Recruitment and appointment
Initial policies and further adaptations
Recruitment in Zimbabwe is regulated through the Public Service Regulations (PSR), 2000 sections 2 and 3/1a-d . These policies envisage that recruitment should be merit-based on the applicant’s knowledge about their tasks and their ability to perform them. Appointments can be either under ‘indefinite pensionable conditions’ or ‘temporary’ to fill casual vacancies or supernumerary posts. All appointments should follow principles of equality of fair competition among candidates and need to be included in the Estimates of Expenditure approved by the Ministry of Finance each fiscal year. To confirm the suitability of new workers, they need to go through a probation period which initially was not less than 1 year after which and, if satisfactory, appointment was confirmed.
With the introduction of HSR 2006, recruitment responsibility for the health sector was shifted to the HSB . Besides merit, HSR 2006 introduced criteria of professional and moral standing and considered apprenticeship for individuals less than 18 years (previously not allowed under PSR 2000) as legal to allow health professional students to undertake their required internships to complete their studies. In order to address the high attrition from the public to the private sector observed after Independence, the new regulation provided greater flexibility for dual practice allowing HSB to authorise specific workers to devote part of their time to private practice and reducing the minimum probation period from 1 year to 6 months.
During the pre-crisis period, HWs would search for jobs on their own after training.
From 1992 to 1995 I did my nursing training as an RGN at Harare central hospital […] we were not being deployed. Each person would look for his/her own place (HW Gvt District 3).
Before the crisis, recruitment of students was done by the relevant health service providers (government or FBO), drawing from their own training schools, but it was carried out in accordance to the MOHCC/HSB standards and criteria. Despite being regulated by the same framework, church-run nursing schools had the opportunity to retain the nurses they like at their facilities after completion of training:
…the DNO [District Nursing Officer] will deploy them to us but [the nurse training school] can just say we need three here [at FBO facility] and they can even mention names preferably so and so […] (Manager FBO District 1)
However, during the crisis period (1997–2008), they had the option to choose three priority provinces, both for students who had trained in government and in FBO-run training schools. Preference listing was withdrawn during the crisis period for nurses and paramedical staff mainly to address the shortage of HWs particularly in rural areas. On the other hand, doctors were still allowed to choose, although the human resources (HR) department at MOHCC head office would intervene to ensure even deployment in areas where majority of newly qualified doctors would have chosen one hospital.
Most people (80%) would choose Harare and only 20% would choose Bulawayo but it was supposed to be 50-50. This meant that 30% of those who chose Harare were then forced to go and work in Bulawayo. To solve the issue there was a list that would come from the head office Human Resources Directorate of who would go where. (Manager Gvt District 1)
Despite the establishment of the HSB which, in the views of the government, aimed at the unification of all health services, there were some differences in the implementation of HSR 2006 between government and FBO service providers. Some managers reported having two different and parallel processes for recruiting new workers: one triggered by the HSB and another one by the specific FBO:
When we are recruiting [under the FBO process] we advertise the posts, and then people apply. When they are sent by the DNO [official HSB process] we just accept them. We sit down with them and do a bit of an interview but not as we do with those we recruit on our own because there is no option to say we want you or we don’t because the person would have been already sent to us. We then ask them to fill the assumption of duty forms and other forms which are needed. (Manager FBO District 3)
These overlapping recruitment systems with different degrees of thoroughness in terms of merit-based selection may have resulted in different recruitment outputs with a fairer system applied to these recruited through the FBO system (e.g. using interviews) as compared with these recruited through the HSB which may be more prone to patronage and weaker accountability. However, this was not substantiated by the study.
Another factor that contributed to the poor staffing situation during the crisis was the recruitment freeze introduced as a response to an over-inflated civil service . However, given its key role and its already precarious staffing situation, the freeze in the health sector was temporarily relaxed to allow for limited recruitment on a periodical basis to cover urgent needs . This affected equally government and FBO-run facilities.
When we have people, who qualify we wait for the unfreezing of posts. The HR [department] will allocate the posts to the provinces and provinces allocate to the districts. (National Manager Gvt)
During the crisis, the number of absconders (i.e. workers leaving the workforce without prior notice or authorisation) increased substantially. While before the crisis the process of re-appointment of absconders was long and often unsuccessful, this was adjusted after the crisis to allow for fast-tracked re-appointment to mitigate the increasing vacancy rate.
A new cadre, a primary care nurse (PCN), was introduced during the crisis to resolve staff shortages in rural areas and this cadre was meant to work at rural health centres/clinics only.
In hospital [District Hospital] it [introduction of PCNs] did not help in any way, but it helped in the rural areas, that cadre was meant to work in the rural areas. They are not supposed to work at district hospitals or other upper hospitals. (Manager Gvt District 2)
Initial policies and further adaptations
Bonding policies were first adopted in Zimbabwe through the “Health for All Action Plan” in 1986. Initially bonding arrangements were between MOHCW and professional associations [13, 17, 31] by which all new HWs were to serve generally in the public sector for a period equivalent to the period of their training. However, bonding was not mentioned in the PSR 2000 or in the HSR 2006. This policy gap may be the cause behind recent research showing inconsistent implementation of this specific policy element . New regulation was introduced in 2007 by which all newly graduated nurses had their certificates withheld until they completed their bonding obligations. However, after the introduction of the recruitment freeze and the subsequent difficulties for new professionals in finding a job in the public sector, the regulation was not enforced from 2010.
Before the crisis, bonding regulations were well enforced with bonding playing a dual role: improving retention and providing a supervised induction after the training.
Long back it [bonding] was there to retain nurses as the nurses were trained using public funds. It was also used to make sure that the nurse will be moulded through the supervision by the senior [staff] during the bonding period. (Provincial Manager Gvt).
There was change in bonding policy in 2007 when it included withholding of certificates to mitigate the increasing attrition from the public to the private sector and through out-migration. Bonding rules were the same for staff working in both government and FBO sectors especially after the creation of the HSB.
The nurses were bonded for a period equivalent to the training period and you would not get certificates for the three years you are bonded. (Provincial Manager Gvt)
There were some exceptions in the application of bonding rules within the FBO sector for ordained staff who are directly managed by the church authorities through internal church policies
Like after the training we used to know that a person will be bonded for a year before he/she can say I no longer want to be here, but for us, sisters [ordained staff], that rule doesn’t apply, we stay at a place until we are told to move. (HW Gvt District 2)
The introduction of the recruitment freeze led to discontinuation of withholding of certificates as the government could no longer guarantee employment to new graduates.
At the moment because of the shortage of vacancies and the freezing of posts, the nurses are now being given their certificates immediately after qualifying. (Provincial Manager Gvt)
Bonding for in-service training, particularly after the crisis, was perceived as fairer than for pre-service training, as it was reported by many HWs as a way of giving back to the system what the system invested in their education:
It is good in the sense that you would have been sent by the facility, so you have to render back the service, if you think of going somewhere it would not be fair that after training you will just go without rendering the service. (HW Gvt District 3)
Initial policies and further adaptations
Before 2006, transfer of civil servants was regulated through section 13 of PSR 2000. The policy reflects a compulsory top-down approach to transfer, for example stating, ‘a member may at any time without his consent be transferred by the Commission or a delegated authority from the post which he occupies to any other post in the Public Service whether the post is inside or outside Zimbabwe’ (page 16). Refusal to obey an instruction of transfer is treated as an act of misconduct. However, the regulations say that transfer should be planned to minimise discomfort to the member concerned and their family and that the member should be provided with all necessary information relating to the transfer and notified in time. Transfers cannot be used as a punitive measure except in cases of disciplinary procedures.
The PSR 2000 was replaced by HSR 2006 and in the new regulation the length of a temporary posting was left to be determined by the HSB as opposed to the initial transfer for a limited period of maximum 3 years.
During the pre-crisis period, managers were more in control of the processes of transferring workers, but during the crisis, due to substantial problems with attrition, they were less eager to allow transfers of staff.
…as an HOD [Head of Department] I just realize that if someone moves away there will be less [fewer] nurses here so I might refuse the person to move to another facility. (Manager Gvt District 3)
These circumstances made it difficult for managers to deploy staff in a way that would improve geographical coverage. Managers also needed to balance carefully the requests from workers willing to be transferred as refusals may trigger greatly needed HRH to withdraw, abscond and go to private sector or leave the country.
Transfers were easy during the crisis because there were more vacancies than HWs seeking those posts. One [a manager] had to be reasonable; it was either you let the cadre transfer to a preferred post or the system will lose the cadre altogether. (Manager Gvt District 1)
In this regard, workers were allowed to transfer only when they found another worker in a similar position willing to exchange/swap positions.
[…] when I tried to talk to the DNO that I want to go to XXXX [Province] I was told that I should seek for a lateral transfer. I should convince somebody who is at a facility where I want to go so that he will come here, and I will go there. (HW Gvt District 1)
Initial policies and further adaptations
The PSR 2000 states that a worker may at any time, with his/her consent and at the invitation of head of Ministry or the Commission, be seconded (a temporary form of transfer) by the Commission for a period not exceeding 3 years to a post in an approved service. Terms and conditions of services for seconded workers should be governed by the contract between the worker and the service concerned. The HSR 2006 revision points out that the period of secondment will be determined by the HSB without his/her consent while the rest of the terms and conditions are as stipulated by PSR 2000.
During the crisis, because of the challenges of transferring staff explained above, managers used secondment to fill vacant posts, but it was unpopular among HWs as the legal terms for secondment were not appropriately applied. In some cases, HWs were seconded for a longer period of time than stipulated and sometimes communication about the secondment was not provided timely and it was not clear:
I heard that the first group volunteered but as for our group we did not volunteer we were told to go. We were just told that you are going tomorrow, and we were not prepared to go. We could not even give excuses we were just told to go (HW FBO District 3)
Some key positions within the FBO health services such as medical doctors were historically staffed through internal church-related networks and were never made explicit and included in the Public Service staffing norms when the HSB was introduced. During the crisis, when even FBO facilities faced problems with mobilisation of resources from external sources, many FBOs found themselves with shortage of this specific cadre. In these cases, secondment was used to allocate physicians to these facilities.
My post is at XXX District Hospital [HSB]. When I came into the district, mission hospitals did not have posts for doctors from the government, so I was seconded here at XXX Hospital [FBO]. (Manager FBO District 1)