Effects of Voluntary Separation Package on the Health Workforce in Zambia

In 1993 the Public Sector Reform Project (PSRP) was initiated in Zambia as a result of a growing need for a Public Sector Reform. The aim was to make the public sector affordable and to improve its performance. One of the strategies included in the PSRP was the Voluntary Separation Package (VSP). The VSP was a separation package, which gave the employee three times his or her annual salary for being separated from the government payroll for a minimum period of five years. The VSP was open to all civil servants in all ministries and the administration of the program was delegated to the different line ministries. More than 3600 employees were retrenched during the years the VSP program was on in the late 90s. About 1500 came from the health sector. A majority of these were nurses and paramedical staff. Anecdotal evidence point to the fact that migration overseas of health workers increased during the time of implementation of the VSP. The number of nurses leaving Zambia shows a dramatic increase during these years, and has since then stayed at a higher level. Whether the surging migration of nurses in the late 90s was an effect of the VSP or not, is not clear. But the increase in migration at this time could very well be an effect of the financial opportunities the VSP provided individuals with. The hypothesis in this study is that the financial package provided through the VSP made it possible for a number of individuals to migrate overseas and look for a new employment. These individuals obviously kept in touch with their colleagues in Zambia acting as "officers of marketing" for overseas employment, which would explain the continuously high level of migration of nurses since the implementation of the VSP. If the hypothesis proves to be correct it means that financial incentives should be implemented with great caution, especially since the migration patterns has changed since the implementation of the VSP. Financial incentives such as salary top up could, given the situation, have an adverse effect on the retention of staff in Zambia. Instead of retaining staff in the sector and the country as intended, financial incentives could provide individuals with the opportunity to leave the country and work overseas. It is therefore important to establish the reasons for the increase in migration of health workers in Zambia during the late 90s and its links to the VSP in order to be able to design appropriate retention schemes for the health workforce in Zambia. Expected outcome: The objectives of the study are to analyse and document the effects of the VSP package as a financial incentive on migration behaviour in the health workforce in Zambia. The study will provide important information to the understanding of reasons for migration and the potential risks of financial incentives. The study should give guidance as to how financial incentive packages should be designed in order to retain health staff in the sector and in the country.