Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
The accuracy of the HMIS data, reported in annual HMIS bulletins, has not been verified. In
some instances, certain indicators are reported as achieving over 100% coverage where this
is not possible (for example, % of fully immunised children or % of HIV-positive mothers
receiving Nevirapine for PMTCT). However, as no other service utilisation data exists on a
national scale, this evaluation uses the HMIS figures to evaluate the impact of EHRP.
The population figures for Malawi in 2009 are questionable and have been the source of
some controversy. The latest census data available from the National Statistics Office is
for 2008, and the population figures reported for 2009 in the HMIS bulletin show a
significant decrease (over half a million people) from the previous year. At the writing of
this evaluation, the population issue has not been resolved. Lack of accurate population
data is a particular issue in comparing staff to population-based ratios. For this reason, the
evaluation team intends comparisons of population-based ratios across different countries
to be rough illustrative approximations. 35
Finally, there are some cases in which data reported from different sources were
contradictory or did not correspond. Monthly top-up reports were aggregated by district
and included no detail on cadres of staff, and did not always correspond precisely to the
staff ‘vacancy analyses’ provided, which included staff that were not receiving top-ups.
Based on our assumptions described earlier and in Annex H, we have removed the staff
that should not have received top-ups from the vacancy analyses provided by the MOH
and CHAM.
Scope of this evaluation
The availability and reliability of data had an impact on the scope and level of analysis
that could be performed for this evaluation. In the absence of attrition data collected by the
MOH and CHAM, there is still no exact picture of how many staff were retained per year.
The evaluation team compared the change in total numbers of health workers with the
expected number of entrants into the public sector (training institution and recruitment
gala outputs) to get an approximate idea of attrition.
Secondly, undertaking an analysis of cost-effectiveness of the EHRP was limited by the
lack of a control for comparison. The salary top-ups were rolled out simultaneously on a
national scale, across all districts, so no in-country controls are available. The unique
nature of this Programme does not allow for direct comparison with interventions from
other countries. Undertaking an analysis of impact of the EHRP has been limited by the
availability of outcome data that is typically reported in household surveys such as the
Demographic and Health Survey, the latest of which was published in 2004. The next
DHS for Malawi will not be available until 2011.
Finally, the scope of the evaluation does not include an assessment of quality and
productivity of health workers. The goal of the EHRP was to improve the numbers of
health workers available in Malawi, and therefore we have focused on the quantitative
outputs of this Programme.
35 Population-based staffing ratios may also vary due to differences in the calculation of numerators. For
example, when calculating nurses per 100,000 population, the definition of a nurse may not be uniform
across all countries.
EHRP Evaluation Final Report Page 21