Human Resources for Health. Country Profile. Zimbabwe

Transcription

1 Human Resources for Health Country Profile Zimbabwe 1

2 Human Resources for Health Country Profile ZIMBABWE Zimbabwe Health Workforec OBservatory, March

3 Content 1. Country context Geography and demography Economic context Political context Health status Country health system Governance Service provision Health care financing Health information system Health Workers Situation Health workers stock and trends HRH Production Pre-service education In-service and continuing education Health workforce requirements HRH Utilization Recruitment, Deployment and Distribution mechanisms The work environment Governance for HRH HRH policies and plans Policy development, planning and managing for HRH Professional Regulation HRH information HRH research Stakeholders in HRH...34 Annex 1: Definition of Health workforce Data...37 Annex2: Members involved in the working Group... Error! Bookmark not defined. Annex3: Detailed HRH Stock Data for Critical cadres (Doctors, Nurses, Pharmacy and Laboratory Staff)...38 CONTENT 3

4 Acronyms BSS CSO DMO ESP EU GoZ HIA HPA HR HRIS HSB ICDS IDRS IMF LATH LSTM MDGs MoF MoHCW MoHTE MoLSS MP NAC NGO NHIS NIHR NHS NSSA NUST OPD PCC PHC PMD SADC SSB TWG UCA VHW WHO ZACH ZDHS ZIMPREST ZOU Basic Services Sector Central Statistics Office District Medical Office European Support Programme European Union Government of Zimbabwe Health Information Assistants Health Professions Authority Human Resources Human Resources Information System Health Services Board Inter-Censal Demographic Survey Integrated Disease Surveillance and Response International Monetary Fund Liverpool Associates in Tropical Health Liverpool School of Tropical Medicine Millennium Development Goals Ministry of Finance Ministry of Health and Child Welfare Ministry of Higher and Tertiary Education Ministry of Labour and Social Services Member of Parliament National AIDS Council Non-Governmental Organization National Health Information and Surveillance National Institute of Health Research National Health Strategy National Social Security Authority National University of Science and Technology Out Patient Department Primary Care Counsellors Primary Health Care Provincial Medical Directorate Southern African Development Community Salary Services Bureau Technical Working Group Urban Councils Act Village Health Worker World Health Organization Zimbabwe Association of Church Related Hospitals Zimbabwe Demographic and Health Survey Zimbabwe Programme for Economic and Social Transformation Zimbabwe Open University 4

5 Tables Table 1.1 Percent Population Distribution by Age Group and year (last available year and 10 year earlier if possible)...9 Table 1.2 Population distribution by Sex...10 Table 1.3 Economic indicators...10 Table 1.4 Trends of Population growth rate and economic growth rate in the past 5 years...11 Table 1.5 Main causes of morbidity and mortality...12 Table 1.6 Health indicators...12 Table 2.1 Health Facilities by levels of care and by province...18 Table 2.2 Registered Private Health Facilities by Province and Service Type...19 Table 3.1 Health worker/population ratios at national level...22 Table 3.3 Gender distribution by health occupation/cadre... Error! Bookmark not defined. (See definition of each occupational category in annex)... Error! Bookmark not defined. Table 3.4 Workers by age group and cadre... Error! Bookmark not defined. Table 3.5 Province distribution of health workers per 1000 population. Error! Bookmark not defined. Table 3.6 Regional/District/province distribution of workers... Error! Bookmark not defined. Table 3.7 Urban/Rural distribution of workers... Error! Bookmark not defined. (See definition of each occupational category in annex)... Error! Bookmark not defined. Table 3.8 Public/Private for profit/faith based organization/private not for profit distribution of health workers (See definition of each occupational category in annex)error! Bookmark not defined. Table 4.1 Number of Training Institutions by type of ownership...25 Table 4.2 Number of entrants and graduates by Table 4.3 Projections for health workforce requirements for the coming years...27 Table MOHCW Staff Attrition (Resignations and Retirements 2008 & 2009)...30 Table The original Emergency Retention Scheme Allowances versus District Pay scales

6 Figures Figure 1.1 Map of Zimbabwe...9 Figure 2.1 The MoHCW structure...17 Figure 5.2.1: MoHCW Establishment Vacancy Rates Analysis

7 Executive Summary The development of the Zimbabwean Human Resources for Health (HRH) country profile began in June 2010 and was completed in August This assignment was carried out by an International and local consultant who used secondary data sources and key informant interviews from the Ministry of Health and Child Welfare (MoHCW), government departments, health council and associations, missions and NGOs in health. The development of the HRH profile is part of an initiative by the African Health Workforce Observatory to develop a mechanism that could assist countries to compare and contrast their HRH policies and systems with other countries experiencing similar HRH challenges. The experiences in the development of the first HRH profile in Zimbabwe are very much similar to most African countries that carried out the activity for the first time. The lessons learnt from the process have motivated governments to view HRH challenges from a sectoral perspective. The profile suggests that the MoHCW should develop HRH systems that provide adequate information that includes the public, private, private for profit, and faith based organizations (missions). This profile reports that Zimbabwe was projected to have a population of Million people in 2009 who were being served by a public health workforce of approximately 27,840. The country s service delivery system has developed over the years and most communities live within at least 8 kilometers of the nearest health facility. Zimbabwe is reported to have 1431 public health facilities and 1920 private health facilities across the country providing both primary and tertiary health services. These health facilities are also complemented by 3,943 traditional health workers and 4,013 Village Health Workers. The economic depression experienced in 2008 heavily affected the stability of health workers in the public sector. The profile reports that at the peak of the economic depression the MoHCW lost 3,588 staff through resignations. The effects of the these losses are still felt in some critical cadres such as doctors, laboratory and environmental health staff who still have vacancy rates above 50% of established posts. Realizing that the health sector was in crisis the MoHCW and partners developed an Emergency Retention Scheme in 2008 to cover the whole public sector including council employees in rural and urban areas. In March 2009, the government and its partners revised the retention scheme to only apply to grades C5 and above of the MoHCW posts. There seems to be evidence suggesting that the retention scheme currently managed by Crown Agents has brought some stability in the public health sector. The number of resignations in 2009 dropped to 84% (567) of the previous year. The production of health workers seems to have gone down during the last five years before this HRH profile. A review of data on intakes and graduates from 2006 to 2009 shows that approximately 7,896 students were registered and 10,233 graduates were produced from the same training institutions. The misnomer between intake and graduate numbers could be evidence that the enrollments into schools are becoming lower than the previous years. This could also be as a result of the reported losses of teaching staff in health training schools. Despite the high attrition of health staff from MoHCW, there was evidence that showed that government continued employing staff to work in public health facilities across the country. The number of new appointments increased from 2,057 in 2008 to 2,320 in If we are to compare the total number of graduates for 2008 and 2009 against appointments; it seems that MoHCW employed 4,377 of 5,268 graduates. However there is also evidence of internal health worker migration between MoHCW and City health departments due to salary differentials. 7

8 Introduction The development of the Zimbabwean Human Resources for Health (HRH) profile is the first step in the whole process of developing and implementing an HRH Observatory. In addition the whole process adds to the country s development of an HRH system that makes decisions based on verifiable HR information collected from the public, private, private not for profit and faith based organizations. Purpose The purpose of the HRH country profile is to serve as a tool for: Providing a comprehensive picture of the Health Workforce situation; Systematically presenting the HRH policies and management situation to help monitoring the HRH stock and trends; Communication with and between policy-makers and stakeholders; Strengthening the HRH information system by establishing evidence for baselines and trends; Facilitating information sharing and cross-country comparisons Methodology The main source of information to develop this HRH profile was document review complemented by key informant interviews. Key informant interviews were conducted to solicit information missing from document reviews. A meeting with the HRH Technical Working Group (TWG) also helped generate valuable information and validate findings from document reviews and interviews. The TWG members involve organizations from government, training institutions and NGOs who play key roles in HRH in Zimbabwe. The members include the following organizations: DFID, USAID, EU, World Bank Training institutions: College of Health Sciences, Nursing Schools etc. MoHCW: Personnel unit, Chief Nursing Officer, Zimbabwean Nursing Council, Medical Council of Zimbabwe, Heads of Directorates including the Planning unit The Participants for the interviews included: MoHCW (Health Services Board, HR Directorate, City Health Departments, Health Professions Authority, Zimbabwean Nursing Council, Medical Council of Zimbabwe, Directorates of HR, Planning Directorate, HMIS unit, Reproductive Health Unit, HIV/AIDS Directorate) Ministry of Finance, Central Statistics Office, Training institutions principals Scope of the HRH profile The Zimbabwean HRH profile covers the following areas mainly from the public sector: 8 Comprehensive picture of the Health Workforce situation in the country Geography, demography, and economic situation. Country s health services system, its governance and policies HRH stock and trends; HRH production including pre-service and post basic training processes; HRH utilization Stakeholders in the health sector

9 1. Country context 1.1 Geography and demography Figure 1.1 Map of Zimbabwe Zimbabwe lies between the Limpopo and Zambezi rivers. The country is landlocked, bordered by Mozambique on the east, South Africa on the south, Botswana on the West, and Zambia on the north and northwest. The country has a land area of 390,757 square kilometres composed of abundant natural resources, including 8.6 million hectares of potentially arable land and more than 5 million hectares of forests, national parks and wildlife estates. Administratively, Zimbabwe is divided into ten provinces. The climate of Zimbabwe is a blend of cool, dry, sunny winters and warm, wet summers. The three distinct seasons are the cool dry winter from May to August, a hot dry season during September and October, and a warm wet season from November to April. According to the Central Statistics Office (CSO, 2010), Zimbabwe has a population of circa million. Approximately 65% of the population lives in the rural areas while the remaining 35% live in the urban areas. It has a population growth rate of approximately 0.7% and a population density of 29 persons per square kilometre. The Zimbabwe Demographic and Health Survey (ZDHS) ( ) reported a decline in fertility rate to 3.8 births per woman from 5.4 births in The sex ratio for Zimbabwe is almost 93. According to the 2008 Inter-Censal. Demographic Survey (ICDS) 41.1% of the total population is under 15 years of age. For detailed information please see Tables 1.1 and 1.2. Table 1.1 Percent Population Distribution by Age Group and year (last available year and 10 year earlier if possible) Age Group years % % % years % % % 60+ years 5.65% 6.70 % 6.70 % Total % % % Total population 11,631,657 12,040,262 12,121,665 Source: CSO, Census 2002 & ICDS

10 Table 1.2 Population distribution by Sex Year Total Male Female Male Growth rate /Female (%) (%) ,631,657 5,583,195 6,048,462 94% ,040,262 5,794,978 6,245,284 93% ,121,665 5,834,157 6,287,508 93% 0.7 Source: CSO, Census 2002 & ICDS Economic context. Zimbabwe experienced a severe economic depression in the last decade. Economical growth had been negative with an average GDP growth of - 5.4% per year from 2000 to GDPper capita in 2008 was US$392. In , the government of Zimbabwe implemented a five year economic development programme, the Zimbabwe Programme for Economic and Social Transformation (ZIMPREST). It was envisaged that the government of Zimbabwe would implement ZIMPREST with financial support from the World Bank, the International Monetary Fund (IMF), and other international organizations. However, the financial aid was not received in a timely manner. Direct development assistance has declined from US$71 million in 1997 to US$7 million in Currently domestic revenue is mainly from the agriculture, manufacturing and tourism sectors which are the major sources of funding for the national budget. In 2010 the Government of Zimbabwe (GoZ) has allocated 12.7 % of the total budget to health. This is a decline from previous years, with a budget allocation for health 13% in 2006 and 14% in Table 1.3 Economic indicators Indicators GDP (Million $) External Debt as % of GDP 150% External Debt $6.7Bn Economic Aid as % of GDP NA NA NA Proportion of Budget on health as % of total GoZ budget 13% (2003) 14% Proportion GoZ total expenditure on health % 1 GDP per capita (in PPP) $454 $438 $392 Proportion of population living below poverty line NA NA NA Proportion of population in extreme poverty 60% (2003) Proportion of Under 5 with severe malnutrition NA NA NA Unemployment rate 80% Inflation rate (Consumer price) 4% (2010) Source: MoF, CSO, June 2010; ZDHS ; MOLSS Poverty Assessment Survey 2003 Note: NA means Not Available (The consultants had no access to this information) 1 This high proportion is due to heavy inflation in The health budget was prepared in Zimbabwean dollars. 10

11 Table 1.4 shows a constant population growth of 1% in the last 5 years whilst also demonstrating a constant negative economic growth rate in the same period. Table 1.4 Trends of Population growth rate and economic growth rate in the past 5 years Year Population Growth Economic Growth % -4% % -4% % -4% % -3% % -10% 1.3 Political context The Republic of Zimbabwe is a presidential and pluralistic system where the head of the state and the executive is elected by direct universal suffrage. At central level, the country has a bicameral parliamentary system composing Members of Parliament (MPs) and Senators voted through a general election. The current structure comprises of decentralized and deconcentrated levels consisting of provinces, districts, wards and villages. Provinces a r e deconcentrated levels of the central government and serve as coordinating organs for the central government planning, implementation and supervision. Each province is headed politically by a Provincial Governor. There are 10 provinces in Zimbabwe, including Harare and Bulawayo Cities. Districts a r e decentralized local levels that are the main organ of service delivery to populations. They are based on a local pluralistic system. The legislative body of the districts is the district council, which is elected through local government elections. The executive body of the district is the executive committee, which is chaired by a mayor in urban areas and council chairman in rural districts. The administration of the district in urban areas is headed by a Town Clerk. In the rural district councils the head of administration is referred to as Chief Executive Officer and also serves as a secretary to the councils. The local councils are supported by various sub-committees of council with various thematic areas, one of which is the Social Services Sub-committee responsible for health education and social welfare. Wards are planning and implementation units of the district. They have a similar governing structure to districts with an elected ward council composed of members from the lowest political-administrative level (villages). An executive committee is responsible for the d a i l y administration of the ward and for the implementation of ward decisions. It also oversees and is responsible for the supervision of the health centres in a ward. Villages are the smallest political-administrative units. The ward councillor is the political voice of communities in the identification, discussion and prioritization of problems and actions to be taken at village level. It can also refer any relevant issue to higher levels. 1.4 Health status The Zimbabwean health indicators are generally poor making it clear that the country might struggle to meet its health Millennium Development Goals (MDG) targets. Maternal Mortality Rate is very high 11

12 at 725 per 100,000 deliveries. Table 1.5 also shows that normal delivery represents 32.3 % of national health morbidity. These indicators may reflect weak reproductive health services and a lack of availability of midwives in the health facilities. Infant and Child Mortality Rates are still high standing at 64 and 82 deaths per 1000 live births respectively. Table 1.5 Main causes of morbidity and mortality Main causes of morbidity Value (%) Main causes of mortality Value (%) 1. Normal Delivery ARI ARI Pulmonary TB Direct & In-direct Obstetric HIV related/ AIDS Malaria Intestinal Infections Certain Conditions originated Intestinal Infections in the Perinatal period 6. Pulmonary TB Malaria Other reasons for contact with health system Meningococcal & other Meningitis Other reasons for contact with Abortion 9. HIV related/ HIV 10. Signs, Symptoms & ill defined conditions health system Nervous system (except meningitis Signs, symptons and illdefined conditions Total Total Source MoHCW, National Health Profile (2008) Table 1.6 Health indicators Indicators Both sex Source and year Life expectancy 43 (41 male; 46 female) ICDS 2008 Crude mortality rate per 19.7 ICDS population (Adult yrs) Infant mortality rate 64/1000 ICDS 2008 Under-5 mortality rate 82/1000 ZDHS Maternal mortality rate 725/100,000 NHS HIV/AIDS prevalence rate 13.7 NHS % with access to safe water 75 ICDS 2008 % with access to sanitation 69 ICDS 2008 HIV/AIDS prevalence was estimated at 13.7% in 2008 with substantial differences between geographical areas and population groups. Social determinants strongly influence the profile of distribution and spread of the epidemic. Life expectancy at birth was estimated at 43 years for both sexes. However the women have a higher life expectancy at birth of 46 years whilst the men s is estimated at 41 years. The ICDS 2008 reports that 75% and 69% of the population have access to safe water and sanitation respectively. 12

13 2. Country health system 2.1 Governance Health service delivery in Zimbabwe is structured in four levels: the central, provincial, district and community levels. Service delivery is provided by the public sector and privately registered practitioners under an Act of Parliament, the Health Services Act 2004, which also includes the participation of traditional medicine practitioners. The public health sector comprises the Ministry of Health and Child Welfare (MoHCW), Local Authorities (municipalities), the Ministry of Higher and Tertiary Education, the Ministry of Defence Forces, Prisons Services Department and the Ministry of Home Affairs, Ministry of Labour and Social Services (National Social Security Authority - NSSA). According to the MoHCW, the public sector provides 65% of health care services in the country. The private for-profit sector comprises private for-profit hospitals, mines, nursing homes, maternity homes, industrial clinics and general practitioners, private laboratories and imaging facilities. The non-profit sector comprises faith-based organizations with Zimbabwe Association of Church Related Hospitals (ZACH) as an umbrella organization and other non-governmental organizations (NGOs). All health facilities (public and private) in Zimbabwe are registered under the Health Professions Authority (HPA), including their sub-units such as laboratories, pharmacies, nursing homes etc. All these facilities are guided by the Public Health Acts of Zimbabwe and relevant statutory instruments in terms of their day-to-day operations. However oversight for the entire health system is provided by the MoHCW. All public facilities are supported and supervised by the MoHCW directly or through provincial and district health offices. Faith-based facilities are recognized by the MoHCW as part of the public health systems and the norms, standards and programmes of the public sector are extended to those facilities. Approximately 35% and 65% of national and rural bed capacity respectively are provided by faith-based organizations. The private sector is relatively large in absolute numbers of facilities but is however mainly found in urban areas and cities. The government funded health system is organized along the national administrative lay-out including central, provincial, districts, wards and village administrative and service provision structure.. The MoHCW and its units provide the strategic vision and stewardship for national programmes, setting of norms and standards, and the monitoring of central/referral hospitals. The Ministry is under the political leadership of the Minister of Health and administratively under the Permanent Secretary. The MoHCW has 3 Principal Directors who head curative services, preventive services and Policy, Planning, Monitoring and Evaluation directorates. There are five other principals who report directly to the Permanent Secretary and these include Provincial Medical Directors, Director Human Resources, Director Finance and Administration, Chief Internal Auditor and the Chief Engineer. The MoHCW structure has 14 other directors reporting to the principal directors. These directors are also assisted by their deputies. In addition to these structures, the MoHCW supervises a large number of health related agencies and professional bodies. Some of them are under its full supervision such as the National Pharmaceutical Company of Zimbabwe and Health Services Board and others are autonomous but handle substantial programmes such as the National AIDS Council (NAC), Medicines Control Authority of Zimbabwe, and Health Professional Authority etc. 13

14 The MoHCW has devolved structures at the provincial level referred to as Provincial Medical Directorate (PMD). They are responsible for the coordination of health programmes at local level and to provide technical assistance to districts. At district and city level, the public health structures split according to their respective government departments. Health facilities under MoHCW report through a District Medical Office (DMO) whilst health facilities under city and urban councils report through their respective councils. The DMO is however responsible for planning, coordination and evaluation of health service delivery at district level down to ward and village level. At Ward level, health centres, dispensaries, health posts and community health workers are under the administrative responsibility of the Ward Committee. The sub-committee on health supervises the activities of the health facilities at this level. 14

15 Figure 2.1 The MoHCW structure 17

16 2.2 Service provision The MoHCW NHS reports that in 1997, 85% of the population lived within 8 km of a primary care facility. Population movements, as a result of the agrarian reform programme and natural population growth, have reduced geographic accessibility in some parts of the country. The Access to Health Care Services Study (2008), found that most communities live within 5km radius from their nearest health facilities, whilst 23% between 5 to 10 km and 17% are over 10km from their nearest health centre. The health sector in Zimbabwe could be described as one that has expanded progressively over the last decade. The first line of care involves community health workers. The formal MoHCW service delivery facilities are divided into a four tier referral system. The primary level, which is the first point in primary health care (PHC) services, is represented by 1,231 facilities. These are mainly public, faith based and rural council health centres. The secondary level in the referral system is represented by 179 district hospitals. The tertiary level is mainly represented by 7 provincial hospitals and at the apex are quaternary facilities which are mainly national level teaching hospitals. All the facilities from the secondary level to the quaternary provide curative, long term care and rehabilitative services. Table 2.1 Health Facilities by levels of care and by province Province Primary Level Secondary (1st Referral) Level Tertiary (2nd Referral) level Quaternary (3rd Referral) Level Total Harare Manicaland Mashonaland Central Mashonaland East Mashonaland West Matebeleland North Matebeleland South Midlands Masvingo Bulawayo Total Source: MoHCW National Health Strategy In addition to the 1,431 public health institutions curative, long term care and rehabilitative services are also available in 1,920 private health facilities. Table 2.2 shows that the largest numbers of private facilities are medical consulting rooms, with a total of 716 practising rooms nationally. These private for-profit institutions are mostly found in urban areas (Harare, Bulawayo and provincial headquarters). Mission hospitals have 126 hospitals and clinics, while the rural district councils have 582 clinics. These last two stakeholders are the main health service providers in rural areas. 18

17 Table 2.2 Registered Private Health Facilities by Province and Service Type Category Harare Bulaw a yo Mash East Mash West Mash Central Mat North Mat South Masvi n go Midlan d s Manic a land Dental Medical laboratories Speech and Occup Physiotherapy Nursing homes Consulting rooms Nurses' consulting Maternity homes /polyclinics Special clinics Pharmacies Private hospitals Industrial clinics (mnes/compa Estate clinics Psychological services Operating theatres Dietetics Natural therapy Emergency services Radiology services Optical Total Source: Health Professions Authority Register 2009 TOTAL Preventive health services are mainly provided through the public health units within the national, district health offices, rural councils and urban councils. These units provide a variety of family health programmes which include maternal and child health services, HIV/AIDS preventive services, epidemiological surveillance services and environmental health services. Public health services are coordinated through the preventive health directorate at MoHCW headquarters. 2.3 Health care financing The National Health Strategy ( ) set the agenda for launching the health sector into the new millennium. However the implementation of the NHS was frustrated by the economic depression and limited external aid support. The Government of Zimbabwe has however continued to recognise the importance of the social sectors and health is still within the top five sectors in terms of resource allocation. Health care services have been financed from several sources, inclusive of government allocations, private voluntary organizations, medical aid / health insurance schemes, direct out of pocket payments and development assistance from both bilateral and multi-lateral partners. Government has remained the single largest source of health financing in the public sector with taxation being the major source of revenue. 19

18 The 2001 National Health Accounts estimated government s contribution to total healthcare expenditure to be 39%, while the contribution by households was 29% against 10.8% by employers. The private sector has continued to contribute to the mobilization of resources for health through once-off donations and adoption of wards in public health institutions. However their contribution has been limited due to the economic depression. The declining performance of the economy has meant less funding for the health sector. The situation has been further exacerbated by the fact that development assistance, which used to augment expenditure on health services has declined from US$71 million in 1997 to US$7 million in While donor financing was 13% of the total national health expenditure in 1999, by 2002 it had reduced to only 1%, a trend which reflects the almost total absence of bilateral assistance. This picture has improved in the recent past, but the effects are still witnessed in the health system. The NHS states that in order to achieve the MDGs Zimbabwe should be spending at least US$34 per capita per annum on health. This is the minimum required to provide an essential package of health services. The 2009 revised budgetary allocations works out to about US$7 per capita per annum on health, leaving a deficit of about US$27 per capita per annum. 2.4 Health information system The Ministry of Health and Child Welfare responded to emerging calls for increased availability of data for planning, implementation and monitoring of health programmes, by designing a National Health Information and Surveillance (NHIS) system in The NHIS system was rolled out nationwide in 1988 followed by a joint evaluation of the system in 1999 conducted by MoHCW and WHO. Some data collection, analysis, reporting and uniformity issues were identified and recommendations for improving the system made. Despite these challenges, the NHIS was awarded a SADC trophy for being the best surveillance system in the region in A lot of effort has gone towards improving the NHIS in the past ten years. Posts for Health Information Assistants (HIA) were created at district and mission hospital levels. Data collection tools have been constantly adapted to suite new information needs. Software packages have been developed for data capture and storage. HIA training was established at Harare Polytechnic, while Integrated Disease Surveillance and Response (IDSR) and basic epidemiology courses were introduced for staff at all levels. The training was designed to equip staff at these levels with skills to enable them to use health information for decision making. According to the National Health Strategy , The training has proved to be very useful and has enabled operational levels to detect and respond to outbreaks early. Weekly sentinel surveillance data is being used to a limited extent at the local levels, especially by those trained in IDSR and basic epidemiology. Others are collecting data only for transmission to higher levels. This has resulted in some outbreaks only detected at the provincial and national levels, with the district or facility unaware of the outbreak. This problem has been compounded by on-going professional migration facilities are forced to accept ever more inexperienced staff take up posts at the operational level. Furthermore completeness of returns remains a challenge while no success has been achieved towards monitoring the private sector. Extensive support has gone towards providing information technology support to districts, provinces and national levels. Most NHIS departments at the various levels have access to computers as well as access to telephone and facilities. Telephone facilities have however been unreliable especially at the rural health centre level. Radio communication equipment linking Rural Health Centres and District hospitals, has largely been vandalized and is now 20

19 unreliable. In addition to the NHIS data the MoHCW also relies on information generated from research. The National Institute of Health Research (formerly Blair) is mandated to champion the research function. The NHS reports that the National Institute of Health Research (NIHR) has however been inactive in the last five years mainly due to professional migration. Research activities at district and provincial levels have virtually stopped. The NHIS collects limited Human Resources (HR) data, mainly related to Out Patient Department OPD and in-patient daily staff to client ratio information. The MoHCW mainly relies on the monthly Staff Returns introduced by the HR Directorate. 21

20 3. Health Workers Situation This section of the report had limitations in the collection of information on unemployment, internal and international migration, age, gender, employment sector distribution, and rural/urban distribution. The main reason for excluding this important information is mainly because it was never analysed or collected at the time of the developing the HRH profile. However a detailed account of information challenges and weaknesses of the Human Resources Information System (HRIS) is covered in chapter 6 of this report. 3.1 Health workers stock and trends Table 3.1 shows a general absolute increment in the numbers of public health workers from 2007 to It is only the 2008 figures that showed a decline from in 2007 to in However in 2009 the total numbers of staff increased to During the same period, the doctors increased from 667 to 827. Nursing staff decreased by 1069 from 2007 to 2008, but increased substantially in 2009, bringing the total complement to The only cadres that decreased in numbers are Laboratory, Health Promotion and Environmental Health staff. Table 3.1 Health worker/population ratios at national level Occupational categories /Cadres Number HW/ 1000 Population Number HW/ 1000 Population Number HW/ 1000 Population Doctors Nurses Environmental Health Pharmacy Radiography Physiotherapy Nutrition Orthopaedic Oral Health Laboratory Research Officers Health Information Health Promotion Hospital equipment Administration General Programme Managers Top Management TOTAL Source: 2007 & 2008 HR Data from National Health Profile 2008 Report; 2009 data from National HR Returns database 2009 (Data includes MoHCW, Missions and Rural Councils only) Note: See Annex 3 for detailed information on doctors, nurses, pharmacy and laboratory staff 22

21 In addition to professional health workers, the sector also includes community and traditional health workers. According to the 2008 traditional medicine register there are 3,943 registered community/ traditional health workers in Zimbabwe. In addition there are 4,013 Village Health Workers (VHW) in 7 provinces (excluding Matebeleland north) and 149 Primary Care Counsellors (PCC) supported by the European Support Programme (ESP) in 17 districts including Harare City. These PCC numbers exclude those supported by The Global Fund. These c o m m u n i t y health workers, VHWs and PCCs are not formal health workers and as such are not paid by the government but supported by various programmes within MoHCW. The World Health Organization (WHO) recommends that for African countries to meet the MDGs, a population should be covered by a minimum of 2.5 health workers per 1000 population. This staffing norm represents a combination of doctors at 0.2 per 1000 population and nurses and mid-wives at 2.3 per 1000 population. Table 3.2 above shows that only the two city provinces of Bulawayo (3.6 per 1000) and Harare (2.3 per 1000) seem to have HRH staffing close to the above standards. The province w i t h the lowest health worker population ratio is Manicaland at per 1000 population. In addition to professional health workers the sector also includes community and traditional health workers. According to the 2008 traditional medicine register there are 3,943 registered community/ traditional health workers in Zimbabwe. In addition there are 4,013 Village Health Workers (VHW) in 7 provinces (excluding Matabeleland north) and 149 Primary Care Counsellors (PCC) supported by the European Support Programme (ESP) in 17 districts including Harare City. These PCC numbers exclude those supported by The Global Fund. These community health workers, VHWs and PCCs are not formal health workers and as such are not paid by the Government but supported by various programmes within MoHCW. 23

22 4. HRH Production The MoHCW has an established training a n d development unit which is headed by a Senior Human Resources Officer. The operations of the unit are guided by the HRH Strategic Plan and the Human Resources Policy. A review of the operational tools and guidelines provided evidence that the MoHCW coordinates both pre and in-service training programmes. The MoHCW has developed a draft guideline which provides information on the basic requirements for enrolment in each pre-service training programme. The document also h i g h li gh t s the training institutions, training programmes offered, entry requirements, duration, qualification awarded, intakes and the foreign quota allocation. The production, training a n d d e v e l o p m e n t section o f the H R H policy clearly highlights the terms of bonding for government sponsored health workers. The policy s t a t e s that, All categories of staff whose train in g h as been facilitated b y Government may be called upon to offer services to government after qualification. The minimum length of this service will depend on the length of training and qualification obtained. The MoHCW works closely with health p r o f e s s i o n a l councils on standardisation a n d development of curricula for health workers. However it was observed that training institutions highly affected by staff attrition have not been reviewing their curricula due to workload challenges. This situation mainly affected the College of Health Sciences at the University of Zimbabwe who lost close to 80% of its teaching staff. Accreditation of health professionals in Zimbabwe rests with the various professional councils. All foreign trained health workers who wish to practice in Zimbabwe have to go through their respective councils for the accreditation of their qualification. 4.1 Pre-service education Pre service education for health workers in Zimbabwe is delivered through health training institutions under both the Ministry of Higher and Tertiary Education (MoHTE) and the MoHCW. The University of Zimbabwe - College of Health Sciences trains doctors, pharmacists, laboratory scientists, nurses and other professionals at degree and post graduate level. National University of Science and Technology (NUST), Solusi, Africa University, Zimbabwe Open University (ZOU), Women s University in Africa and Masvingo State University also provide degree courses for various health professional programmes. Harare and Bulawayo Polytechnics colleges offer training to pharmacy technicians and environmental health officers. The MoHCW is responsible for providing diploma programmes for MOHCW - run schools of nursing, dental therapy and environmental health technicians. However, the involvement of more than one ministry in the training of health workers needs good coordination between the MoHTE and the MoHCW. This coordination should involve a symbiotic relationship in curricula development, including management of staff (health worker retention schemes), planning and accreditation of health programmes and student outputs. Health workers working at training institutions move between the policies and regulations of the two ministries. Lecturers at the university and the polytechnic colleges are employed by the MoHTE, but are also expected to provide medical services at the University Teaching Hospitals falling under MoHCW. Each ministry is responsible for paying its workers. 24

23 Table 4.1 Number of Training Institutions by type of ownership Type of training institution Type of ownership Total Public Private not Private for for profit, Profitc FBOs Medicine Pharmacy Nursing & Midwifery Laboratory Environnent health Radiology Physiotherapy/ Rehabilitation Dental Technology/ Therapy Dietician/ Food Services Source: MoHCW FBO: Faith based Organization Training schools supported by MoHCW Table 4.1 shows that Zimbabwe has a good number of training schools and programmes offered by the various Universities and colleges with a total annual output of nearly 2,500 health personnel (see Table 4.2). Table 4.2 Number of entrants and graduates by 2010 Number of entrants Cadre Total input Physicians Nurses Midwifery NA Primary Care Nurses BSC HOT Dental Therapy Dental Technicians 10(2005) BSC HPT Pharmacy Technicians Laboratory Technicians Laboratory Scientists BDS HPM Total NA

24 Number of graduates Cadre Physicians Nurses Midwifery Primary Care Nurses Total output BSC HOT Dental Therapy Dental Technicians BSC HPT Pharmacy Technicians Laboratory 23 Technicians Laboratory Scientists BDS HPM Total Source: MOHCW Training Intakes and Graduates data collection Note: N/A = Not Available NB. The consultancy team did not have access to data from all training programmes and institutions. This data is therefore incomplete. Table 4.2 shows that in the last four years the training institutions in Zimbabwe enrolled approximately 7896 health students. Within the same period approximately 10,233 graduates were produced. These figures only recognise trainings done locally within Zimbabwe. The MoHCW has included the post of trainee cadet to its establishment with concurrence of the Ministry of Finance. These trainee cadet positions are applicable to students at MoHCW and MoHTE training institutions. In other words, the trainee cadet positions are a form of guaranteed sponsorship. However the training institutions are responsible for receiving and processing applications for admission for both local and foreign applicants. The capacity to produce health professionals in Zimbabwe was heavily impacted by the economic depression. Health training schools lost many of their teaching staff through international migration. Professional migration led to the closure of some schools. In 2008, the teaching activities in some schools were suspended and for instance some medical student interns left the country to do their practice in foreign countries. The country s only dental technician course was also abandoned due to loss of the only 2 tutors in the school. At the time of carrying out the situation analysis the dental technician programme was still closed. However the Principal Tutor for the Dental College confirmed that they were in the process of recruiting new tutors for the schools. 26

25 4.2 In-service and continuing education The MoHCW recognizes the importance of staff development and skills updates for its staff in its HRH policy. However, in-service and continuing education though beneficial to the health sector in Zimbabwe, has also been viewed as counterproductive by some health managers. The lack of coordination of existing health training programmes leads to a large drain on the time of health professionals, and a loss of control of health facilities over the number of staff attending training at any one time. A standard calendar for in-service training each year might be one way to reduce the negative impact of continuing professional development. 4.3 Health workforce requirements The staff requirements projections were based on the current established posts. The main assumption in projecting them forward was based on maintaining the current staff requirements - population ratios. The population growth rate of 0.7 % was used to project the staffing requirements. The consultants decided to use this simple method but recommend that much more robust methods could be used to query the current staff establishment posts. These projections are not costed or budgeted. However it our hope that when the HRH plan is revised both the staff in-post and projected requirements will be costed and budgeted. Table 4.3 Projections for health workforce requirements for the coming years Cadre Doctors Physiotherapist Med. Laboratory Radiographers Pharmacists/ Tech Nurses Nutritionists Orthopaedic Technician Health Education Environmental

26 5. HRH Utilization 5.1 Recruitment, Deployment and Distribution mechanisms The Zimbabwean health sector provides one of the most diverse local HRH labour markets compared to other countries within the region in the sense that the various employers in the sector apply different strategies to attract and retain their health workers. The MoHCW however provides the most clear and transparent policies on how staff are deployed and distributed throughout the MoHCW structure. Effective June 2005, the Health Services Board (HSB) was established with the sole responsibility of employer of public health workers under the MoHCW. The HSB is a form of health services commission found in some other African countries, but structured such that it reports to the Permanent Secretary of health instead of the Civil Service Commission. The HSB has since developed an Human Resources for Health Policy in order to guide and facilitate the optimum production, training, management and retention of human resources for health in the Zimbabwean public health sector. The HSB has also decentralised its recruitment functions to the lower levels within the MoHCW structures. The HSB has given Provincial Medical Departments authority, in conjunction with their service delivery partners to recruit staff up to the Matron II level. Health institutions have also been given powers to directly recruit staff below the C5 grade. The HSB retains the powers for recruitment of staff from Matron I and above including the appointment of senior directors at MoHCW. Recruitment of all MoHCW staff is based on the staff establishment. However there is a unique feature in the Zimbabwean MoHCW establishment in that it also includes student positions. In other words, the MoHCW provides a stipend to students studying in health programmes both within and outside Zimbabwe. This makes it easy for the MoHCW to plan and estimate the number of expected graduates that would be recruited each year, but makes it imperative that the MoHCW collect accurate figures on intakes and continuing students. In the event that training schools register student numbers that are more than the establishment posts, then the MoHCW considers those as excess to be absorbed by other partners in the health sector. 5.2 The work environment The MoHCW pays its health workers through the Salary Services Bureau (SSB). The SSB maintains the payroll for all health workers working under MoHCW, rural health centres under councils and all mission health facilities. An assessment of the products of the SSB payroll suggests that it is an advanced system that could also function appropriately as a human resources information system for MoHCW. The SSB payroll provides personnel data that includes names, age, gender, province, district, designation, salary grade and allowances for health workers. In spite of these highly developed systems, tools and guidelines, the MoHCW was not spared by the economic depression that affected the country in the last decade. Anecdotal evidence from draft reports seems to suggest that the social sectors, education and health were the most affected by professional migration of teachers and health workers respectively. However, 28

27 Figure below shows that the MoHCW has had an average vacancy rate of over 50% in a selected number of critical cadres such as doctors, laboratory and environmental health staff in the 5 years under review. It is likely that this situation increases workplace stress and burn-out amongst the remaining affected health workers in the MOHCW. The 2009 vacancy rates show a general reduction in the numbers of vacancies in the MOHCW compared in the earlier years under review. Figure 5.2.1: MoHCW Establishment Vacancy Rates Analysis Source: MoHCW 2005, 2006, 2007, 2008 Annual Reports (Cited from the Rapid Assessment on HR requirements and training capacity for the BSS in Zimbabwe) 29

28 Table MOHCW Staff Attrition (Resignations and Retirements 2008 & 2009) Cadres Numbers of Resignations Central Hospitals Provinces National Totals Number of Numbers of Number of Numbers of Retirements Resignations Retirements Resignations Number of Retirements Doctors Physiother apist Med. Laboratory Radiograp hers Pharmacis ts/ Tech Nurse Tutor Sister in Charge RGN/SCN Matron II & III Students Nurses Nurse Aides Nutritionis ts Rehab. Technician JRMO Health Education Lab. Tech s Environme ntal Other Staff Grand Total Source: MOHCW HSB Annual Report 2009 Recognising that the staffing situation in health was worsening, the MoHCW with its remaining cooperating partners implemented an emergency health sector retention scheme in The retention scheme is currently being managed by Crown Agents on behalf of the MoHCW and cooperating partners. The retention scheme first began as an emergency public health sector remuneration scheme for all public health workers under MoHCW, Missions and both urban and rural councils. This was at a time when GoZ could not raise enough resources to pay civil servants; at the peak of the economic depression. The retention scheme was revised in March 2009 to only apply to staff at grades C5 and above. The revision also excluded city health departments and town councils. 30

29 Table The original Emergency Retention Scheme Allowances versus District Pay scales District Level MoHCW Pay Scale MoHCW Pay Scale (Rural Examples of Grades Scales (USD) incentive USD) F+ 700 Principal Directors, CEO Central Hospitals F 500 PMDs, Specialist/consultants, Directors E Dep. Directors, District Medical Officers E4 360 Senior Registrar, Government Medical Officer, Principal Nursing Officer E E2 270 District Nursing officer E D Matron III, JRMO D Malaria and Disease Control Officer D Senior Pharmacist D Environmental Health Officer/Sister in Charge D Principal Radiographer Tutor C RGN, Principal Radiographer C X- ray Operator C PCN, Health Information Assistant C1-C Student Nurse, Trainee Pharmacy Tech B Grades Data Capture Officer, Nurse Aid A Grades Store Hand, Security Officer, and Mortuary Assistant Source: Emergency Short Term Human Resource Retention Policy, 3 December 2008 With the economy improving in 2009, greater stability of health workers has also been observed. Table above shows a reduction in resignations from 3,588 in 2008 to 567 in This represents an 84% reduction in the numbers of health workers resigning in 2009 after the implementation of the retention scheme. However there is evidence that suggests that the salary differential between MoHCW and City Health Councils is leading to a new form of internal migration. The current City Health Council salaries and benefits are reported to be three times the MoHCW ones (inclusive of the retention allowance). Greater harmony between the scales of pay of the MoHCW and CHC would improve the health worker stability in the sector. Despite the recognition of the importance of retention scheme mechanisms the MoHCW is yet to enforce health worker supervision and performance management systems to enhance productivity. The MoHCW reported that they were in the process of implementing a performance management system to work in tandem with the retention scheme mechanisms. 31

30 6. Governance for HRH The governance of health workers in Zimbabwe was transferred from the public service commission in 2005to the Health Services Board, which is responsible for all matters of conditions of service, recruitment, deployment, hiring of staff or providing local incentives to retain health staff in the MoHCW. Other public sector health institutions determine their own conditions of service without any consultation or cooperation with the MoHCW. Each city health department determines their own salaries based on the Urban Councils Act 1995 which restricts the allocation of staff salaries to 30% of council revenue. The private for profit health facilities pay their staff based on their internal remuneration policies. There is currently no official source providing comparative differentials in HR and remuneration policies. 6.1 HRH policies and plans The MoHCW, through the HSB, has developed a Human Resources for Health Strategic Plan in order to operationalise the HRH policy at all levels of the health service delivery system. The HRH strategic plan includes broad strategies on HR planning and financing (HIV/AIDS workplace policies, platforms for strategic partnerships; HRH skills mix requirements; HRIS and planning; HRH Observatory establishment). In addition, the plan has detailed strategies on HRH production, training and development, deployment, retention utilization, management and HRH information and research. The HRH strategic plan expands on the broad objectives of the NHS The development of an HRH country profile is the first step in providing HRH mapping and situation analysis that will guide strategic decisions on HR planning, financing and implementation. 6.2 Policy development, planning and managing for HRH Policy development, planning and management of HRH under MoHCW is mandated to the Health Services Board (HSB) according to the Health Services Act (Chapter 15:16). However the HSB has made significant delegation of responsibilities and functions to local levels. These include recruitment, promotions, and handling of disciplinary cases. These delegatory functions have been made at three different levels, MoHCW HQ, PMDs and DMOs. 6.3 Professional Regulation The HPA is an umbrella organization consisting of seven professional councils; Medical and Dental Practitioners Council; Nurses Council; Pharmacists Council; Environmental Health Practitioners Council; Medical Rehabilitation Practitioners Council; Medical Laboratory and Clinical Scientist Council and the Allied Health Practitioners Council. The ethical conduct of health professionals is regulated by the different councils, which are the registration authorities. They are therefore critical stakeholders in instilling professional discipline, curriculum development, examinations and research. In addition to professional councils some of the critical cadres have registered professional associations. These include the Zimbabwe Medical Doctors Association, Zimbabwe Nurses Association, etc. The professional associations are also critical stakeholders in lobbying for professional development, and participating in bi-partite negotiating fora with government (negotiations for wages and conditions of service). 32

31 6.4 HRH information The management and development of human resources information systems (HRIS) is key to assisting in the planning and rationalisation of HRH decision making processes. The current HR policy recognises the lack of a central sectorwide database. However there are many possible sources for HR information in the health sector. When combined these databases could provide most of the data for a central HRIS database that would also include age, gender, type of employer, urban/rural split, and attrition information. These include: Salary Services Bureau: This mainly contains HR information for government workers, missions, rural district councils and lecturers under the Ministry of Higher and Tertiary Education. MoHCW Establishment Returns: This is a monthly report which covers MoHCW health institutions and diverse set of independent authorities (grant aided institutions and statutory bodies), totalling 17 reporting units. Crown Agents Health Worker Retention scheme payrolls: This database covers MoHCW, missions and rural council employees from grades C5 and above. City Health Departments/Town Council payrolls: These are various payrolls from the different urban councils. Other Government Departments: This includes payrolls for health facilities under the Ministry of Defence, Prisons Services Department, Zimbabwe Republic Police, Ministry of Labour and Social Services (National Social Services Authority NSSA). Private Health Sector payrolls: These are various payrolls from private health facilities working throughout Zimbabwe. Professional Councils: The various professional councils hold registration databases for their respective members. The situation analysis on the HRIS suggests that the public sector currently has the most wellorganized and reported HRH information compared to other sectors. However this information suffers from inconsistent and inadequate reporting. Most of the non-public sector sources of HRH data heavily rely on manual processes and there was no evidence of systematic HR reports. HRH data from the uniformed sources (defense, police and prisons) could not be accessed due to the nature of the institutions in the context of Zimbabwe. An effort to install an HRIS was made in 2008 with funding from EU for MoHCW institutions only. MoHCW installed MySQL (Structured Query Language) at head office, all central hospitals and all provincial offices. District hospitals have remained outside this system. The challenges cited include lack of technical staff to provide systems maintenance when breakdowns occur, tendency of rotating trained staff by institutions and poor communication networks between districts and provinces for data collection. The system is not networked and data entry is incomplete. The HRIS is not linked to the health information system although this remains an ultimate objective. There are no standing reporting requirements for the private sector, other departments with health workforce and NGOs and professional councils feeding into the HRIS. The HRIS therefore remains fragmented. 33

32 6.5 HRH research The area of HRH research remains weak due to lack of funding. The few HRH research activities conducted to date include A Rapid Assessment of HR Requirements and Training Capacity for the Basic Services Sector in Zimbabwe, 2 a recent study on workforce internal migration 3 and a feasibility study on HRH retention 4. The HR Directorate has placed research activities high on the agenda by including a research objective and strategies in the HRH Strategic Plan The list of HRH research topics are yet to be developed through stakeholder consultations. 6.6 Stakeholders in HRH According to the HRH Policy for Zimbabwe the HSB/MoHCW will:- support mechanisms and processes for co-ordination and collaboration with stakeholders (e.g. inter-ministerial committees, Health Professions Authorities, development partners, private sector); clarify the roles of key stakeholders; develop, implement and monitor MoU with relevant organizations and institutions; and strengthen mechanisms for community involvement in prevention, care, treatment and good governance of health services, in line with the Health Sector reforms. INSTITUTIONAL FRAMEWORK SUPPORTING HRH POLICY IMPLEMENTATION HRH Functions and responsibilities are spread over many institutions, facilities and programmes. The HSB and the MoHCW will collaborate with the following institutions to ensure timely financing, implementation and monitoring of this HRH Policy. The implementation, monitoring and review of this Policy require firm collaboration between all stakeholders, among whom many HRH functions and responsibilities are spread. The following Ministries/organisations shall be central to the implementation and success of this HRH Policy: HEALTH SERVICE BOARD The HSB is a statutory body created by an Act of Parliament. It employs all health workers in the Public Sector. It sets and reviews conditions of service and is responsible for recruitment, advancement, promotion, transfer and disciplinary matters. The HSB, together with the MoHCW, will be responsible for policy formulation. The HSB will, from time to time, ensure the success of this Policy through the issuing of the necessary policy guidelines particularly those related to HRH management and development. The HSB will endeavour to ensure that resources for the implementation of this Policy are mobilised, and will also establish a coordinating mechanism to monitor the implementation of this Policy. MINISTRY OF HEALTH AND CHILD WELFARE The MoHCW will ensure the mobilisation of human, material and financial resources for the 2 Authors Ankie van den Broek, Ria van Hoewijk, Vuyelwa T. Sidile-Chitimbire and Maria Mbudzi, (Draft May 2010), A Rapid Assessment of HR Requirements and Training Capacity for the Basic Services Sector in Zimbabwe, Development Policy & Practice 3 Mark Wheeler, (Draft June 2010), Internal Migration, Ministry of Health 4 Feasibility study on the Crown Agents managed Health Worker Retention Scheme 34

33 successful implementation of this Policy, working closely with hospital management boards and PMDs. MINISTRY OF FINANCE The MoF is responsible for setting long-term macro-economic policies and plans. It is also responsible for allocating the financial resources to different expenditure points within the country. Salaries and allowances for health workers are financed by the MoF. The success of this Policy, to a great extent, will depend on the active support of the MoF. MINISTRY OF PUBLIC WORKS The infrastructure in the institutions of MoHCW statutorily belongs to the Ministry of Public Works, which is responsible for the installation and maintenance of the infrastructure. Electricity, water and sewer reticulations and boilers, if not properly maintained, will constitute occupational and health hazards. Functional infrastructure is one of the key motivational factors for HRH. Government buildings will need to receive adequate care and maintenance. The Ministry of Public Works will be engaged to decentralise maintenance and repair of health infrastructure to health institutions, while it remains the supervisory agency for all work. This Ministry will be expected to play a crucial role in ensuring a conducive working environment for HRH. MINISTRY OF NATIONAL HOUSING AND SOCIAL AMENITIES All Government buildings are managed by the Ministry of National Housing and Social Amenities. It is responsible for the construction of Government buildings, including staff quarters. The HSB intends in collaboration with stakeholders to initiate housing schemes for health workers. This Ministry is central to the realisation of this initiative. MINISTRY OF LANDS AND RESETTLEMENT AND MINISTRY OF AGRICULTURE, MECHANISATION AND IRRIGATION DEVELOPMENT The Ministry of Lands and Lands Resettlement and the Ministry of Agriculture, Mechanisation and Irrigation Development is responsible for all State land. The initiative to provide health workers with accommodation, both private and institutional, as well as farming space will require land. These Ministries will be approached by the HSB with a list of its needs. MINISTRY OF HIGHER AND TERTIARY EDUCATION The University of Zimbabwe College of Health Sciences (UZ-CHS), NUST and all Polytechnic colleges fall under the MoHTE. The two universities produce undergraduate and postgraduate medical practitioners. The lecturers play a critical role in the training of vital health workers and the production and development of human resources. There is need to strengthen the partnership between the MoHCW and MoHTE through a co-operation agreement so as to ensure success in the implementation of this Policy. HEALTH PROFESSIONS AUTHORITY AND HEALTH PROFESSIONS COUNCILS The HPA is an umbrella organisation consisting of seven professional councils: Pharmacists Council; Medical Laboratory and Clinical Scientists Council; Medical and Dental Practitioners Council; Nurses Council; Environmental Health Practitioners Council; Medical Rehabilitation Practitioners Council and the Allied Health Practitioners Council. The ethical conduct of Health Professionals is regulated by different councils, which are the registration authorities. They are therefore critical stakeholders in instilling professional discipline, curricula development and research. 35

34 ZIMBABWEAN ASSOCIATION OF CHURCH-RELATED HOSPITALS These health facilities belong to, and are managed by faith-based institutions. The majority of the health workers working in these FBOs are financed through Government grants through the MoHCW. Sixteen hospitals under this Association operate as district referral hospitals. The MoHCW and ZACH will, therefore, review the legal and procedural framework for their collaboration and sign a MoU. INTERNATIONAL AID ORGANIZATIONS AND COOPERATING PARTNERS The MOHCW/HSB works with cooperating partners and AID organizations such as the World Bank, DFID, USAID, European Union, PEPFAR and Global Fund. The international organizations usually bring in both technical and financial assistance into the health sector. HRH TASKFORCE HSB will establish and monitor an HRH Taskforce to co-ordinate the financing, implementation and monitoring of the HRH Policy and Plans. This will be a multi-stakeholder team, with representatives from identified Ministries, Departments, institutions and organizations. The HSB will provide the HRH Taskforce with a clear mandate and budget and a time frame. The Taskforce will meet on a regular basis and report to the HSB on a regular basis. 36

35 Annex 1: Definition of Health workforce Data Health Workforce: Aggregated Data In the aggregated data, the health workforce is grouped into the following 10 categories: Physicians Includes generalists and specialists. Nurses Includes professional nurses, auxiliary nurses, enrolled nurses and other nurses, such as dental nurses and primary care nurses. Midwives Includes professional midwives, auxiliary midwives and enrolled midwives. Traditional birth attendants, who are counted as community health workers, appear elsewhere. Dentists Includes dentists, dental assistants and dental technicians Pharmacists Includes pharmacists, pharmaceutical assistants and pharmaceutical technicians Laboratory workers Includes laboratory scientists, laboratory assistants, laboratory technicians and radiographers. Environment & public health workers Includes environmental and public health officers, sanitarians, hygienists, environmental and public health technicians, district health officers, malaria technicians, meat inspectors, public health supervisors and similar professions. Community health workers Includes traditional medicine practitioners, faith healers, assistant/community health education workers, community health officers, family health workers, lady health visitors, health extension package workers, community midwives, institution-based personal care workers and traditional birth attendants. Other health workers Includes a large number of occupations such as dieticians and nutritionists, medical assistants, occupational therapists, operators of medical and dentistry equipment, optometrists and opticians, physiotherapists, podiatrists, prosthetic/orthetic engineers, psychologists, respiratory therapists, speech pathologists, medical trainees and interns. Health management and support workers Includes general managers, statisticians, lawyers, accountants, medical secretaries, gardeners, computer technicians, ambulance staff, cleaning staff, building and engineering staff, skilled administrative staff and general support staff. 37

36 Annex2: Detailed HRH Stock Data for Critical cadres (Doctors, Nurses, Pharmacy and Laboratory Staff) Occupational category/cadre Total Number Harare Bulawa yo Mat South Mat North Manic a Land Mash Centra l Mash West Midlan ds Masvin go Mash East Establi sh men t Inpo st Rate % Population Doctors % HOD Specialists % Specialist Consultant % EPI Disease Control Officer/PEDCO % Provincial Maternal & Child Health Medical Officer % Medical Superintendent % Senior Registrar % Junior Registrar % District Medical Officer % Senior House Officer % Government Medical Officer/Training posts % Hospital Medical Officer % Senior Resident Medical Officer % Junior Resident Medical Officer % Nursing Staff % Deputy Director, Nurse Training and Administration % Matron 1/Principal Nursing Officer % Provincial Nursing Officer/ Primary Care Coordinator % Principal Tutor(PGH approved ) % 38

37 Occupational category/cadre Total Number Harare Bulawa yo Mat South Mat North Manic a Land Mash Centra l Mash West Midlan ds Masvin go Mash East Establish ment Inpo st Rate % Nurse Training and Administration Officer % Provincial Child Welfare Officer (EPI, IMCI, NPA, OVC) Provincial Reproductive & Mental Health % Officer % District Nursing Officer % Matron 11/allocation Officer % Clinical Officer/Senior/Principal % Matron % Nurse Tutor/Senior/Principal % Sister In Charge/Clinical Instructor % Trainee Midwife % Sister/Senior % State Certified Nurse/ Senior/Principal % Student Nurse & Trainee Primary Care Nurse % Nurse Aides % Primary Care Nurse 2536 NA NA NA NA NA NA NA NA NA NA NA NA Pharmacy Staff % Deputy Director, Pharmacy Logistics & Research % Pharmacy Logistics & Research Officer % Chief Pharmacist % Pharmacist Senior/Principal (Training Officer) % Provincial Pharmacist % Pharmacist Senior/Principal % 39

38 Occupational category/cadre Total Number Harare ulawa yo Mat South Mat North Manic a Land Mash Centra l Mash West Midlan dsmasvin go Mash East stablish ment Inpo st Rate % Pharmacy Technician Senior/Principal % Pharmacy Cadet % Trainee Pharmacy Technician % Dispensary Assistant % Laboratory % TB Reference Laboratory Services Coordinator % Microbiology Reference Lab Service Coordinator % Deputy Director Clinical Laboratory Services % Chief Pathologist % Deputy Chief Pathologist % Specialist Pathologist (Registrar) % Chief Laboratoy Scientist/Technician % Analytical Chemist/Principal % State Certified Medical Laboratory Technician % Medical Laboratory Scientist/Technologist (Snr/Principal) % Laboratory/Technical Assistant % Trainee State Certifed Medical Laboratory Technician % Laboratory Hand % Source: MOHCW HRH Returns Database

39 Table 3.5 Province distribution of health workers per 1000 population Occupational category/cadr Total Number Harare Bulawayo Mat South Mat North Manica Land Mash Central Mash West Midlands Masvingo Mash East Population Doctors Nurses Environmental Health Pharmacy Radiography Physiotherapy Nutrition Orthopaedic Oral Health Laboratory Research Officers Health Information Health Promotion Hospital equipment Administration General Programme Managers Top Management Total Source: MoHCW Staff Returns (2009); NB: The regional distribution excludes Harare, Bulawayo City Health Departments, Town Councils, Uniformed forces and the private sector 41