Malawi saves over 13,000 lives and facilitates access to ART for more than 230,000 HIV positive citizens through dynamic leadership on human resources for health.

Statement by the Alliance on the report of the evaluation of Malawi's Emergency Human Resources Programme

On the occasion of the release of the evaluation report of Malawi's Emergency Human Resources Programme (EHRP), the Global Health Workforce Alliance secretariat would like to commend the Government of Malawi and its partners, particularly the British Government and the Global Fund, for funding and implementing this very innovative programme. Without addressing the Human Resources for Health (HRH) crisis, achieving the health related Millenium Development Goals (MDGs) will be difficult, if not impossible.

In order to revamp its health system, the Government of Malawi launched in 2004 an ambitious emergency human resources programme, which entailed provision of incentives for recruitment and retention, scaling up domestic training capacity, filling short-term gaps through international volunteer doctors and nurse tutors, providing technical support to bolster management and planning and capacity. A few years on, the EHRP evaluation report highlights significant achievements. The report, prepared by a North-South partnership between Management Sciences for Health (USA) and Management Solutions Consulting (Malawi), ably demonstrates that with the development and implementation of a multi-stakeholder, inter-sectoral, comprehensive Human Resources for Health (HRH) plan, bringing together different elements as laid out in the Kampala Declaration and Agenda for Global Action (KD/AGA), the acute shortage of health workers can be addressed.

Highlights of some of the key findings of the evaluation of the EHRP include:

  • The EHRP successfully accomplished its primary goal - to increase the number of professional health workers in Ministry of Health and Christian Health Association of Malawi (CHAM) institutions.
  • Across the 11 priority cadres, the total number of professional health workers increased by 53%, from 5,453 in 2004 to 8,369 in 2009.
  • Total graduates from Malawi's four main training institutions showed an overall increase of 39%, from 917 in 2004 to 1,277 in 2009 (Physicians by 72%; Nurses by 22%).
  • As pointed out in the evaluation report, health worker density has been established to be related to positive health outcomes. At the outset of the EHRP in 2004, the total health provider density was 0.87 per 1,000 population in the public sector (MOH and CHAM). This figure rose to 1.44 by 2009, representing a 66% increase. Over the same period of time, the total population of Malawi increased by 10%. Thus, health worker density increased beyond simply keeping pace with the population increase.

The evaluation selected four indicators (among others) to analyze using Lives Saved Tool (LiST) (antenatal care, deliveries by trained attendants, prevention of mother to child transmission (PMTCT) of HIV, and immunization). They found that 13,187 additional lives were saved due to increased coverage of these indicators alone attributable to the increased health workforce. What's more, from a low of 3,000 in 2004, there are now 230,000 HIV positive Malawians placed on ARTs. This scale up would not have been possible without the EHRP and the investment in human resources.

This is a significant improvement. Yet the choice of indicators also masks some of the other benefits of a productive health workforce. For instance, the scale up of ARTs could not have happened without the EHRP. From a low of 3,000 in 2004 there are are now 230,000 HIV positive Malawians alive and on ARTs largely due to the parallel investment in human resources.

Some of the key lessons learnt highlighted by the report include the following:

  • Government commitment to taking direct action is essential.
  • Successful implementation of a comprehensive Human Resources plan needs the collaboration and commitment of a multi-sector group.
  • Development partners' willingness to support the 52% salary top-ups and the Government of Malawi‘s willingness to allow the different pay scales was a key success factor.
  • A long time horizon is necessary to see improvements.

The relationship between the five elements of the Malawi EHRP and the Kampala Declaration and Agenda for Global Action are illustrated in the table below:

Relationship between the five elements of the Malawi EHRP and the Kampala Declaration and Agenda for Global Action

The Global Health Workforce Alliance secretariat welcomes the release of this evaluation report. This innovative programme in Malawi demonstrates that progress is possible and lives can be saved when political will, sound strategies and adequate resources come together. A lot can be achieved when the national government, various stakeholders and development partners commit to and work together to implement a well thought out coherent national programme to address the HRH crisis.