UNAIDS: The First 10 Years

Chapter 7Special human resources programme in Malawi199In an effort to resolve the human resource crisis in Malawi, in 2004, the Ministry of Health,with the support of its development partners, put together a plan called ‘The 6-YearEmergency Human Resources Relief Programme’. This programme includes the expansionof health workers’ training institutions and the retention of health workers in the publicsector, through improving their remuneration package and providing incentives to healthworkers operating in underserved areas. By October 2005, this US$ 273 million programmehad been fully funded 29 .“This problemstared us right inthe face. It wasn’tjust a brain drainof skilled workers,it was a brainhaemorrhage”.The Malawi Government had been well aware of the scarcity of health workers and theeffect on the country’s response to AIDS, and had documented this. But the plan totackle the problem emerged only after Piot made a joint visit to the country with SumaChakrabarti, the Permanent Secretary at DFID.As Piot explained: “This problem stared us right in the face. It wasn’t just a brain drainof skilled workers, it was a brain haemorrhage”. Human resources clearly had to becomea top priority, even though the visit was intended to focus on harmonization and the“Three Ones”; otherwise how could Malawi effectively use all the funding pouring intothe country?But who would provide the funding? Erasmus Morah, who was UNAIDS Country Coordinatorin Malawi until July 2007, explained: “The UN family, UNAIDS, was able to devise a strategyin collaboration with DFID. … DFID said, ‘We will put $100 million to this plan if UNAIDScould use its position to get the Global Fund to put in another $100 million’. We tookon the challenge and we did just that. We immediately advocated and supported thetechnical reprogramming of about $40 million of the existing resources. When Round Fiveof the Global Fund came around, we also marshalled the arguments and provided thetechnical support for Malawi to apply”.“Under the leadership of the National AIDS Commission, we brought in WHO consultantsand contributed UNAIDS staff such as David Chitate, the Monitoring and EvaluationAdviser. We sequestered them with the government counterparts for about a week. Amonth later, Voilà!, Malawi became the only country globally that received assistance($65 million) for health system strengthening and human resources for health. So, thattotalled just over the US$100 million DFID talked about”.By providing money for training and human resources, DFID broke some taboos. But theresult is that the Emergency Human Resources Programme has shown encouraging signsof early success.29Malawi HIV and AIDS Monitoring and Evaluation Report, 2005 (2005). Follow-up to the Declaration of Commitmenton HIV and AIDS (UNGASS). Office of the President and Cabinet, Malawi, December.