January 6, 2007

Each migrating nurse costs Malawi up to US$26 million

Malawi is losing up to US$26 million for every nurse who leaves the country in search of greener pastures, according to a new research paper. "Better salaries and good working conditions are among the contributing factors for these nurses' migration," said Fresier Maseko, one of the authors of 'The financial losses from the migration of nurses from Malawi'. The paper by researchers from the College of Medicine at the University of Malawi and the US-based University of North Carolina, attempts to quantify the financial loss to the country, besides the obvious impact on its health services. "For each enrolled nurse-midwife that migrates out of Malawi, the country loses between $71,081.76 and $7.5 million ... For a ... nurse-midwife [with a degree], the lost investment ranges from $241,508 to $25.6 million," the document claimed.

The researchers calculated the amount by taking into account the expense to the government of training a nurse or a midwife, at interest rates ranging from 7 percent to 25 percent, over a period of 30 years - the time the migrating worker is expected to spend outside the country.
Students at nursing schools are not required to pay tuition or boarding fees, as these costs are paid to the institution by the government. The cost of primary and secondary education was also included.

The shortage of medical personnel has hit crisis point in Malawi, where there is one doctor per 60.000 people instead of the required ratio of one physician per 5.000. According to government sources, 64 percent of nursing posts in Malawi are unfilled and there are just 100 doctors in public hospitals serving a population of 12 million. Anyone requiring the attention of a specialist has to travel outside the country. "In Malawi, the high maternal mortality ratio - estimated at about 1.120 deaths per 100.000 live births - has been partly blamed on the unavailability of trained midwives to deliver satisfactory quality ... care," the paper said.

The researchers also voiced concern that the rapid scaling-up of antiretroviral (ARV) therapy, aimed at reaching about 170.000 Malawians, would be constrained by the unavailability of adequately trained nurses, clinical officers and doctors. A five-year government plan to scale up ARV therapy means an additional 40,000 patients will begin receiving treatment in 2007, and another 45.000 in each of the following three years.

Maseko commented that if the government improved the working conditions of nurses, many of whom look after 60 to 80 patients per shift, provided better wages and motivated personnel it could help reduce migration. Pubic healthcare workers received a 52 percent wage top-up in 2005 and a campaign funded by Britain's international development agency (DFID) was mounted to entice nurses back from the private sector. Money from the Global Fund to Fight AIDS, Tuberculosis and Malaria is also being used to expand the capacity of Malawi's training institutions and provide extra incentives for health workers in remote, rural areas.

Until these efforts yield results, some of the countries that have lured health workers from Malawi are lending doctors to fill the gap. About 25 percent to 30 percent of Malawi's doctors come from overseas: some are United Nations volunteers; others come with Britain's Voluntary Services International or through agreements with European governments. (Rts)


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