In collaboration with partners, we put the need to invest in health workers in Malawi and Uganda on national and global agenda’s.
Malawi and Uganda grapple with an urgent health workforce crisis. At the time of our analyses, Malawi had only around 0.5 skilled health worker per 1,000 people and Uganda only 1. This is far from WHO’s recommended ratio of 4.45 per 1,000 people. The main cause for this gap is a lack of funding to employ health workers. The health budgets in the two countries largely depend on funding by development partners. The latest data (2022) shows this amounts to 65% in Malawi and 40% in Uganda. This money can usually not be used to pay for health workers’ salaries. In Uganda this creates the strange paradox that the country has a large pool of trained and licensed health professionals, but they remain unemployed – pushing some to seek better opportunities abroad or in other sectors.
Although raising sufficient domestic resources to pay for healthcare staff would be the best solution for Malawi and Uganda, they are not able to realize that in the short or even medium term. A large part of their health budget will therefore depend on external funding in the coming years. To improve health outcomes, development partners and donors should raise their support for health worker recruitment and salaries. They can do so by offering more funding that is both predictable – so countries can plan ahead – and more flexible – so countries can use it to recruit and retain many more health workers.
In the longer-term, reforms are needed that enable low- and middle-income countries to reduce their dependency on development funds and increase their capacity to raise public resources domestically and enlarge their health budgets.
With partners in Malawi and Uganda, we developed two country reports on the financing of human resources for health (Malawi report Nov. 2018 and Uganda report Feb. 2020). The reports contain data showing that both countries have a dire health workforce shortage, mainly caused by a lack of funding. They include recommendations for policy solutions on national and global level.
Our partners used the reports and the recommendations in dialogues with their governments. As Wemos, we used the reports to substantiate our inputs to the Strategy Refresh process of the Global Financing Facility in 2020. This multilateral initiative, hosted and supported by the World Bank, aims to advance health and rights of women, children and adolescents in low- and middle-income countries, including in Malawi and Uganda.
Working with partners in Malawi and Uganda led to mutual strengthening of knowledge: combining their insights on the national situation, actors and factors for change with Wemos’ knowledge on international policies and actors.
In Malawi, our partner AMAMI was invited to present the findings of the report to the Malawi Parliament, getting a chance to explain the dire situation of the health workforce and possible policy solutions. Our Ugandan partner, ACHEST, discussed the report with the Ugandan Parliament and had the findings validated by the Ugandan Ministry of Health. Their contribution is acknowledged in the HRH Strategic Plan 2020-2030. The Lancet refered to our report in an editorial on a universal shortfall of staffing in healthcare.
Moreover, thanks to the joint international advocacy we led, the Global Financing Facility Strategy 2021-2025 mentions human resource for health (HRH) for the first time after being absent in previous drafts. Our global health expert, Myria Koutsoumpa, served as the civil society representative in the HRH Technical Working Group that contributed to its development. In November 2022, the GFF HRH operational plan 2023-2025 was adopted, explicitly acknowledging Wemos’ contributions.
We are pleased that human resources for health are now receiving more attention. The Global Financing Facility’s annual report 2022-2023 highlights key results in Uganda, including an increase in deliveries attended by a skilled provider (from 64% to 79%) and a decline in the maternal mortality rate (from 108 to 68 deaths per 100,000 live births).
Country report Malawi – Mind the funding gap: Who is paying the health workers?
Advocacy brief – Uganda’s human resources for health: paradoxes and dilemmas
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