Priority Setting in Planning for Recruitment and Allocation of Healthcare Workers at National and District Level in Zambia

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Abstract Background Priority setting has widely been used in healthcare systems to justify allocation of limited resources such as health services against a huge demand. Zambia, a low-income country is faced with a critical shortage of health workers whose distribution is skewed towards urban areas. This affects effective health service delivery and creates a gap in skills mix. This study therefore sought to explore the priority setting process and its fairness in the planning for recruitment and distribution of health workers in Zambia. Methods This was a qualitative study that collected data using two methods; a document review of national health documents, and interviews (n = 20) with district level officers who took part in human resource meetings and decisions. The accountability for reasonableness (AFR) framework was also used to explore fairness and transparency in the processes. Data was analyzed thematically. Results The district level management felt they had limited participation in decision making regarding recruitment and distribution of human resources for health. They felt excluded because most decisions for human resources for health were made at national level. The national level used district vacancies to recruit workers who would later be transferred to other places which perpetuated shortages in the rural districts. Decentralization would help districts have more context-based decisions relating to the human resource challenges they face. Meeting the A4R framework conditions of fairness, transparency and accountability in priority setting proved a challenge as there were mixed feelings from participants in each condition. As a result, fairness and transparency could not be easily determined. The document review highlighted that despite the various strategies put in place to improve transparency, accountability, there continues to be a misalignment between national and district HRH recruitment and distribution. Conclusion Human resource for health challenges call for more strategies to improve financing for workers, strengthen private sector partnerships and exercise a decentralized approach in order for districts to make human resource decisions that are more relevant to the districts themselves. This will help improve the priority setting process as well as mitigate challenges of mal-distribution.

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