Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
where there is an acute shortage of medical staff. This voluntary code of practice for WHO
member states, under negotiation since 2004, provides hope that low-income countries, like
Malawi, will not lose precious resources after investing in their training.
Against this backdrop, Malawi’s EHRP was ahead of its time. 13 Designed in 2004 and
implemented in 2005, the EHRP not only meets most of the dimensions of the Kampala
Declaration, but it has had sustained donor support for close to six years. The importance of
sustained funding cannot be underestimated when addressing the magnitude of the HRH
crisis because of the time horizon needed to train health workers and reform policy systems.
The three largest donors to the EHRP are the Government of Malawi, DFID, and the
Global Fund to Fight AIDS, TB and Malaria (Global Fund); additional donors include the
World Bank, the Norwegian Agency for Development Cooperation (NORAD), the
German Development Cooperation (GDC), UNFPA, and UNICEF. The EHRP forms the
first pillar of Malawi’s six-year Programme of Work (POW). The remaining five pillars of
the POW are: pharmaceutical and medical supplies; essential basic equipment and
infrastructure development; routine operations at the facility level; and central operations,
policy and systems development. The POW is administered by the MOH with support
from a network of donors, ministries and other stakeholders and is implemented through a
Sector Wide Approach (SWAp). The SWAp in Malawi is considered to be a highly
effective mechanism because of its high level of collaboration across the various
departments within the health sector. Progress on Pillar 1, Human Resources, is monitored
by the HR Technical Working Group.
At its inception, the EHRP set a target to increase Malawi’s health workers to the level of
staffing ratios in Tanzania (see Table 1 below). 14 In 2004, Tanzania had doctor and nurse
to population ratios of 2.3 and 36.6, respectively. Malawi at the time had 1.1 doctors and
25.5 nurses per 100,000 population.
Table 1: Staffing Levels per 100,000 Population in 2004 15
Cadre South
Africa
Botswana Ghana Zambia Tanzania Malawi
Physicians 69.2 28.7 9.0 6.9 2.3 1.1
Nurses 388 241 64 113 36.6 25.5
From the beginning, the EHRP was seen as an ‘emergency response,’ but there was strong
consensus that its ultimate success would depend upon other factors to sustain it, including
stronger institutional capacity and human resource management systems. Now, six years
later, the Government of Malawi, supported by DFID, has called for an evaluation of the
13
Martin-Staple, Anne. Six-Year Human Resource Relief Programme: Retention, Deployment and
Recruitment, June 2004.
14
Please note that staff to population ratios are used as rough illustrative comparisons and may be subject to
variations in numerators and denominators (i.e., the definition of what cadres comprise a nurse).
15
WHO Global Health Atlas – An Interactive World Map. http://atlas.globalhealth.org/
EHRP Evaluation Final Report Page 9