All 32 potential respondents who were identified in the stakeholder mapping also responded to the questionnaire. This represents a response rate of 100%. Key results from the study are summarised in the sections below.
3.1 Level of Training
We first report on the levels of training in the specified public health disciplines, skills gaps and need for training. In particular, the respondents indicated whether their organisation had anyone with some training in each of the three public health disciplines (see Table 2). For health policy and systems, 56% of the respondents indicated that no one had been formally trained in their organisation. For those who reported having had some form of training in the health policy and systems, 19% were trained at masters’ level, 13% had received in-service training, 9% had been trained at the bachelor’s degree level, and 3% at the PhD level. However, it is important to note that in almost all instances the health policy and systems training was received as a part of training in other public health disciplines and not as a specialist field of study.
Only 34% of the respondents reported having someone with some training in health economics in their organisation. Among those trained, 3% received in-service training, 3% were trained at the bachelor’s degree level, and 28% at the master’s degree level. In terms of full or specialized training, only one respondent reported having had someone in the organisation specially trained in health economics; at the master’s level. The rest received health economics training either in-service or as part of other public health related training.
For health services management and planning training, only 22% of the respondents reported having had some training in health services management and planning. Of these, 3% had received in-service training, 3% at the bachelor’s degree level, and 16% at the master’s degree level. Strikingly, none of the people trained had a full or specialized training in health services management and planning.
Table 2: Level of Training across the Three Disciplines
Discipline
|
Level of Training
|
Total
|
|
No Training
|
Trained
|
|
|
In-service
|
Certificate
|
Diploma
|
Degree
|
Masters
|
PhD
|
Health Policy and Systems
|
18
(56%)
|
4
(13%)
|
0
(0%)
|
0
(0%)
|
3
(9%)
|
6
(19%)
|
1
(3%)
|
32
(100 %)
|
Health Economics
|
21
(66%)
|
1
(3%)
|
0
(0%)
|
0
(0%)
|
1
(3%)
|
9
(28%)
|
0
(0%)
|
32
(100%)
|
Health Services Mgt. & Planning
|
25
(78%)
|
1
(3%)
|
0
(0%)
|
0
(0%)
|
1
(3%)
|
5
(16%)
|
0
(0%)
|
32
(100%)
|
3.2 Stakeholder Perspectives on Training Needs and Skills Gap
Almost all organizations indicated that training in the proposed public health disciplines would be beneficial to their organizations (see Table 3). We found that 94% of the respondents felt that specialized postgraduate programs in health policy and systems as well as health economics would be very beneficial to their organisations. In addition, 91% of the respondents were of the view that formal training in health services management and planning would benefit their organisations.
Table 3: Whether the Training Would be Beneficial to the Organisation
Discipline
|
Yes
|
No
|
Do Not Know
|
Total
|
Health Policy and Systems
|
30
(94%)
|
0
(0%)
|
2
(6%)
|
32
(100%)
|
Health Economics
|
30
(94%)
|
2
(6%)
|
0
(0%)
|
32
(100%)
|
Health Services Mgt. & Planning
|
29
(91%)
|
3
(9%)
|
0
(0%)
|
32
(100%)
|
In terms of the extent of benefit, we asked respondents to indicate, on a Likert scale (High, Medium, and Low), how important specialized training for each discipline would be for their organization. Most respondents indicated that the need is high (see Table 4). In particular, across all three disciplines, at least two-thirds of the respondents were of the view that formal training in these fields was a matter of agency; while at least a quarter of the respondents were of the view that skills gap across the three fields was moderate.
Table 4: Ranking of the Importance of Introducing Each Programme
Discipline
|
High
|
Medium
|
Low
|
Total
|
Health Policy and Systems
|
23
(72%)
|
8
(25%)
|
1
(3%)
|
32
(100%)
|
Health Economics
|
22
(69%)
|
9
(28%)
|
1
(3%)
|
32
(100%)
|
Health Services Mgt. & Planning
|
21
(66%)
|
8
(25%)
|
3
(9%)
|
32
(100%)
|
Participants’ views in the semi-structured interviews were captured through open text – respondents were required to write down detailed explanations on some of the open-ended questions. Below, we report some of these views using the exact text as provided by the respondents. These views illustrate participants’ perspectives on why training in the three discipline is critical, and more so, what kind of competencies they expected and how they would benefit their organisations.
3.3 Health Policy and Systems Training
Most of the participants agreed that health policy and systems training was important across the entire health sector. They thought having many professionals trained in health policy and systems would provide competencies to improve the running of the health sector. It would help change paradigm shift from mostly focusing on clinical challenges within the health system, but also focus on supporting functions and how the interact with broader structural factors within which services are provided. Furthermore, health policy and systems was said to be critical in providing skills to people to handle systems issues like managing change within health systems and being able to set achieve strategic goals for population health improvement. It was also stated that health policy and systems training at postgraduate level had a greater role to with regards facilitating innovative research to strengthen health systems.
“Zambia has a gap in this health policy and systems training and if this is strengthened, it means even employees in MOH will be keen to carry out the right procedures when it comes to health systems strengthening. These skills will benefit both the private and public health sectors.” [KII 23, Research]
“Very essential especially for Directors because they are the policy makers. They need to know what it takes and the impact of their decisions on health services. They also need to be able to do research.” [K1I15, Government Ministry]
“Trained people would know what to do and how to go about formulating policies. When evidence is provided trained personnel would know how to transform it into policy brief and present to the government.” [KII19, Cooperating partner]
3.4 Health Economics Training
For health economics, the respondents reported that it would benefit their organisations through providing competencies to facilitate efficient use of meagre health resources. Priority setting was said to be one of the key areas that this training may consider addressing. Health economics was said to be vital in producing professionals with competencies to formulate, evaluate health policies and strategies using economics analysis tools. This training would help health sector personnel to participate adequately in shaping health policy and development on health financing. Health financing was reported to be a huge challenge, particularly in the Zambian context. It was also reported that health economics training could enable the Zambian health sector to count on a pool of locally trained health economists; with full understanding of local context as opposed to outsourcing from outside the country, which is the practice in most HSOs.
“This would be important for our organisation to conduct research, analyse policy and participate in policy shaping and development of health financing” [KII18, Regulatory]
“This training would benefit the organisation because many health service providers we deal with lack the necessary acumen to efficiently manage their health services delivery. This often leads to disputed insurance claims.” [KII 27, Insurance]
3.5 Healthcare services Management and Planning Training
Participants reported that training people in management functions like planning would greatly benefit their institutions. For example, they stated for planning functions, the Ministry of Health (MoH) would greatly benefit from personnel trained in key competencies in planning and with good understanding of health services and local systems dynamics. Furthermore, management training was said to be critical in proving competencies to enhance leadership across health services teams and organisations.
“We will be more precise in planning and avoid budget variations. Secondly, it would also be more beneficial to planners in MoH. Currently they employ people who have done development studies. But the demographers don’t have a good understanding of the health system” [K14, Regulatory]
“Effective health services management and planning will help assist both public and private institutions in planning and managing resources and programs effectively in organisations where resources are finite.” [K22, Health services]
3.6 Skills Training Needs
We also identified the particular skills training needed in order of importance. These are summarized in Table 5. For health policy and systems training, the top skills desired were policy analysis and planning, monitoring and evaluation of health programs, and health systems research capacity; followed by implementation and management of health programs, change management, and training relating to policy, politics and power; in that order. For health economics training, the most pressing skills needs are health care financing, economic evaluation of health programs; followed by decision analytic modelling, and health economics research capacity. There is also a demand for training in the operations of the health insurance market and measuring health system efficiency. For health services management and training, the most sought out skill was strategic management in health programs, followed by leadership and management in health programs, and program implementation.
Table 5: Competency Needs by Discipline
Health Policy and Systems
|
Health Economics
|
Health Services Management and Planning
|
· Policy analysis and Planning
· Monitoring and Evaluating Health Programs in Health Systems
· Health Systems Research Capacity
· Implementing and Managing Programs in Health Systems
· Managing Change in Health Systems
· Policy, Politics and Power
|
· Health Care Financing
· Economic Evaluation of Health Programs
· Decision Analytic Modelling
· Health Economics Research Capacity
· Understanding the Health Insurance Market
· Measuring Health System Efficiency
|
· Strategic Management in Health Programs
· Leadership and Management in Health Programs
· Implementing Programs in the Health System
|
3.7 Skills Mismatch
An alternative way of looking at the skills gap is to look at the skills mismatch – the misplacement of skills for a given job description. In this study, this is taken to imply a situation where a person not formally trained (as part of a specialist programme) to perform roles related to a given public health field is performing those roles. We found significant horizontal skills mismatch in both health economics and health services management and planning (see Table 6). All people performing roles relating to health services management and planning were not formally trained to perform them. For health economics related roles, 93% of people performing them were not formally trained.
Table 6: Assessing the Level of Skills Mismatch
Disciplines
|
Someone Performing Related Roles
|
Formally Trained for the Role
|
Skills Match
|
Skills Mismatch
|
Health Economics
|
14
|
1
|
79%
|
93%
|
Health Services Mgt. & Planning
|
14
|
0
|
0%
|
100%
|