Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health Annexes
Part IV: Lessons Learned
Leadership
1. The successful implementation of a comprehensive HR plan needs the collaboration
and commitment of a multi-sector group that includes the MOH, MOE, MOF, donors,
and NGOs. In the case of Malawi, the SWAp has effectively served as the mechanism
for this collaboration.
2. Government commitment and leadership to taking direct action in regards to the health
workforce crisis, as was evidenced in Malawi, is essential.
3. Donor willingness to support salary increases, through the top-ups, and the
Government’s willingness to allow different pay scales was a key factor that led to
improvements in Malawi.
4. Clear and regular communication to all stakeholders, including students in pre-service
training and people already employed in the health workforce, about the goals and
expectations of the HRH plan is critical in order to avoid confusion and/or backsliding
that could result from any changes in policy, especially those involving compensation
or the payment of student fees.
5. A long time horizon is necessary to see improvements as the production and retention
of health workers is a lengthy process. Short term interventions will not produce any
lasting impact.
6. In the face of severe staffing shortages, a combination of short-term, emergency
interventions (UN volunteers) and longer term interventions, (investment in training
infrastructure) combine for success.
Planning and Monitoring
1. When faced with an emergency situation, as Malawi was in 2004, it was necessary to
make haste in responding to the crisis. In the case of Malawi the most appropriate
intervention was to increase salaries, but there was no clear plan to sustain these
salaries at the end of the programme.
2. The early assumption to maintain the top-up salary increase by creating a separate
division of the Health Service Commission that was solely dedicated to restructuring
the pay levels for health care workers and focused on conditions of service specific to
the health care field, proved difficult because of the different goals and competing
priorities of the various players in HRH.
3. A detailed plan of the specific interventions to be implemented is critical at the design
phase of a Human Resources strategy. The EHRP, for example, did not have a single
finalised design document but rather was drafted at several stages in 2004. In addition,
Element 5 (improving M&E capacity) as well as the implementation of a hardship
incentive package (under Element 1) did not have clearly laid out plans for
implementation.
4. Even in an emergency, it is worthwhile to take time and put a monitoring and
evaluation system in place in order to track results that can inform the next phase.
EHRP Initial Findings & Implications Page 78