A silent epidemic of understaffed hospitals unveiled

By Linda Soko Tembo

The upcoming recruitment of 4,000 healthcare workers in the next year has generated significant excitement and optimism, as it is expected to enhance the quality of healthcare in Zambia.

This comes amidst ongoing concerns about the state of the nation’s healthcare workforce. However, the previous strain on Zambia’s overwhelmed healthcare system underscores the necessity for a more robust recruitment effort to bring about substantive, rather than superficial, improvements.

Levy Hospital’s struggle

Tragically, in August, Levy Mwanawasa University Teaching Hospital (LMUTH) in Lusaka experienced the heartbreaking loss of over 30 newborn babies.

Insufficient staffing levels played a significant factor in the hospital’s ability to provide adequate care to these vulnerable infants during their critical early stages.

Levy Hospital management has not offered any explanations for the causes of these deaths. Instead, they have redirected our inquiries to the Permanent Secretary at the Ministry of Health, who is yet to respond.

Dr. Charles Mutemba, the Senior Medical Superintendent at the hospital, stated in a letter to MakanDay, ‘As per government policy, you need to seek guidance from the Ministry of Health, … through the Permanent Secretary, Technical Services, to be accorded your request as above”.

But a close observation of the bustling Neonatal Intensive Care Unit, where newborn babies with various health conditions are admitted, revealed that the ward operates with a meagre maximum of three nurses per shift to care for 50 newborns.

These newborns require feeding, diaper changes, investigations, and medication administration, which poses a substantial challenge for the nursing staff.

One anonymous staff member expressed her concerns about the workload.

A senior staff nurse at Levy Hospital who preferred to remain anonymous, shared with MakanDay that despite its reputation as one of the country’s premier referral hospitals, the hospital is grappling with a substantial understaffing challenge, further exacerbated by a sudden surge in the disease burden.

“It places an undue burden on the dedicated nurses who are stretched to their limits, making it increasingly challenging to provide the high-quality care these infants require for their survival and development,” she said.

She explained that the staffing resource imbalance has severe repercussions, resulting in preventable infant deaths.

Another nurse, a volunteer at the same hospital, echoed similar concerns. She explained that typically, only two nurses are available to attend to a ward comprising 50 patients with a diverse range of medical conditions.

“These two nurses shoulder a multitude of responsibilities, including accompanying patients for procedures outside the ward, monitoring vital signs, administering medications, and maintaining patient records,” she said.

Additionally, she pointed out that these two nurses are also tasked with providing assistance to patients in the acute bay, where critically ill individuals require constant attention and care, including tasks such as feeding, changing diapers, and providing bed baths, among other critical duties.

In response to this crisis, the hospital management has introduced stand-in healthcare workers to help alleviate the situation.

However, even with this additional support, the maximum number of nurses available during the day shift is only six, and during the night shift, it is limited to four.

According to the official hospital website, Levy Hospital employs approximately 906 medical and administrative professionals, including around 396 nurses and approximately 146 medical doctors. It operates as a provincial hospital for Lusaka, offering third level services.

Healthcare Workforce Shortage in Zambia

According to the National Health Strategic Plan for 2022 – 2026, the state of Zambia’s healthcare workforce remains a pressing concern, with particular attention to issues of quantity, quality, and equity.

The 2020 report by the World Health Organisation (WHO), reveals that Zambia’s doctor-to-patient ratio is 1 to 12,000, which is below the recommended ideal of 1 to 5,000. The report also underscores that the nurse-to-patient ratio is 1 to 14,960, significantly lower than the WHO’s recommended standard of 1 nurse for every 700 patients.

This distressing situation is mirrored in the increasing death rates at Levy Mwanawasa hospital. Since August 2023, the hospital has recorded 33 deaths, with an additional 30 in September and 22 more from October 01 to October 19.

Chilenje Level One Hospital

Chilenje Level One Hospital, another healthcare facility serving patients from neighbouring clinics like Bauleni and Kabwata, faces an ongoing challenge due to a shortage of nursing staff. This concern was raised by a student nurse who was undergoing training at the hospital and chose to remain anonymous.

“Typically, the clinic operates with just two to four nurses per shift, a number insufficient to adequately attend to the high volume of patients it accommodates. To compensate for this shortfall, the hospital relies heavily on volunteer nurses and student nurses, who step in to provide essential patient care,” the source said.

She noted that the post-natal department experiences approximately five to six cesarean births, commonly known as C-sections, every day.

Remarkably, there are only two nurses available to attend to both the mothers and the newborns on a daily basis.

The hospital currently employs only two to four nurses per shift, a number that falls far short of meeting the necessary care requirements for both mothers and newborns following delivery.

Vigilant monitoring of both mother and baby during the crucial first six hours is of great importance to identify and address potential complications, such as ‘postpartum hemorrhage’ or infant feeding challenges 1.

In addition, pregnant women coming in for delivery also require close and attentive monitoring to ensure a safe and uneventful delivery process. Unfortunately, the current shortage of midwives makes this level of monitoring unattainable.

The overwhelming demand is evident when considering our catchment population and the number of daily deliveries, which includes both normal deliveries and cesarean sections, averaging approximately six or more per day, as reported by one of the nurses.

Migration of Healthcare Workers

Although the past year witnessed the symbolic recruitment of more than 11,000 healthcare professionals, experts emphasise the pressing need for continuous and substantial efforts to confront a healthcare system on the verge of crisis.

A Zambian nurse who has relocated to Scotland attributes the emigration of healthcare workers and the issue of subpar salaries in the country to the inadequate government investment in the state’s healthcare sector.

When contacted in Inverness, the 28-year-old nurse voiced his frustration over receiving the same salary as nurses with lower qualifications.

“For example, individuals with a master’s or a degree, along with additional specialised qualifications, may still receive a salary equivalent to that of a diploma or certificate holder,” mentioned the nurse, who preferred to remain anonymous.

He went on to clarify that the nurse-to-patient ratio is unmanageable and does not correspond with the current salary structure.

Data deficiency

The Health Professional Council of Zambia (HPCZ), responsible for ensuring adherence to healthcare and training standards, has reported a lack of available data regarding healthcare workers who have emigrated.

However, Chief Executive Officer (CEO) Professor Fastone Goma explained that there has been a discernible decrease in the number of doctors departing Zambia in recent years.

“While HPCZ issues these certificates on an annual basis, the exact quantity issued each year remains elusive,” said Prof. Goma. “However, there has been a noticeable decline in the number of doctors leaving Zambia over the past few years.”

Professor Goma emphasised the need for the government to re-evaluate its support for healthcare workers, noting that investing significant resources in the training of healthcare professionals like doctors and nurses, only to see many of them emigrate upon completing their education, is not a sustainable approach.

While acknowledging that hiring 11,000 workers last year represented a step in the right direction, Professor Goma expressed his concern that the government’s current employment efforts are falling short of addressing the pressing issue.

“Employing just 4,000 health workers this (next) year is far from adequate, particularly in light of the existing shortage of 80,000 trained healthcare professionals. The government should set its sights on employing between 15,000 and 20,000 workers annually as a gradual means to bridge this significant gap,” he said.

1. According to WHO, postpartum haemorrhage (PPH) refers to excessive bleeding following child birth. It’s a severe medical condition that can potentially result in death.