Análisis conceptual de las variables: nivel de conocimientos,

According to Vidal (2015), the Ministry of Health report states that the human resources situation in the Malawi health sector is critical, dangerously close to collapse. Health care is a highly political issue in the country of nearly 17 million people, more than half of whom live in poverty and with gross domestic product (GDP) per capita of US $226.46 in 2013. In the early 2000s, a drastic shortage of workers due largely to emigration severely affected the delivery of health services (Vidal, 2015). Malawi currently still counts with insufficient health workforce for its fast-growing population. The shortage of health personnel constitutes a major constraint to the improvement of health care and the achievement of health related MDGs. For instance, the provision of HIV/AIDS related treatment, safe delivery, maternal and child health at birth and the introduction of an essential health package, meant to bring the poor population access to basic care, require a far larger health workforce, in particular of nurses (McCoy et al., 2008;

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Joint Learning Initiative, 2004). Migration has become an important option for Malawian nurses leaving the public health service.

In this realm, Denton (2006) reveals that Malawi one of the world’s poorest countries trains 60 nurses per year, yet it loses around 100 nurses annually and more than half of them travel to United Kingdom. Furthermore, the Malawi Ministry of Health reported a nearly 80 percent vacancy rate for registered nurses in 2003 and 65 percent in 2006. With such a low density of health workers, the coverage and quality of health services is significantly constrained (Vidal, 2015). According to Clemens and Pettersson (2008) 17 percent of Malawian nurses were overseas in 2000, and 633 nurses had been validated to work overseas (See Table 2-4). The total number may appear small, but it represents a significant proportion of nurses in Malawi. Validation figures provide important data on intention to migrate and refer to those nurses requesting appropriate documentation to migrate. In 2014, the National Health Service (NHS) in the United Kingdom employed 454 Malawian including 138 professionally qualified clinical staff (Vidal, 2015). For nurses to gain employment overseas in Malawi, they seek validation from the Nurses and Midwives Council of Malawi and then provide proof of qualification from their training institution.

According to Winkelmann-Gleed (2006) all migrant nurses working in the NHS and the independent sector (for example, a private care home) need to register with the UK NMC in order to practice. Malawi has 10,000 practicing nurses against a projected population of 16 million (Mzungu, 2015a). It is estimated that 7,000 of them are enrolled nurses and not recognised at international level as nurses because they are not registered nurses (Nation, 2013a). Enrolled nurses hold a maximum of a diploma in nursing whereas registered nurses have a minimum of a bachelor’s degree (Nation, 2013b). Malawi’s nurse to patient ratio stands at 1 to 3000 compared to 1 to 1000 recommended by the World Health Organisation (Kadzakumanja, 2015). According to Mzungu (2015b) in Malawi about 18 years ago, the nurse to patient ratio was 1 nurse to 20 or 30 patients and service delivery was of high quality. In contrast, recent literature points out that Malawi has 75% vacancy rate for nurses (Kasalika, 2014) because of low outputs from training institutions and brain drain (Tambulasi and Chasukwa, 2015).

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Table 2-4 Number of Malawian nurses validated to work overseas, 2000-2008

Year Number of verifications/validations

2000 90 2001 111 2002 90 2003 81 2004 85 2005 98 2006 30 2007 23 2008 25 Total 633

(Source: NMCM unpublished data, 2009)

Table 2-5 below shows the number of Malawian nurses verified/validated to migrate to other countries 2009-2015 for either employment or further studies. The number of nurses working outside the country may have been even higher as some emigrated to pursue careers other than nursing and did not require qualifications validation (Vidal, 2015).

Table 2-5 Number of Malawian nurses verified/validated between 2009 and 2015

Year Number verifications/validations

2009 15 2010 12 2011 33 2012 25 2013 19 2014 14 2015 10 Total 128

(Source: Nurses and Midwives Council of Malawi, 2016)

2.5.3 Summary of Brain Drain of Healthcare Professionals in Developing Countries

Developing countries continue to experience the loss of an increasing number of highly skilled health professionals such as nurses, doctors, dentists, and pharmacists by migrating to developed countries. The developed countries have had in market terms, a higher demand for healthcare workers that has not been satisfied domestically and have imported such labour. Today, a decrease in supply that cannot meet the increased demand has affected the society. The migration of nurses and doctors from sub-Saharan Africa to the Global North is a subsection of wider movements, yet this aspect of migration came to dominate the global public health agenda. The departure of trained professionals from low-income countries to find work in high-income countries emerges as a perverse subsidy. However, increasing trend would continue because of growing wage differentials, standards of living between developed

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and developing countries, and prevalence of poverty, employment and political instability in many fragile and least developing countries. The dearth of healthcare professionals is one of the major obstacles to achieving the United Nations Millennium Development Goals because global healthcare workforce is experiencing a major nursing shortage. This shortage of nurses is measured in relation to a country’s historical staffing levels, resources and estimates of demand for healthcare services. Increased demand for health workers in high-income countries leads to a growth in career options for qualified health personnel. Brain drain has become an important option for Malawian nurses and other countries leaving the public health service.