01 Dec Steering HIV Epidemic Control in Malawi: Additional health workers relieve health system
Among the poorest countries in Africa, Malawi faces myriad health challenges. Approximately 28,000 of an estimated 18 million Malawians are infected with HIV annually and nearly 980,000 Malawians are HIV positive. Of these, more than one third do not know their HIV status.* The HIV/AIDS epidemic is most severe in the Southern Region where about 18 percent of the population lives with HIV. In the capital city Lilongwe, more than 10 percent of people are HIV positive. The country also has one of the most severe health worker shortages in the world, which constrains epidemic control. The World Health Organization estimates that Malawi has three doctors, nurses, and/or midwives per 10,000 population against its recommended number of 23.**
HRH2030, in partnership with USAID through PEPFAR, supports implementation of the Government of Malawi’s commitment to control the HIV/AIDS epidemic, including test and start and the 90-90-90 goals. HRH2030 is recruiting nearly 300 health workers for 64 Ministry of Health and Christian Health Association of Malawi (CHAM) health facilities in Lilongwe and Zomba, two of the highest HIV/AIDS burden districts in the country. Salary support of these workers will last until 2019. The Government of Malawi welcomes the support to recruit and pay salaries for health workers, who are critical to the provision of health and HIV/AIDS services and has signed an agreement with the U.S. Government to gradually absorb the health workers by 2020.
“We have noted a tremendous improvement in the delivery of services since HRH2030 recruited for us additional health care workers. We had health centers [that] were handicapped because they only had nurses without a clinician … Now with the recruitment, we have been able to post at least one medical assistant in these facilities.”
— Dr. Wilson Ching’ani, District Medical Officer, Zomba
Salary support not only relieves work pressures in the health facilities, but also provides job opportunities for health workers who have been unemployed due to a multiyear government freeze on recruitment. By November 2017 — one month after initiation of the recruitment drive — HRH2030 had deployed 222 health workers. Of these, 195 officially reported to health facilities, representing an 88 percent retention rate at initial deployment. Health workers recruited include nurse midwife technicians, clinical technicians, laboratory assistants, medical assistants, and pharmacy assistants. Twenty-eight percent of these health workers are PEPFAR scholarship beneficiaries who had been unemployed for nearly a year since graduation. Therefore, the salary support also ensures that PEPFAR’s pre-service education efforts benefit Malawi’s health sector.
“There is a need for qualified pharmacy assistants in Malawi but, since I graduated, I have been working in the private sector in temporary jobs. The job [through] HRH2030 is for a longer period, so it is an improvement,” said Blessings Mbengwa, a newly recruited pharmacy assistant in Lilongwe.
Of the 195 health workers who reported to their posts, the majority (117) work in outpatient departments, antenatal clinics, and labor and maternity wards, providing much-needed health and HIV/AIDS services to the Malawian population.
Dr. Wilson Ching’ani, Zomba District health officer, has already noted one benefit of the additional health workers.
“As a district, we also had a challenge of over expenditure on the budget for medicines because the medicines were being handled by security guards or cleaners due to lack of pharmacy cadres. Now with the pharmacy assistants, we are optimistic things will improve … the change is visible.”
Photo: Newly recruited health workers participate in induction in October 2017 before deploying to health facilities for service. The health workers recruited include nurse midwife technicians, clinical technicians, laboratory assistants, medical assistants, and pharmacy assistants.
*Malawi Population-Based HIV Impact Assessment, MPHIA (2016)
**Malawi Country Operational Plan COP16 Strategic Direction Summary (2016)