Overview

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This study will be conducted within South Africa and Zambia as we seek to cover, however crudely, the spectrum of health systems in southern Africa, in terms of capacity, infrastructure and reach. Simply put, Zambia represents one extreme of limited capacity and means. South Africa represents relatively abundant capacity and means.

The research does not presume that South Africa's health-care capacity functions better than in the other countries. Rather, the expectation is that comparative research will reveal particular local political, economic and social contexts that hinder and stimulate effective responses to the extraordinary demands on health-care personnel. The spectrum framework is simply a practical means to establish a foundation for comparative research.

The aim of the research is to describe current trends in "salaries and benefits" of health-care workers across different domains in South Africa and Zambia and the mechanisms through which these are effected, and to make recommendations for strategies to promote positive impacts and mitigate or prevent negative outcomes. The study focuses on salaries, analysing a wide range of data to provide an assessment of determinants of salary packages. The purpose is to provide baseline empirical information for strategic review of the problem. An initial pilot study will be completed by March 2008.

The objectives of the work are:

• To describe the health-worker "salaries and benefits" across cadres, within different domains and in the four nominated countries
• To describe: the macro-economic and fiscal determinants, political factors, public sector reforms and policies affecting the civil service; government decisions about budget allocations; the pattern of health care financing in the four countries
• To describe the impact of "salaries and benefits" on availability, deployment, morale and degree of stigma in personnel across health systems.

In Africa, 1.3% of the world's health workers contend with 25% of the global disease burden (World Health Organization 3x5 Report, 2005). In 2004, 38 countries in sub-Saharan Africa (SSA) fell short of the WHO minimum standard of 20 physicians per 100 000 population; 13 of these countries had five or fewer physicians per 100 000 population. Seventeen SSA countries had fewer than 50 nurses per 100 000 population, whereas the WHO standard is 100:100 000. (Physicians for Human Rights, 2004).

This situation is due partly to the migration of individuals to better paid jobs in developed countries. For instance, the number of nurses in the UK from non-EU countries grew from approximately 2 000 in 1994 -1995, to more than 15 000 in 2001 - 2002 (Hamilton et al, 2004). African countries are a source of such professionals. For instance, in 2002 it was estimated that 5 000 doctors emigrated from South Africa. Zambia's public sector retained only 50 of the 600 physicians who had been trained in the country from approximately 1978 to 1999 (Physicians for Human Rights, 2004).

Finding appropriate solutions to this problem is the critical challenge. Improving salaries may be an answer, but there is no solid information on conditions and salaries that can serve as a foundation to guide changes in national policies and plans. Furthermore, the situation is complex, and not simply one of disparities between "developed" and "developing" countries.

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