Reviving girls’ shattered hopes
Mercy Masiyawo had a dream. She wanted to become a nurse once she was through with tertiary education. Mercy was influenced by Dorothy Ngoma, Nurses and Midwifes Association of Malawi (NONM) executive director.
“I think she (Ngoma) is an intelligent woman who knows what she is doing,” says the seemingly shy girl from the area of Traditional Authority Malemia in Nsanje District.
Mercy, who did her basic education at Nyamadzere School in Nsanje, was, like the rest of us, born bright and used to score high marks in class. Unfortunately, she was born in a poor family.
However, despite attaining good grades in Form Four, Mercy could not make it to nursing college. Lack of tuition fees after the demise of her parents nearly forced her to lose the hope of achieving her dreams. Mercy banged at the door of almost every company and individual for sponsorships, to no avail.
In fact, Mercy’s plight is not unique to Malawi. Across the continent of Africa, girls fail to pursue their dreams due to exorbitant tuition fees demanded by nursing institutions, a situation which has contributed to shortage of nurses in the hospitals.
Many countries in sub-Saharan Africa face the challenge of shortage of healthcare workers and this negatively affects access to healthcare services by the ultra-poor.
In Malawi, the estimated doctor –to-population ratio is 0.2:10; 000 and the nurse-to-population ratio is 3.4:10, 1000. This is against a population of over 17 million, according to National Statistical Office figures of 2008.
This nursing ratio is one-third of the World Health Organisation (WHO)’s recommendation of 10 nurses per every 10,000 people, leaving Malawi’s health facilities with a 65 percent vacancy rate for nurses and nurse – midwives.
Various efforts have been made to address the situation. For example, in 2004, the Ministry of Health (MoH) and the Christian Health Association of Malawi (Cham) began a six-year Emergency Human Resource Programme (EHRP) aimed to address the shortage of health workers.
According to MoH, the EHRP improved recruitment and retention of health workers in the country, expanded domestic health care training capacity, and facilitated the employment of international volunteer health care workers on short term basis.
According to MoH, the programme contributed to the overall increase in the population of nurses who were providing healthcare services to the country. The population increased by 30 percent between 2014 and 2009.
But, despite the moderate success of the EHRP, shortage of health workers in the public sector persists, with the largest vacancies existing in rural areas of Malawi.
However, luck smiled on Mercy along the way when Global Aids Interfaith Alliance (GAIA) identified her as one of the beneficiaries of training in nursing. GAIA is a non-profit making organisation that offers nursing scholarship programmes that require graduates to work in the public health sector for a period of four to five years following graduation from nursing school.
“When I visited one of the public hospitals in my district, I met a nurse who seemed interested in my dream to become a nurse.. She told me about an organisation that offers scholarships to needy students. This is how I got registered by the organisation after they were satisfied with my credentials,” Mercy says.
According to GAIA projects officer, Chimwemwe Mwangonde, the scholarship programme aims to increase the number of nurses working in the public sector, especially those in rural hospitals.
Mwangonde says his organisation found that most ambitious and qualified girls fail to pursue their nursing dreams due to high tuition fees offered by various nursing institutions, a situation which contributes to the high nurse-ratio population in the public sectors.
“As a result most girls do not complete their education and, instead, indulge in transactional sex, leading to early pregnancies, marriages or any other risky behaviour out of frustration. Poverty is another contributing factor,” he explains.
Mwangonde says, through the programme, nurses get support in terms of tuition fees, upkeep stipends, uniforms, nursing supplies, and payment of council examinations’ fees to improve yearly school progression of nursing students, on-time graduation rates and licensing examinations’ performance.
Under the programme, the students demonstrate a commitment to work in the public health system after graduation and are required to sign a service agreement to work for MoH or Christian Health Association (Cham).
Mwangonde says the programme, which is run by MoH, Cham and other training institutions, started in 2005 and has so far awarded scholarships to 480 nursing students at technician, diploma, bachelors and masters levels.
“Although the programme started before (coming in of) the 2010 WHO policy recommendations to improve retention of the health workers in remote areas, we have implemented some of the WHO recommendations, including targeted admission policies, supporting students attending rural nursing colleges, designing and conducting continuing professional development events for GAIA scholars, and ensuring a compulsory service agreement after graduation,” Mwangonde says.
He says the pre-service scholarship programme supports nursing students who are predominantly orphans or those who are from lower socio economic backgrounds, a strategy which he says aligns with the “transformative education agenda” recommendations from the Commission of Education of Health Professionals from the 21st century.
“ In fact, the nursing scholarship recruitment phase targets young, needy students who have been accepted in nursing colleges, including one located in and serving a rural area but who are facing financial hardship and would otherwise be unable to complete a diploma or degree [programme] in nursing,” Mwangonde says.
Mwangonde explains that GAIA monitors licensed nurse graduates deployed into the public health system by the MoH to ensure they fulfil their service agreement. This is done while in school and after graduation, up to two years after completion of the graduation service agreement.
He says the organisation conducts follow up data activities on all graduates in a continually updated database to assist the MoH and Cham in tracking the scholars and ensuring that they have reported to deployment sites.
“We maintain close follow up with each scholar through site visits, text messaging, phone calls, and regional get-together events, providing academic educational psychosocial and clinical mentoring, and educational opportunities for continuing professional development,” Mwangonde says.
But, while commending GAIA for the scholarship programme, Professor Joseph Mfutso Bengo of the College of Medicine [University of Malawi], says such initiatives would be beneficial if they incorporated the component of motivating the health workers by improving their working conditions.
“Otherwise the majority of nurses will still travel abroad for greener pastures,” Bengo says.
NONM executive director, Ngoma, says more needs to be done to address the problem of nurse-patient ratio in the country. She describes the current ratio as worrisome, as many girls continue to lose the hope of pursuing their dreams of becoming nurses due to high tuition fees.
With smiles on her face, Mercy says the scholarship programme has helped her to realise her dream of becoming a nurse.
“Without this programme, I would probably end up indulging in risky behaviours, thereby thwarting my long time dream. I can see a light at the end of the tunnel,” Mercy says.
In fact, Mercy is not alone in signing this success story as many others have joined the chorus.
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