Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
Despite early assumptions, there is not a clearly developed government plan to assume
responsibility for the salary top-ups. In addition, the enhanced health workforce needs to
be supported by stronger health systems in order to achieve maximum performance, and
the increased production demonstrated by health training institutions under the EHRP
needs additional resources to sustain this higher level of training.
At the same time, Malawi is also vulnerable due to high population growth (averaging
3% increase per year) and a continuing high burden of disease. For these reasons, the
next Programme of Work should be considered a transition phase, moving from
emergency to a fully staffed health system through a development phase that emphasises
strategic planning, systems strengthening, performance management and sustainable
funding for financial incentives.
A first step in planning for the next Programme of Work should be an analysis of the
cadres most needed to positively impact the MDGs as well as the Malawi Essential
Health Package, and set targets for increases in these cadres over the next five years. The
scenarios outlined earlier present various options for setting targets and the Costing and
Staffing Projection Tool that accompanies this report can be used by the Government to
create and analyse other additional options, or scenarios based in their specific goals.
RECOMMENDATIONS FOR ELEMENTS 1 ‐5
The recommendations below are provided in relationship to each of the five elements.
They are followed by an analysis of what was missing and what is being recommended to
be part of Phase 2 of the Programme of Work. This section concludes with a
consolidated list of all recommendations resulting from this evaluation.
Element 1: Incentives for recruitment and retention of staff
Top-Ups: At the beginning of the EHRP, it was assumed that the HSC would establish a
separate health service with more competitive salaries that would replace the top-ups by
2009. As this has not happened, there is a need for a government plan to sustain the
improved salaries.
Recruitment Galas and 3-Year Contracts: Although the galas/3-year contracts as a
recruitment strategy suffered from the bureaucracy and lack of communication, they were
seen as being valuable by prospective health staff.
Hardship Incentives: There was consensus among key informants and focus group
participants that the provision of a hardship incentive package for rural areas should have
received more attention under the EHRP, but no budgetary allocation or policy guidance
was issued. As the majority of Malawian people live in rural areas, incentives (both
financial and non-financial) are necessary to attract health workers to these areas.
Implementation of a hardship incentive package should become a top priority under the
next Programme of work. In doing so, Malawi would be in step with various global calls
EHRP Evaluation Final Report Page 70