Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health Annexes
Pre-Service Training
1. In the case of Malawi, the expansion of pre-service training was, and is, a cornerstone
of the EHRP, yet the MOH does not have direct control over the costs involved. Since
well trained health workers are essential to the Ministry achieving its goal of providing
health services, this poses a dilemma that must be addressed.
2. Accelerating the production of traditional cadres (such as physicians and nurses) may
not meet all the needs of the Government’s health plan or be the most cost effective.
In the case of Malawi, the focus on implementing the Essential Health Plan calls for
skills of other cadres, including HSAs, pharmacists, and lab technicians.
Human Resource Strategy
1. Increase in staffing numbers must be accompanied by improvements in Human
Resource Management (workforce analysis, recruitment, deployment, supervision and
staff development).
2. A well functioning Human Resource Management system is the foundation on which
to base implementation of an HR strategy. In the case of Malawi, there were delays in
deployment, continued high numbers of staff transfers, etc., that created obstacles to
the effectiveness of the EHRP implementation.
3. As part of any effort to build capacity in HRM, it is critical to establish the importance
of this role in the Ministry at a high level so that it is respected as a key contributor to
the decision making process around HRH.
4. In order to move from an ‘emergency’ phase to a more sustained strategy, a strong
emphasis on systems strengthening and leadership development is called for in order
to ground the gains made during the emergency in the ongoing business of HRH.
TA and Volunteers
1. When planning to use international volunteers as a stop gap measure, it is important to
realise that this process takes time, for example, more than a year before volunteers are
actually in place and working.
2. International volunteers should be selected based on an analysis of where the most
critical gaps are, not only in terms of staff, but in terms of speciality. Their role should
include skills transfer as much as possible.
3. With all international consultants, including the volunteers, differential can cause demotivation
of national staff.
4. Long term technical assistance with a focus on capacity building, i.e., HRM, is only
effective if there is a stable team of counterparts who participate in deciding how the
TA can contribute to their challenges.
Conclusion
There was significant progress made under SWAp 1 in addressing the HRH crisis and, as
evidenced by this evaluation, the investments made by the Government have resulted in
tangible increases in access to health services and lives saved for the people of Malawi.
At this point, the Government is in a strong position to build on the experience of the last
5 years and continue to expand health services for the benefit of the country as a whole.
EHRP Initial Findings & Implications Page 79