The lukewarm approach by authorities in the training and recruitment of healthcare workers may soon cost lives of poor Malawians who rely on public hospitals, as the country has only 10 000 practising nurses against a projected population of 16 million, according to the National Organisation of Nurses and Midwives (Nonm).
This makes the nurse to patient ratio at one to 1 600, against the recommended one to six.
Malawi Health Equity Network (Mhen) executive director, Martha Kwataine, says Malawi is sitting on a ticking time-bomb by not training and recruiting more healthcare workers to match the ever-increasing population growth.
Kwataine noted the high nurse-to-patient ratio provides a fertile ground for compromised health services, leading to needless deaths.
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.
ICN, a federation of more than 130 national nurses’ associations representing millions of nurses worldwide, stresses that the diminishing number of nurses against the increasing workloads puts both patients and health workers at risk of infection and unprofessional conduct due to fatigue and other disappointments, among others.
“It is also recommended that one nurse be assigned to one unconscious patient in the post-anaesthetic care unit/recovery room. This is done to ensure safety and quality care of the patient,” says ICN.
Nonm president, Dorothy Ngoma, says Malawi is far from meeting the recommended ratio as currently the average nurse-patient ratio stands at one to 80.
Ngoma says this is one of the highest in Africa and the world over. She cites Kamuzu Central Hospital (KCH) where, she says, a paediatric 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 paediatric patients per shift.
Mzuzu Central Hospital chief hospital administrator, Rose Nyirenda, refused to provide the statistics when called in the week, but Ngoma notes 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.
She 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.”
However, Ngoma notes 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.
The number has largely improved because of a joint ‘I want to be nurse!’ campaign by Nonm, Medicins Sans Frontiers—Belgium (MSF) and Oxfam launched in 2010.
The campaign aimed at enticing students to aspire for the nursing profession as well as committing themselves to working in Malawi.
“The campaign played a significant role in improving the number of healthcare workers from 4 500 to 10 000. Half of these are working in government hospitals and health centres while the rest are in the private sector,” Ngoma explains.
She is, however, quick to point out that the ‘combined figure still remains unacceptably low’ for a population being projected at 16 million.
“This country needs at least 50 000 practicing healthcare workers to ensure patients get the best quality service possible,” she says.
Ngoma warns that anything short of this results in compromised service delivery and raises the risk of inward infections between the nurse and the patient.
According to National Association for Nurses and Midwives in Malawi (Nanm) 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.
However, Kapyepye notes that due to understaffing levels, one nurse cares for more than 100 patients in public health institutions.
“And when a comparison is made with other countries in the Southern African Development Community (Sadc), Malawi has the lowest number of nurses in the public sector, thus making the nurse-patient ratio the highest,” she explains.
She says the problem is compounded by a low annual graduation of about 100 registered nurses and 400 nurse-midwife technicians against the prevailing population.
Kapyepye does not have handy information on the ratios in Sadc countries.
Principal of Kamuzu College of Nursing and Midwifery, Professor Address Malata, says quality healthcare could not be achieved with the prevailing shortage of human resources in the health sector.
Speaking at Consortium for Advanced Research Training in Africa (Carta) in Lilongwe in September 2014, Malata called for a stronger and determined collaboration between government and its stakeholders in rectifying the situation by training and recruiting adequate human resource.
Ministry of Health acting spokesperson, Adrian Chikumbe, says the average national nurse-to-patient ratio currently hovers around one to 1 600 if 10 000 nurses were to be assigned to the projected population of 16 million.
But Chikumbe says government has tripled the intake of nursing students to seal the gap.
“For instance, we have increased the intake at KCN [Kamuzu College of Nursing] from 50 to 250 per year. We have introduced nursing courses at Mzuzu University (Mzuni) and we are also working with private nursing colleges to quadruple our efforts,” he explained.
However, Chikumbe admits government has an uphill task to bring down the nurse-to-patient ratio to recommended levels in the face of an ever growing population.
He narrates: “Rapid population growth remains one of our major challenges. It is not hard to match the number of patients with that of nurses as the population keeps rising each passing day.”
President Peter Mutharika, too, acknowledged 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.
