Strengthening specialised medical care

Project description

Title: Reintegration of highly qualified medical staff (specialists) into the health sector in Malawi
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ); European Union (EU)
Country: Malawi
Lead executing agency: Ministry of Health (MoH)
Overall term: 2013 to 2016

Malawi Dr Patrick Noah was trained as a head and neck specialist in South Africa. He returned home with the support of the project and now runs Queen Elizabeth Central Hospital's head and neck unit. © GIZ

Context

Although the physician to population density in Malawi rose from 1.6 doctors per 100,000 inhabitants to 2.9 doctors per 100,000 inhabitants between 2005 and 2010, the country's health system continues to experience an acute shortage of medical specialists. Figures released by the Ministry of Health in October 2014 showed that just 35 of the Ministry of Health's 222 designated specialist posts had been filled. Reasons for this include scarcity of funds, emigration of qualified medical personnel, insufficiently equipped workplaces and a lack of career prospects in Malawi. Additional factors include a shortage of staff accommodation, insufficient or excessively expensive training opportunities for the specialist’s children, and the fact that monthly salaries are far lower than those in other countries. As certain types of residency training are not offered in Malawi, a number of registrars and young medical doctors continue their studies in South Africa. Due to a lack of incentives, these doctors often do not return to Malawi once they have completed their residency.

Objective

The Malawian Government provides medical specialists with a better working environment that more effectively meets their needs. Improvements in residency training ensure that the Malawian population receives high-quality health care services.

Malawi. GIZ has contracted kidney specialist Dr Valerie Luyckx to teach at Queen Elizabeth Central Hospital. As part of her role, she advises renal registrar Dr Mwayiwathu Mtekateka (right) on dialysis. © GIZ

Approach

GIZ advises the Ministry of Health and seven faculties of the University of Malawi's College of Medicine with a view to assuring the quality of specialist medical services. To this end, the project is recruiting up to ten Malawian medical specialists from abroad to work in the country's health system, and is also financing temporary teaching contracts to fill gaps in the curriculum for medical specialists. The quality of degree qualifications is being improved through the financing and organisation of fixed-term study placements abroad for selected students. Medical specialists already practising in Malawi are being offered placements in other countries for sub-specialisation.

Finally, the project is assisting the Ministry of Health and the College of Medicine in strengthening institutional partnerships and specialist medical networks and in gathering more data about Malawian medical specialists living abroad. The development of a web-based platform is playing a major role in facilitating this work.

This project is being implemented by GIZ in close cooperation with the College of Medicine and is receiving considerable funding from the European Union as a co-financier.

Results

Reintegrating Malawian medical specialists from abroad is improving the provision of medical care and, as a result, the health of the Malawian population. So far, the project is 60 per cent of the way to achieving its goal of recruiting 10 Malawian doctors.

By supporting further training for up to 12 medical specialists already practising in Malawi, it is also helping to counteract brain drain. Six trainings have already been initiated.

Finance was provided for four temporary teaching assignments in the areas of internal medicine, paediatrics and pharmacy in 2014, improving the quality of specialist training. 10 additional assignments are currently planned. By seconding 19 students, the project is strengthening areas of specialist training that are not yet offered in Malawi. So far, nine students in the areas of paediatrics, radiology, internal medicine and surgery have benefited from this support.

Malawi. Two Malawian medical specialists during a surgery at Central Government Hospital (a tertiary health facility).  © GIZ

Finally, the project is working closely with cross-sectoral migration programmes, such as the European Union's Migration EU eXpertise (MIEUX) project, which is advising the Malawian Government on drafting a national migration and citizenship policy. GIZ is engaged in in-depth dialogue with MIEUX, thereby making a key contribution to the development of Malawi's national migration policy.