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<p class=MsoNormal><tt><b><font size=2 color=maroon face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:maroon;font-weight:bold'>EQUINET
Discussion Paper 65: Retention incentives for health workers in Zimbabwe,</span></font></b></tt><o:p></o:p></p>
<p><tt><b><font size=2 color="#660000" face=Arial><span style='font-size:10.0pt;
font-family:Arial;color:#660000;font-weight:bold'>MJ Chimbari, D Madhina, F
Nyamangara, H Mtandwa, and V Damba; <st1:place w:st="on"><st1:PlaceName w:st="on">National</st1:PlaceName>
<st1:PlaceType w:st="on">University</st1:PlaceType></st1:place> of Science and
Technology</span></font></b></tt><o:p></o:p></p>
<p class=MsoNormal><tt><b><font size=2 color="#660000" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#660000;font-weight:bold'>Cite
as:</span></font></b></tt><tt><font size=2 face="Courier New"><span
style='font-size:10.0pt'> </span></font></tt><tt><font size=2 color=purple
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:purple'>C</span></font></tt><font
size=2 color=purple face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:purple'>himbari MJ, Madhina D, Nyamangara F, Mtandwa H, Damba V (2008)
'Retention incentives for health workers in Zimbabwe’<span
style='mso-spacerun:yes'> </span>EQUINET Discussion Paper Series 65. <span
class=GramE>EQUINET, National University of Science and Technology in
co-operation with UNAM, U <span class=SpellE>Limpopo</span> and ECSA-HC, <st1:City
w:st="on"><st1:place w:st="on">Harare</st1:place></st1:City>.</span></span></font><b><font
size=2 color="#660000" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#660000;font-weight:bold'><br>
<br>
<tt><font face=Arial><span style='font-family:Arial'>Available online at:</span></font></tt></span></font></b><tt><font
size=2 face=Arial><span style='font-size:10.0pt;font-family:Arial'> </span></font></tt><tt><u><font
size=2 color="#000099" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#000099'><a
href="http://www.equinetafrica.org/bibl/docs/DIS65HRchimbari.pdf">http://www.equinetafrica.org/bibl/docs/DIS65HRchimbari.pdf</a></span></font></u></tt><tt><font
size=2 face="Courier New"><span style='font-size:10.0pt'> </span></font></tt><font
size=2 face="Courier New"><span style='font-size:10.0pt;font-family:"Courier New"'><br>
</span></font><font size=2 color=purple face=Arial><span style='font-size:10.0pt;
font-family:Arial;color:purple'>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 <st1:place w:st="on"><st1:country-region
w:st="on">Zimbabwe</st1:country-region></st1:place> is losing the most
experienced CHPs, but even newly qualified <span class=GramE>staff aspire</span>
to migrate to gain experience. </span></font><font size=2 color=purple
face=Arial><span lang=EN-GB style='font-size:10.0pt;font-family:Arial;
color:purple;mso-ansi-language:EN-GB'>Migration was found to be taking place at
all levels (primary, district, provincial, central and private sector) of the
health delivery system. Most <span class=SpellE>CHPs</span> from <st1:country-region
w:st="on">Zimbabwe</st1:country-region> migrate to <st1:country-region w:st="on">South
Africa</st1:country-region>, <st1:country-region w:st="on">Botswana</st1:country-region>,
<st1:country-region w:st="on">Namibia</st1:country-region>, <st1:country-region
w:st="on">Australia</st1:country-region>, <st1:country-region w:st="on"><st1:place
w:st="on">United Kingdom</st1:place></st1:country-region> and New Zealand.</span></font><font
size=2 color=purple face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:purple'>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. </span></font><font size=2 color=purple face=Arial><span
lang=EN-GB style='font-size:10.0pt;font-family:Arial;color:purple;mso-ansi-language:
EN-GB'>Hyper-inflation has rapidly eroded the value of the financial retention
incentives awarded by the ZHSB, <span class=GramE>while<span
style='mso-spacerun:yes'> </span>negative</span> economic growth
rate<span style='mso-spacerun:yes'> </span>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 </span></font><font size=2
color=purple face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:purple'>Zimbabwe Health Service Board (ZHSB) mandate. </span></font><font
size=2 color=purple face=Arial><span lang=EN-GB style='font-size:10.0pt;
font-family:Arial;color:purple;mso-ansi-language:EN-GB'><span
style='mso-spacerun:yes'> </span>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 <span class=SpellE>CHPs</span>. Retention strategies
should target all staff categories, including those in training institutions,
given the tendency for staff at all levels to migrate.<span
style='mso-spacerun:yes'> </span>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<span style='mso-spacerun:yes'>
</span>effective in retaining staff.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=maroon face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:maroon'><br>
<tt><font face=Arial><span style='font-family:Arial'>September 2008</span></font></tt><br>
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