experience of malawi by ann m. phoya, phd, rnm, …by ann m. phoya, phd, rnm, phn 1 country back...
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Experience of Malawi
By Ann M. Phoya, PhD, RNM, PHN
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Country back ground
Status of Health Work Force in 2004
Factors Contributing to HRH Crisis in the Public health sector
Strategy to address HRH Crisis
Achievements
Lessons Learnt
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Population is 13.2 million, 51% female, 49% male, with population growth rate of 2.8%
48% is above 18% years of age,
15.3% urban population
Literacy level 62% ( men 69%, women 59%)
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Economy is Agri-based ; Agriculture accounts for 35% of GDP
GDP per Capita: USD 290
39% of population lives below poverty line
Budge Allocation for Health: 13. 5%
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At the expiry of the 5th National Health Plan for in the year 2000, performance of Malawi health system was described as weak & un responsive to health needs of the people
Unresponsiveness was attributed to critical shortage of health workers to deliver an essential health package capable of addressing the high burden of disease in the country
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High staff patient ratio: ◦ 1 physician per 100,100 population
◦ 25 nurses per 100,100 population
◦ 10% of primary health centers meeting minimum staff norms ( 2 clinicians, 2 NM, 1AEHO
◦ 40% pregnant women accessing skilled attendance at birth
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Life expectancy: 39
Infant Mortality: 133
U/5 Mortality: 189
Maternal Mortality: 984
HIV Prevalence : 15%
HIV infected persons accessing ART: <4,000
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Under investment in training for decades as of unfavourable macroeconomic policies
HIV and AIDS – increased demand for services and reduced capacity to respond
Poor retention Push: low wages, high workloads, weak supervision,
inadequate housing, poor work environment (shortages of drugs/supplies) limited career progression & development
Pull: international migration: more than 500 nurses migrated between 2003-2005 domestic dynamics - more lucrative jobs in the Private
Sector, Donors agenicies, NGOs & research institutes
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Sector Wide approach was adopted as framework to guide the planning, financing and monitoring implementation of a comprehensive program of work to address health system challenges
Interventions to address issues of HRH were designed as part of a wider health sector strategic plan and not as a stand alone project
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Incentives to attract and retain health workers in the public sector
Expand Training capacity of health training institutions
Support students with tuitions fees
Use international Volunteers and Technical Assistants
Establishing a robust HRMIS to monitor progress
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De-Linking health workers from Public Service to Health Service Commission
11 categories of health workers identified as critical and incentivised with 52% salary top up
Retired health workers re-employed on 3 yr contract with gratuity
Fast tracking post basic training after 2 yrs of district/rural experience
Construction and rehabilitation of staff houses in health centers
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13 health training institutions requested to double intake & New University requested to introduce faculty of health sciencies
Each school supported to expand infrastructure to accommodate increased intake as well as training of teaching staff
MOH staff seconded to faith based training schools to increase teaching staffs
Students supported with fees coupled with bonding and active recruitment at gradutation
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For immediate relief in staffing crisis and to expand roll out HIV/AIDS related services, volunteers were recruited from UN, VSO & CIM. Other Volunteers were deployed as lecturers in training schools
Deployed as general physicians or specialists, lectures, coaches and mentors
Technical Assistants recruited to coach and mentor staff in HRH Planning , development and management
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Govt and Development Partners contributed to the through the SWAP program of work. Total cost of the HRH component of program was USD 95.5 million
Support for Training & Regulation : USD 53.3 m
Retention & Recruitment: USD 34.3 m
Gap filling & Mentoring: USD 7.2 m
M&E: USD . 7 m
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Govt Commitment to take direction is critical
Multi-sectoral collaboration in designing a comprehensive HRH program is essential
DPS willingness to support salary and infrastructure development key factor to success
A long period of implementation is necessary to achieve long lasting improvements
Planning for sustainability should be built into the program at the beginning
Flexible policy and legal environment is crucial
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Maintaining momentum and leadership
Moving from ‘emergency’ to ‘strategic workforce planning’
Supervision & Career Development
Sustainability of Financing: Advocacy for continued commitment from Govt & DPs
Innovative rural incentives
Lobby for bonding to target all professionals benefiting from govt subsidy on education
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