Retention of Health Workers in Malawi: Perpectives of Health Workers and District Management

Most of the district health services in Malawi are provided by nurses and clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists. This study explores how these cadres are managed and motivated and the impact this has on their performance. [adapted from abstract]

Equity in Health Sector Responses to HIV/AIDS in Malawi

This technical paper analyzes the equity issues in HIV/AIDS health sector responses
in Malawi, including access to ART. [from executive summary]

Cross-Country Review of Strategies of the German Development Cooperation to Strengthen Human Resources

Recent years have seen growing awareness of the importance of human resources for health in health systems and with it an intensifying of the international and national policies in place to steer a response. This paper looks at how governments and donors in five countries: Cameroon, Indonesia, Malawi, Rwanda and Tanzania, have translated such policies into action. [from abstract]

Health Sector in Malawi

This report summarizes elements of the primary health strategy and the health sector goals established by the Malawi Ministry of Health.

Human Resources and Financing for the Health Sector in Malawi

This report summarizes the key problems in the health sector and their implications on human resources for health and financing of the health sector; discusses the issues on human resources for health; explores options for improving the production, deployment, retention and management of these workers; analyzes the current state of financing in the health sector; explores options for the financing of essential health services and non-EHP services; and summarizes the way forward. [adapted from introduction]

What Can Health Care Professionals in the United Kingdom Learn from Malawi?

This commentary article is focused on encouraging debate and discussion as to how health care professionals in the developed world might wish to re-think the relationship with colleagues in other health care environments and consider how to work together on a theme of two-way shared learning rather than one-way aid. [adapted from abstract]

Mid-Level Providers in Emergency Obstetric and Newborn Health Care: Factors Affecting their Performance and Retention within the Malawian Health System

Mid-level cadres of health workers provide the bulk of emergency obstetric and neonatal care in Malawi. This study set out to explore the perceptions of mid-level providers regarding the factors affecting their performance and retention within the Malawian health system. [adapted from author]

Measuring and Managing the Work Environment of the Mid-Level Provider: the Neglected Human Resource

Our study aimed to explore a neglected but crucial aspect of human resources for health in Africa: the provision of a work environment that will promote motivation and performance of mid-level providers. This paper explores the work environment of mid-level providers in Malawi, and contributes to the validation of an instrument to measure the work environment of mid-level providers in low income countries. [from abstract]

Malawi’s Emergency Human Resources Program: an Overview

This presentation on the emergency HR program in Malawi was offered during a dialogue hosted by the WHO and OECD.

Effectiveness of the TBA Program in Reducing Maternal Mortality and Morbidity in Malawi

The main objective of this study was to assess the role of traditional birth attendants and the quality of their services in contributing to the reduction of maternal deaths in Malawi. [from abstract]

Improving Human Resources for Health while Scaling Up ARV Access in Ethiopia and Malawi

In the space of just a few years, close to 300,000 people with HIV have been put onto ART in Ethiopia and Malawi - two of the countries most severely affected by the human resources for health crisis. But while some might suggest that such a rapid scale-up could only have come at the expense of other general health services, Ethiopia and Malawi performed this remarkable feat using HIV/AIDS funding and technical support to launch ambitious and comprehensive human resource plans to strengthen their health sectors overall. [from author]

Tackling Malawi's Human Resources Crisis

Malawi is one of the poorest nations in the world, with some of the worst health worker to population ratios. Most health services are provided by clinical officers, medical assistants and enrolled nurses. The government has taken action to address the staffing shortfall, estimated at 15,000. [from author]

Double Burden of Human Resource and HIV Crises: a Case Study of Malawi

Two crises dominate the health sectors of sub-Saharan African countries: those of human resources and of HIV. There is considerable variation in the extent to which these two phenomena affect sub-Saharan countries, with a few facing extreme levels of both. This paper reviews the continent-wide situation with respect to this double burden before considering the case of Malawi in more detail. [from abstract]

National Survey of the Impact of Rapid Scale-Up of Antiretroviral Therapy on Health-Care Workers in Malawi: Effects on Human Resources and Survival

Sub-Saharan Africa is the epicenter of the HIV/AIDS epidemic. An assessment of health-care worker availability in the region against health system needs for that area reveals stark gaps. This article details the contributing reasons for health-care worker shortages, as well as the effect of these shortages on antiretroviral therapy (ART) for HIV-infected patients. [from abstract]

Malawi's Emergency Human Resources Program

Malawi’s health human resources initiatives since the late 1990s provide a good example of a comprehensive national scale-up plan for the health workforce. Its Emergency Human Resources Plan has shown modest but promising results. Health worker attrition remains high and tutor supply low, but training capacity has been substantially expanded and Malawi is expected to begin meeting training output targets in 2008. [from introduction]

Scaling Up, Saving Lives

This report calls for a rapid and significant scaling up of the education and training of health workers as part of a broader effort to strengthen health systems. It highlights the importance of training to meet a country’s own health needs and the great opportunity represented by the increased use of community- and mid-level workers. [from foreword]

There are also case studies from Ghana, Malawi, Pakistan, Ethiopia and Bangladesh on strategic implementation of health worker training plans.

Addressing the Human Resource Crisis in Malawi's Health Sector: Employment Preferences of Public Sector Registered Nurses

This paper examines the employment preferences of public sector registered nurses working in Malawi and identifies the range and relative importance of the factors that affect their motivation. The research was designed in the light of the Malawi government’s programme to address the shortage of health workers, which is based on salary top-ups as a means of increasing employee motivation and reducing high rates of attrition. This policy has been adopted despite relatively little quantitative exploration into the employment preferences of health workers in developing countries.

Estimated Financial and Human Resources Requirements for the Treatment of Malaria in Malawi

The main aim of the study was to estimate how much clinician-time that malaria exacts on Malawi’s Ministry of Health resources. It estimates the proportion of finances that anti-malarial medications exact on the country’s health budget and determines whether the Malawi public health sector had adequate human resources to provide treatment. [adapted from author]

Medical Dialogue: How to Kick-Start a Joint AIDS Response by Health Workers and Traditional Healers

This publication provides information on the medical dialogue, a method formulated to address the recommendation for collaboration between biomedical practitioners and traditional healers and the integration of traditional medicine into public health care to respond to AIDS. [adapted from author]

Human Resources Requirements for Highly Active Antiretroviral Therapy (HAART) Scale-up in Malawi

Twelve percent of the adult population in Malawi is estimated to be HIV infected and 15% to 20% of these are in need of life saving antiretroviral therapy. Using data on the total number of patients on highly active antiretroviral treatment (HAART) and estimates of the number of health professionals required to deliver HAART, researchers set out to determine the human resources requirements for HAART scale-up in Malawi. Results show that the human resources requirements are significant and that Malawi is using far fewer human resources than would be expected based on past studies. [adapted

Tackling Malawi’s Human Resources Crisis

Since the late 1990s, Malawi’s public health services have appeared to be heading for collapse due to declining staffing levels. The government launched the Essential Health Package in 2004 to help improve the health of the population, which includes scaling-up HIV and AIDS-related services. The biggest challenge facing the initiative is improving human resource levels. [adapted from author]

Access to Continued Professional Education Among Health Workers in Blantyre, Malawi

This study was carried out to document the current situation regarding continued or in-service training opportunities amongst healthcare workers serving in government (public) health centres within Blantyre District Health office. Knowledge of such a situation would better inform health personnel trainers, professional regulatory bodies, the Ministry of Health and international agencies to design appropriate intervention programs towards professional development of healthcare personnel. [from introduction]

Why Might Clinicians in Malawi Not Offer HIV Testing to Their Patients?

In order to identify reasons clinicians in Malawi might not offer HIV testing to patients, a cross-sectional descriptive postal census with telephone and fax follow-up was conducted. Proportions were calculated for each reason given for not offering HIV testing. Multiple logistic regression was used to determine whether responses differed by demographic characteristics. The five most common reasons for not offering HIV testing were: inadequate training in HIV counselling; perception that the patient is not ready; no indication; testing facilities unavailable; and insufficient time.

Shortage of Health Workers in the Malawian Public Health Services System: How Do Parliamentarians Perceive the Problem?

The quality and quantity of health care services delivered by the Malawi public health system is severely limited, due to, among other things the shortage of adequate numbers of trained health care workers. In order to suggest policy changes and implement corrective measures, there may be need to describe the perceptions of the legislature on how they perceive as the cause of the problem, which could be the solutions and an evaluation of those solution. In this paper, I present the finding from a qualitative study of Hansards (official verbatim record of parliamentary speeches) analysed by discourse analysis.

Malawi Case Study: Choice, Not Chance: a Repositioning Family Planning Case Study

This report evaluates the success of a program to improve family planning services in Malawi. It discusses the importance of community-based distribution, i.e. mobile clinics and community health workers, to the success of family planning in the country since so much of the population is rural.

Impact of HIV/AIDS on Human Resources in the Malawi Public Sector

This report presents the finding from an study to determine the impact of HIV/AIDS on the public sector in Malawi. Section E, 3 establishes the impacts of HIV/AIDS on the Ministry of Health and Population and on health workers including statistics of attrition by occupational category in the health sector, morbidity and absenteesim, vacancy levels. It also analyzes effect on health worker workload, discusses the impact on productivity and performance, the financial implications, impact on service provision, and institutional vulnurability to HIV/AIDS.

Postoperative Outcome of Caesarean Sections and Other Major Emergency Obstetric Surgery by Clinical Officers and Medical Officers in Malawi

Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors. [abstract]

College of Medicine in the Republic of Malawi: Towards Sustainable Staff Development

Malawi has a critical human resources problem particularly in the health sector. The College of Medicine (COM)is the only medical school. For senior staff it heavily depends on expatriates. We explore to what extent a brain drain took place among the COM graduates by investigating their professional development and geographical distribution.

Help Wanted: Confronting the Health Care Worker Crisis to Expand Access to HIV/AIDS treatment: MSF Experience in Southern Africa

This report focuses on the impact of human resource shortages witnessed by MSF teams in four southern African countries - Lesotho, Malawi, Mozambique, and South Africa. While the focus is largely on nurses in rural areas, it should be acknowledged that health staff is lacking across the spectrum - from doctors to laboratory technicians to pharmacists - at all levels of care. In all these cases the need for access to ART, as well as other health needs, is outstripping human resource capacity. [from introduction]

Attracting and Retaining Nurse Tutors in Malawi

This paper focuses on the scheme by the Malawi Ministry of Health (MOH) to retain nurse tutors in collaboration with the Christian Health Association of Malawi (CHAM). It chronicles the scheme’s successful elements for purposes of eventual replication, suggests how to address some of the challenges and identifies effective incentives, including salary supplements. [from executive summary]