Youth employment in the primary health care ecosystem in Zambia: barriers and opportunities

Abstract

Youth unemployment remains a critical challenge in Zambia despite increasing demand for health services and investments in primary health care (PHC). While PHC has the potential to generate both health and health adjacent employment opportunities, limited empirical evidence exists on the institutional and individual factors shaping youth employment readiness within this ecosystem. This study aimed to identify barriers and facilitators influencing youth employment readiness and opportunities in Zambia's PHC sector. A mixed-method, cross sectional study was conducted in four districts (Lusaka, Kafue, Kitwe, and Ndola). Quantitative data were collected from 859 PHC trainees, interns, volunteers, and early-career professionals using a structured digital questionnaire. Qualitative data were gathered through 64 key informant interviews and 5 focus group discussions, including educators, employers, regulators, and PHC workers. Quantitative data were analyzed using descriptive statistics and multivariate logistic regression with Stata, while qualitative data were thematically analyzed on Atlas.ti. Employment readiness was significantly associated with age, education level, and early-career exposure. Youth aged 25–29 years (OR = 2.05), 30–34 years (OR = 4.31), and ≥35 years (OR = 3.28) were more likely to be employment-ready than those aged 18–24 years. Interns (OR = 2.97) and volunteers/early-career workers (OR = 17.55) had substantially higher odds of readiness compared to students, while respondents with undergraduate education or higher were nearly three times more likely to be employment-ready than diploma holders. No significant sex differences were observed. Qualitative findings identified gaps in training quality, limited clinical exposure, weak regulation, poor working conditions, and constrained career progression, while internships, mentorship, blended learning, and health-adjacent employment pathways emerged as facilitators. Youth employment readiness within Zambia's PHC ecosystem is shaped by education quality, practical exposure, and system-level workforce conditions rather than demographic characteristics alone. Strengthening training regulation, expanding structured school-to-work transition pathways, improving working conditions, and recognizing PHC as a broader employment ecosystem could enhance youth employability while supporting resilient primary health care systems.