Nation Online

Rural trainees cure for health staff gaps?

Doctors recently diagnosed the country’s healthcare system with “worsening shortage of essential drugs.” But this is just one of the shortages which have left Malawians dying of curable diseases.

Also demanding an urgent cure is the shortage of health workers pronounced “severe even by African standards” in 2004.

Exemplifying the setback to delivery of quality healthcare services in needy areas, Chang’ambika and Chithumba health centres in Chikhwawa rural are on the verge of closure due to lack of medical assistants and nurses.  People walk over two hours to access treatment at an understaffed Gaga Health Centre about 30 kilometres away.

While HIV and Aids has increased the need for qualified health personnel in the country, the workforce has shrunk due to multiple factors ranging from brain drain to lack of incentives.

To ease patients’ plight, the Ministry of Health, in partnership with Medicines sans Frontieres (Doctor without Borders), has recruited 10 students from rural backgrounds to Malamulo College of Heath Sciences.  The scholarships require the cohort to work in understaffed clinics in traditional authorities Chapananga in Chikhwawa and Mlolo in Nsanje. Can this be prescribed for the rest of the country?

Critics would denounce the recruitment of locals to work in their communities as sanitising nepotism in a country founded on principles of equality. However, voices are overwhelming that this is a lesser evil, an affirmative action to reach out to hard-to-reach populations often let down by equal opportunities.

“After 10 years of working in Thyolo, it was impossible to ignore human resources constraints as one of the challenges to the delivery of quality healthcare services,” says MSF head of mission Rodd Gerstenhaber, trumpeting the initiative as a “unique partnership” to enhance retention of staff in areas usually shunned by trained health personnel.

The training scheme was launched in Thyolo where 30 benefited in the past three years and whose graduates are working in the steep slopes of Thekerani and Sandama.

 “The Thyolo experience has shown us that students from rural background are likely to stay longer in areas where their friends from urban places fear to work. Apart from being born and brought up near the health centres they are trained to serve, the recruits are already accustomed to the realities visitors find harsh,” says MSF advocacy focal point Amanda Banda.

In 2010, World Health Organisation (WHO) established that students from rural backgrounds are two to three times more likely to stay in their environment than their urban colleagues.

Chang’ambika residents, who cry for the reopening of their nearest health centre, say pro-rural training schemes would  prevent pregnant women from delivering at home and on the way to distant clinics and prevent people from dying from treatable diseases.

“If trained, our kindred would serve us without grumbling about harsh conditions. They are used to the so-called harsh realities,” says village head Chang’ambika.

As early as 2009, the village health committee indicated that health personnel kept leaving the health centre due to poor housing as well unreliable electricity and water supply.  The village head feels health colleges are training selfish people who  shun rural areas.

Gaga Health Centre in-charge Khwatcha Kabwera Banda and two nurses work day and night. The medical officer, whose team sees over 100 patients per day, reckons enrolment of students to health colleges tends to favour those from urban set-ups.

“Health work is a calling, but a majority of students come from urban areas. Some get enrolled because of unhindered access to calls for application or their parents’ wish. Such people tend to shun remote clinics in preference for urban areas,” says Banda.

According to Malamulo registrar Paul Moyo, medical, midwifery  and nursing studies cost K650 000 per year, but scholarships offered by government and the Christian Health Association of Malawi (Cham) require students to contribute K75 000—an amount he described as “way too unaffordable for the poor” who hardly have three meals per day.

Baskets of delayed applications from rural areas could  be symptomatic of widespread information pitfalls, argues Moyo. MSF placed posters right in the cutaway clusters.

“Scholarships targeting rural students could help fill the vacancies in areas worst hit by shortages of health workers in their areas. After all, the scholars are guaranteed jobs unlike other graduates who wait for months before they are know where they are going to work. The suspense compels some of those posted to rural areas to find alternative jobs in urban areas or other sectors,” says Moyo.

Personifying the national staff shortage, Nsanje district health officer (DHO) Dr Medson Matchaya and Chikhwawa’s Dr Elizabeth Nkosi estimate the vacancy rate in the Shire Valley at 60 percent of what they need  to meet the required minimum of two nurses, two medical assistants and one environmental health officer as every health centre.

This interrogates free-for-all Cham and government scholarships bonding students to work in public health centres for five years. According to Nkosi, The donor-funded emergency package has boosted the health workforce by 53 percent from 5 453 in 2004.

As imbalances between rural and urban areas persist, WHO recommendations indicate improving training systems is just one of the remedies. Others include better incentives such as increased locum, the 52 percent pay top-up Britain’s the Department for International Development (DfID) introduced and hardship allowances.

Matchaya, who originates from Malaka border area in the district and has served for the past four years, says nearly all districts have areas that health workers avoid due to various reasons—but serving your kindred brings fulfilment and motivates the youth who lack role models.

Thus, targeted training could be more just reaching the unreached.