the-need

There is a worldwide shortage of healthcare workers, particularly in sub-Saharan Africa. Africa bears 24% of the global disease burden, but has only 3% of the world’s health workforce1. The World Health Organisation estimates that this continent alone will need 1.5 million more health workers to provide basic health services for its population.

Many aid and governmental health programmes have found the lack of trained healthcare workers to be a limiting factor in the implementation of their objectives2. Studies have shown that the relative density of health workers can account for variations in maternal mortality, infant mortality, and immunisation rates across countries3-6.

For Malawi, there was only 266 doctors working in the public sector in total7 in 2004. This equates to less than 2 doctors per 100 000 population. In the UK, we have 233 doctors per 100 000. The World Health Organisation recommends a figure of at least 250 health professionals (including doctors, nurses, and midwives) per 100 000 people in order to provide basic health services1.

The problem is worsened by the skewed distribution of the existing health workers. 85% of the Malawian population live in rural areas. However, out of Malawi’s 156 public sector doctors, 81 are working in central hospitals8. This leaves many districts without any doctors at all.

Specialists also remain in short supply. Only 8% of paediatrician and 9% of obstetrician posts are filled. There is one neurosurgeon for the whole of the country8.

The problem is not just limited to doctors. 33% of nurses’ posts are unfilled. It is also estimated that around 100 nurses emigrate each year, far outstripping Malawi’s training number of just 60 per year8.

Malawi is a very poor country ranked in the bottom 5% by the World Bank9. It has no major mineral or oil deposits and so has not been party to the major inward investment received by other (neighbouring) countries. Despite or perhaps because of this, it is a politically stable country with a democratic electoral system.  Blantyre is the base for many governmental and non-governmental organisations.

^{1) World Health Report 2006, World Health Organisation. World Health Organisation, Geneva, Switzerland.}

^{2) Scaling Up, Saving Lives. Task force for scaling up education and training for health workers, Global Health Workforce Alliance, 2008. World Health Organisation, Geneva, Switzerland.}

^{3) Anand S, Bärnighausen T (2004) Human resources and health outcomes: cross-country econometric study. Lancet, 364: 1603–09.}

^{4) Anand S, Bärnighausen T (2007) Health workers and vaccination coverage in developing countries: an econometric analysis. Lancet, 369: 1277–85.}

^{5) Zurn P, Vujicic M, Diallo K, et al. (2005) Planning for human resources for health: human
resources for health and the production of health outcomes/outputs. Cah Sociol Demogr Med,45(1): 107–33.}

^{6) Speybroeck N, Kinfu Y, Dal Poz MR, Evans DB (2006) Reassessing the relationship between
human resources for health, intervention coverage and health outcomes. World Health Organisation, Geneva, Switzerland.}

^{7) World Health Organisation Statistical Information System (WHOSIS). Available at http://www.who.int/whosis/en/index.html. Last accessed 8 July 2008.}

^{8) Malawi Ministry of Health 2004. Accessed in: Record R, Mohiddin A (2006) An economic perspective on Malawi’s medical “brain drain”. Globalization and Health, 2: 12-8}

^{9) Central Intelligence Agency, World Factbook: Malawi. Available at: www.cia.gov. Last accessed 8 July 2008.}