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Saturday 26th May 2018

Malawi's healthcare crisis

25th June 2007

Emma Dent writes in the Health Service Journal about Malawi's terrible shortage of nursing staff, high disease rates and poor resources.


Most people first heard of Malawi when Madonna adopted her son from the country. The country, located in southern Africa, faces huge healthcare challenges.

Hastings Banda, Malawi's dictatorial ruler for over thirty years until 1994, banned contraception. The country now has a population of 13m, of which half exist "below the poverty line."

90% are unemployed, the average salary is £80 a year and more than one third cannot find clean water. Around 14% - almost a million people - are infected with HIV or AIDS and 1m children have lost their parents to the disease.

There is a huge lack of healthcare workers due to their "shockingly low" wages. Around half of Malawi's nurses have left the country to work abroad. The NHS has said it will not employ nurses from developing countries, but many overseas workers are able to find work in the private sector.

UK funding, provided by the Department for International Development, will increase nurses' salaries by 52% by 2010-11. The department wants 8,000 healthcare workers recruited by the same date. They say this has led to increased "retention, from 100 health workers being lost down to 25."

HSJ's visit showed "the reality was different." Interviews with Malawi's healthcare workers revealed that although salaries have increased, they still fall far below what is necessary "to constitute a living wage."

In some rural clinics nurses do not even have gloves, work 24-hour shifts and are expected to manage in excess of 100 patients. Maternity wards are terribly overcrowded, with few staff and shortages of basic equipment.

The spectre of HIV and AIDS overshadows Malawi. Due to lack of equipment, workers are at risk of contracting the disease and "one nurse a week dies of AIDS, adding to huge recruitment problems."

Kamuzu's Lighthouse centre offers a positive example of a successful treatment and advice centre. Its director, Enous Chang'ana asserts: "We are so innovative here that we want to send this out on a national level."


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