Narrativa, creación y reconocimiento para la reconciliación

Sampling is the ability of the research to select a portion of the population that is truly representative of the said population (Frey et al., 2000) because it is practically impossible to conduct a case study research of the whole population (Saunders et al., 2003). Different

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sampling techniques such as quota, purposive (judgmental), snowball, self-select and convenience can be located in business research (Saunders et al., 2009).

For the purpose of this research, purposive sampling also known as judgemental sampling was adopted. Purposive sampling is a sampling method usually used in a small sample whereby the researcher knows the population and that, the data collected from the selected sample is able to answer the research question and meet the research objectives (Saunders et al., 2009). Similarly, Punch (2005) defines purposive sampling as a non-probability technique where sampling is done in a deliberate way, with some purpose or focus in mind. The composition of such a sample is not made with the aim of being statistically representative of the population. Such samples comprise individuals considered to have the knowledge and information to provide useful ideas and insights (Remenyi et al., 1998).

To justify the use of purposive sampling in this study, Bhattacharyya (2006) opines that, judgemental sampling can be used in case studies, ‘rare event’ and if the targeted population is made of people with positions in the organisation or society. Schutt (2006) tells us that researchers should try to select interviewees, who are knowledgeable about the subject of the interview, open to talking and represent a range of perspectives. This is where the respondents were purposively selected in this study based on their nature of work and association with the Ministry of Health. The population consists of registered nurses, and people with close proximity to policy and decision making in the Malawi health sector (See Appendix 3). Purposive sampling allowed for respondents to the research to tailor fit the characteristics required by the researcher, to answer the research question. It was also less time consuming and less expensive. For the actual selection of the respondents in purposive sampling, the procedure is to establish contact with a key person, or highly placed manager, [in order] to take his or her help in identifying the right persons (Ghauri and Gronhaug, 2002). According to Stake (1995), this is critical in order to maximise what can be learned because it enables the selection of information rich cases for in-depth analysis related to the central issues being studied (CEMCA, 2002). Yin (2009); Saunders et al. (2009) propose that it is ideal for very small samples such as in case study research and when selecting cases that are informative and explanatory.

The health care system in Malawi is based on referral principles organised in a three-tier institutional framework starting with health centres offering basic primary care, district hospitals offering general secondary care, and central hospitals providing tertiary specialist care. Six hospitals were chosen for the study. These were four central hospitals in Malawi namely Queen Elizabeth Central in Blantyre, Zomba Central in Zomba, Kamuzu Central in Lilongwe, Mzuzu Central in Mzimba, and two district hospitals namely Nkhotakota in

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Nkhotakota and Mzimba in Mzimba (See Appendix 1). Queen Elizabeth and Kamuzu Central Hospitals are teaching hospitals with links to the College of Medicine and Kamuzu College of Nursing. The Central hospitals are responsible for professional training, conducting research and providing support to districts.

An interview guide was used to interview sampled participants. The rationale for choosing the six hospitals was motivated by the significant brain drain of nurses in these hospitals. In addition, the hospitals were purposively chosen to include both urban and rural areas to make the study representative of Malawi as a whole. The interview guide was aimed at Registered Nurses, Chief Nursing Officers and a Manager each from Nurses and Midwives Council of Malawi (NMCM), Christian Health Association of Malawi (CHAM) and Ministry of Health Headquarters. They all had experiences of the brain drain of nurses in the Malawi health sector and provided substantial insights for the research. The nurses were selected with the support of Chief Nursing Officers and Administrators by virtual of holding their positions. In fact, two Administrators as Table 3 indicates were included in the sample because they represented District Nursing Officers who were not available at the time the researcher visited the two district hospitals. Chief Nursing Officers are ward managers at central hospitals while District Nursing Officers are ward managers at district hospitals. Eighteen nurses in total thus three from each hospital participated in the research and represented the whole potential population.

The justification for including Chief Nursing Officers, District Nursing Officers and Administrators was to get not just multiple data but to relate them to the views of nurses and other key informants in order to have valid results. They had the knowledge and provided substantial insights for the research.

CHAM is a key partner to the Government of Malawi through the Ministry of Health in implementing the Health Sector Strategic Plan, including delivery of the Essential Health Package and training of human resources for health, and in other sector-wide initiatives. The NMCM is the sole regulatory body of nursing and midwifery education, training, practice and professional conduct of nursing and midwifery personnel in the country. It has a mandate to formulate professional education and/training standards and to regulate health services based on professional standards (Nove, 2011). Table 3-2 shows semi-structured interviews with registered nurses, Table 3-3 shows semi-structured interviews with key informants from hospitals and Table 3-4 shows semi-structured interviews with key informants from NMCM, CHAM and the Ministry of Health.

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Table 3-2 Semi-Structured Interviews with Nurses

No Hospital and District Region in Malawi Interviewees’ position Nurses interviewed at each hospital 1 Queen Elizabeth in Blantyre South Registered Nurse 3 2 Zomba Central in Zomba South Registered Nurse 3 3 Kamuzu Central in Lilongwe Central Registered Nurse 3 4 Nkhotakota District in

Nkhotakota

Central Registered Nurse 3 5 Mzuzu Central in Mzimba North Registered Nurse 3 6 Mzimba District in Mzimba North Registered Nurse 3

Total 18

Table 3-3 Semi-Structured Interviews with Key informants from Hospitals

No Hospital and District Region in Malawi Interviewee’s position Key informants interviewed at each hospital 1 Queen Elizabeth in Blantyre South Chief Nursing Officer 1

2 Zomba Central in Zomba South Administrator 1 3 Kamuzu Central in Lilongwe Central Chief Nursing Officer 1 4 Nkhotakota District in

Nkhotakota

Central Administrator 1 5 Mzuzu Central in Mzimba North Chief Nursing Officer 1 6 Mzimba District in Mzimba North District Nursing

Officer

1

Total 6

Table 3-4 Semi-Structured Interviews with Key informants from NMCM, CHAM and Ministry of Health

No Name of Organisation Interviewee’s position Key informants interviewed at each organisation

1 Nurses and Midwives Council of Malawi (NMCM)

Manager 1

2 Christian Health Association of Malawi (CHAM)

Manager 1

3 Ministry of Health Technical/Policy Advisors

1

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Table 3-5 shows the number of focus groups, names of hospital where discussions took place and the number of participants in each focus group.

Table 3-5: Focus Group Discussions with Nurses

Focus Group Name of Hospital Discussions Held

Number of Participants in each Group

Focus Group 1 Queen Elizabeth Central 5

Focus Group 2 Mzuzu Central 4

Focus Group 3 Kamuzu Central 6

3.6.5.1 Limitations of Purposive Sampling Technique

Purposive technique that the research used has its own limitations. According to Stake (1995), participants selected through purposive sampling are unlikely to be a strong representation of others. Black (1999) concurs that purposive samples are not easily defensible as being representative of populations due to potential subjectivity of the researcher. However, Richie et al. (2009) opine that the purposive sample is not intended to be statistically representative, the chances of selection for each element are unknown but, instead, the characteristics of the population are used as the basis of selection. In addition, George and Bennett (2005), underscores purposive selection because it can be prone to version of selection bias that concerns statistical researchers. As described by Pole and Lampard (2002), this could be the case because purposive sampling gate keepers may direct the researcher to certain interviewees while avoiding others knowingly or unknowingly.

Although limitations of purposive sampling have been highlighted, Silverman (2005) states that sampling technique is seen as central in qualitative research. Despite its obvious limitations, this does not mean that purposive or judgmental assessment should never be used in assessing the impact of different programmes (Ulin et al., 2004). According to Ghauri and Gronhaug (2002) see also Yin (2009), which methods and techniques are most suitable for which research depends on the research problem and its purpose.