Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
Analysis of Inputs and Outputs into the Public Health System
� Table 11 below shows the inputs and outputs of the health system, combining
the results from Elements 1 and 2. The inputs into the health system
considered under this evaluation are two-fold: graduates from training
institutions, and recruits from the recruitment galas. In addition to a steady
yearly increase of the training institutions outputs, the two galas in 2006 and
2008 added more than 7,000 health workers into the system over the span of
the EHRP.
� The increases in the 11 priority cadres of health workers at MOH and CHAM
are also shown in Table 9. The changes in the 11 cadre totals from year to year
are shown in row C. This number represents the increase (or decrease) in
absolute terms for MOH and CHAM staff. Attrition is estimated by taking the
difference between total inputs by year, and total absolute change in staff by
year (row D). The calculation assumes a one-year lag between leaving training
institutions or galas and entering the public system. For example, the 914
outputs in 2004 would be expected to cause an increase of 914 in 2005,
assuming both an attrition rate of 0% and an uptake of 100% of all outputs
into the public sector. If these assumptions were true, the difference in row D
would be zero. However, the actual change in 2005 was a loss of 256 health
workers, thus resulting in a difference of 1,173. This suggests a high attrition
rate, because even if every single graduate entered the public system (which is
unlikely), there was still a net loss of 256 people. The only year to see a
decrease in this difference was 2006, in which an additional 987 people
entered the public sector from the previous year, even though there were only
923 graduates from training schools. This would suggest additional inputs into
the system that are not documented here.
� Row D is used as a proxy in the absence of actual attrition data for 20042009.
However, as mentioned earlier, this assumes that all outputs are entering the
public sector, which is unlikely. The recruitment galas saw serious delays in
deployment of candidates (see Discussion, Element 1) and the bonding
schemes for students at training institutions were not always upheld (see
Discussion, Element 2).
EHRP Evaluation Final Report Page 41