Career Aspirations of Zambia Medical Graduates Training for District Health Systems

Abstract

There is increasing interest in assessing the medical manpower needs of Zambia. If doctors, who graduate in Zambia are to remain in the country they will need to have their career aspirations met.Objective: To assess the career aspirations of Zambian Medical Graduates and the training needs for District Health Systems.Design: A descriptive cross sectional study using a structured self administered closed and open ended questioimaire and focus group discussion were undertaken from November 1996 to February 1997.Setting: The UNZA Medical School, Two Tertiary Internship Training hospitals, 61 District hospitals and Chainama College of Health Sciences were the setting for this study.Subjects: A total of 85 repondents; 36 final year Medical Students (group 1), 27 Junior and Senior Resident Medical Officers at Ndola and Kitwe Central hospitals (group 2), and 22 District Medical Officers (group 3)responded to the questionnaire. In addition a Focus Group discussion of 11 people composed of four lecturers and seven final year students at Chainama College was conducted.Main Outcome/Measures: The study sought to find out the Career choices and factors influencing them. Zambia's health needs, Training for District Hospitals, Preference of where to work. Finally respondents were requested to give their opinion of the M.Med (DHS) programme.Results: About a third (36.1%) of medical students were interested in Internal Medicine, 44.4% Resident doctors were interested in Obstetrics & Gynaecology, while just over half (54.6%)) of District Medical Officers were interested in Surgery and Public Health. The overall factors influencing career choices were personal interest and hope for job satisfaction.About two thirds (64.6%) of the respondents perceived that Ignorance and the alleviation of poverty were leading to the main health needs of Zambia. Three quarters (72.2%) of group 1 92.0% of group 2 and 86.4% of group 3 considered Public Health and hospital based General Practice as the appropriate specialization for district hospital medicine. More than two thirds (66.6%) of the medical students and nearly half (48.1%)) of the resident doctors would prefer to work in Tertiary hospitals while 63.6%) of District Medical Officers would prefer working in Secondary Care hospitals. More than half (55.5%>), while 87.7%o and 81.3%) of groups 1, 2 and 3 respectively indicated that the M.Med (DHS) course was good for Zambia and supported the Health Reforms emphasis on the district.Conclusion: The study found out that most Zambian medical graduates would like to be specialists working in Tertiary health care hospitals for personal interest and job satisfaction. This is despite their indication that Zambia's health needs were essential health care/primary health care which can cost effectively be dealth with at primary and secondary health care levels. The M.med (DHS) course was considered to be good for Zambia and it supports the Health Reforms.The study recommends that specific policies be agreed upon by the Ministry of Health and UNZA School of Medicine to train medical doctors for the health needs of Zambia and set up or make available a National Medical Man