Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
which had a primary focus on increasing staffing levels through financial incentives and a
massive scale-up of pre-service training.
The EHRP was, and is, unique in its scope and innovation. A study of five countries
(Cameroon, Indonesia, Malawi, Rwanda and Tanzania) in the area of human resources
indicated that Malawi was the only one to have initiated relatively extensive sets of
incentive schemes to retain health workers both in the public and private sector. 9 (The
EHRP and, as a result, this evaluation, focus only on Malawi’s public sector health
services). The study also found that, while attention to the HR crisis is increasing, there is
still a focus on single initiatives. Another study of interventions in Sub-Saharan Africa,
ranging from non-financial incentives to bonding schemes, but with none as
comprehensive as those undertaken in Malawi, showed mixed results. 10
In examining the current state of the global health workforce, it is clear that the EHRP is
unique not only in its scope and innovation, but also in the level of funding and support it
has received from donors. A 2009 tracking survey by the Global Health Workforce
Alliance (GHWA) conducted desk research on 57 countries identified as being in ‘crisis’
because of shortages of health staff. The survey tracked progress on a set of indicators tied
to the Kampala Declaration adopted in March 2008 at the first Global Forum on HRH held
in Kampala, as well as the Agenda for Global Action. Progress has been made. Overall,
55 countries have at least an HRH plan, an HRH unit, and stakeholder involvement.
Additionally, many of these countries (31) have donor commitment for at least one part of
their plan. 11
In their 2008 Declaration, the G8 recognised the importance of the Kampala documents
and pledged to support efforts to address the chronic shortages of health staff. Donor
commitments from the UK, the US and Japan to train new health workers have put this
response into practice. Several countries have made great strides in training new health
workers, especially midwives and community level staff, including Afghanistan, Ethiopia,
and Southern Sudan. A few countries, including Ghana and Nigeria, have pledged to
increase salaries, while other countries are working to improve the availability of data to
inform their HRH policies.
To address the challenge of providing access to health services in the rural areas, WHO
recently completed a year-long initiative to gather evidence on practices that work to attract
and keep staff in these areas. Their report, “Increasing Access to Health Workers in Remote
and Rural Areas through Improved Retention”, provides expert guidance to countries as
they tackle this pressing challenge. 12 Countries will also get support from a recent accord
adopted by Health Ministers to avoid recruiting doctors and nurses from poor countries
9
A cross-country review of strategies of the German Development Cooperation to strengthen human
resources. Windisch et al. 2008.
10
Maximising Human Resource Capacity in Rural District Health Systems in Malawi: August 2008. Eilish
McAuliffe, Ogenna Manafa, Cam Bowie, Fresier Maseko, Malcolm MacLachlan and Charles Normand
11
Baseline Report of Tracking Survey (Kampala Declaration and Agenda for Global Action) and Preparing
for the 2 nd Global Forum).
12
“Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention: Global
Recommendations” WHO, Accepted for Publication.
EHRP Evaluation Final Report Page 8