Local brain drain – Correlates of nursing shortages in rural Zambia

Introduction

In Zambia, nurses provide about 60% of primary health services. The critical shortage of nurses in Africa is well documented but few studies have investigated facility nursing shortages and reasons why nurses leave. In this study we investigated reasons for loss of health care workers in two rural districts of Zambia over a two year period – 2007 and 2008.

Background

Our study focused on two rural districts which are located in southern Zambia - Kalomo district (180 000 population and 45 nurses) and Kazungula (80 000 population and 26 nurses).

Methodology

We interviewed hospital administrators to find out the number of nurses in the district at baseline (January 2007), and at the end of 2007 and 2008. We also found out how many new nurses were recruited each year. Then find out why the nurses left the hospitals and where the nurses went.

Results

The nurse-to-population ratio was 1 to 3500 (in the U.S it's 1 to 100) and the patient-to-nurse ratio was 1 to 40 (U.S it is about1:4). Overall, the two districts lost an average of 20% of its staff with 90 years of combined experience. For every person that was lost 1 new person was hired resulting in a net experience loss was 20 years of experience per year. Death accounted for 40% of the loss while retirement accounted for 1% of the loss and 60% change of jobs. One nurse commented that, “we are losing more than we are gaining”. The commonly reported destination of the nurses that left included, private practice (2%); none profit international organization 40%; 18% urban hospital and 40% died. Another administrator decried, “Private organizations are stealing away personnel from government hospitals”.

Conclusion

These results show that death and intra (not international) migration are the main cause of nursing shortages in rural Zambia. There is need to engage private organizations, including PEPFAR, into developing systems that limit the "stealing" of nurses from government hospitals upon which the majority of Zambian depend. Further studies are needed to examine the effect of nursing shortages on quality and outcomes of care.