Experience of Malawi

By Ann M. Phoya, PhD, RNM, PHN

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Country back ground

Status of Health Work Force in 2004

Factors Contributing to HRH Crisis in the Public health sector

Strategy to address HRH Crisis

Achievements

Lessons Learnt

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Population is 13.2 million, 51% female, 49% male, with population growth rate of 2.8%

48% is above 18% years of age,

15.3% urban population

Literacy level 62% ( men 69%, women 59%)

Economy is Agri-based ; Agriculture accounts for 35% of GDP

GDP per Capita: USD 290

39% of population lives below poverty line

Budge Allocation for Health: 13. 5%

At the expiry of the 5th National Health Plan for in the year 2000, performance of Malawi health system was described as weak & un responsive to health needs of the people

Unresponsiveness was attributed to critical shortage of health workers to deliver an essential health package capable of addressing the high burden of disease in the country

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High staff patient ratio: ◦ 1 physician per 100,100 population

◦ 25 nurses per 100,100 population

◦ 10% of primary health centers meeting minimum staff norms ( 2 clinicians, 2 NM, 1AEHO

◦ 40% pregnant women accessing skilled attendance at birth

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Life expectancy: 39

Infant Mortality: 133

U/5 Mortality: 189

Maternal Mortality: 984

HIV Prevalence : 15%

HIV infected persons accessing ART: <4,000

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Under investment in training for decades as of unfavourable macroeconomic policies

HIV and AIDS – increased demand for services and reduced capacity to respond

Poor retention Push: low wages, high workloads, weak supervision,

inadequate housing, poor work environment (shortages of drugs/supplies) limited career progression & development

Pull: international migration: more than 500 nurses migrated between 2003-2005 domestic dynamics - more lucrative jobs in the Private

Sector, Donors agenicies, NGOs & research institutes

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Sector Wide approach was adopted as framework to guide the planning, financing and monitoring implementation of a comprehensive program of work to address health system challenges

Interventions to address issues of HRH were designed as part of a wider health sector strategic plan and not as a stand alone project

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Incentives to attract and retain health workers in the public sector

Expand Training capacity of health training institutions

Support students with tuitions fees

Use international Volunteers and Technical Assistants

Establishing a robust HRMIS to monitor progress

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De-Linking health workers from Public Service to Health Service Commission

11 categories of health workers identified as critical and incentivised with 52% salary top up

Retired health workers re-employed on 3 yr contract with gratuity

Fast tracking post basic training after 2 yrs of district/rural experience

Construction and rehabilitation of staff houses in health centers

13 health training institutions requested to double intake & New University requested to introduce faculty of health sciencies

Each school supported to expand infrastructure to accommodate increased intake as well as training of teaching staff

MOH staff seconded to faith based training schools to increase teaching staffs

Students supported with fees coupled with bonding and active recruitment at gradutation

For immediate relief in staffing crisis and to expand roll out HIV/AIDS related services, volunteers were recruited from UN, VSO & CIM. Other Volunteers were deployed as lecturers in training schools

Deployed as general physicians or specialists, lectures, coaches and mentors

Technical Assistants recruited to coach and mentor staff in HRH Planning , development and management

Govt and Development Partners contributed to the through the SWAP program of work. Total cost of the HRH component of program was USD 95.5 million

Support for Training & Regulation : USD 53.3 m

Retention & Recruitment: USD 34.3 m

Gap filling & Mentoring: USD 7.2 m

M&E: USD . 7 m

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Govt Commitment to take direction is critical

Multi-sectoral collaboration in designing a comprehensive HRH program is essential

DPS willingness to support salary and infrastructure development key factor to success

A long period of implementation is necessary to achieve long lasting improvements

Planning for sustainability should be built into the program at the beginning

Flexible policy and legal environment is crucial

Maintaining momentum and leadership

Moving from ‘emergency’ to ‘strategic workforce planning’

Supervision & Career Development

Sustainability of Financing: Advocacy for continued commitment from Govt & DPs

Innovative rural incentives

Lobby for bonding to target all professionals benefiting from govt subsidy on education

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