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

ADDRESSING HEALTH WORK FORCE CRISIS FOR HIV/AIDS PREVENTION CARE & SUPPORT: The Experience of Malawi. Paper Presented at the XIX International AIDS Conference, July 2012 Ann M.M. Phoya , PhD, RNM,PHN. The Health Work force: Who cares & Where.

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

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  1. ADDRESSING HEALTH WORK FORCE CRISIS FOR HIV/AIDS PREVENTION CARE & SUPPORT: The Experience of Malawi Paper Presented at the XIX International AIDS Conference, July 2012 Ann M.M. Phoya, PhD, RNM,PHN

  2. The Health Work force: Who cares & Where • 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

  3. Context of the Malawi HRH Strategic Interventions • 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

  4. Impact of health system Challenges on selected health indicators (2004) • 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

  5. Health Workers available for delivery of essential health services & HIV/AIS interventions

  6. Health Sector Reforms to Address HRH issues • 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

  7. HRH Strategies Implemented within the Health Sector Plan ( 2004 -2010) • 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

  8. HRH Strategies Implemented within the Health Sector Plan • 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

  9. Financing Health the Sector Plan & HRH Strategy • Through Sector Wide Approach MOH implements common basket / pool fund supported by Govt and DPs ( USD 95 m 2004 -2010 ) • 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

  10. Impact of program on HRH • 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

  11. Impact of HRH strategies: Vacancy rates are declining

  12. Outcomes of the EHRP : 39% increase in Training outputs:917 - 1277

  13. Impact on HIV Prevalence

  14. Impact on selected health indicators

  15. Thank you for your antetionmerci ZIKOMO

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