Malawi health service ailing from brain drain

For Malawian nurse Hilda Maganga, the financial pull of a spell in a ward in Britain is close to overwhelming her desire to tend to patients in her Aids-stricken and impoverished homeland.

"I would like to do a two-year stint in the United Kingdom, make my money and come back to retire for good," says the 54-year-old as she contemplates joining the brain drain of Malawian health professionals.

Official figures show about 120 registered nurses have migrated to Britain and the United States alone every year in the last decade, with the Health Ministry unable to even begin to match the wages on offer abroad.

With 14% of the country's 12-million population infected with HIV, the demands on the health service are as great as at any stage in the former British colony's history since independence in 1964.

While the World Health Organisation recommends health services should employ a minimum of 100 nurses and 20 doctors per 100 000 people, Malawi currently has only 56,4 nurses and two doctors for every 100 000 potential patients.

The figure is in sharp contrast, not just to the West, but to other countries in the region as well. Wealthier South Africa, for example, has 393 nurses and 74,3 doctors for every 100 000 people.

Dorothy Ng'oma, executive director of National Organisation of Nurses and Midwives of Malawi, said there was no hiding from the impact of the shortages.

"The situation is very bad, it's a crisis," she said. "The shortage of nurses in particular is very acute, with one nurse handling over 100 very sick patients in most hospital wards."

"We have only 3 000 nurses on register for a population of 12-million ... It's a heavy burden on them when they have to deal with various infectious diseases like HIV and Aids, tuberculosis and malaria."

Officials say half of 70 doctors sent abroad for specialist training have not returned home after completing their studies in the last five years, often lured by better salaries.

The vacancy rate for nurses in rural areas -- where the majority of people live -- is 60%, according to a 2006 survey by the Ministry of Health.

According to the volunteer group Médécins Sans Frontières (MSF), staff shortages are most severe in the southern districts of Thyolo and Chiradzulu, where the number of nurses working at the main hospital has fallen from 50 to 28 in the last year alone.

"The situation is dramatic and constitutes in our eyes an acute emergency that is still widely underestimated," Ulrike von Pilar, MSF's head of mission in Malawi, wrote in a recent activity report.

Health workers are "overwhelmed, overworked and exhausted", the report added, citing a single medical assistant in Thyolo who sees 200 patients a day.

In a bid to counter the shortages, Malawi launched an emergency plan three years ago, which saw health workers receive an average 52% pay rise thanks to a $236-million fund bankrolled by donors such as Britain.

A junior doctor now earns $450, while a senior nurse goes home with $300.

The plan also aims to strengthen training capacity, repatriate professionals that left the country and fund recruitment of foreigners.

However, the sums on offer are still a fraction of the cash available in places such as Britain and also fail to address complaints about pensions.

Maganga, who works at the children's wing of Queen Elizabeth Central Hospital in Blantyre, was recently lured back into nursing as a result of the increased salary but she still feels "short-changed" after pocketing a one-off payment of $1 000 as her pension three years ago.

"It was peanuts when you consider 25 years of service. This is one of the reasons why Malawian nurses have abandoned their posts and flocked to Britain."

She said the impact of the brain drain could be clearly felt during her shifts at Queen Elizabeth, where she attends to 75 children in one ward.

"We are only two nurses in the ward at a time. Sometimes you are all alone when in the past there could be six of you," she said.

Health Minister Marjorie Ngaunje acknowledged the health service was struggling at a time when the population was rapidly growing.

"Yes, there are serious problems, but Malawi needs to train 1 000 nurses annually if we want to arrest the situation," she said.

"The number of nurses we train every year is small. We need to increase intake at our colleges."

MSF warned that failure to address the situation rapidly could undermine Malawi's ambitions plans to provide free anti-Aids drugs to 150 000 HIV sufferers by the end of 2008.

"It is evident that the rapid scaling-up of antiretroviral therapy aimed at urgently serving 180 000 Malawians will be limited by non-availability of adequately trained nurses, clinical officers and doctors," it said.