Health Workers in Zambia

To watch the IGC’s film, Health Workers in Zambia, click here.

How do you improve the recruitment, retention and performance of community health workers in rural Zambia? A new film by the International Growth Centre, based at LSE, shows how economists and policymakers can collaborate to provide answers to questions like these.

Zambia is facing a shortage of health professionals, particularly in rural areas where few people with the right skills want to work. Since training enough doctors would take decades, Zambia’s Ministry of Health decided to address the problem by investing in recruiting and training more community health workers from rural areas.

However, policymakers at the Ministry of Health were ill equipped to undertake the research that could guide their strategy.

In the film Victor Mukonka, former Head of Policy Development in the Zambian Ministry of Health, explains the questions they asked while thinking about recruiting the right people: “Are we looking at recruiting a community health worker who is part of and committed to the community? Or are we looking at a health professional who wants to progress to become a nurse, environmental health technician, clinic officer or a doctor?”

Economists from the International Growth Centre collaborated with the Ministry of Health to design research which would test different recruitment strategies. Practitioners, policymakers and academics worked together to generate questions that would be of real scientific interest and have an important policy impact.

In a campaign covering 160 villages, half were targeted with posters which emphasised becoming a community health worker to help the community. The other half was given posters which emphasised building a career in the Ministry of Health.

The researchers followed applicants through selection and training and into their first roles in the field. They found that the applicants who replied to the ‘career’ poster were likely to be more highly qualified. Also, when the successful applicants from this group took up their roles in the field they visited 20 per cent more households while spending the same amount of time with them as those who had responded to the ‘community’ poster. They also organised 50 per cent more community meetings, addressing issues such as vaccination and HIV testing.

One of the researchers Oriana Bandiera, Professor of Economics at LSE, says: “These findings show that giving people a career goal and a professional opportunity does not come at the expense of their pro-social motivation.

“We can take many lessons from this research and apply it to recruitment for public service in general, not just in Zambia or in the health sector.”

Zambia’s Ministry of Health has since scaled up its training of community health workers by opening another centre which trains people from every district in the country.