Brain drain affects Malawi’s health service delivery
Frazer Potani, Malawi
Nurses,
midwives, doctors, clinicians and health workers in general do also
feel some pains because, like all other human beings on the planet, they
are made up of three Bs namely Blood, Brain and Bones!
Yes! While these
professionals have to treat and care for patients with empathy,
therefore, they also deserve a dignified life to sustain their bodies,
minds and souls if they have to serve the sick professionally and
ethically to save lives.
This
is why after for instance taking into account that she could not bear
the pains of routine unending experiences of stress emanating from heavy
pressure of work against being paid low wages in a ward at Kamuzu
Central Hospital (KCH) in Lilongwe over 20 years ago, Malawian nurse
Chimwemwe Nhlane had no choice but resign, pack up her belongings and
take a Heathrow [United Kingdom (UK)] bound plane via Kamuzu
International Airport (KIA) in search for greener pastures.
She then connected to Bristol where she got a job at a hospital and was overwhelmed with joy when she was offered an annual salary of about 18, 000 British Pounds Sterling (about K5 million) per year.
Nhlane also got substantial pay raises, bonuses and boxes of chocolate including a bottle of wine for her hard work.
But while Nhlane lived in luxury and even drove poshy cars abroad her fellow nurses back in Malawi struggled to make ends meet for doing the same job.
On several occasions, fed up by poor conditions at work, nurses in Malawi have often dropped their equipment including syringes, gloves, stethoscopes demanding that government pay them better wages including money for overtime also commonly as locum.The health workers have claimed that they beef up their low salaries with locum.
A visiting British medical student from the University of Nottingham in United Kingdom (UK) expressed his shock on the shortage of doctors and nurses in Malawi.
Bilal Hassam, a fourth year student at the University and then doing his practicals at Queens Medical Centre said the shortage of doctors in Malawi was putting pressure of work on the few in the southern African nation.
"At the hospital where I am doing my practicals in the UK there are 1,500 doctors, yet they are not adequate," he said adding that he was shocked to learn that in some hospitals in Malawi there was just one, two or three doctors or even none.
"We visited Nkhotakota District Hospital and we were told that Malawian hospitals have few doctors . I can’t imagine how these doctors are copping up with pressure of work to deliver adequate, quality health delivery services to patients," he said.
Due to poor working conditions in the public health sector in Malawi some doctors, nurses, midwives have been fleeing the sector to work in private health sectors, Non-Governmental-Organizations (NGOs) within the country or fleeing the country to work outside Malawi.
However, a recent research reveals that there has been a sharp decline in the number of nurses from poor developing countries including Malawi emigrating to greener pastures in the United Kingdom (UK) widely attributed to UK Immigration tougher immigration controls on overseas nurses.
Yet some researchers also reveal that foreign nurses are shunning the UK due to some forms of discrimination against foreign nurses.
"It's more difficult for Malawian doctors to emigrate to the UK now, as the immigration rules changed a few years ago,” said Kate Mandeville from Charity Medic to Medic in the UK.
She was however quick to add: "But anecdotally some are emigrating to other African countries like Botswana and Lesotho, which offer higher wages.”
Mandeville further explained that fortunately in Malawi the College of Medicine is doing a fantastic job.
“The College of Medicine is producing many more doctors than before, so hopefully the situation will improve in the future," she said.
Before 2005, 10,000 to 16,000 nurses were emigrating to the UK each year from foreign countries.
But following the changes in immigration procedures in 2005 the numbers decreased to 2,000 to 2,500 foreign nurses arriving in the UK annually.
However, some researchers’ findings filed to UK Immigration claim that "Some nurses felt aggrieved that the doors of the UK that had previously been open to them, were now closed," adding that foreign nurses perceived the tightening up of UK regulations as "discriminatory".
The former Executive Director for National Organization of Nurses and Midwives in Malawi (NONM) [also a union for nurses, midwives and health workers in Malawi] Dorothy Ngoma, said some nurses were not performing especially in public health facilities and fleeing the country’s public health sector because of lack of motivation, poor salaries, pressure of work due to inadequate staff, shortage of equipment and drugs.
“Nurses as well as other health workers in general have been complaining that their working conditions are poor and this is affecting the way they discharge their duties,” she said, disclosing that some nurses in Malawi were even working in hospitals without running water and electricity.
“As a result, some flee public hospitals to work in institutions under the Christian Hospitals Association of Malawi (Cham) while others travel abroad looking for greener pastures,” said Ngoma also National Coordinator for Safe Motherhood in President Joyce Banda’s Government.
She further explained that brain drain alone especially to the West was creating pressure among the few remaining nurses in public hospitals in Malawi to the extent that even the quality of health delivery service to the needy is compromized.
“Imagine being attended to a nurse who has been working for 24 hours. She is likely to be rude and angry. Infact in some cases, unskilled people are even engaged to cover the gap in our public hospitals yet it’s not right, for instance, for guardians and hospital cleaners to attend to patients because that is the job of a nurse and other trained medical personnel,” said Ngoma who has an over 30 year first hand experience in the hardships that nurses and midwives go through in Malawi’s public hospital wards.
She explained that due to among other things, staff shortages in Malawi’s public hospitals, both nurses and patients including guardians have become victims of various circumstances.
“We need 16,000 to 20,000 nurses and they need to work on a shift that is, we need four people for one job and it’s expensive but necessary,” said Ngoma.
Kamuzu College of Nursing (KCN) Principal Address Malata disclosed that as a country Malawi has just about 9,000 nurses and can not afford to lose any of them as they are already inadequate hence overwhelmed by the demand for services required by Malawians in public hospitals.
She therefore, emphasized the need for Malawi to recruit more nurses, return those that had left the public health system for other greener pastures and motivate them at work to improve the country’s public health service delivery.
In a study at the Department of Community Health, University of Malawi’s College of Medicine in Blantyre, Adamson Muula reveals that staff shortages in public hospitals in the country were indeed compromising adequate quality health delivery service.
“The quality and quantity of health care services delivered by the Malawi public health system is severely limited, due to, among other things the shortage of adequate numbers of trained health care workers,” he said.
Muula said in order to suggest policy changes and implement corrective measures, there may be need to describe the perceptions of the legislature on how they perceive as the cause of the problem, which could be the solutions and an evaluation of those solutions.
“Parliamentarians [in Malawi] identified the shortage of health workers as resulting from death, retirement and brain drain to other countries mostly the UK, Saudi Arabia and South Africa,” he said.
The researcher further explained that training more health workers, training new but lower cadres of health workers not marketable to the outside world, improving the working conditions and remuneration of health workers were suggested as some of the solutions for the problem in Malawi.
“Even without the brain drain of health workers to other countries, Malawi’s health sector personnel numbers are not adequate to serve the needs of the country,” said Muula.
He also expounded that relying on training more health workers in the numbers normally produced from the prevailing training institutions is unlikely to remove the shortages.
Muula disclosed that one of the solutions to the problem which was also suggested to increase the number of health workers in Malawi was training of auxiliary nurses and introducing them in the country’s public hospitals.
“This cadre [auxiliary nurses] receives bedside training for a period of one year under a qualified nurse,” he said however, also adding, “The Malawi Nurses and Midwives Council (MNMC) doesn’t recognize this cadre of health workers, complaining that nursing standards may deteriorate by introducing such a lower cadre.”
The Ministry of Health however argues that this group will contribute to service provision while on training and on qualification and they are unlikely to migrate to work in another country.
Malawi’s Health Minister also the country’s Vice President Khumbo Kachali said government was aware of the many challenges that nurses and health workers in general were going through in the course of their work.
“Government has therefore, has laid down several strategies in place to address such problems,” he said.
On their part, in a joint statement, International Nurses Council (ICN) President Rosemary Bryant and Chief Executive Officer (CEO) David C. Benton say that only well qualified nurses can effect professional practices in the quest of adequate, quality, health delivery service to the needy.
“Now, more than ever, nurses need to learn not only how to gather evidence but also how to put that knowledge into everyday use. Not all evidence is robust or reliable,” they say.
The two further say assessing the consequences for staff and patients in the public health sector can be a key aspect of the decision making process.
The two also emphasize that understanding what the evidence means for individual patients can on the other hand be difficult to assess as the findings tend to be given as probabilities or an expression of the likelihood that an intervention was by chance hence, there are ways of calculating whether results are clinically meaningful.
It is for the above reasons that only well qualified nurses and health workers in general can be able to interpret such matters.
Therefore, for the sake of sustainability of implementation of professional and ethical practices authorities in poor developing countries such as Malawi have to put measures in place to deal with brain drain to prevent it from continuing draining the quality health service delivery for the needy.
She then connected to Bristol where she got a job at a hospital and was overwhelmed with joy when she was offered an annual salary of about 18, 000 British Pounds Sterling (about K5 million) per year.
Nhlane also got substantial pay raises, bonuses and boxes of chocolate including a bottle of wine for her hard work.
But while Nhlane lived in luxury and even drove poshy cars abroad her fellow nurses back in Malawi struggled to make ends meet for doing the same job.
On several occasions, fed up by poor conditions at work, nurses in Malawi have often dropped their equipment including syringes, gloves, stethoscopes demanding that government pay them better wages including money for overtime also commonly as locum.The health workers have claimed that they beef up their low salaries with locum.
A visiting British medical student from the University of Nottingham in United Kingdom (UK) expressed his shock on the shortage of doctors and nurses in Malawi.
Bilal Hassam, a fourth year student at the University and then doing his practicals at Queens Medical Centre said the shortage of doctors in Malawi was putting pressure of work on the few in the southern African nation.
"At the hospital where I am doing my practicals in the UK there are 1,500 doctors, yet they are not adequate," he said adding that he was shocked to learn that in some hospitals in Malawi there was just one, two or three doctors or even none.
"We visited Nkhotakota District Hospital and we were told that Malawian hospitals have few doctors . I can’t imagine how these doctors are copping up with pressure of work to deliver adequate, quality health delivery services to patients," he said.
Due to poor working conditions in the public health sector in Malawi some doctors, nurses, midwives have been fleeing the sector to work in private health sectors, Non-Governmental-Organizations (NGOs) within the country or fleeing the country to work outside Malawi.
However, a recent research reveals that there has been a sharp decline in the number of nurses from poor developing countries including Malawi emigrating to greener pastures in the United Kingdom (UK) widely attributed to UK Immigration tougher immigration controls on overseas nurses.
Yet some researchers also reveal that foreign nurses are shunning the UK due to some forms of discrimination against foreign nurses.
"It's more difficult for Malawian doctors to emigrate to the UK now, as the immigration rules changed a few years ago,” said Kate Mandeville from Charity Medic to Medic in the UK.
She was however quick to add: "But anecdotally some are emigrating to other African countries like Botswana and Lesotho, which offer higher wages.”
Mandeville further explained that fortunately in Malawi the College of Medicine is doing a fantastic job.
“The College of Medicine is producing many more doctors than before, so hopefully the situation will improve in the future," she said.
Before 2005, 10,000 to 16,000 nurses were emigrating to the UK each year from foreign countries.
But following the changes in immigration procedures in 2005 the numbers decreased to 2,000 to 2,500 foreign nurses arriving in the UK annually.
However, some researchers’ findings filed to UK Immigration claim that "Some nurses felt aggrieved that the doors of the UK that had previously been open to them, were now closed," adding that foreign nurses perceived the tightening up of UK regulations as "discriminatory".
The former Executive Director for National Organization of Nurses and Midwives in Malawi (NONM) [also a union for nurses, midwives and health workers in Malawi] Dorothy Ngoma, said some nurses were not performing especially in public health facilities and fleeing the country’s public health sector because of lack of motivation, poor salaries, pressure of work due to inadequate staff, shortage of equipment and drugs.
“Nurses as well as other health workers in general have been complaining that their working conditions are poor and this is affecting the way they discharge their duties,” she said, disclosing that some nurses in Malawi were even working in hospitals without running water and electricity.
“As a result, some flee public hospitals to work in institutions under the Christian Hospitals Association of Malawi (Cham) while others travel abroad looking for greener pastures,” said Ngoma also National Coordinator for Safe Motherhood in President Joyce Banda’s Government.
She further explained that brain drain alone especially to the West was creating pressure among the few remaining nurses in public hospitals in Malawi to the extent that even the quality of health delivery service to the needy is compromized.
“Imagine being attended to a nurse who has been working for 24 hours. She is likely to be rude and angry. Infact in some cases, unskilled people are even engaged to cover the gap in our public hospitals yet it’s not right, for instance, for guardians and hospital cleaners to attend to patients because that is the job of a nurse and other trained medical personnel,” said Ngoma who has an over 30 year first hand experience in the hardships that nurses and midwives go through in Malawi’s public hospital wards.
She explained that due to among other things, staff shortages in Malawi’s public hospitals, both nurses and patients including guardians have become victims of various circumstances.
“We need 16,000 to 20,000 nurses and they need to work on a shift that is, we need four people for one job and it’s expensive but necessary,” said Ngoma.
Kamuzu College of Nursing (KCN) Principal Address Malata disclosed that as a country Malawi has just about 9,000 nurses and can not afford to lose any of them as they are already inadequate hence overwhelmed by the demand for services required by Malawians in public hospitals.
She therefore, emphasized the need for Malawi to recruit more nurses, return those that had left the public health system for other greener pastures and motivate them at work to improve the country’s public health service delivery.
In a study at the Department of Community Health, University of Malawi’s College of Medicine in Blantyre, Adamson Muula reveals that staff shortages in public hospitals in the country were indeed compromising adequate quality health delivery service.
“The quality and quantity of health care services delivered by the Malawi public health system is severely limited, due to, among other things the shortage of adequate numbers of trained health care workers,” he said.
Muula said in order to suggest policy changes and implement corrective measures, there may be need to describe the perceptions of the legislature on how they perceive as the cause of the problem, which could be the solutions and an evaluation of those solutions.
“Parliamentarians [in Malawi] identified the shortage of health workers as resulting from death, retirement and brain drain to other countries mostly the UK, Saudi Arabia and South Africa,” he said.
The researcher further explained that training more health workers, training new but lower cadres of health workers not marketable to the outside world, improving the working conditions and remuneration of health workers were suggested as some of the solutions for the problem in Malawi.
“Even without the brain drain of health workers to other countries, Malawi’s health sector personnel numbers are not adequate to serve the needs of the country,” said Muula.
He also expounded that relying on training more health workers in the numbers normally produced from the prevailing training institutions is unlikely to remove the shortages.
Muula disclosed that one of the solutions to the problem which was also suggested to increase the number of health workers in Malawi was training of auxiliary nurses and introducing them in the country’s public hospitals.
“This cadre [auxiliary nurses] receives bedside training for a period of one year under a qualified nurse,” he said however, also adding, “The Malawi Nurses and Midwives Council (MNMC) doesn’t recognize this cadre of health workers, complaining that nursing standards may deteriorate by introducing such a lower cadre.”
The Ministry of Health however argues that this group will contribute to service provision while on training and on qualification and they are unlikely to migrate to work in another country.
Malawi’s Health Minister also the country’s Vice President Khumbo Kachali said government was aware of the many challenges that nurses and health workers in general were going through in the course of their work.
“Government has therefore, has laid down several strategies in place to address such problems,” he said.
On their part, in a joint statement, International Nurses Council (ICN) President Rosemary Bryant and Chief Executive Officer (CEO) David C. Benton say that only well qualified nurses can effect professional practices in the quest of adequate, quality, health delivery service to the needy.
“Now, more than ever, nurses need to learn not only how to gather evidence but also how to put that knowledge into everyday use. Not all evidence is robust or reliable,” they say.
The two further say assessing the consequences for staff and patients in the public health sector can be a key aspect of the decision making process.
The two also emphasize that understanding what the evidence means for individual patients can on the other hand be difficult to assess as the findings tend to be given as probabilities or an expression of the likelihood that an intervention was by chance hence, there are ways of calculating whether results are clinically meaningful.
It is for the above reasons that only well qualified nurses and health workers in general can be able to interpret such matters.
Therefore, for the sake of sustainability of implementation of professional and ethical practices authorities in poor developing countries such as Malawi have to put measures in place to deal with brain drain to prevent it from continuing draining the quality health service delivery for the needy.
Frazer Potani, AfricaNews reporter in Lilongwe, Malawi
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