Survival and Retention Strategies for Malawian Health Professionals

One of the biggest challenges facing African health systems is the shortage of human resources for health (HRH). This shortage has been exacerbated by the AIDS pandemic, which has not only increased attrition of health workers, but has also increased work loads as a result of increased morbidity in the general population. In addition, morbidity among health workers themselves leads to absenteeism, resulting in work overload for the remaining health professionals (Paradath et al, 2003).

The major formal health services provider in Malawi is the Ministry of Health (MoH), which provides approximately 60% of all services. The Christian Health Association of Malawi (CHAM) is responsible for the provision of about 37% of all services. Other providers include both private-for-profit and private not-for-profit, local government, the military and police health services and small clinics offering care for company employees and their families (Ministry of Health and Population, 1999).

The 'push factors' that lead to health workers leaving their posts in Africa, and the 'pull factors' operating in the recipient countries have been described elsewhere (Hagopian et al, 2004; Hagopian et al, 2005; Kline, 2003). While it is generally appreciated that remuneration packages and general work conditions in most health systems are inadequate (Hagopian et al, 2005), not all health workers leave. What are the factors that retain or could retain health workers in their posts? It is well recognised that the salaries/wages of health workers in many places in Africa may barely meet family living expenses. How are health workers surviving on such meagre wages? These are the questions that form the basis of this research. Hopefully the lessons learnt in Malawi may guide policy makers and health workers’ associations in advocating for better working conditions for health workers here and in other African countries.