Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
Part III: Recommendations
In considering recommendations for this evaluation, the MSH/MSC team analysed the
data, both quantitative and qualitative, in light of the original goals of the EHRP to
determine if an ‘emergency’ response is still needed, or if Malawi has progressed
beyond this state. The team examined the outputs of each Element to identify which
ones should be carried forward and/or if there are adjustments to be made six years
later to ensure long term sustainability. The team looked at overarching issues such as
the service utilisation, policy, finance and sustainability. The team developed a
costing tool in order to present various scenarios for the Government to consider as
they move to the next stage of the EHRP. Finally, the team examined the EHRP in
light of the HRH Action Framework to identify elements that were missing. In
conclusion, the evidence is clear that Malawi has moved out of the crisis that
precipitated the EHRP, but there is much to do to consolidate these gains in order to
achieve an adequate and sustainable health workforce.
It is important to note that Malawi’s achievements have been cadre-specific. For
example, though the country has been able to produce more doctors (which has ultimately
influenced the government to dispense with the continued recruitment of international
volunteer general practitioners), there continues to be shortages amongst nurses and
midwives. This shortage in such a critical cadre was one of the primary causes of the
original crisis. Furthermore, other professional cadres such as dental therapists,
physiotherapists and radiography technicians did not reach the original targets set out in
the beginning of the EHRP.
Emergency or Beyond?
The evidence presented in this evaluation shows that Malawi has moved beyond the
emergency stage with regards to staffing levels and the production of health workers.
Sizeable gains have been made in the number of health workers in the public sector
(over a 50% increase) and the number of enroled students in the health training
colleges. This is to be highly commended. Malawi is currently at the level of Tanzania
in terms of staffing ratios of physicians and nurses to population, thus achieving one of
the original goals of the EHRP. 106 However, of the 11 priority cadres, only 4 met or
exceeded the yearly staffing targets outlined in the original EHRP design document.
These four cadres were physicians, clinical officers, lab technicians, and pharmacy
technicians.
Nonetheless, the gains realised are fragile for several reasons. The overall Malawi health
provider density of 1.44 per 1,000 population is still well below the African average of
1.91 per 1,000 107 . Nurses, a particularly critical cadre, remain below the targeted level.
106 Source: WHO Global Health Atlas; Malawi 2009 figures based on primary data from MOH and CHAM
vacancy analyses; Tanzania 2009 figures from: The health worker shortage in Africa: are enough
physicians and nurses being trained? Yohannes Kinfu, Mario R Dal Poz, Hugo Mercer & David B Evans
Volume 87, Number 3, March 2009, 225-230. Note Tanzania figures decreased from 2004 to 2009.
107 World Health Organization, The World Health Report, 2006: Working together for health.
EHRP Evaluation Final Report Page 69