By Joana Ndabala | MakanDay Investigates
Every morning, Dr Mapalo slips into his white coat and heads to a public hospital in Lusaka—where he works long hours, tends to dozens of patients, and takes night shifts. Yet at the end of the day, he walks home hungry. *
Like hundreds of other volunteer doctors propping up Zambia’s fragile public healthcare system, he receives no salary, no food, no contract—just the hope that one day, his unpaid labour will lead to formal employment.
A MakanDay investigation reveals a system dangerously dependent on these young, jobless doctors, whose exploitation threatens to collapse the very sector they’re trying to hold together.
Despite the country’s severe doctor shortage, a ratio of 1 doctor to 12,000 patients, far below the WHO recommendation, the government has not provided clear action or assurance to these healthcare workers.
At Chipata Level One Hospital in Lusaka, MakanDay found patients waiting in long queues—often for more than two hours—to see a doctor. Even when they are finally attended to, consultations are typically rushed and last no longer than ten minutes.
“I’ve been waiting for over two hours and still haven’t been seen,” said one of the patients in the queue.
The author also experienced a similar situation, waiting over two hours for a consultation that lasted just eight minutes.
The long waiting times are largely due to a severe shortage of healthcare staff and an overwhelming number of patients.
Government’s response sparks anger
A recent statement by Health Minister Elijah Muchima, indicating that volunteering does not guarantee employment, sparked outrage among these doctors. Many say they feel exploited, demoralised, and financially strained, with some forced to quit due to harsh conditions.
Dr Mapalo and several other volunteer doctors describe their experiences as disheartening and financially exhausting. Despite handling full patient loads, night shifts, and the same responsibilities as their employed counterparts, they receive no pay, no meals, no contracts, and no institutional support.
One doctor recalled walking home late at night because he couldn’t afford food at the hospital—until the hardship eventually forced him to quit.
Another expressed uncertainty over whether to continue volunteering, citing the Ministry of Health’s silence on job prospects.
A third doctor highlighted the psychological and financial toll, describing long, unpaid hours, exhausting responsibilities, and a lack of empathy from senior staff.
He noted that although volunteers are not promised anything, they are often asked to submit personal information with vague suggestions of future employment.
“The hospital where I volunteered didn’t provide meals or any assistance,” he said. “Sometimes I had to walk home late at night—between 10 and 11 p.m.—just to eat because I couldn’t afford food at the hospital. Eventually, I had to stop.”
Another doctor expressed frustration over the ongoing uncertainty.
“Honestly, many of us where I work are just volunteers. I’m torn—I don’t know whether to continue or stop because the ministry hasn’t given us any clear information. So far, nothing they’ve done is in our favor.”
He added that, despite the unfair treatment, most volunteer doctors continue because they need to complete the required period to obtain their full practicing licences.
The testimonies reveal a system that heavily relies on unpaid labour, pushing young doctors to breaking point as they endure poor conditions in pursuit of full practicing licences.
Action by the resident doctors
On May 30, 2025, a collective resolution by an association of resident doctors was made for all volunteer doctors to withdraw from their respective stations, effective Monday, June 2, 2025.
“This decision has not been taken lightly but stems from the urgent need to address the longstanding issue of unpaid medical labour and secure fair working conditions for our members,” the Resident Doctors Association of Zambia (RDAZ) said in a statement.
The association also expressed deep concern over the continued reliance on unemployed resident doctors to deliver essential medical services—often under voluntary arrangements—in more than 50 percent of public hospitals.
In an interview with MakanDay, RDAZ president, Dr Paul Chibwe revealed that only one or two out of every ten junior doctors are formally employed. He added that some volunteers are even being threatened with blacklisting if they choose to stop working.
He revealed that over 1,500 doctors are currently volunteering—many in hopes of gaining full registration after one or two years to access opportunities outside the government system, while others do so to support the struggling public healthcare sector.
Out of every ten junior resident doctors, only one or two are formally employed—the rest serve as volunteers, Dr Chibwe said.
“This is not a fight between doctors and the Ministry of Health,” he explained. “It is a call for dialogue and engagement. If it is viewed as a confrontation, that would be both unfortunate and unacceptable.”
He added: “We have consistently engaged in discussions about the gaps in the system—specifically, the shortage of doctors in public health facilities. Volunteers are the ones filling these critical gaps.”
One of the volunteer doctors urged the Ministry of Health and other stakeholders to treat the concerns raised by the doctors with compassion and urgency.
Government’s inadequate response and denial of the extent of volunteer dependence
However, the Ministry of Health has refuted claims by the medical association that more than 50 percent of doctors in public health institutions are volunteers.
In response to MakanDay’s request for comment, the Ministry’s Principal Public Relations Officer, Georgia Mutale Chimombo said that there are fewer than 200 volunteer doctors currently serving in public health institutions nationwide. Of these, 75 are in Lusaka, 46 in North-Western Province, 40 in Central Province, and 22 in Northern Province. Muchinga and Luapula provinces have five and two volunteer doctors respectively.
The Ministry of Health admits that Zambia’s healthcare workforce is in crisis—citing critical gaps in staffing levels, skills, and equitable distribution. The 2022–2026 National Health Strategic Plan lays bare the extent of the problem, citing a 2020 World Health Organisation (WHO) report that found Zambia had just one doctor for every 12,000 patients—more than double the WHO’s recommended ratio of 1 to 5,000.
The situation for nursing staff is even more alarming. The nurse-to-patient ratio stood at 1 to 14,960, far from the global benchmark of 1 to 700.
These figures highlight a deeply strained system, where existing recruitment efforts have fallen short of addressing the severe shortfall of qualified health professionals. The findings suggest that unless urgent, large-scale hiring and retention strategies are implemented, Zambia’s public healthcare system will continue to operate under dangerous pressure—placing both patients and health workers at risk.
Joana is on a three-month internship at MakanDay after winning the inaugural MakanDay Award for Overall Best Student in Specialised Reporting at the ZAMCOM 7th Graduation Ceremony.
Discover more from MAKANDAY
Subscribe to get the latest posts sent to your email.
