|Author(s)||Klaus Thieme1, Martina Weber2.
|Affiliation(s)||1SolidarMed Zambia, SolidarMed Zambia, Chongwe, Zambia, 2Zambia, Solidarmed Zambia, Chongwe, Zambia.|
|Country - ies of focus||Zambia|
|Relevant to the conference tracks||Health Workforce|
|Summary||The SolidarMed pilot project Staff houses and income generation for rural hospitals in Zambia started in 2013. The project targets improved attraction, recruitment and retention of rural health workers and focuses on the staff’s accommodation problem at rural hospitals. The innovative feature is that the staff houses are not handed over to the hospitals. They are rented out in the context of the Zambian housing allowance, so the rental income can be used for maintenance of the houses and further hospital improvements. While the state maintains the obligation to pay for housing, rural staff are familiarized with paying rent.|
|What challenges does your project address and why is it of importance?||Zambia like many other low income countries in the region faces considerable challenges in terms of providing sufficient human resources for health. Especially rural hospitals show a drastic gap between the planned establishment of medical staff and the actual staffing situation. One of the problems of the hospitals is that they cannot offer adequate staff accommodation to the required staff. Even the already placed staff lack adequate accommodation, meaning that hospital staff and their families often need to share small and sometimes run down houses meant for only one family. Funding of hospitals and salary payment is centralized by the Ministry of Health – but the governmental monthly grants for hospitals are so low that they hardly cover the running costs. There are no funds left to renovate the existing houses or build new ones. Accommodation for rent is not available in the rural areas.
Following the WHO Global Policy Recommendations (2010) where “increasing access to health workers in remote and rural areas through improved retention” the project perceives accommodation as a fundamental aspect of living conditions, so implemented a public benefit housing cooperative for medical staff.
|How have you addressed these challenges? Do you see a solution?||Staff without hospital-offered accommodation receive a housing allowance as a part of their salary. Ironically there is no possibility for renting accommodation in most rural areas. Existing staff houses are too few and oftentimes rundown. Additionally the Ministry of Health only sends new staff if enough accommodation is secured. In this way a bad accommodation situation will contribute to a bad staffing situation at the hospitals, and in turn reduces the availability of medical services in the rural areas.
A preliminary case-study of the impact of investment in constructing and renting out staff houses in the rural areas was done in 2012. The target was to study the feasibility of an impact investment in constructing and renting out staff houses in rural Zambia. The case study included a market analysis and undertook research on land acquisition, building processes, costs of construction in rural Zambia and issues of management and administration, maintenance and investment terms. Profitable construction and renting out of staff houses is not possible in the rural areas because of high construction costs and low return-assumption. The difficulty of regaining the invested money within a decent time period is a clear obstacle for involving private initiatives in constructing staff houses and renting them out for profit. In this context, donor funding offers an alternative for channeling large-scale private capital for social benefit.
The SolidarMed pilot project “Staff houses and income generation for rural hospitals in Zambia” is addressing this problem with an innovative approach. New staff houses are built and rented out in a cost-effective way at different rural hospital sites by a private public benefit cooperative.
The rentals will be collected by deduction codes at the Ministry level to secure reliable and regular payments. Hitherto deduction codes were used for back-payments of loans only, but for this project were innovatively utilized for rent collection. The rental income will be used for the maintenance of the project houses and the expected surplus will be used for further hospital development. In this way, the hospitals will be supplied with needed staff houses, will attract additional staff, better retain existing staff, and raise their monthly income. Communication and advocacy with all district and ministerial health administration levels are ensured throughout all processes.
|How do you know whether you have made a difference?||The pilot started 2013 with a proof of concept with three semi-detached duplex houses at one rural construction site. Depending on the further success of fundraising, the aspired target would be the construction and renting out of 26 duplex houses within a timeframe of three and a half years.
Constructing and renting out staff houses addresses one of the most urgent problems of the rural health system as it possibly solves the lack of medical staff. With the availability of adequate accommodation, existing staff can be retained and new staff could be attracted to the rural areas. With satisfying and sufficient room for retreat and recreation, job satisfaction and performance are likely to rise for employees.
Satisfied staff are less absent due to illnesses and perform better services. Additionally, if new staff are attracted by staff houses, and existing staff are more motivated to remain at the hospital, the health services at the hospital will improve.
Rent at the amount of the housing allowance will be collected by deduction code at Ministry level to secure reliable and regular payments. The income will primarily be used for maintenance and renovation of the houses and the residue will be used for further hospital development. Given how small the governmental grants for hospitals are, the additional income for the hospitals are needed for equipment acquisition as well as for renovation works. This will reduce the dependency on the governmental funding and raise the scope for the hospital management as well.
The local communities can be involved in a large scale by using local workmanship and local suppliers for construction materials. Construction works will trickle down income to the communities, particularly if not underdone by companies from the urbanized centers of Zambia or even by the often used Chinese contractors. By engaging local craftsmen work and construction skills will be enhanced and self-esteem of the local workers can be raised.
The project offers further learning oportunities for the project partners in Zambia. For the hospitals the pilot will offer insights in construction and management of staff houses as a private corporation. The project with its new approach of supporting hospitals through the attraction of additional staff houses as well as rental income is in line with the Zambian Ministry of Health’s new policy of the proliferation of private-public-partnerships.
|Have you or the project mobilized others and if so, who, why and how?||Direct partners of the pilot project are the Hospital Management Teams of Chongwe District Hospital, Sacred Heart Mission Hospital Katondwe and St. Luke`s Mission Hospital Mpanshya, all in Lusaka province in Zambia.
As a pilot, this project attracts high interest at all levels: from traditional authorities, health facilities, district health administration and ministerial level likewise. The Ministry of Health, the Ministry of Community Development and Mother & Child Health and the Ministry of Finance are involved and show support in all processes because of the well-known problem of lacking accommodation in rural areas for all state workers.
Other institutional players (NGOs) have started to copy the pilot already. In future, especially the now proven and executable possibility of obtaining deduction codes at ministry level, will most probably attract private-for-profit investors.
|When your donor funding runs out how will your idea continue to live?||The housing cooperative is self-financed at the moment when the first accommodation units are ready for occupancy and to commence rent collection, therefore it is sustainable. Because of the executable deduction code only low administration effort is needed in terms of rent collection. Through the involvement of the housing committees of the respective hospitals and the collected rent income, maintenance is ensured. The extension of the housing cooperative with respect to new participating hospitals and / or more houses at this stage is not predictable but possible. But a Zambian-wide cooperative is not the focus rather the main output idea is the “proof of concept” and the its widespread emulation.|