances to particular health workers, and the exclusion of critical
health workers employed by the Ministry of Higher and Tertiary Education
from the Zimbabwe Health Service Board (ZHSB) mandate.  The authors suggest
that non-financial incentives that are not directly eroded by inflation be
given greater attention, including in partnership with non government
organisations and communities served by CHPs. Retention strategies should
target all staff categories, including those in training institutions, given
the tendency for staff at all levels to migrate.  The bonding of staff as a
retention measure should be reviewed so that it does not appear to be
punitive. Development of defined career paths and opportunities for
continuing education were considered to be better 'bonding' strategies,
which, while not legally binding, were already more  effective in retaining
staff.

September 2008



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