Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
to action that underscore the importance of this issue, such as The Kampala Declaration
(2008) and the Task Force on Innovative International Financing for Health (2009).
WHO’s new global recommendations “Increasing Access to Health Workers in Remote
and Rural Areas through Improved Retention” provides practical guidance to policy and
decision makers on this issue.
Recommendations
1. Revisit the Health Service Commission Act as one option to establish a
mechanism to champion and institutionalise a new pay structure for health
workers that would lead to sustaining pay increases resulting from the 52% topups.
2. In collaboration with SWAp partners, establish staffing norms for each facility
type / level of the health system based on standard catchment population size and
burden of disease. In addition to physicians, nurses, midwives, and other service
providers, these staffing norms should be expanded to include pharmacy
technicians, lab technicians, and health statistical clerks.
3. Based on the above staffing norms, establish specific targets for staffing increases
in cadres that will best effect the EHP and MDGs for the next Programme of
Work.
4. In addition to establishing staffing targets, ensure that the performance appraisal
system evaluates the performance of staff on a regular basis in order to ensure that
quality services are being offered.
5. Expedite implementation of a hardship incentive package to attract health workers
to hardship areas. This package should include both financial and nonfinancial
incentives, but it must be tailored to the needs of Malawi.
6. Support increased investment in the Umuyo housing scheme in order to ensure
adequate staff housing is available, especially for staff in rural locations.
7. Continue to organise recruitment galas and offer three-year contracts with a
concentrated effort on tracking deployment and performance of those recruited
back.
Element 2: Pre-Service Training
At the moment, there are several challenges to the MOE and CHAM’s ability to maintain
the momentum of training seen under the EHRP: (1) the Government is reviewing its
commitment to pay student fees; (2) the fees for training have increased dramatically, for
example, key informants reported that certain nursing Programme fees have increased
from MK25,000 in 2004 to MK335, 000 currently; (3) even with the top-ups, the salary
for a nurse is not high enough for prospective students to justify paying the higher fee,
which most of them cannot afford; (4) without the Government providing support for
training, the option to require up to five years of bonding, a distinct advantage for the
Government, is lost; (5) the increased production of health training institutions under the
EHRP cannot be sustained without additional investment in teaching staff.
EHRP Evaluation Final Report Page 71