Shortage of human resources is a major problem facing Malawi, where more than 50% of the population lives in rural areas. Most of the district health services are provided by clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists.
As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population. This study explores how these cadres are managed and motivated and the impact this has on their performance.
Methods: A quantitative survey measured health workers'job satisfaction, perceptions of the work environment and sense of justice in the workplace, and was reported elsewhere.
It emerged that health workers were particularly dissatisfied with what they perceived as unfair access to continuous education and career advancement opportunities, as well as inadequate supervision. These issues and their contribution to demotivation, from the perspective of both management and health workers, were further explored by means of qualitative techniques.Focus group discussions were held with health workers, and key-informant interviews were conducted with members of district health management teams and human resource officers in the Ministry of Health.
The focus groups used convenience sampling that included all the different cadres of health workers available and willing to participate on the day the research team visited the health facility. The interviews targeted district health management teams in three districts and the human resources personnel in the Ministry of Health, also sampling those who were available and agreed to participate.
Results: The results showed that health workers consider continuous education and career progression strategies to be inadequate.
Standard human resource management practices such as performance appraisal and the provision of job descriptions were not present in many cases. Health workers felt that they were inadequately supervised, with no feedback on performance.
In contrast to health workers, managers did not perceive these human resources management deficiencies in the system as having an impact on motivation.
Conclusions: A strong human resource management function operating at the district level is likely to improve worker motivation and performance.
Tuesday, 28 July 2009
Retention of health workers in Malawi: perspectives of health workers and district management
Shortage of human resources is a major problem facing Malawi, where more than 50% of the population lives in rural areas. Most of the district health services are provided by clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists.
As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population. This study explores how these cadres are managed and motivated and the impact this has on their performance.
Methods: A quantitative survey measured health workers'job satisfaction, perceptions of the work environment and sense of justice in the workplace, and was reported elsewhere.
It emerged that health workers were particularly dissatisfied with what they perceived as unfair access to continuous education and career advancement opportunities, as well as inadequate supervision. These issues and their contribution to demotivation, from the perspective of both management and health workers, were further explored by means of qualitative techniques.Focus group discussions were held with health workers, and key-informant interviews were conducted with members of district health management teams and human resource officers in the Ministry of Health.
The focus groups used convenience sampling that included all the different cadres of health workers available and willing to participate on the day the research team visited the health facility. The interviews targeted district health management teams in three districts and the human resources personnel in the Ministry of Health, also sampling those who were available and agreed to participate.
Results: The results showed that health workers consider continuous education and career progression strategies to be inadequate.
Standard human resource management practices such as performance appraisal and the provision of job descriptions were not present in many cases. Health workers felt that they were inadequately supervised, with no feedback on performance.
In contrast to health workers, managers did not perceive these human resources management deficiencies in the system as having an impact on motivation.
Conclusions: A strong human resource management function operating at the district level is likely to improve worker motivation and performance.
As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population. This study explores how these cadres are managed and motivated and the impact this has on their performance.
Methods: A quantitative survey measured health workers'job satisfaction, perceptions of the work environment and sense of justice in the workplace, and was reported elsewhere.
It emerged that health workers were particularly dissatisfied with what they perceived as unfair access to continuous education and career advancement opportunities, as well as inadequate supervision. These issues and their contribution to demotivation, from the perspective of both management and health workers, were further explored by means of qualitative techniques.Focus group discussions were held with health workers, and key-informant interviews were conducted with members of district health management teams and human resource officers in the Ministry of Health.
The focus groups used convenience sampling that included all the different cadres of health workers available and willing to participate on the day the research team visited the health facility. The interviews targeted district health management teams in three districts and the human resources personnel in the Ministry of Health, also sampling those who were available and agreed to participate.
Results: The results showed that health workers consider continuous education and career progression strategies to be inadequate.
Standard human resource management practices such as performance appraisal and the provision of job descriptions were not present in many cases. Health workers felt that they were inadequately supervised, with no feedback on performance.
In contrast to health workers, managers did not perceive these human resources management deficiencies in the system as having an impact on motivation.
Conclusions: A strong human resource management function operating at the district level is likely to improve worker motivation and performance.
Malawi schedules local elections, but is unsure how to pay for them
Voters in Malawi
Malawi plans to hold a long overdue local election next year, but is still not sure how to finance it. Germany, which supports development projects there, says the government must show its commitment to democracy.
After years of delay, Malawi's government has now scheduled local elections for May 2010. Originally, local polls were supposed to take place in 2005, but the government failed to hold the election, saying it didn't have the money to pay for it.
While a date has now been set, it remains unclear how the election will be financed. The Malawi Electoral Commission announced recently that it will need 16 million euros ($22.7 million) to conduct the polls which are expected to have the largest turnout of candidates since the May 2009 general election. According to Malawi's constitution, local government elections must be held one year after the presidential and parliamentary polls.
The problem is that so far every election in Malawi has been donor funded, so it is possible that the election will be cancelled if no sponsor is found.
Germany, through its development arm, the German Technical Cooperation (GTZ), says it will not fund the local elections, but wants the government to show that it is committed to democracy by organizing the polls.
GTZ country manager for Malawi and Zambia Elmar Kreutzer told Deutsche Welle that his organisation will instead continue to support sector devolution. "In 2001, three central areas for Malawi-German development cooperation were agreed in government negotiations," he said. "These are basic education, health and democratic decentralisation."
GTZ wants to promote the decentralization of institutional structures and is also trying to educate the people, so they can understand this process.
According to this plan, the country's 40 predominantly rural districts are being helped to finance their own investments and local governments are being assisted in local development planning and in building administrative structures.
Malawi committed to decentralization
Local elections were originally scheduled for 2005 But the Malawi government said the fact that it has managed to put in place institutional structures both at national and local levels which are crucial for the successful implementation of the decentralization process, is already a demonstration of its commitment.
The structures set up according to the government include, at national level, the Malawi Local Government Service Commission, the National Local Government Finance Committee and the Malawi Local Government Association, the ministry of local government said. At the local level, the ministry has facilitated the formation of development structures such as Area and Village Development Committees.
NGOs chastise government's failure
"A government must abide by upholding the constitutional obligation. Local government makes people enjoy the right to participate in national affairs at grassroots level. But it is also a measure of how we value democracy," Dan Msowoya, a political analyst, said.
Msowoya criticized the government for failing to uphold the constitution. "This is a crime. It may also mean that there is an infringement on the political rights of local people such as their right to choose representatives and stand for political position as councillors," he said.
Undule Mwakasungula, executive director of the Center for Human Rights and Rehabilitation thinks that the government's claim that a lack of resources is to blame for the stalled elections is not convincing.
Instead Mwakasungula believes the government was worried about a lack of grass roots support and therefore did not want to have elections because it was afraid of a negative outcome.
"What it also means is that any development activities are just being imposed because the people have no say," Pan African Civic Educators Network executive director Steve Duwa said.
Local assemblies operate illegally
It is still unclear who will pay for local elections What's more, added Catholic Commission for Justice and Peace secretary John Chawinga, the existence and operation of the country's local assemblies is illegal because it violates Malawi's constitution. Their setup creates fertile ground for the abuse of funds because councillors have discretion in the management of local affairs, argued Chawinga.
While the absence of elected local officials is a clear and continuing problem for Malawi, it could be solved if the polls are held as planned next May.
Malawi plans to hold a long overdue local election next year, but is still not sure how to finance it. Germany, which supports development projects there, says the government must show its commitment to democracy.
After years of delay, Malawi's government has now scheduled local elections for May 2010. Originally, local polls were supposed to take place in 2005, but the government failed to hold the election, saying it didn't have the money to pay for it.
While a date has now been set, it remains unclear how the election will be financed. The Malawi Electoral Commission announced recently that it will need 16 million euros ($22.7 million) to conduct the polls which are expected to have the largest turnout of candidates since the May 2009 general election. According to Malawi's constitution, local government elections must be held one year after the presidential and parliamentary polls.
The problem is that so far every election in Malawi has been donor funded, so it is possible that the election will be cancelled if no sponsor is found.
Germany, through its development arm, the German Technical Cooperation (GTZ), says it will not fund the local elections, but wants the government to show that it is committed to democracy by organizing the polls.
GTZ country manager for Malawi and Zambia Elmar Kreutzer told Deutsche Welle that his organisation will instead continue to support sector devolution. "In 2001, three central areas for Malawi-German development cooperation were agreed in government negotiations," he said. "These are basic education, health and democratic decentralisation."
GTZ wants to promote the decentralization of institutional structures and is also trying to educate the people, so they can understand this process.
According to this plan, the country's 40 predominantly rural districts are being helped to finance their own investments and local governments are being assisted in local development planning and in building administrative structures.
Malawi committed to decentralization
Local elections were originally scheduled for 2005 But the Malawi government said the fact that it has managed to put in place institutional structures both at national and local levels which are crucial for the successful implementation of the decentralization process, is already a demonstration of its commitment.
The structures set up according to the government include, at national level, the Malawi Local Government Service Commission, the National Local Government Finance Committee and the Malawi Local Government Association, the ministry of local government said. At the local level, the ministry has facilitated the formation of development structures such as Area and Village Development Committees.
NGOs chastise government's failure
"A government must abide by upholding the constitutional obligation. Local government makes people enjoy the right to participate in national affairs at grassroots level. But it is also a measure of how we value democracy," Dan Msowoya, a political analyst, said.
Msowoya criticized the government for failing to uphold the constitution. "This is a crime. It may also mean that there is an infringement on the political rights of local people such as their right to choose representatives and stand for political position as councillors," he said.
Undule Mwakasungula, executive director of the Center for Human Rights and Rehabilitation thinks that the government's claim that a lack of resources is to blame for the stalled elections is not convincing.
Instead Mwakasungula believes the government was worried about a lack of grass roots support and therefore did not want to have elections because it was afraid of a negative outcome.
"What it also means is that any development activities are just being imposed because the people have no say," Pan African Civic Educators Network executive director Steve Duwa said.
Local assemblies operate illegally
It is still unclear who will pay for local elections What's more, added Catholic Commission for Justice and Peace secretary John Chawinga, the existence and operation of the country's local assemblies is illegal because it violates Malawi's constitution. Their setup creates fertile ground for the abuse of funds because councillors have discretion in the management of local affairs, argued Chawinga.
While the absence of elected local officials is a clear and continuing problem for Malawi, it could be solved if the polls are held as planned next May.
Gates boost for Irish aid charity
Computer entrepreneur Bill Gates has pledged 41 million US dollars (28.7 million euro/£24.8 million) to Irish aid agency Concern to help fight spiralling baby and mother death rates in developing countries.
The massive grant, from the Bill and Melinda Gates Foundation, will fund a Dragons' Den-style initiative to identify new ways of improving essential healthcare in Africa and South Asia.
The ground-breaking plan will field-test bold and inventive ways to overcome barriers to delivering proven maternal, newborn and child health solutions in six countries.
Tom Arnold, chief executive of Concern Worldwide, said the donation would undoubtedly save lives on the ground.
"Half a million women die every year in childbirth, the majority in developing countries," said Mr Arnold.
"The whole point of this is to look for breakthroughs."
The scheme will initially be rolled out in Sierra Leone, where more than 25% of children die before reaching their fifth birthday, and Malawi, where one in every 18 women dies during pregnancy or childbirth.
In India and Malawi two-thirds of mothers and children also lack essential health services like vaccinations, skilled care at birth and micronutrient supplements.
Health workers, academics, and community members will be able to bring their ideas to a panel for consideration.
The initiative will seek out, field-test and evaluate at least 27 breakthrough ideas which have the potential for rapidly increasing intervention coverage, as well as the characteristics most conducive to scaling-up.
The massive grant, from the Bill and Melinda Gates Foundation, will fund a Dragons' Den-style initiative to identify new ways of improving essential healthcare in Africa and South Asia.
The ground-breaking plan will field-test bold and inventive ways to overcome barriers to delivering proven maternal, newborn and child health solutions in six countries.
Tom Arnold, chief executive of Concern Worldwide, said the donation would undoubtedly save lives on the ground.
"Half a million women die every year in childbirth, the majority in developing countries," said Mr Arnold.
"The whole point of this is to look for breakthroughs."
The scheme will initially be rolled out in Sierra Leone, where more than 25% of children die before reaching their fifth birthday, and Malawi, where one in every 18 women dies during pregnancy or childbirth.
In India and Malawi two-thirds of mothers and children also lack essential health services like vaccinations, skilled care at birth and micronutrient supplements.
Health workers, academics, and community members will be able to bring their ideas to a panel for consideration.
The initiative will seek out, field-test and evaluate at least 27 breakthrough ideas which have the potential for rapidly increasing intervention coverage, as well as the characteristics most conducive to scaling-up.
Malawi: Tourism levy effective 1st August
The Ministry of Tourism, Wildlife and Culture says the Tourism Marketing Levy [TML] for the Tourism Industry announced by Finance Minister Ken Kandodo (pictured) as he recently presented the 2009/10 national budget in Parliament, will be effective starting August 1, 2009.
The Finance Minister disclosed that beginning this national financial year, which started on July 1, government would start collecting one percent tax on all client bills per tourism enterprise.
The Department of Tourism (DoT) in the Ministry says the levy, which has been re-introduced after its abolishment in the 2002/03 national budget statement, will help to promote Malawi as a tourism destination.
This comes at a time when the department is trying to create an effective sustainable fund for destination marketing and promote domestic tourism in line with the Strategic Tourism Marketing Plan [STMP].
According to the Ministry, the STMP will be effectively implemented if the department works closely with all players in the travel and tourism industry, including tour operators and guides, travel agents, car hire companies, event organizers, horse riding and hunting safaris, cruises, yachts and restaurants.
DoT says among others, the tax money will be used for generic tourism marketing in major source markets and building brand of the Malawi tourism product, both locally and internationally.
“The Malawi Tourism Marketing Plan has identified a number of markets for Malawi to focus on. The Ministry would like to work hand in hand with all enterprises to promote the industry in the country,” said DoT deputy director Sosten Lingwalanya at a stakeholders’ workshop recently.
The tourism department further points out that “there’s need for enterprises to be part of this collaborative public, private sector effort to grow Malawi tourism”, which experts believe can tremendously contribute to growth of the country’s economy.
“It’s a very welcome development because as a country, we need to market our tourism destinations. Malawi has marketable places that have the potential to boost our economy,” said Dolvic Hotel Manager, Baldwin Madinga, in an interview with Nyasa Times.
The Ministry indicates the tourism levy creates a practical means for an effective partnership between the private sector and government through the DoT.
“It allows the private sector to be actively involved in the planning, strategy and implementation of Malawi’s tourism marketing activities.”
The enterprises paying tourism levy are also expected to benefit through providing product marketing material for distribution by the DoT internationally and also are given preferential profiling on [government] tourism website.
As outlined by the DoT, it is a criminal offence and constitutes fraud if a tourism enterprise collects tourism levy from tourists and is not paid over into the Tourism Marketing Fund (TMF) within twelve days at the end of each month.
The TML in Malawi was set up to provide additional marketing funding for promoting Malawi as a tourist destination under the Tourism and Hotels Act of 1968 as amended in 2007.
Malawi’s major international markets include the UK, Germany, France, USA, Italy, Netherlands, China, Japan, Australia and South Africa.
The Finance Minister disclosed that beginning this national financial year, which started on July 1, government would start collecting one percent tax on all client bills per tourism enterprise.
The Department of Tourism (DoT) in the Ministry says the levy, which has been re-introduced after its abolishment in the 2002/03 national budget statement, will help to promote Malawi as a tourism destination.
This comes at a time when the department is trying to create an effective sustainable fund for destination marketing and promote domestic tourism in line with the Strategic Tourism Marketing Plan [STMP].
According to the Ministry, the STMP will be effectively implemented if the department works closely with all players in the travel and tourism industry, including tour operators and guides, travel agents, car hire companies, event organizers, horse riding and hunting safaris, cruises, yachts and restaurants.
DoT says among others, the tax money will be used for generic tourism marketing in major source markets and building brand of the Malawi tourism product, both locally and internationally.
“The Malawi Tourism Marketing Plan has identified a number of markets for Malawi to focus on. The Ministry would like to work hand in hand with all enterprises to promote the industry in the country,” said DoT deputy director Sosten Lingwalanya at a stakeholders’ workshop recently.
The tourism department further points out that “there’s need for enterprises to be part of this collaborative public, private sector effort to grow Malawi tourism”, which experts believe can tremendously contribute to growth of the country’s economy.
“It’s a very welcome development because as a country, we need to market our tourism destinations. Malawi has marketable places that have the potential to boost our economy,” said Dolvic Hotel Manager, Baldwin Madinga, in an interview with Nyasa Times.
The Ministry indicates the tourism levy creates a practical means for an effective partnership between the private sector and government through the DoT.
“It allows the private sector to be actively involved in the planning, strategy and implementation of Malawi’s tourism marketing activities.”
The enterprises paying tourism levy are also expected to benefit through providing product marketing material for distribution by the DoT internationally and also are given preferential profiling on [government] tourism website.
As outlined by the DoT, it is a criminal offence and constitutes fraud if a tourism enterprise collects tourism levy from tourists and is not paid over into the Tourism Marketing Fund (TMF) within twelve days at the end of each month.
The TML in Malawi was set up to provide additional marketing funding for promoting Malawi as a tourist destination under the Tourism and Hotels Act of 1968 as amended in 2007.
Malawi’s major international markets include the UK, Germany, France, USA, Italy, Netherlands, China, Japan, Australia and South Africa.
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