Moves to stem the medical skills exodus

A critical shortage of medical staff in Zambia is compromising the quality of public healthcare as doctors and nurses continue to leave the country in search of more lucrative employment. Zambia has about 10,000 registered nurses for a population of around 10 million, according to statistics released by the health ministry in 2004. "Without any strategy the health sector will continuously face a shortage of nursing manpower," said Zambia Nurses Association (ZNA) board member Beatrice Zulu. Poor working conditions and meagre salaries are seen as the main push factors behind the country's medical brain drain. A recent study by the UN Population Fund found that at the University Teaching Hospital (UTH), the country's largest referral hospital, only one nurse is assigned to each ward. "Britain, South Africa and Australia are currently large drawers of Zambian nurses, who are well trained but unable to make ends meet at home. For this reason, nurse-aides are becoming more widely used, a situation that is an understandable 'stop-gap' measure, but undoubtedly not a long-term solution," the report noted. Catherine Zimba, a Zambian nurse working in the United Kingdom told IRIN: "Nurses come here primarily for money. Here we are respected - but back home, when people see a nurse, they see poverty." Zimba worked as a psychiatric nurse in Zambia's public health system for 12 years before leaving for Britain in 2002. "In hospitals back home we run out of drugs, equipment and simple IV (intravenous) fluids," she added. Zimba said there were also greater opportunities for further training in the UK. "Here we are encouraged by our employers to study, but back home it is a struggle; in Zambia, the same people attend workshops - here they advertise these things and it is up to an individual to apply." Erick Ndhlovu, a male nurse working in Britain, said the financial reward has been worth the move. "You can't blame anybody who leaves the country because the money is so meagre that one cannot even dream of buying property, or providing a decent quality life for the family. The morale at work didn't help, because a patient would die in your care because of the lack of basic facilities," he commented. Zulu said another consequence of the exodus was that nurses who remained in Zambia had their workload doubled. Earlier this year the government set aside 32 billion Zambian kwacha (around US $7 million) as part of an incentive package aimed at retaining medical doctors. "Our desire is to provide basic requirements for the doctors, and indirectly it will stem the brain drain," Minister of Health Brian Chituwo told IRIN. "We started with doctors, but we realise that a doctor does not work in isolation; it is an ongoing process, so the nurses and other health personnel are not forgotten," Chituwo said. Other efforts include upgrading hospital equipment to improve working conditions.