Brain drain hits Malawi’s safe motherhood

Date: January 1, 1970
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Most health workers in Malawi, and even across Southern Africa, dream of trekking to the United Kingdom or other far off places, drawn by prospects of good remuneration and working conditions. Yet this outward trek endangers the lives of the thousands of pregnant women left behind.

"Inadequate staffing in hospitals is contributing to high cases of maternal mortality, nurses have too much work load," laments Dorothy Ngoma, National Association of Nurses in Malawi (NANM) Executive Director.
In Malawi, 16 women die every day giving birth or during pregnancy. Across the world, women continue to die of pregnancy-related causes at a rate of about one a minute, with ninety-nine percent of maternal deaths occurring in developing countries, primarily in Africa and South Asia.
Maternal deaths are preventable, and access to health care is the primary factor. Malawi has one of the lowest nurse to patient ratios, which stands at 1:1,500 instead of the 1:7 ratio recommended by the World Health Organization (WHO).
The nurses’ exodus for greener pastures abroad further hampers struggling infrastructure "In the absence of nurses, there will be a shortage.  There is need of political will. We are calling upon civil society organisations and politicians to stop maternal death," Ngoma says.
According to Care of Carer Givers, a project funded by the Norwegian Nurses Organization, nurses abroad make a lot of money, hence the need for government to put in place mechanisms to keep nurses home.
"Government has introduced attractive contracts, it has also put in place an assessment plan, to find out which nurses have stopped working, so that nurses who are in the profession are given attractive packages," reveals Mabvuto Kapyepye, Care of Carer Givers Project Coordinator.
Ngoma adds that nurses also face unsafe working conditions, coupled with gender discrimination amongst male and female medical practitioners themselves. Registrar of the Nurses and Midwives Council of Malawi, Maureen Chirwa, mentions that the Ministry of Health conducted an assessment on non-monetary incentives, aimed at improving working conditions of health workers.
"Poor conditions are not only in hospitals, but in their houses as well, they lack running water and other essentials," adds Chirwa.  Added to the brain drain, HIV and AIDS is also hitting the medics, exacerbated by poor occupational health safety standards. In turn this negatively impacts on service delivery to pregnant mothers.
However, despite brain drain hitting hard, nurses also need adequate training to uphold standards when discharging their duties. Kapyepye points out that nurses who are in the profession are receiving training on ethics for professional behaviour and codes of conduct.
However, Ngoma backs the professionalism of nurses, saying that sometimes their perceived hostile attitude towards patients comes due to poor working conditions they encounter.
"We do get reports of nurses being harsh to patients; sometimes a nurse has a lot of sick babies to attend to, what can she do? Deaths of women can come because nurses cannot cope, in a certain labour ward, 40 women were in need of attention of one nurse, what can a nurse do in such a situation?" she queried.
Worldwide, 380 women become pregnant, 190 face unplanned or unwanted pregnancies, 110 women experience pregnancy- related complications, 40 have unsafe abortions, while 1 woman dies, every minute.
Editor of The Lancet, Richard Horton, states that over the past 20 years, a series of strategic errors focusing only on mothers at risk of complications and relying on traditional rather than skilled birth attendants, have stifled progress in safe motherhood.
Horton says that the immediate priority for governments and donors should be to invest in the training, deployment and retention of skilled attendants, especially midwives. "The sheer lack of staff and facilities is the most substantial barrier to progress in many developing countries, retention of workers  is a major part of the supply problem," stresses Horton.
In Ghana, for instance, annual out flow of registered nurses to the UK increased 6 times during the 5 years before 2003.
The White Ribbon Alliance (WRA), which operates in 70 countries globally, encourages people to wear a white ribbon as one way of advocacy efforts to promote and create awareness on safe motherhood. Giving life should not be the end of life for women, just because they are poor.
Dingaan Mithi is a Malawian journalist and writer. This article is part of the Gender Links Opinion and Commentary Service that provides fresh views on everyday news.

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