Zambian public sector nurses' incentives and motivation in the context of migration : how to retain Zambian nurses?

In Africa, attrition of health workers has reached critical rates in recent years and many countries have implemented incentive programmes without an empirical basis to guide their choice of intervention. This research uses a thorough understanding of nurses' perspectives to examine the complex factors and mechanisms that influence them to leave public hospitals. A case study approach was employed. Data were collected using mainly qualitative methods: in-depth semi-structured interviews. Quantitative data such as verifications from the professional body were also collected. Contextual factors (e.g. Structural Adjustment Program (SAP), Public Service Reform Programme (PSRP), health reform) and the increasing HIV/AIDS epidemic significantly influenced nurses' migration decisions. This was reflected in the concentration of breadwinners or widows in the failed migrants' group - those who had attempted, but failed, to migrate mainly due to high costs. Declining levels of funding for tertiary-level hospitals have broad implications for the motivation and turnover of their nurses as a result of fewer professional development opportunities, lower allowances, fewer staff and reduced access to essential equipment/drugs. The importance of a lifelong wage structure is stressed, especially the important role of training, a living wage and an adequate pension. While younger nurses tend to give higher value to training opportunities, senior nurses with family responsibilities need more financial support. While most nurses interviewed consider it important to meet a minimum standard of living, they are also guided strongly by their professional conscience. The quantitative data in this study suggest that restrictive immigration policies were effective in decreasing migration numbers. However, the primary focus of any retention strategy should be on retaining a motivated workforce through improved work and policy environments rather than restricting their migration. Specific areas are identified where the Government might intervene to provide effective incentive programmes for Zambian nurses.