Analytical summary - Health workforce
In Malawi, public health workers are public servants and their management is under the Department of Public Service Management, which formulates and articulates all strategic public human resources policy. In the case of the Ministry of Health, the Public Service Commission has delegated some of its responsibilities to the Health Service Commission.
The Health Services Commission was established in 2003 and is responsible for:
- recruiting, appointing and promoting health workers
- disciplinary control of health workers
- setting salaries for health workers
- setting working conditions for health workers.
However, there is a lack of clarity regarding the Act that established the Health Services Commission and the powers invested in the Commission. This has resulted in some confusion regarding the respective roles of the Ministry of Health and the Commission in addressing human resource for health issues in Malawi.
There are three regulatory professional councils in Malawi, namely:
- the Medical Council of Malawi, which is responsible for registration and licensing of medical and dental practitioners. Its responsibilities include coordination and regulation of registration of clinical services in the country.
- The Nurses and Midwives Council of Malawi, which is the sole regulatory body mandated to regulate training, education and practice of all nursing and midwifery services.
- The Pharmacy, Medicines and Poisons Board of Malawi, which is responsible for registration and licensing of pharmacy practitioners. It also helps regulate the quality and distribution of drugs in the country and inspects the inflow of these drugs to ensure quality and validity.
In Malawi there are four mechanisms of remuneration in the health sector:
- monthly salary payment;
- salary top-up allowance has also been paid to all health professionals working in Government health institutions since 2005 (a total of 11 professional and technical cadres are eligible for this top-up allowance);
- risk and professional allowances for all professional health workers.
The Ministry of Health is implementing an emergency retention strategy for publicly trained professionals. This includes two components: accelerated remuneration enhancement, and enforcement of retention policies and incentives. The first component proposes remuneration increases (salary plus allowances) for selected professional and technical cadres up to a certain grade to conform to the Government of Malawi's pay reform strategy.
The second component of the retention strategy proposes development and/or enforcement of existing policies that will require publicly funded health sector trainees to carry out a specified period of public health service such as:
- development of student loan agreements that require public health service in lieu of loan repayment;
- part-time work contracts;
- bonding and compulsory service schemes;
- maintaining salary tops-ups and other incentives for essential health worker categories, particularly for tutors and professional and technical staff.
The Civil Service performance appraisal system was introduced in Malawi in 2008 with a view to improving the performance of employees in all ministries and departments, including the Ministry of Health. The performance appraisal system forms a basis for rewarding employees such as providing opportunities for promotion, training and development, and supporting supervision. It is also used to discipline/sanction in case there is no improvement.
A study on the Human Resource Incentive Scheme in the health sector in 2008 indicates that health workers highly value non-financial incentives such as:
- public recognition as health professionals within the communities in which they work
- certificates of recognition
- employee of the month or year awards
- professional opportunities
- access to and knowledge of their job description
- medical insurance for themselves and family
- supervision and educational opportunities for themselves and family.
The study observes that there is no systematic and standardized way of implementing a non-incentive scheme in the health sector and recommends the development and implementation of a comprehensive package of non-financial incentive scheme applicable to the health sector.
The function of preservice training for health workers is the responsibility of the Ministry of Education. The largest health training institution in Malawi is the Malawi College of Health Sciences, which produces paramedics and nurse technicians at its main campus in Lilongwe. The College has other campuses distributed throughout the country. Training outputs of nursing and allied health cadres in the country has increased over time. The Government plans to gradually expand health training institutions to meet the current human resources demand for professional health workers.
Most local health worker training schools face capacity limitations, including shortage of tutors, preceptors at practical sites, teaching equipment and classroom space. The Government suspended funding for nurse technician training in 2008; however, the issue has now been resolved and it has resumed funding students.
Migration of health workers to other countries still occurs, although at a smaller scale due to implementation of the incentive package, including top allowances. However, numbers leaving Malawi may be higher as there is evidence to suggest that many nurses pursue careers other than nursing. Information on leaving rates of current and previous health service staff is not well documented.