The cholera outbreak has exposed deficiencies in the country's readiness to respond to emergency disease outbreaks, prompting President Hakainde Hichilema’s government to make emergency hires and falling behind on paying allowances to frontline health workers.
Despite the Ministry of Health’s efforts to implement an emergency response to combat the recent cholera outbreak, which has tragically claimed close to 700 lives since October 2023, the dedicated team of workers at these centres still haven't received their due payments promised to them.
On February 04, 2024, during his visit to the cholera centre at Heroes Stadium in Lusaka, Hichilema pledged to employ all volunteers aiding in the fight against cholera.
However, after two months of dedicated service, healthcare workers find themselves disheartened by the government's failure to fulfill its commitments as outlined in the letter from the Ministry of Health to all provincial health directors.
Dated December 29, 2023, the letter, seen by MakanDay Centre for Investigative Journalism, specifies that meal and transport allowances are to be provided to officers working extended hours at cholera treatment centres across the country.
In the letter, the Permanent Secretary for Administration, Professor Christopher Simoonga, authorised all provincial health directors to provide meal and transport allowances to officers working extended hours at cholera treatment centres.
Volunteers speak out
A volunteer health worker at Heroes Stadium, who opted to remain anonymous due to concerns about potential exclusion from the list of volunteers promised formal employment in the government, informed MakanDay that some workers at Heroes are deeply disappointed with the Ministry's handling of allowance-related matters.
She expressed her dismay upon discovering that both full-time employees and volunteers at the center were expected to sign for K100 per day, which is the standard procedure for all health workers involved. However, MakanDay has discovered that some of them have not signed yet.
“Upon receiving the (voluntary) jobs, many of us were taken aback as we did not anticipate employment, let alone the lack of clarity regarding allowances," she said.
Another nurse at Levy Mwanawasa University Teaching Hospital in Lusaka, who also served at the Levy cholera centre, and chose to remain anonymous for fear of being dismissed, told MakanDay that she, too, expected the Ministry to adhere to the government’s rate of K100 for transport per day and a lunch allowance of K135.
She expressed disappointment at the Ministry's decision to adopt a daily rate of K100, questioning the basis for this discrepancy and adding that they have not even been approached by the Ministry to sign for the same K100, as was the case at Heroes.
“It’s disheartening that despite providing lunch and transportation for health workers during this challenging cholera pandemic, the Ministry has failed to fulfill its promise of motivation. They should have honoured their pledge to support us during this time, just as they provided other forms of assistance," she explained.
At the time of the interview, no one had signed for the K100 at Levy Hospital, but as of Monday, a few individuals had been approached to sign.
On Friday, February 23, 2024, during a press briefing at Heroes Stadium, Minister of Health Sylvia Masebo was unable to offer a conclusive response when questioned by a MakanDay journalist about the discrepancies in allowances.
A Perspective from the HPCZ
The Health Professions Council of Zambia (HPCZ), the health regulatory body, (1) praised President Hichilema for pledging formal employment to volunteers aiding in the cholera pandemic fight.
However, it has been noted that the outbreak exposed the scarcity of healthcare workers, emphasising the critical need for increased recruitment in the health sector.
In an interview with MakanDay, Prof. Goma, the registrar of HPCZ, explained that the cholera pandemic, which affected the country, has underscored the importance of having a comprehensive plan for health workforce development and deployment.
He emphasised that this process is crucial, beginning with training, followed by exit training, and ultimately leading to employment opportunities.
He explained that a significant problem in the healthcare system emerged when the previous (Patriotic Front) government enforced a wage freeze for about two to three years, which had adverse effects on the system.
Prof Goma highlighted Zambia’s significant shortage of health workers, noting that the healthcare deficit was close to 87,000 last year.
He added that the government should actively work towards bridging this gap, emphasising the importance of a structured approach. This includes determining how many doctors, nurses, environmental officers, among others, will be employed each year.
“…the government should ideally advertise job openings, allow individuals to apply for those positions, and conduct interviews to select the most suitable candidates,” he said.
However, he said the current situation suggests that the government is facing financial constraints, which has disrupted the availability of paid posts.
“Efforts to bridge this gap have resulted in circumstances where the government gives a greenlight to workers found in certain places,” he added.
Prof Goma explained that the practice of hiring volunteers poses disadvantages, particularly for individuals from remote rural communities.
“For instance, those who undergo training may return to their villages, where opportunities to volunteer are scarce, consequently, they may not be present in the centres where volunteers are typically recruited, leading to biases in employment opportunities,” he observed.
“I don’t think as HPCZ we will be looking forward to seeing more of that but we would like to see more recruitments done mostly in primary care facilities were health workers are encouraged to apply in their districts this is the more equitable way of getting more health workforce into play.”
Prof. Goma urged the government to broaden the scope of volunteer employment, covering not just those serving at cholera centres but also individuals offering their services as volunteers across all health facilities.
He also emphasised the need for the government to expedite its regular employment procedures to effectively address the shortage of healthcare workers.
“Instead of the current annual rate of 4,500 health workers, the government should aim to employ close to 15,000 annually,” he said. “This accelerated effort could potentially eliminate the existing deficit of 87,000 healthcare workers within the next five to six years, ensuring that all positions in the health sector are filled.”
He also stressed the importance for the Ministry of Health to be consulting HPCZ during the recruitment process adding that one of the requirements for applicants is to present a valid practicing license from the HPCZ, as these licenses are issued by them to avoid candidates presenting fraudulent HPCZ licenses during interviews.
“When it comes to interviews, we are supposed to be present to authenticate the copies of certificates that the candidates bring. However, in the last two recruitment periods, HPCZ has not been invited for the interviews,” he said.
MakanDay has further established that the absence of HPCZ during employment interviews has resulted in instances of improper recruitment, with individuals holding fraudulent qualifications being offered jobs. Some of these individuals have already been removed from the system, while others are still under police investigation.
1. The HPCZ is a statutory regulatory body established under the Health Professions Act No. 24 of 2009 of the Laws of Zambia. The functions of HPCZ as enshrined in the Act are as follows;
- Registration of health practitioners and regulation of their professional conduct (except for nurses who are registered and regulated under another Act);
- Licensing and regulation of all health facilities;
- Accreditation of healthcare services provided by health facilities; and the
- Recognition and approval of training programmes for health practitioners.
