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Staff shortage in Malawi’s health sector

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It is 22:00 hours on a rainy night and a health worker is beginning to enjoy his sleep after a tiresome day.

Suddenly, he hears a knock like noise on his main door but ignores it. He is in too much slumber, precipitated by a long day’s work.

But the irritating knock continues and he finally wakes up and goes to check it. It is Chimatilo Health Centre’s watchman at the door.

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He has come to inform the health worker that there is a very sick patient seeking his help at the health facility, which is 100 metres away.

Without asking many questions, the Medical Assistant for Chimatilo health post, Stanley Banda rushes to the facility in his pyjamas.

Even though it is rainy season, there is no time to put on proper closed shoes, he simply goes in his slippers.

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According to the facility’s Health Advisory Committee (Hac) members, Banda often wakes up to attend to patients. The Committee says at times this happens three times a night and he does not tire or falter.

Chimatilo health post is located in Traditional Authority Sawali, over ten kilometres away from Balaka boma.

In the middle of the night, Banda switches on his light to see his way through as well as to see where to record the patient’s symptoms in the health passport. He has used this lamp for a few months, as he initially used a paraffin one.

“My job is about saving lives and not minding my dressing, especially at night. I have no chance to have lots of time for myself. I was the only one working here until November 2016.

There were always people in need of assistance,” he says.

The ceiling of the facility is dilapidated and has become a haven for bats that constantly disturb him when assisting patients in the night.

The health post is situated in a very remote setting. Banda’s house does not have electricity or running water. The pit latrine toilet and bathroom are outside the house. His house is so basic. It has a sizeable sitting room, a bedroom and a storeroom.

There are no social amenities around, where he could go and relax at times, just like his counterparts in the city. If he wants such, he has to use a bicycle taxi and travel over ten kilometres to Balaka boma.

Banda is serving an estimated population of 15,869 and assists an average of 100 people per day.

This signifies the extent of shortage of human resource in the health sector in Malawi, especially in a rural set up like Chimatilo Health Post in Balaka district.

The World Health Organisation (WHO) says Malawi ranks as one of the countries with an acute shortage of health workers. The WHO says patient to doctor ratio is at 6 to 100,000 while the nurse to patient ratio is at 34 to 100,000. This is below the

WHO’s recommended ratio.

It says a health workforce of adequate size and skills is critical to the attainment of any population health goal.

“However, countries at all levels of socioeconomic development face, to varying degrees, difficulties in the education and training, deployment, retention and performance of their health workforce.”

A research, which University of Malawi’s College of Medicine (COM) conducted in 2007 established that Malawi has a critical human resources problem, particularly in the health sector. The country has a severe shortage of doctors and there are only few medical specialists. Ten years later, the situation seems to be the same.

Executive Director for Patients and Community Welfare (Pawe), Amade Alide says his organisation is a member of Human Resources for Health Coalition whose aim is to ensure that Malawi’s acute health workers shortage should improve.

“Malawi has very low human resource for health. This is creating a worrisome situation. The health sector may collapse due to this factor,” he notes.

Alide adds: “There is need to prevent diseases so that the disease burden is reduced. The increased disease burden also affects the human resources. It’s now alarming that’s why it has become difficult to have enough health workers as compared to the patients.”

Most public health institutions in Malawi are characterised by the presence of many patients waiting for their turn to receive treatment.

During the commemoration of the 2017’s Universal Health Care Coverage day on December 12, 2017, Universal Health Coverage Coalition members noted that there is a high vacancy rate of about 45 percent in the country’s health system. They said this is one thing that contributes to poor service delivery.

Amref Health Malawi is one of the coalition members working on improving access to high-quality healthworkers and sexual and reproductive health commodities,

while also advocating for good governance and equitable health financing.

Recently, Amref Health Malawi organised a two day workshop for health journalists in order to orient them on health system’s strengthening.

Health Systems Advocacy Manager for Amref Health Malawi, Benedicto Chinsakaso says it requires a vibrant and influential civil society and network of health stewards to initiate discussion and reform.

He says together, these individuals and organisations have the potential to act as watchdogs—to hold the private and public sectors to account—and to advocate for stronger health systems, share their expert knowledge in an effort to shape health policy, and represent the voices of fellow citizens who are unable to realise their right to health.

“As a country, we have challenges as regards to number of health workers… If we continue to go at this rate, it means we might have more problems in the health sector,” Chinsakako says.

According to Malawi Sexual and Reproductive Health Alliance, inadequate human resources is somehow affecting the accessibility of family planning and Youth Friendly Health Services.

The National Programme Technical Committee member of the Alliance, Jimmy Kachale says (the Alliance) is striving to enable young people to freely access Sexual Reproductive Health commodities.

“We want young people to access Sexual Reproductive Health services freely and we want all these services to be available. So what happens on the ground is that some facilities are failing to make the services available due to the shortage of staff,” he notes.

Despite progress made in Sub-Saharan Africa towards achievement of the previous Millennium Development Goals, maternal mortality remains high as the risk of a women dying during childbirth, or from pregnancy complications is still there.

The WHO reports that increasing numbers of women are now seeking care during childbirth in health facilities, but still less than 55 percent of women in Sub-Saharan Africa deliver under the supervision of a skilled birth attendant. Underlying causes for the poor status of Sexual Reproductive Health and Rights in Sub-Saharan Africa (like Malawi) are diverse and include financial obstacles to health services, limited access to contraceptives and other sexual and reproductive Health commodities.

“There is also poor availability of professionally trained health personnel, gender inequality and socio-cultural,” the WHO says.

The WHO’s Global Strategy on Human Resources for Health: Workforce 2030 set out the policy agenda in to ensure a workforce that is fit for purpose to attain the targets of the Sustainable Development Goals (SDGs).

Goal three of the SDG states the need to ensure health lives and promote health well-being for all by year 2030.

Fingers are crossed if Malawi can ever achieve this without solving the problem of acute shortage of human resource.

Dedicated Health workers like Banda could remain the best if they are not over worked.

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