There is no chance that Malawi will meet the World Health Organisation (WHO) requirement for patient versus doctor, nurse and midwife ratio as figures indicate a 52 percent vacancy rate in government health facilities.
But Ministry of Health (MoH) has said the personnel audit conducted in 2015 in the civil service should give an improved outlook of the vacancy rate once an analysis is done.
The revelation also comes at a time government has effected a recruitment freeze in the public sector in the wake of financial challenges. This will likely further aggravate the shortage of staff in the health sector.
Recently, government was forced to hire 51 new graduate doctors and nurse and midwives after practicing doctors threatened to strike.
However, government refused to pay tuition and board for 99 needy students pursuing studies in clinical medicine, biomedical sciences, nursing and midwifery at Malamulo College of Health Sciences, a constituent college of the private Malawi Adventist University.
According to the Annual Economic Report for 2016, about 12 million outpatient department attendances in the nine months under review were being attended to by low numbers of nurses and clinical officers in the public hospitals.
The report indicates that there are just below 4 000 filled posts in the nursing cadre against 13 600 established posts tasked with providing frontline care and 161 in pharmacy against 545 established posts.
Further, the report states that medical specialists fared no better than nurses as they number about 32 against 228 established posts.
The only cadre in MoH which fared better was preventive health services where about 5 000 posts were filled against 7 500 established posts.
This means that these few personnel were responsible for managing 940 546 hospital admissions in public health facilities out of which 574 497 were reported in-patient deaths.
“The human resources shortage is partly exacerbated by the failure to train adequate numbers of health workers and inability to retain those who are already in the system,” the report states.
However, over 60 percent of government’s staff establishment comprises of health surveillance assistants (HSAs) who are classified as non-technical support personnel.
Maziko Matemba, who heads the Health and Rights Education Programme (Hrep), confirmed the huge vacancy rate in the health sector where a study the organisation conducted three years ago found that one qualified doctor looks after not less than 70 000 Malawians.
He said: “We failed to meet health goals on reducing maternal deaths in the Millennium Development Goals [MDGs] to go from 675 per 100 000 live births to the target of 155 per 100 000 live births which Malawi set itself by the end of 2015. One of the factors which led to this was lack of trained specialist health personnel.”
Matemba urged government to rescind the ban on new recruits and put a special consideration for the health workforce as has been in the education sector.
Chairperson of the Health Committee of Parliament, Juliana Lunguzi, said if the vacancy rates are not reduced, the country will continue to have poor health indicators.
Giving an example of high malnutrition rates, Lunguzi, who is Dedza East member of Parliament (MP), said if there were community health nurses to monitor child and mother health, such incidents would be reduced, but an HSA was being relied on to carry out multiple duties.
The committee has for a long time advocated for targeted recruitment of health personnel and to focus on preventive health services to reduce the burden on the drug budget as well as the already strained human resource.
However, the challenge is not just with training but also recruitment processes as the Health Service Commission is poorly funded and has failed to recruit 1 040 health personnel in the past year because it received K85 million ($118 881) out of the K198 million ($276 923) it requested in the 2015/16 budget.
The health sector is under financial pressure as only a quarter of the amount projected for 2015/16 was realised, $160 million (MK114.4 billion) against $635 million (MK454 billion).
The Health Sector Strategic Plan for 2011-2016 had projected a need for $1 billion in 2015/16.
The economic report has blamed the poor coordination and possible duplication of health sector activities due to a large number of implementers given funds by donors who have opted for off-budget financing to avoid another Cashgate.
But the funding shortages hit the drug budget hardest with a K64 billion shortfall which the report says was an underestimation considering that it is difficult to quantify actual need at the clinical level as opposed to services accessed.