Malawi Struggles to Retain Nurses in Public Hospitals

In a pediatric ward at Queen Elizabeth Central hospital, the largest referral health facility in Malawi, mothers look frustrated because of a long wait for a nurse to check on their children. A visit to other outpatient wards reveals more packed waiting rooms.

Such is the situation in public hospitals across Malawi where 65 percent of nursing positions remain vacant.

The shortages leave the country’s public health system in dire need of nurses, and recruiting trained staff remains difficult as many registered nurses prefer the higher pay and better working conditions they can find in private hospitals or abroad.  

Malawi’s National Association of Nurses and Midwifery president, Dorothy Ngoma, says it’s a matter of economics.

“They quit on us because we cannot pay them well.  Most of them are joining the NGOs or to private [hospitals].  So they go where they are paid a bit more money and also where they have more incentives.”

Ngoma said incentives can include housing allowances and overtime pay, and private sector salaries can be double what public hospitals offer.

Health ministry spokesman Adrian Chikumbe says the government cannot afford to pay more.

“The government purse now is constrained, and we have not only health workers to provide for.  We also have other cadres in the civil service.”

Well below international standards

Government statistics show that Malawi has three nurses per 10,000 people.  That is well below the World Health Organization recommendation of 10 nurses for every 10,000 people.

But efforts are underway to plug the shortage.

To fill vacancies, the health ministry says it has more than tripled the number of students in its nurse training institutions from 40 to 150 per class.

A U.S.-based NGO, the Global AIDS Interfaith Alliance, has also been trying to address the gap.  GAIA sponsors education for nursing students in Malawi who commit to work in public hospitals for the first four years after they graduate.

Scholarship program project officer Chimwemwe Mwangonde explains the incentive program.

“Throughout, we support their tuition and also their upkeep.  At the end of their program in the fourth year we also pay their license examinations for them to work anywhere in the country, be it in the hospital or in the community.”

The program has supported more than 500 registered nurses since its inception in 2005.  GAIA is now seeking funding to double the program’s annual intake to as many as 80 students a year.   

Statistics from the recent program evaluation report show that 93 percent of the graduated nurses have honored their public service commitment. And of those nurses who have met the requirement, nearly all of them have continued to work in the public hospitals.

One of them is Patricia Siyabu. She says her decision was driven by a commitment to service.

“Now it is hard to work in government considering the amount of money that we get comparing to the people in NGO’s.  But I still love working in the government because it is my desire to serve the government.  So I have no dreams of going to the NGOs yet.  Not now.”

And it’s the “not now” part that is causing the concern. Recruiting new nurses to work in public hospitals is one challenge, retaining them over the long term is another one entirely.

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