The financial losses from the migration of nurses from Malawi

Abstract Background The migration of health professionals trained in Africa to developed nations has compromised health systems in the African region. The financial losses from the investment in training due to the migration from the developing nations are hardly known. Methods The cost of training a health professional was estimated by including fees for primary, secondary and tertiary education. Accepted derivation of formula as used in economic analysis was used to estimate the lost investment. Results The total cost of training an enrolled nurse-midwife from primary school through nurse-midwifery training in Malawi was estimated as US$9,329.53. For a degree nurse-midwife, the total cost was US$ 31,726.26. For each enrolled nurse-midwife that migrates out of Malawi, the country loses between US$71,081.76 and US$ 7.5 million at bank interest rates of 7% and 25% per annum for 30 years respectively. For a degree nurse-midwife, the lost investment ranges from US$241,508 to US$ 25.6 million at 7% and 25% interest rate per annum for 30 years respectively. Conclusion Developing countries are losing significant amounts of money through lost investment of health care professionals who emigrate. There is need to quantify the amount of remittances that developing nations get in return from those who migrate

Comparing the Job Satisfaction and Intention to Leave of Different Categories of Health Workers in Tanzania, Malawi, and South Africa.

Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies. The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave. There were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (χ2=140.3, p<0.001). 18.8% of health workers in Tanzania and 26.5% in Malawi indicated that they were actively seeking employment elsewhere, compared to 41.4% in South Africa (χ2=83.5, p<0.001). The country differences were confirmed by multiple regression. The study also confirmed that job satisfaction is statistically related to intention to leave. We have shown differences in the levels of job satisfaction and intention to leave between different groups of health workers from Tanzania, Malawi, and South Africa. Our results caution against generalising about the effectiveness of interventions in different contexts and highlight the need for less standardised and more targeted HRH strategies than has been practised to date

Opinions on integrating couple counselling and female sexual reproductive health services into Voluntary Medical Male Circumcision services in Lilongwe, Malawi

Background Couples HIV Counselling and Testing (CHCT) has been found to be potentially beneficial than individual HIV Counselling and Testing for prevention and treatment of HIV. However, there are few health care opportunities for men and women to access health services together, leading to underutilization of CHCT service. Integrating female Sexual and Reproductive Health (SRH) services into male-dominated service could be more effective than trying to integrate men's health services into female-dominated health services. A potential site for male-female service integration could be Voluntary Medical Male Circumcision (VMMC) centers. Methodology We conducted a qualitative study in Lilongwe, Malawi between June to August 2018. Twenty VMMC clients, 20 peers and 20 VMMC providers completed individual in-depth interviews to share their opinions on what they thought about integrating CHCT and other SRH Services into VMMC services. These proposed SRH services include family planning, cervical cancer screening, sexually transmitted infection management and pre-exposure prophylaxis (PrEP). Content analysis was used to analyze the results. Results All participants were receptive to integration of CHCT, and most accepted the integration of SRH services into VMMC Services. Most VMMC clients, peers and care providers said that CHCT integration would help couples to know their HIV status, prevent HIV transmission, encourage healthy relationships, and provide a chance for women to participate in VMMC counselling and wound care. However, integration of other services, such as family planning and cervical cancer screening, drew mixed opinions among participants. Most VMMC clients, peers and providers felt that integration of services would promote male involvement and increase men's knowledge in feminine sexual reproductive health services. A few providers expressed concerns over service integration, citing reasons such as overcrowding, work overload, gender mixing, and lack of provider capacity and space. Most participants supported integrating PrEP with VMMC Services and felt that PrEP would complement VMMC in HIV prevention. Few providers, peers and VMMC clients felt the addition of PrEP to VMMC services would lead to high-risk sexual activity that would then increase the risk for HIV acquisition. A few participants recommended community sensitization when integrating some of sexual reproductive health services into VMMC Services to mitigate negative perceptions about VMMC services and encourage service uptake among couples Conclusion Most participants service providers, VMMC clients and Peers were receptive to integrating SRH services, particularly HIV prevention services such as CHCT and PrEP, into male dominated VMMC services. Adequate community sensitization is required when introducing other SRH services into VMMC services

Decolonising the Human

"Decolonising the Human examines the ongoing project of constituting ‘the human’ in light of the durability of coloniality and the persistence of multiple oppressions. The ‘human’ emerges as a deeply political category, historically constructed as a scarce existential resource. Once weaponised, it allows for the social, political and economic elevation of those who are centred within its magic circle, and the degradation, marginalisation and immiseration of those excluded as the different and inferior Other, the less than human. Speaking from Africa, a key site where the category of the human has been used throughout European modernity to control, exclude and deny equality of being, the contributors use decoloniality as a potent theoretical and philosophical tool, gesturing towards a liberated, pluriversal world where human difference will be recognised as a gift, not used to police the boundaries of the human. Here is a transdisciplinary critical exploration of a wide range of subjects, including history, politics, philosophy, sociology, anthropology and decolonial studies.

Forest as Stronghold of Local Ecological Practice: Currently Used Wild Food Plants in Polesia, Northern Ukraine

Local ecological practice (LEP, e.g., the everyday practice of collecting and using plants, including wild food plants) is shaped by nature (available local resources) and culture (local perceptions and knowledge on their usability), including a multitude of factors, among which language and geographical or cultural separation have been found to play crucial roles in affecting biocultural diversity. Also, proximity to the forest has been shown to increase the use of plants. We conducted ethnobotanical fieldwork within eastern and western regions of Ukrainian Polesia, during which we interviewed 118 people. Through semi-structured interviews, we recorded the distribution of the current uses of 70 wild food taxa. The analysis of use records revealed homogeneous distribution of use despite the geographical distance and different spoken dialects; however, we were able to single out the highly sylvan region of eastern Polesia as the area with highest biocultural diversity for the use of wild food plants. The results suggest that in the context of the overall homogenization of local ecological knowledge, the continued existence of unintended contact with nature through living and working in the forest may be the primary factor maintaining the broader LEP in the sylvan area of eastern Polesia. Місцева екологічна практика (MЕП, що включає повсякденну практику збору та використання дикорослих рослин у їжу) формується природою (місцевими ресурсами) та культурою (місцеві знання про їх використання), що включає безліч чинників, серед яких мова та географічне або культурне відокремлення відіграють вирішальну роль у впливі на біокультурне різноманіття. Також показано, що близькість до лісу збільшує використання рослин. Ми проводили етноботанічні польові роботи у двох областях Українського Полісся, в ході яких ми провели інтерв’ю з 118 людьми. За допомогою напівструктурованих інтерв’ю ми задокументували поточне використання 70 таксонів дикорослих рослин у їжу. Аналіз записів про вживання свідчить про однорідний розподіл використання, незважаючи на географічне розташування та різні розмовні діалекти; однак, ми змогли виділити лісистий регіон Східного Полісся як територію з найвищим біокультурним різноманіттям використання дикорослих рослин уїжу. Результати свідчать, що в контексті загальної гомогенізації місцевих екологічних знань, продовження існування контакту з природою живучи та працюючи в лісі може бути основним чинником, який підтримує ширшу MЕПу в лісовій зоні Східного Полісся

How are health professionals earning their living in Malawi?

BACKGROUND: The migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied. METHODS: The present study utilized a qualitative data collection and analysis method. This was achieved through focus group discussions and in-depth interviews with health professionals and administrators to determine the challenges they face and the coping systems they resort to and the perceptions towards those coping methods. RESULTS: Health professionals identified the following as some of the challenges there faced: inequitable and poor remuneration, overwhelming responsibilities with limited resources, lack of a stimulating work environment, inadequate supervision, poor access to continued professionals training, limited career progression, lack of transparent recruitment and discriminatory remuneration. When asked what kept them still working in Malawi when the pressures to emigrate were there, the following were some of the ways the health professionals mentioned as useful for earning extra income to support their families: working in rural areas where life was perceived to be cheaper, working closer to home village so as to run farms, stealing drugs from health facilities, having more than one job, running small to medium scale businesses. Health professionals would also minimize expenditure by missing meals and walking to work. CONCLUSION: Many health professionals in Malawi experience overly challenging environments. In order to survive some are involved in ethically and legally questionable activities such as receiving "gifts" from patients and pilfering drugs. The efforts by the Malawi government and the international community to retain health workers in Malawi are recognized. There is however need to evaluate of these human resources-retaining measures are having the desired effects

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd