IFGH 2012: Addressing Malawi’s Human Resources Capacity to Address Obstetrics and Neonatal Care

January 30, 2012

Authors: Lotya J.1, McCauley T.1, Mwapasa G.2, Borgstein E.2, Mkandawire N.2, Mhango F 3, Brugha R.1

Author Affiliations:1Royal College of Surgeons in Ireland, 2College of Medicine Malawi, 3Malawi Ministry ofHealth

Option 1– Scientific / Empirical Research Findings Presented as – Oral Presentation


The objective of this study was to assess Malawi’s progress and the nature of the health workforce constraints towards reaching the maternal health Millennium Development Goal (MDG5)


In 2010, The Malawi Ministry of Health (MoH) conducted an assessment survey of Emergency Obstetric and Newborn Care (EmONC) in all 205 government, 89 Christian Health Association of Malawi (CHAM) and 15 private health facilities that provided deliveries in the twelve months preceding the survey. The MoH provided the authors with the database. The lead author cleaned the data, recoded variables and analysed the dataset in STATA 12.


Malawi has only 40% of the recommended EmONC facilities per 500,000 population. The 27 district hospitals were staffed by only 48 doctors and 317 Clinical Officers (COs). There were no Obstetrician/Gynaecologists or General surgeons in the 27 government hospitals, whilst there were 6 in CHAM hospitals. In most government hospitals, caesarean section (CS) were performed by both COs (82%) and doctors (60%), but 50% more COs than doctors carried out CS’s. At district hospital level, there was a severe shortfall of COs (21%) and doctors (27%). 12% of COs had left government facilities in the previous 12 months, which suggests a problem of chronic attrition of a cadre of health worker that is the cornerstone of health care in Malawi.

Conclusions and next steps:

These recent national data illustrate the scale of the health workforce shortage in Malawi; and also its reliance on COs – a form of non-physician clinician – for delivery of much of the life-saving emergency obstetrical care. The Clinical Officer Surgical Training in Africa (COST-Africa) research project, 2011-15, will augment COs surgical skills, expanding from emergency obstetrics to general surgery and trauma care. A health impact (DALY) and cost- effectiveness analysis will be conducted in a cluster randomised controlled trial.


The EmONC assessment was conducted in collaboration and with financial support, from UNFPA, UNICEF, WHO and AMDD. COST-Africa is funded by the EU FP7 Programme.




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