Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
costs under Element 3: the average cost per UNV was approximately USD 37,600
compared with VSOs at an average of USD 13,600. The costs per UNV are significantly
higher due to larger stipends and allowances (resettlement, security, settling-in grant,
etc.) than those provided VSOs. There is no data currently available to provide a
comparison of outputs between the two types of volunteers.
The second level of analysis would require a comparison group within Malawi, in which
some parts of the POW were implemented and others were not. Malawi’s six-year POW,
implemented through the Health SWAp, was a multi-pronged strategy that launched
numerous interventions aimed at improving health outcomes for the population.
Determining cost-effectiveness of a single component of the POW (such as the
EHRP/Pillar 1) would require a comparison group which did not receive the same
intervention, as noted in the definition of cost-effectiveness above. In addition, the pillars
are all interdependent, and the specific impact of one pillar cannot be isolated. For
example, staffing is clearly a major component of service delivery, but availability of
drugs also plays a key role. The desired outcomes are produced by a mix of interventions
and therefore cannot be solely attributed to just one.
Finally, the third approach would be to compare the effectiveness of the EHRP in Malawi
with interventions to increase staff retention in another country. To date, there have been
no comparable wide-scale approaches to increasing staff in a country similar to Malawi,
as discussed in the background. The comprehensive and innovative nature of the EHRP,
and in particular the donor-funded salary top-ups, make Malawi a unique case.
To give an idea of cost-effectiveness, the overall inputs, outputs, outcomes and impact of
the EHRP are summarised in Table 18 below. As stated previously, increases in
utilisation cannot be attributed to a single intervention in the EHRP; however, the strong
correlation between health workers and greater utilisation and impact has been
demonstrated in the literature. The interventions in the POW have resulted in gains in
utilisation and coverage of services for Malawi’s population. The final step will be an
assessment of the health status of the country, to be undertaken when data from the
upcoming DHS are made available to further assess outcome in terms of morbidity and
mortality.
EHRP Evaluation Final Report Page 66