Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
Interventions proposed under Element 1 included salary top-ups and strategies for
recruitment and retention. Through these components, numbers of health workers were
expected to increase significantly by 2010. Individual targets were set on a yearly basis,
by cadre, with an overall increase of 6,047 health workers in 2004 to 10,543 health
workers in 2010, representing a targeted 74% overall increase (Annex A). 17 The staffing
targets were established by senior officials in the MOH in collaboration with a consultant
health economist.
The eleven priority cadres of staff identified to receive the top-ups are: physicians, nurses
(including midwives), clinical officers, medical assistants, laboratory technicians,
radiography technicians, pharmacy technicians, dental therapists, physiotherapists,
environmental health officers, and medical engineers. The 11 cadres were selected in
discussion with the MOH, training schools and professional associations. These cadres
were perceived to be the most under stress and necessary to deliver the Essential Health
Package and roll out HIV/AIDS-related services. 18
Recruitment galas were planned to identify and recruit graduates from training
institutions, as well as to re-engage health workers that had left the public sector for a
variety of reasons. In addition, a hardship package was proposed, in which health workers
would receive additional incentives for accepting posts in remote hardship areas.
The purpose of Element 2 was to significantly increase the number of Malawian health
workers in training, and to improve capacity at the major training institutions. This was to
be accomplished by paying for student tuition fees at the institutions, and providing
money for infrastructure development to allow for increased student capacity. The training
institutions were expected to increase graduate output by 50%, including doubling the
number of doctors and tripling the number of nurses and clinical officers. This general
target was refined with a training costing model that detailed outputs by cadre, taking into
consideration the current and projected capacity of the major training institutions (Annex
B). 19 The model projected an increase in graduates from 842 in 2004 to 1,534 in 2010,
representing an 82% increase. The four main training institutions are Malawi College of
Health Sciences (MCHS), Kamuzu College of Nursing (KCN), College of Medicine
(COM), and the CHAM institutes.
No specific targets were set for the number of volunteers for Element 3 in the EHRP
design documents, although an approximate number of 90-100 was suggested. 20 The
volunteers were suggested as a stop-gap measure, to fill emergency gaps while more
Malawian doctors were being trained under Element 2; therefore, this element of the
EHRP was not planned to be sustained indefinitely.
17
Martin-Staple, Anne. Six-Year Human Resource Relief Programme: Revisions and Year-One
Implementation Plan. Short-term consultancy report, December 2004.
18
Source: Debbie Palmer, personal communication, May 26, 2010
19
Martin-Staple, Anne. Proposed 6-Year Human Resource Relief Programme for the Malawi Health Sector,
Part II: Training and Tutor Incentive. June 2004.
20
Presentation by Matt Gordon, “Malawi’s Emergency Human Resources Programme: An Overview” made
to DFID, 5 November 2008.
EHRP Evaluation Final Report Page 11