MALAWI: Solving health worker shortages
LILONGWE, 1 October 2008 (PlusNews) - A chronic lack of healthcare workers in Malawi has crippled the health system, but a different way of doing things has alleviated the shortages, bringing new players to the field.
Many Malawian doctors and nurses head to wealthier countries in search of greener pastures, so the government has been forced to come up with a plan driven by an idea known as "task shifting", in which some tasks performed by doctors are shifted to nurses, some duties traditionally performed by nurses are shifted to community health workers, and some responsibilities of community health workers are shifted to patients or their families.
The country was one of the first to introduce task shifting, and the results seem to be paying off: in 2007, around 625,000 HIV tests were performed, 95 percent of them by non-medical counsellors.
Clinical officers and nurses in Malawi can also prescribe HIV treatment and run clinics dispensing antiretrovirals (ARVs); by the end of 2007 there were about 97,000 patients receiving HIV treatment at 118 ARV clinics.
When Veronica Chabinga was admitted to Bwaila Hospital, a referral clinic in Malawi's capital, Lilongwe, after doctors had diagnosed her with tuberculosis (TB), her main concern was the long time she was would have to stay there.
"But I was surprised that after six weeks only, the doctors discharged me, saying I was free to take the rest of my medication at home. I am a living example of people who successfully cured TB from the confines of my home," said Chabinga, a businesswoman and mother of three. "I think that I recuperated faster because I was treated in an environment that I am familiar with."
Professor Felix Salaniponi, director of the Malawi National TB Control Programme, told IRIN/PlusNews that task shifting had helped government reduce the number of patients, who had overwhelmed the clinics in the past.
Initiative paying off?
"Malawi is one of the countries in the southern Africa region that have been drastically affected by brain drain, but through task shifting the workload is slowly being reduced because communities are now able to care for the sick in their respective areas," said Salaniponi.
The government is also training Health Surveillance Assistants (HSAs) to perform some of the tasks normally carried out by qualified doctors and nurses as another way of dealing with the ongoing shortage.
Salaniponi said some groups, such as the Nurses and Midwives Association, had resisted the move because they were sceptical about the quality of services HSAs would offer. "But we told them that there was no need to worry because there are supervisors who go around making sure that quality is not compromised," he told IRIN/PlusNews.
A government survey conducted three years ago to find out if task shifting would work in Malawi revealed that most people preferred to be treated in their homes rather than being admitted to a clinic.
Adamson Muula, a lecturer at the Malawi College of Health Sciences, a government institution that trains clinical officers in the commercial hub, Blantyre, cautioned that while the initiative could be paying dividends in some areas, there should be careful identification of the tasks that could be transferred to lay counsellors.
"The public and policy makers look for simple solutions to complex problems. Some people think wound cleaning and giving injections are simple - so much so that they do not require a nurse - but inappropriate injection, or mere wrong shifting of a patient from one place to another can kill a person," said Muula.
He warned that it could be a grave mistake to put the lives of unsuspecting Malawians in the hands of people who had received only a few weeks' training.
"Task shifting, in my opinion, increases the number of health workers and not health professionals," he said. "It is the professional and not just the workers that we need."
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