London ~~ Sunday August 19, 2007
£100m UK aid, but Malawi's nurses are still overworked and underpaid
Alex Renton in Lilongwe
Mary Luliyazi is falling asleep at her desk in the post-natal ward of Lilongwe's Bwaila Hospital. She sat down to find her pay slip, but even a moment's rest is fatal on the third of three consecutive 24-hour shifts in intensive care. 'I do feel very tired,' says Mary. 'I don't have to do the extra shifts, but you feel you should. There are not enough nurses. And I need the money.'
Mothers lie waiting for attention - some of them in beds, some on the floors - of this colonial-era hospital in Malawi's capital city. By African standards it's clean and tidy, but the lack of nurses and essential equipment results in a fatality rate for births that no Western hospital could tolerate. This despite years of efforts by Western donors - including £100m from Britain - to improve healthcare in Malawi.
A normal day shift earns Mary 600 kwacha (£2.10) - about a third of it paid through a British government funding scheme. A 'Petroda shift' (the nurses call them that after Malawi's chain of 24-hour petrol stations) pays 1,500 kwacha - about £5.30. Many nurses do regular 24-hour shifts: one said she'd left her home and children on Tuesday morning and wouldn't return till Friday - she was sleeping in the office in meal breaks.
Mary finds the pay slip. Her salary for April 2007 was 21,955 kwacha after tax - £77. 'It's not enough,' said Mary. 'I have four children: the school fees and the care cost 6,000 a month. My rent is 5,000 a month. The minibus to come to work is about 120 a day.' The list goes on.
We came to the major hospital of Malawi's capital expecting to hear of a success: the fruits of a unique £100m programme funded by the British Department for International Development to improve Malawi's health services, raise pay and stop the brain drain of doctors and nurses to the staff-hungry hospitals of Europe and America. There are no precise figures, but it's believed there are more Malawian nurses in Britain now than there are in Malawi.
Most years this decade 100 nurses and other health workers have left Malawi - more than 80 per cent of them for Britain - while the training system turned out fewer than 60 nurses each year. Malawi's 13 million people, of whom one in six is HIV-positive, had only 560 registered nurses left in 2005 and only one doctor for every 50,000 people. Britain has one health worker for every 100 people.
But Malawian nurses were even worse off before the aid scheme began. A 'nurse technician' got 7,500 kwacha (£26) a month, a fully registered nurse 16,000 (£56). And they were leaving in droves. When the UK's £100m arrived, more than half of it was earmarked for salaries. The Malawian Health Ministry gave all health workers a 52 per cent pay rise. But Dorothy Ngoma, president of the Nurses' Association of Malawi, said this was a mistake. 'Even the top officials in the Health Ministry got the 52 per cent - so some of them were earning 50,000 more per month. But a nurse-technician got only 4,000 more. You could spend that on one big meal for a family. These nurses are still buying their uniforms in the secondhand clothes market. They use plastic bags on their hands because there are no protective gloves. You're surprised if they want to go to Britain?'
At the Malawian Ministry of Health, Dr Ann Phoya, a former nurse who is now the official in charge of administering the British grant, said the cash had been distributed across the board because of the higher taxes that better-earning officials paid. But Dr Phoya agreed that the nurses' salaries were not enough. 'If they have to pay rent in Lilongwe, they are left with peanuts. We would have liked to do more.'
Jenny Chinsenga, head matron of the 220-bed maternity unit, said only two midwives were on duty that day to deal with a normal flow of 40 babies. She needed to double the 31 nurses on her roster for a proper service. A chart told the stark truth of the understaffing - each month the unit delivers around 900 babies, and up to 40 do not survive.
The international development department says that the Emergency Human Resources Programme in Malawi has had 'positive results', but agrees that more needs to be done. The flow of nurses to the UK has slowed: figures for last year showed that 23 health workers had left the country, a 70 per cent decline. And 1,812 new health workers have been recruited.
Malawi wants Britain to extend its support for the programme beyond 2011. The EU is considering a new funding scheme that will extend the length of donor nations' commitments from three years to six or longer. 'We know that aid can change the lives of people in poor countries,' says Oxfam's Max Lawson, a policy adviser on essential services for the developing world. 'In Malawi it means more nurses, and increasing wages: it may not have been enough, but that's an argument for doing more, not less. Programmes like this are needed in every poor country in Africa.'