New publication outlines evidence-based strategic planning for the health workforce in Malawi

Use modeling and analytics to guide targeted investments in human resources for health.

A strong and well-distributed health workforce is essential for delivering quality health services. However, too often the health workforce is often insufficient to meet the needs, especially in low- and middle-income countries. Human resource costs often make up a large portion of public sector health spending, forcing governments with limited budgets to make difficult decisions about what types of health workers to train and employ and where to place them.

CHAI collaborated with the Government of Malawi to conduct three modeling exercises to inform the Human Resources for Health (HRH SP) Strategic Plan 2018-2022 which outlines planning, education and management interventions for the workforce health of the country. The Government of Malawi uses a facility-based staffing standard which designates a targeted number of staff that should be employed in each type of health facility in the country; these positions are called permanent positions. Modeling for the HRH SP provided a new way of thinking about service demand-based staffing targets and how to achieve them by: 1) comparing current staff numbers to established positions to calculate vacancy rates; 2) estimate the immediate need for additional health workers based on the current demand for services in each facility in the country; and 3) forecast the future workforce available under various scenarios of interventions in the training pipeline. Estimating health worker needs based on demand can provide countries with more responsive and achievable manpower estimates than facility-based standards, as this approach to setting targets takes into account the variation in service utilization between geographic areas and how services are provided by different categories of health workers.

SP HRH analyzes found that in 2018, 55% of established positions were filled, with an average of 1.49 health professionals per 1,000 population; however, there were significant variations in staffing at the subnational level. The demand-based model shows an immediate shortfall of 7,374 health workers to provide services optimally at current utilization rates, with the largest gaps among nurses and midwives and pharmacists. According to current trends in health worker training, Malawi is expected to meet its establishment targets in 2030, but will fall short of the World Health Organization (WHO) standard of 4.45 health workers to 1,000 inhabitants by 2040. These results are presented and inform priority interventions and investments in the PS HRH.

This work is documented and described in a recent publication in the journal Human Resources for Health, as Malawi’s approach and experience could be applicable to other countries. CHAI is now supporting the Government of Malawi to update and adapt these modeling tools for the Health Sector Strategic Plan 2022-2030.