Training More, Employing Less: The Parlous State of Zambia’s Medical Sector
Dr Kelvin Shaba
The Republic of Zambia, a landlocked nation in the heart of Africa, richly endowed with natural resources and breathtaking landscapes, paradoxically finds itself grappling with the underemployment of its trained medical professionals. Despite a persistently low doctor-patient ratio and a significant gap in healthcare provision, the country struggles to absorb the very individuals equipped to address these challenges.
Zambia’s doctor-patient ratio currently stands at a concerning 1 to 12,000, far below the World Health Organization’s recommended ratio of 1 to 5,000. The government of the Republic of Zambia has undertaken efforts to employ healthcare workers. Recent initiatives include the recruitment of 4,140 healthcare workers, among whom 391 were medical doctors. This followed an earlier employment drive of 11,000 healthcare workers, with approximately 400 medical doctors included. Regrettably, while significant, these efforts fall considerably short of meeting the country’s substantial demand, especially considering the considerable number of medical doctors graduating annually from both public and private institutions.
The current number of unemployed medical doctors stands at over 1,500, with over 800 more expected to graduate by the end of year. At this alarming rate, we can anticipate having at least 4,000 unemployed medical doctor graduates by the end of 2027. The critical question that lingers is: what concrete measures is the government implementing to address this massive disequilibrium between the production and system uptake of qualified medical professionals? The future trajectory of the medical profession in Zambia remains disconcertingly unclear. We cannot afford to ignore the fact that if this trend continues unabated, the problem will escalate beyond manageable proportions.
As wisdom reminds us, “fix the leak, not the floorboards.” We cannot attempt to solve one problem (the doctor-patient ratio) while inadvertently creating an even larger one (mass unemployment of medical professionals). Our focus must shift towards addressing the root causes of this issue rather than merely treating the superficial symptoms. The large number of medical graduates without a corresponding capacity for their employment is unsustainable and counterproductive. It is profoundly disheartening to consider individuals dedicating at least six years to rigorous medical training, only to return to society facing unemployment and a bleak job outlook. It is crucial to recognize that in Zambia, the government remains the overwhelmingly dominant employer of medical doctor graduates (>99%), with the private sector absorbing less than 1%. This reality underscores the heavy reliance of new medical graduates on government policies and employment opportunities.
This predicament extends beyond medical doctors, affecting all allied health professions, including nurses, clinical officers, medical licentiates, physiotherapists, and others. There appears to be a lack of a clear and comprehensive plan from those in leadership positions to effectively overcome this multifaceted challenge. The future implications of this continued overproduction coupled with limited employment are concerning. We risk a surge in corruption as thousands of qualified professionals are forced to compete fiercely for a dwindling number of positions. Employment may increasingly become a matter of social connections rather than merit – a system where only the children of the elite, and those who “know someone” with influence, are able to secure jobs. This is a devastating prospect for the determined individual from a humble background whose only leverage is hard work and dedication, and for the impoverished family who invested everything in their bright child’s education.
Is this the kind of nation we aspire to build– one characterized by poorly organized systems lacking respect for merit, and where existing systems disproportionately favor a select few?
Kelvin Shaba
Medical Doctor
