Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
of the equation is equally important. Without the capacity to deliver services—including
adequate staff—facilities will be unable to meet the rising demand.
Impact on Health Outcomes
The ultimate goal of increasing the health workforce is to improve a country’s health
status. Several studies have been undertaken in other countries linking health worker
density to health outcomes. For example, there is a strong association between health
worker density and maternal mortality 97 as well as increased levels of vaccination
coverage. 98 In another study, a dynamic regression model was developed to evaluate the
short and long term impact of changes in number of physicians per capita. 99 Using a data
set of 99 countries, the regression model showed that increasing the number of physicians
by one per 1,000 population resulted in a decrease in infant mortality of 15% within five
years, and by 45% in the long run (half of which would be achieved in fifteen years).
Impact on health outcomes is analysed in this evaluation by assessing the changes in
service delivery, and thereby health outcomes, from the baseline year of the EHRP to 2009,
with the assumption that the increased staff played a significant role in these health
outcomes.
The impact on health outcomes is measured by approximating the number of lives saved
and morbidity averted as a result of the increased service utilisation described in the
section above. At the completion of the upcoming DHS for Malawi in 2011, outcomes in
terms of maternal, infant, neonatal, and child mortality rates can also be measured.
The estimation of morbidity and mortality averted by increased service utilisation was
made using the Lives Saved Tool (LiST) from the Spectrum suite of tools. 100 The
changes in coverage for the HMIS indicators discussed in the previous section (antenatal
care, trained deliveries, PMTCT, and immunisation) were input into the LiST tool for the
span of the EHRP (2004 to 2009). Table 17 on the following page shows the
interventions, percentage coverage in 2004 and 2009, and the resulting lives saved or
infections averted based on the modeling (for complete results, see Annex S). 101 Note
that OPD attendance is not included in this analysis because this is not a specific
intervention and therefore cannot be used to calculate lives saved using LiST.
97
Lincoln Chen et al. Human Resources for Health: Overcoming the Crisis. The Lancet, Vol 364,
November 27, 2004. pp. 1984 – 1990.
98
Sudhir Anand, Till Barnighausen; Health Workers and Vaccination Coverage in Developing Countries:
AnEconometric Analysis. The Lancet. Vol 369, April 14, 2007. pp. 1277 – 1284.
99
Mansour Farahani et al. The Effect of Changes in Health Sector Resources on Infant Mortality in the
Short-Run and Long Run; a longitudinal Econometric Analysis. Social Science and Medicine, No. 68,
2009; pp 1918-1925.
100
The Spectrum suite of tools, developed by Futures Institute, is accessible online at
http://www.futuresinstitute.org/Pages/Spectrum.aspx.
101
Note that impact presented in Table 17 represents an approximation based on pre-determined
effectiveness coefficients for each intervention and using all default parameters for Malawi that are preloaded
in the LiST tool and assuming 12% HIV prevalence for adults. An outcome assessment should be
performed when information from upcoming DHS 2011 is made available.
EHRP Evaluation Final Report Page 64