Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
ELEMENT 1: IMPROVING INCENTIVES FOR RECRUITMENT AND RETENTION OF HEALTH
WORKERS
Overview of Implementation
The 52% top-ups to the 11 priority cadres of staff were implemented nationwide at MOH
and CHAM facilities beginning in April 2005. Although not part of the original plan, an
additional cadre, the Health Surveillance Assistants (HSAs), also received top-ups under
the EHRP. HSAs are salaried community-based health workers that deliver various
services, including: immunisations, family planning, well-child visits, and disease
surveillance. MOH targets for HSAs are 1 per 1,000 population (CHAM does not employ
HSAs). The HSAs are recruited and trained within each district by the District Health
Teams. Currently, the HSA cadre is divided into two cohorts: those in established posts, as
determined by the DHRMD, and those in non-established posts, recruited on an indefinite
basis by the Global Fund. The new cohort of non-established HSAs was recruited in 2007
and received a 26% salary top-up. In response, established HSAs were also given 26%
top-ups, beginning in October 2008.
The recruitment and re-engagement strategy under Element 1 involved two large-scale
recruitment galas, in June/July 2006 and November/December 2008. The galas were
advertised nation-wide, and held over the course of five days in each district. In addition
to recruiting new health workers, a major focus of the galas was re-engaging staff that had
left, due to retirement or other reasons. To address these issues, the retirement age was
increased from 55 to 60 years, and three-year contracts were offered to health workers for
re-engagement.
As of the writing of this Evaluation report, the hardship package proposed under Element
1 has not been implemented. No comprehensive plan has been developed detailing the
components of the hardship package or how it would be implemented. This topic will be
revisited in later sections of the report.
Data and Findings
A. Quantitative
� Yearly targets were set at the inception of the EHRP (see Annex A). As of the end
of 2009, four cadres have met or surpassed the yearly targets – physicians, clinical
officers, laboratory technicians, and pharmacy technicians. 36 (Figures 3 – 6)
� Physicians increased from 43 in 2004 to 265 in 2009; a 516% increase (Figure 3).
(Refer to Table 5 for complete list of percent increases by cadre). 37
36 Full details of MOH and CHAM cadres by year compared with targets can be found in Annex I.
37 Note that the large percentage increase in physicians is due to the low starting figure of 43 physicians. In
real terms, there was an absolute increase of 222 physicians over the EHRP. Nurses, by comparison, saw an
absolute increase of 1,356 nurses during the same period, which was a 39% increase.
EHRP Evaluation Final Report Page 23