Hospital reform in Zambia

As part of its health reform programme, the Zambian government has made second and third-level hospitals autonomous, with the aim of improving the quality and efficiency of hospital services, and of encouraging hospitals to develop fee-paying services to generate additional revenue for the hospital sector. However, the extent to which it is possible to generate additional revenue depends on the demand for hospital services when they are priced at full cost-recovery levels. There is also concern that autonomous hospitals may pursue revenue generation at the expense of access for those who cannot afford to pay net revenue generating fees. The objectives of this paper are to: - examine the factors affecting the demand for hospital services - assess the ability to pay for services in the public and private sectors with the aim of understanding the capacity of the market to support the development of fee-paying services in public hospitals - assess the health care decision making of poor people and to determine threshold prices and other variables, at which they lose access to hospital services.It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were livingoutside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995.As the global labour market strengthens, it is increasingly highly skilled professionals who aremigrating. Medical practitioners and nurses represent a small proportion of highly skilled workerswho migrate, but the loss of health human resources for developing countries can mean that thecapacity of the health system to deliver health care equitably is compromised. However, data tosupport claims on both the extent and the impact of migration in developing countries is patchyand often anecdotal, based on limited databases with highly inconsistent categories of educationand skills.The aim of this paper is to examine some key issues related to the international migration of healthworkers in order to better understand its impact and to find entry points to developing policyoptions with which migration can be managed.The paper is divided into six sections. In the first, the different types of migration are reviewed.Some global trends are depicted in the second section. Scarcity of data on health worker migrationis one major challenge and this is addressed in section three, which reviews and discusses differentdata sources. The consequences of health worker migration and the financial flows associated withit are presented in section four and five, respectively. To illustrate the main issues addressed in theprevious sections, a case study based mainly on the United Kingdom is presented in section six.This section includes a discussion on policies and ends by addressing the policy options from abroader perspective.sch_iihpub367pub2