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Abstract:
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In the paper, inadequate remuneration was found to be the single most important reason why midwives left.
The study found that about half of the deliveries in Malawi are not assisted by a skilled attendant and thus Malawi is not on target in achieving the Millennium Development Goal on maternal health. The research found that the two main forms of losses are that the midwives die or they go abroad. The latter is a loss not only in quantity but also in quality as it is the more experienced midwives who emigrate.
Moreover, the reviewed literature suggested that if there is an issue of inadequate remuneration and this issue is not addressed, then other efforts to retain staff are not likely to have significant and sustainable impact. Therefore it is recommended that:
- The taskforce could facilitate the identification of a realistic level for the remuneration package to retain midwives. This increment could be costed by the MOHP and/or the upcoming Health Service Commission, and discussed with the Ministry of Finance and/or donors under SWAPs or Budget Support. However, there may be risks involved with the sustainability of donor funding of remuneration, and also risks with implications for remuneration of other staff in the public sector.
The following recommendations are a priority because they suggest ways of mitigating the main forms of losses, namely attrition to migration and to HIV/AIDS.
- DFID and development agencies of other countries that employ Malawian midwives could continue advocating enforcement of codes of practice on international recruitment in their home countries.
- The above recommendation could go hand in hand with the MOHP to consider ways of making the public health sector in Malawi more attractive for midwives.
- There is a need for further research on the impact of free ARVs on retention of midwives. This research could benefit from conducting in-depth interviews with midwives living with HIV/AIDS. Experiences could be drawn from MSF Luxembourg in Thyolo District, Malawi, and from some of the mining companies in South Africa |