In 2004, Malawi’s health system was described as close to collapse due to chronic shortage of human resources. Over 10 years later, with leadership of the Ministry of Health (MoH), significant momentum has been created in addressing Malawi’s human resource shortages.
Implementation of the Emergency Human Resources Plan (EHRP 2004-2010) by MoH has extended the health workforce by 34.8 percent from 5 453 health workers in 2004 to 8 369 in 2009, highlighting Malawi as a success story in addressing health workforce shortages.
EHRP was designed to address acute shortage of professional workers in the public health sector and was implemented by the government with technical and financial assistance from cooperating partners through a Sector Wide Approach Program (Swap).
A central tenet of the EHRP was to improve staffing levels by increasing production of health workers through a coherent package of financial incentives and investments in local health training institutions.
Despite progress made with implementation of the EHRP, Malawi is still experiencing critical shortage of qualified health workers, particularly in rural hard-to-reach areas where they are most needed.
The human resource challenges projections show that at current output levels, it will take many years to come anywhere near the numbers of health staff needed to provide minimum standards of service delivery as stipulated in the Malawi Health Sector Strategic Plan 2011-2016.
“Much research is available about the human resource for health crisis in Malawi, from leading national and international NGOs [non-governmental organisations], global institutions and government development partners.
“Yet, there remains a significant gap between the findings and recommendations of these vital pieces of work and the reality on the ground,” reads a statement on Volunteer Services Organisation (VSO) Malawi on its website.
The National Organisation of Nurses and Midwives of Malawi (Nonm), a union body for nurses and midwives in Malawi, says current statistics indicate that Malawi has slightly over 12 000 nurses and midwives against a population is above 17 million.
It says Malawi continues to face challenges in human resources for the delivery of healthcare, a reality that directly affects the health of its population.
A 2011 report on the situation published by MoH and the World Health Organisation (WHO) indicates a doctor-to-population ratio of 0.2:10 000 and a nurse-to-population ratio of 3.4:10 000.
It says nursing ratio is one-fourth of the WHO’s recommended 10 nurses for every 10 000 people, leaving Malawi with a 65 percent vacancy rate for nurses and nurse-midwives technicians in health facilities nationwide.
Nonm president Dorothy Ngoma says solving this shortage requires both educating and retaining more nurses and midwives in the workforce, stressing that sustaining the nurses in the workforce will mean considering a number of factors.
She says: “With one of the highest total fertility rate at five, increasing the contraceptive prevalence rate, currently below 60 percent, and reducing the unmet need of family planning, currently at around 20 percent, could be another long-term strategy for solving the health worker shortage as this will ultimately slow down population growth.
“If it remains unchecked as it is with annual [population] growth rate estimated at 2.3 percent, the more nurses Malawi trains, the more the need will be.”
Stakeholders claim that in Malawi, nurses and midwives seem not to be valued.
Despite being the frontline health workers, nurses and midwives in Malawi are lowly paid compared to neighbouring countries such as Tanzania, Zambia and Mozambique.
“Without nurses and midwives, Malawi would not have been the earliest country in Southern Africa to achieve the MDG [Millennium Development Goal] 4.
“I think as a country we need to start valuing and retaining the nurses and midwives in the workforce because everyone of us came under the care of nurses and midwives,” says Mathias Chatuluka, MamaYe Malawi Country Director.
The Countdown Case Study reveals that by achieving MDG 4, Malawi saved at least 280 000 babies by 2014.
MoH spokesperson Adrian Chikumbe says nurses and midwives play a big role in saving lives of mothers and babies.
“As MoH, we call upon everyone-stakeholders and partners to start valuing the nurses and midwives,” he says.
But how do nurses and midwives become angels on earth when they are getting low remuneration against a huge workload?
Predictors of workforce retention among Malawian nurse and midwives graduates through the Global Aids Iinterface Alliance (Gaia) Nursing Scholarship Programme of August 2014 indicate that the nurses and midwives feel undervalued by the low salaries when the compare them with those of other professions.
When asked why nurses were leaving the public sector, one nurse highlighted the low salaries and stress in the government hospitals as among reasons why the nurses prefer working for NGOs.
All the revelations are coming when people around the world are celebrating the international day of midwives and international day of nurses, both of which fall within the month of May. n