MALAWI: More needs to be done to stem brain drain


LILONGWE, 14 Apr 2006 (IRIN) - Although the government has increased salaries and tried to improve the conditions of Malawi's health workers, the country's health professionals warn it is not yet enough to stem the brain drain.

'Top-up [of salaries] has slightly improved the situation. It has been able to attract some retired paramedics or those who resigned because of frustration, but it has failed to retain doctors and registered nurses,' said the head of the Nurses and Midwives Council of Malawi, Maureen Chirwa.

Malawi has an extremely low ratio of less than 2 doctors and 29 nurses per 100,000 people, with only 13 Malawian doctors working in the 27 district hospitals. 'The main problem is that most of the doctors we sent for training in the UK remain there after completing their studies,' deputy director of Clinical Services, Davis Mtotho, told IRIN.

One consequence of staff shortages and the lack of resources was that Malawi's maternal mortality rate in 2004 was among the worst in the world, at 1,800 deaths per 100,000 live births.

That same year, the UK Department for International Development (DFID) stepped in to help support the health system with a US $175 programme to help raise salaries of health workers, double the number of nurses and triple the number of doctors in training. It also turned to international volunteer health workers to temporarily fill gaps while Malawian professionals were being trained.

A DFID statement stressed that, although it was early days in a six-year programme, salary top-ups have had a positive impact on staff numbers, with 450 new health workers hired in the first nine months of the initiative.

'Reports from districts suggest the top-ups have helped slow the exodus of nurses; the Ministry of Health has recruited over 570 new staff, and aims to fill a further 600 posts by July 2006; recruitment of 61 international volunteers has .. beaten the target set for the first year; new laboratories are being built at the College of Medicine, allowing the start of new degree courses,' a DFID statement noted.

However, Chirwa pointed out the majority of doctors and nurses 'look beyond salary increments, they are looking at their own personal development, which is not there. Some are interested in specialisation, and they cannot find it here in Malawi. Others need better housing and better education for their children, which cannot be provided in remote parts of the country'.

Malawi is a poor landlocked country, which in recent years has struggled to feed itself; 30 percent of the population goes hungry for at least three months every year. Most hospitals do not have adequate equipment, and an HIV infection rate among adults of 14.2 percent has increased the workload of health workers, while also cutting into staff numbers.

At the launch last week of a World Health Organisation (WHO) global health report, Luis Sambo, Regional Director for Africa, said the chronic shortage of staff across the continent was a direct result of decades of under-investment in education, training, salaries and working conditions. He called on national governments and the international community to do more to address the crisis.