Malawi’s innovative scheme for improving attraction and retention of health workers

Background Recognition and documentation of the extent of the HRH situation Quantification of the scale of the problem and implications for service delivery Studies identify inadequate remuneration as one factor in health worker attrition from the public service Options and cost of increased salaries explored to improve recruitment and retention Proposed increases aligned with pay reforms & proposed selective accelerated salary enhancement (SASE) scheme

Background contd. MoH pay enhancement used to pilot SASE scheme Supported harmonization of public and private sector (e.g. CHAM) salaries Donor (DFID & GF) and GoM commitment to support salary increases (GoM health sector contributions have doubled from 2003/04) Global Fund commitment to strengthening the human resource base in Malawi Core and essential health workers targeted – 11 priority cadres: 3750 health workers (18.75%) Malawi one of 2 countries that has received funding from the Global Fund for HRH – funding available to recruit and retain an additional 8200 HSAs over 5 years Plans to pilot additional retention schemes targeting underserved areas, facilities, and essential cadres (both posts and individuals)

Issues for consideration Is there evidence for prioritising and targeting specific cadres/health workers? Is there reliable and accurate information for decision making on retention strategies e.g. service delivery goals, attrition data, etc.? Will increased compensation alone attract and retain health workers? What other factors/interventions should be considered?

Issues contd. What monitoring and evaluation systems will be required to track impact? How to deal with those who will benefit and those who will not? What communication strategy is needed? How to ensure that this investment results in improved performance?