Malawi’s bottlenecks, digital content and health’s human resources crisis

At the opening (2 February 2012) of the Irish Forum for Global Health IFGH) conference in a bitterly cold Dublin, Dorothy Ngoma, Executive director of the National Organization of Nurses and Midwives of Malawi, listed facts that  certainly raised eyebrows in regards to Malawi and its health status.

By 2050, the population of Malawi is expected to rise to 45.2 million, a staggering rise, one which would put incredible strain on the healthcare system and its workers. If one was to consider that today, on average, a woman walks 10km to her nearest maternity unit just to queue up – three to four weeks in advance – to deliver her baby; one can only imagine what maternity provision will be like in 2050.

Ms Ngoma was emphatic; this needs to change and the best way to do so is via  changing how we manage human resources. Currently, there is one nurse per 3680  people, nowhere near the recommended WHO ratio of 1:1000.

Nurses facing tough times

Considering only 10,000 nurses have been trained in the country since 1947,  Ms Ngoma called for a doubling or tripling of intake to meet the demand of nurse provision. In terms of midwives, there are approximately 5,000 in total, well below the 15,000 target estimates suggest the country needs.

With all this in mind, what can be done? While adjusting to the global financial  crisis by recognizing the ‘bottlenecks’ such as a nursing shortage that comes due to decreased funds would be a start. Following this, community and public sensitization on human resources for health, increased lobbying of MPs and further  advocacy and publicity will be required. To be frank, this has all been said  before, but Ms Ngoma’s emphasis on the facts hit the audience today in a way that  may not have happened before.

Following this, Mr Tom O’Callaghan, CEO of the iheed Institute, delivered an enthusiastic, light hearted presentation on innovative ways to mobilize a workforce. He highlighted how the skills of the ‘young technical workforce’ must be utilized so that digital content and distance learning can be integrated into health systems. Mr O’Callaghan argued that this fundamental shift will be key to solving health’s human resources crisis.

In response to this, it was amusing to hear an audience member point out the age  old fact; that this may be good and well but when it comes to human resources, doctors and nurses are the most stubborn to change. Having a medical background, I would agree, but what makes this all the more appropriate, was that this was all being said in the halls and lecture theatres of the Royal College of Surgeons.

*Dr Kunal D Patel; Medic, academic and global Health advocate

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