Motivating rural health workers
Although Makata Health Centre in Blantyre rural is only 10 kilometres away from another health centre, Kadidi, the facility is always congested. In a day, the out-patient department (OPD) alone, which has one medical assistant, receives about 150 patients.
“I attend to all these patients. There is no time to relax,” says the medical assistant, Kondwani Sulani.
Sulani says the facility serves a population of about 34 900 from the surrounding communities and in a week, he attends to at least 500 patients.
“We are only two here—myself and my colleague who is a nurse, who focuses on antenatal services while I work in the OPD. We are always overwhelmed with patients,” he says.
He says although he is fairly new at the facility, the health centre needs a minimum of two medical assistants and two nurses to reduce their pressure.
This situation is not unique to Makata Health Centre. Most health centres nationwide are facing a similar predicament. In Mwanza, for example, Changoima and Thambani health centres have one clinician and a nurse.
District health officer (DHO) for Mwanza, Raphael Piringu, puts the nurse to patient ratio at each of the three facilities in the district at 1:20 000.
“We only have three instead of nine health centres. We need a minimum of four health personnel per facility, but this is not the case and most staff leave after a short stay.
“Thambani serves many people and it is clear that it needs to be upgraded both with infrastructure and staff to serve patients better,” says Piringu.
The ratio of health workers to patients has always been high.
A World Health Organisation (WHO) report for 2010 titled Human Resource for Health shows serious deficits. For instance, in 2008, one nurse was responsible for 5 000 patients while one doctor was looking after 100 000 patients. By 2010, there was a small improvement to 1: 4 166 and 1: 62 500 respectively.
A 2004 joint study by government and WHO described the general shortage of heath staff in Malawi as “severe even by African standards”.
Malawi trains health workers through Kamuzu College of Nursing, Mzuzu University and College of Medicine and Malawi College of Health Sciences, among other colleges that are mainly under the Christian Health Association of Malawi (Cham).
However, insufficient health equipment and poor living conditions in remote areas have pushed most health graduates to work in urban hospitals. This has created an imbalance and a huge deficit of health professions in rural hospitals.
To bridge the gap, government, through the Management Sciences for Health (MSH), introduced a programme that identifies successful individuals who did not make it to college to train as health practitioners under a scholarship bond to work at a rural hospital for three years. The system started last year with 30 scholarships and this year, 60 others have benefitted.
“Rural hospitals are very understaffed and have only one or two medical staff. We want to help increase the population and we are optimistic that this will have an impact in the long run,” says MSH project director Erik Schouten.
Dorothy Ngoma, who once served as Nurses and Midwives Council of Malawi (NMCM) executive director, says the scholarship bond programme is feasible.
“I have not done any assessment, but most rural hospitals are understaffed and the environment is not attractive. Most health staff prefer urban hospitals because conditions in rural facilities are poor. If we want this to work, the communities should also take a role in supporting the initiative,” says Ngoma.
Martha Kwataine, executive director for Malawi Health Equity Network also supports the idea, but says it is weak on ensuring that the staff stay on after the bond.
“It’s a complex situation only that we are handling it lightly. We will send more staff to rural hospitals, but what is the situation in the facilities? We need a holistic approach to influence the staff to stay longer,” she says.
Kwataine says rural health workers should earn more than those in the urban hospitals and be prioritised when training and promotion opportunities arise.
“If we succeed in making working in the rural areas attractive, we will retain more staff in rural hospitals and in the long run, have balanced representation of staff in hospitals,” says Kwataine.
