In her infancy, Idah Jere, now 24, dreamt to become a nurse.
She drew inspiration from a nurse at Embangweni Hospital in Mzimba District, located a few kilometres from Ephangweni Full Primary School where she did her primary education.
“The nurse treated patients with utmost care and love. I couldn’t help, but look up to her as my best role model,” she explains.
Jere remembers how she cherished the ‘when I grow up, I want to be a nurse’ verse, which she cited when parents and teachers asked about her ambition.
That was 18 years ago.
“But I don’t admire nursing anymore. The profession has many challenges. How can one nurse be assigned to over 80 patients per shift?” she wonders, now a practising nurse.
National Organisation of Nurses and Midwives of Malawi (Nonm) president, Dorothy Ngoma says the number of practicing nurses stands at 10 000 against a projected population of 16 million.
This means each nurse treats an average of about 1600 patients against a recommended nurse-to-patient ratio of 1to 6.
The International Council of Nurses (ICN) recommends one nurse for six ‘average sick’ patients or one case if the patient is seriously sick to ensure safe and quality patient care.
It stresses that the diminishing number of nurses against the increasing workloads puts both patients and healthcare workers at risk of infection and unprofessional conduct due to fatigue and other disappointments, among others.
In all levels of the antenatal and postnatal wards, a nurse is supposed to handle five cases in the morning shift and/or six cases during night shift.
In the operating theatre, ICN recommends three nurses per theatre (one scrub, one scout and one anaethetic nurse). This may, however, vary depending on pre-determined factors.
Ngoma notes that Malawi has one of the highest nurse-to-patient ratio in Africa and the world over, currently hovering around one to 80.
She cites Kamuzu Central Hospital (KCH) where a pediatric ward with 400 patients is assigned five nurses [thus committing an average of 80 patients to one nurse].
The situation is similar to Queen Elizabeth Central Hospital (QECH) where a single nurse looks after 80 or more patients per shift, according to Chief Hospital Administrator Themba Mhango.
However, the situation is slightly different at Zomba Central Hospital where Chief Hospital Administrator Thom Chisale says, at worst, a nurse is assigned to look after 40 pediatric patients per shift.
Mzuzu Central Hospital Chief Hospital Administrator, Rose Nyirenda, refused to provide the statistics when called in the week, but Ngoma noted it could not be a taboo for a nurse to care for and treat over 10 ‘very sick’ patients against the recommended ratio of one to one.
Ngoma stresses: “Malawi, as a nation, is far from meeting the internationally recommended ratios.
This is generally due to government laxity on the training and recruitment of healthcare workers.”
She, however, notes that there has been an increase in the number of nurses from 4 500 in 2010 to the present 10 000, effectively reducing the vacancy rate from 76 percent to 60 percent.
She, however, adds Malawi needs at least 50 000 practicing healthcare workers to achieve best quality service for patients.
Studies show that when nurses have fewer patients, they take better care of them, thereby, preventing errors and avoidable deaths.
Principal of Kamuzu College of Nursing and Midwifery, Professor Address Malata, challenged that quality healthcare could not be achieved with the prevailing shortage of human resources in the health sector.
According to Nonm executive director, Harriet Kapyepye, the ideal number of patients a nurse can see is 10 in a general ward, one to seven for the labour ward and one to one in the intensive care unit.
Ministry of Health acting spokesperson, Adrian Chikumbe, says the average national nurse-to-patient ratio currently hovers around 1to 1 600 if 10 000 nurses were to be assigned to the projected population of 16 million.
But Chikumbe says rapid population growth remains one of the major challenges affecting delivery of healthcare services in public hospitals.
“It’s not hard to match the number of patients with that of nurses as the population keeps rising each passing day,” says Chikumbe.
President Peter Mutharika, too, acknowledges in his State of the Nation Address, the existence of enormous challenges besetting delivery of healthcare services, including critical shortage of staff, non-availability of essential drugs, medical supplies and facilities.
But Mutharika fell short of spelling out policies that would facilitate the realisation of this dream.
Blantyre-based health rights activist, Maziko Matemba, argues it would be a tall order for Malawians to expect that things would improve without clear policy direction.
“That would be like pleading with a bull for milk. You can’t get it no matter how much you plead,” challenges Matemba.
He urges government to come up with clear policies to guide the implementation of programmes aimed to improve healthcare services in the country. n