Meeting the health-related needs of the very poor
Survival and retention strategies for Malawian health professionals
Understanding the challenges and solving the health professional crisis in Malawi
Authors:
A. S. Muula; F. C. Maseko; SIDA
Publisher:
EQUINET: Network for Equity in Health in Southern Africa, 2005
Malawi, like many southern African countries, is facing a critical human resources for health (HRH) crisis, preventing it from delivering acceptable quality health care services to its population. This report discusses the challenges and survival strategies of health care workers and suggests policy recommendations to tackle these difficulties. The reasons underlying the shortage of health professionals include limited output from training institutions, high attrition rates resulting from migration and disease, and increased workloads because of HIV and AIDS. The challenges encountered by these health workers (which may eventually become push factors), and the coping or survival strategies that they utilise deserve attention if any meaningful solutions to retain health professionals in Malawi are to be developed.
Health professionals employ a range of survival strategies including:
- Reliance on per diems/allowances from workshops and seminars
- Saving on stipends from long-term training programs
- Business activities
- Working in places where the cost of living is perceived to be lower
- Pilfering of drugs
- Dual practice (working in both private and public sector),
- Consultancy work
- Being paid for work not done at one institution while working for another employer
In order to retain health professionals in Malawi, the authors make the following recommendations:
- Promote the use of health workers on leave or off-duty
- Facilitate the re-employment of health workers who have left the public system.
- Improve the remuneration package of health workers and improve general working conditions
- Institute a mandatory public or national health service for all health workers whose tuition was funded by public finances
- Introduce rural 'hardship' allowances to encourage health workers to choose rural postings
- Refuse to provide certificate for work abroad until a suggested mandatory public service or work in the country is fulfilled.
- Provide specialist training
- Strengthen health professionals’ associations.
- The Ministry of Health should employ, equip and motivate people who are training in human resources administration, management and planning.
- Minimisation of deployment of clinical staff to non-clinical, managerial positions.
- Strengthen HIV infection prevention through training, supplying the requisite prevention supplies and supervising to ensure that the measures are being implemented.
- It may be crucial for government to formally recognise that dual practice exists and to explicitly allow public sector health professionals to work privately in designated time.
- There is a need to define the roles of the DHO and the academic and professional qualifications.
