Paper Presented at the XIX International AIDS Conference, July 2012 Ann M.M. Phoya, PhD, RNM,PHN

 The Government of Malawi Cares and Advocates for inclusion HRH in all health development program  Without an adequate and skilled health workforce, the Govt realises that there will be no health system that will contribute to the national economic development agenda  Significant reforms and investments therefore to ensure availability of an HRH workforce to address universal coverage issues especially to serve in hard to reach underserved areas

 Malawi Adopted a Sector Wide Approach (SWAP) to health service Delivery in 2004  Rationale for adopting the SWAP was to improve performance of the health sector which was faced by system challenges such as: ◦ High Vacancy rates ( 65%) associated with massive exodus of health workers from the public sector & low outputs from training institutions ◦ Inadequate financing for HRH interventions ◦ Poor work environment ( frequent stock outs of essential drugs & medical supplies, inadequate equipment and poor infrastructure ) leading to low motivation

 Life expectancy: 39  Infant Mortality: 133  U/Mortality: 189  MMR : 984  % fully immunized at 1 year : 75%  HIV Prevalence : 15% pregnant women) 23%  Facilities providing HCT/ART <10%  HIV infected persons on ART: <4000

 Defining HIV /AIDS strategies to be delivered as part of the national essential health package  Designing and HRH strategy as an integral part of the Health Systems Strengthening Strategy  Creating an enabling policy environment for All health sector players including Development Partners to participate in financing & implementing the health sector strategy including HRH intervention

 Increasing Capacity of training institutions to increase intake & Incentivising health professional training  Recruitment campaign to promote Public health sector as better employer( in schools and open market)  Institutionalizing retention interventions : - 52% salary increase, ( 52% professional staff % 25% CHW) - employment of retired staff on contract; - Fast track promotion exercise & access to post graduate education - Provision of housing in both urban & rural health facilities - Opportunity to work during off- duty hours for extra cash including operating private clinics  Revising Profession Regulations to allow for expansion of scope of practice and task sharing among health workers

 Development and implementation of care of carer policy  Use of International volunteers for gap filling, ease of work load and capacity building  Increasing positions of CHW for primary community based interventions  Strengthening technical supportive supervision

 Through Sector Wide Approach MOH implements common basket / pool fund supported by Govt and DPs ( USD 95 m ) ◦ DFID ◦ Norway ◦ Global Fund ( up to 2011) ◦ Germany ◦ World Bank ( up to 2008) ◦ Flanders ◦ UNFPA & UNICEF ◦ GAVI  USG, AfDB, WHO, GF, International NGOs support specific activities through discrete funding  More than 40% of the health budget is spent on HRH interventions

 External Migration has reduced drastically  All training institutions have increased enrolment & graduating numbers  Health facilities meeting minimum staff norms have improved from 13% in 2004 to 60% in 2011  Health facilities providing PMTCT are at 95%  HCT services have expanded to community settings using CHWS: More than 1,700, 000 tested in 2011  More clinics are initiating ARTs through Nursing and Midwifery personnel: More than 390,000 are accessing ARTs

ZIKOMO