PRESENTED TO THE NATIONAL ASSEMBLY
BY HON. SYLVIA T. MASEBO, MP
MINISTER OF HEALTH
November, 2023
Madam Speaker,
First and foremost, I would like to express my gratitude for according me this opportunity to update the nation through this August House on the status of the 2023 net recruitment of 3,000 Health workers countrywide.
Madam speaker,
The vision of Government in the health sector is “A nation of healthy and productive people.” To attain this vision, it implies that Government working closely with key stakeholders should put in place a robust an
d resilient health system that will facilitate the attainment of national targets, global sustainable Development Goal (SDG) and Universal Health Coverage, Leaving No One Behind.
Madam Speaker,
I am pleased to inform the House that the New Dawn Government has demonstrated its commitment to strengthening the health system through the increased annual budgetary allocation to the Ministry of Health. The House may wish to recall that the budget allocation to the health sector has i
ncreased over the past three years from K9.2 billion in 2021 to K12.4 billion in 2022 and now K16.1 billion in 2023. The increased budgetary allocation is necessary in order to address the challenges such as unstable supply chain, obsolete medical equipment, inadequate infrastructure and inadequate staffing levels.
Madam Speaker,
The House may wish to note that over time, we have made notable progress in terms of construction of health infrastructure as a country. Currently there are a total of 3,581health facilities across the country of which 3, 419 are GRZ and 162 are faith based. The House may further wish to note that not all these health facilities are operating at full capacity. Most of them are operating at different levels of service delivery. These health facilities include specialised hospitals, tertiary hospitals, second level hospitals, first level hospitals, health centers and health posts. The failure to operate at full capacity has been attributed to the limited fiscal space that has resulted in the number of positions not being funded over long periods from the time the organization structures were approved by Cabinet Office. I wish to reiterate that, the investment in health infrastructure has been informed by a number of factors that include; population growth and the changing disease patterns.
Madam Speaker, while appreciating the increased number of health facilities which aim at promoting access to quality health care as close to the family as possible, the shortage of healthcare workers in these facilities continues to be a concern for government as it counters government efforts to attain the desired health goals.
Madam Speaker,
A competent and adequate health work force is the nerve centre of every resilient health system and is key to achieving universal health coverage. However, there are a number of health workforce challenges that include but not limited to the following:
- critical shortages in the supply of health workers;
- an inadequate mix of skills in the workforce;
- inequitable geographical distribution of health workers; and
- gaps in their competencies, motivation and performance.
Addressing these major health work force challenges is therefore crucial to strengthening the healthcare system and building a robust health system that is resilient to disease outbreaks and other public health emergencies.
Madam speaker,
Currently, there are a total number of 3,581 approved health facilities across the country representing an establishment of 139,590 positions, out of which 72, 697 positions are filled. This accounts for 52% filled up positions while 64,276 remain unfunded representing 48%. These facilities include grant aided institutions (faith based).
Madam Speaker,
As at 30th September, 2023 the construction of an additional 233 new health facilities had been completed. These additional facilities will result in the creation of a total of 7,276 additional positions to be operationalized and this will result in an increase in the establishment from the current 139,590 to 146,866 and further increasing a staffing shortfall from 64,276 to 74,187. Therefore, in order for the Ministry of Health to reach 100% staffing capacity, it shall require a total of seven billion six hundred and forty-eight million four hundred and eighty thousand six hundred and fifty-one Kwacha ninety Ngwee (K7, 648, 480, 651.90) per annum to operationalise the 74,187 positions.
Madam Speaker,
The House may wish to recall that, during the Official Opening of the Third Session of the Thirteenth National Assembly on Friday, 8th September, 2023, His Excellency Mr. Hakainde Hichilema the President of the Republic of Zambia pronounced and assured the nation that, the recruitment of 3, 000 health workers will be undertaken as budgeted for in the 2023 budget estimates. This is a build-up on the landmark recruitment of over eleven thousand (11,000) health workers in 2022. Following the Presidential Pronouncement, the Ministry of Health working closely with key stakeholders commenced the process to ensure that the 3,000 health workers are recruited in a transparent manner and are equitably distributed across the country.
Madam Speaker,
In order to be inclusive and transparent in the 2023 net recruitment, Government through Ministry of Health has consulted with key stakeholders in the sector so as to build consensus on the mode and criteria to be used in the recruitment process. This approach involved:
- Receiving submissions from Provincial Health Offices and health facilities on the priority areas to be considered;
- Meeting with the Public Service Management Division, Ministry of Finance and Civil Service Commission to discuss the recruitment process; and
- Holding consultative meetings with the following professions associations: (a) Zambia Medical Association; (b) Biomedical Association of Zambia (c)Zambia Institute of Environmental Health; (d) Pharmaceutical Society of Zambia; (e)Zambia Union of Nurses Organisation; (f)Midwifery Association of Zambia (g)Clinical Association of Zambia; (h) Resident Doctors Association; (i)Nutrition Association of Zambia; (i)Radiological Association of Zambia; (k)Zambia Society of Physiotherapists; and (l) Zambia Dental Association.
Madam Speaker,
Following the consultations, stakeholders resolved to take a two-fold approach to the recruitment which the Ministry would start with:
- promotion of In-service staff; and followed by
- recruitment of new entrants thereafter.
- Promotion of In-Service Staff
Madam Speaker, this House may wish to note that the past recruitments had always focused on new entrants. This has created stagnation in career progression among most health workers and in some cases contributed to demotivation and poor performance among health workers who remained in same positions for a long time and also those that have been assigned administrative roles in higher positions without receiving commensurate pay.
Therefore, starting with processing promotions for in-service health workers, will not only result in the creation of vacant positions for the new entrants but most importantly, this will motivate the staff who have held same positions for a long time and will allow for optimal performance while at the same time strengthening retention system in the health sector. The transfer by cadre and cascade effect are as follows:
| Transfers by Cadre and cascade effect | |||
| Cadre | TA PIDs | Cascade | Grand Total |
| Administration | 29 | 26 | 55 |
| Audiology | 1 | 1 | |
| Clinical Officer | 321 | 38 | 359 |
| Dental | 13 | 1 | 14 |
| Environmental Health | 24 | 5 | 29 |
| Laboratory | 47 | 26 | 73 |
| Medical Doctor | 253 | 58 | 311 |
| Midwife | 560 | 35 | 595 |
| Nurse | 267 | 343 | 610 |
| Nutrition | 20 | 2 | 22 |
| Orthopeadics | 1 | 1 | |
| Pharmacy | 102 | 30 | 132 |
| Physiotherapy | 24 | 21 | 45 |
| Radiology | 19 | 10 | 29 |
| Teaching | 115 | 33 | 148 |
| Grand Total | 1,796 | 628 | 2,424 |
Madam Speaker,
In line with the National Decentralisation Policy, the promotions of in-service staff will be conducted through the respective Health Facilities District Health Offices, and Provincial Health Offices.
- Recruitment of new entrants
Madam Speaker,
The recruitment of the new entrants will be conducted to fill up the created positions following the promotions. In order to ensure transparency in the recruitment process, the recruitment of new entrants has been decentralised to the district and provincial levels. To this effect, the Civil Service Commission has advertised for the recruitment of 3,000 health workers as per the Conveyance of Treasury Authority No. 7 of 2023 dated 27th September, 2023.
You may wish to note Madam Speaker that, the closing date for receiving applications was Friday, 22nd September, 2023.
Madam Speaker,
The received applications will be screened through a transparent and accountable process as follows:
Firstly, the Human Resource Sub-Committees at District Level will shortlist and select candidates based on a prescribed criterion.
Secondly, the selected candidates will be validated at provincial level by the Human Resource Management Committees.
Thirdly. the selected candidates at provincial level will further be validated for quality assurance by the National Technical Committee comprising officials from the Civil Service Commission, Public Service Management Division and Ministry of Health before the publication of the successful list of candidates in the print media.
Madam Speaker,
Some key activities such as granting of Treasury Authority by Public Service Management Division, advertising for the recruitment of 3000 health workers by the Civil Service Commission and receiving of applications by Provincial and District Health Offices have been implemented. The process of promotions and transfers of in-service staff has reached an advanced stage in that Ministry of Health has completed the exercise and forwarded to Civil Service Commission for finalisation.
Madam Speaker,
The roadmap for the remaining key activities is as follows:
- Screening, shortlisting and selection of applicants by the Human Resource Management Committee and Human Resource Management Sub-Committee is expected to be completed in the month of November, 2023;
- Recommendations of selected candidates to Human Resource Management Committee by the Human Resource Management Sub-Committee is expected to be undertaken in the month of November, 2023;
- Validation and recommendations of selected candidates by the Human Resource Management Committee is expected to be completed by in the month of November, 2023;
- Validation and processing of the recommendations of successful candidates by the Civil Service Commission, Public Service Management Division and Ministry of Health is expected to be completed in the month of November, 2023;
- Publication of successful candidates in the print media, website, Zambia National Broadcasting Corporation (ZNBC) and Community Radio Station is expected to be undertaken the first week of December, 2023; and
- Issuance of appointment letters to successful candidates by Public Service Management Division, Provincial Health and District Health Offices is expected to be done in the first week of December, 2023.
Madam Speaker,
As indicated earlier, the 2023 recruitment of health workers is being implemented in two phases starting with the promotion of in – service staff and followed by the recruitment of new entrants. In order to ensure that suitable candidates are promoted and recruited, the Civil Service Commission has since directed that the recruitment process for health workers be halted until further notice. In addition, the Commission has directed the Provincial Administration to ensure that, in the meantime, the application documents are maintained at the Districts to be submitted to the Province t the opportune time.
Madam Speaker,
I wish to conclude by saying that while the Ministry is operating at 52 percent filled up positions in the current establishment, the recruitment of health workers is a continuous process towards attaining an ideal situation.
In order to match up the skilled-staff to patient ratio, my Ministry will continue to lobby for Treasury Authority in order to attaining staffing sufficiency for improved quality health service provision and for better health outcomes and ultimate national productivity.
Madam Speaker, I thank you.