Staff audit expose staffing gaps
More hands in health centres
Salome Changantuwa’s burning desire to become a midwife was virtually dashed when she spent four months in a fruit factory in a desperate escape from youth unemployment.
The 25-year-old mother of one salvaged her dream in February when Chikwawa district hospital selected her as a hospital attendant.
Since March 1, she has undergone on-the-job training in the hospital’s operation theatre and maternity ward.
Salome is usually seen mopping the rooms, disinfecting frequently touched surfaces, and sterilising medical tools skilled health workers operating on women during C-sections for safe delivery.
“I love my green uniform. I was speechless when I was invited to the orientation in February this year. I had been jobless since 2018, when I passed the Malawi School Certificate of Education. Finally, my prayer has been answered. This job is a stepping stone to fulfilling my dream,” she says smilingly.
Salome is acquiring vital experience and saving money for midwifery training in the footsteps of her aunt, who helped deliver her baby girl when she was 18-years-old.
During day and night shifts, she is seen happily cleaning the maternity wing, changing bed linen, and pushing stretchers carrying pregnant women to the theatre for C-sections and back to the wards.
“During my orientation, I’ve learnt to treat every patient and guardian with a smile and respect like my family,” says Salome. “People in pain need a comforting voice, not torture. I’m happy most clients find me sociable and wish I were a midwife.”
She is one of the five hospital attendants recruited in response to vacancy rates exposed by staff assessments supported by UNICEF through the United Nations Joint Programme for Health System Strengthening (UNJP-HSS) with funding from the UK’s Foreign Commonwealth and Development Office. The ‘Umoyo Wathu’ six-year initiative seeks to halve maternal and newborn deaths and stillbirths in health facilities.
In 2022, Chikwawa district health office (DHO) thoroughly reviewed its workforce size and skills in all 30 health facilities.
After studying more than 5 000 workers’ files, hospital administrator Wakisa Kamwela is happy that the government has approved the recruitment of five hospital attendants and a messenger. It has also promoted 29 ground labourers and hospital attendants.
“It’s a huge relief,” he says. “I joined the civil service in 2020 when Chikwawa DHO had no staff retention report, so we didn’t know how many workers we had, their skills, how old they were, whether they had retired or not, and their grades and salaries.”
Staff retainer reports should be updated monthly, so Kamwela and his team reviewed a stockpile of workers’ files that were gathering dust on their shelves.
“We couldn’t propose recruiting more workers since we didn’t know how many workers and vacancies we had at each level. We still had people on our payroll working in other districts,” he says.
With UNICEF support, Chikwawa audited its workforce and released a staff retainer report that convinced the government’s Health Service Commission to approve the proposed recruitment plan.
“The ripple effect is that we will create space to recruit as many when we promote the 29 ground labourers and hospital attendants. This will help improve service delivery and reduce youth unemployment,” says Kamwera.
He ranks the lower cadres vital for quality service provision, including safe motherhood.
“You can have nurses, clinicians, and all skilled health workers, but lives may still be lost while giving birth because there was no hospital attendant or nursing assistant to clean the room, pass the tools on time and sterilise reusable equipment,” Kamwera explains.
The DHO will deploy some of the recruits to other health facilities within the district, including Therere Health Centre.
“Therere is a new facility with an outpatient department, but it has no hospital attendants, security guards, and ground labourers. Thanks to insights from the staff retainer report, it will be properly staffed alongside Majete 5 and 6 health centres, which have one hospital attendant each.”
Keeping an eye firmly on staffing levels and available skills, coupled with lessons from mandatory inquiries into every maternal death, is making healthcare facilities in Chikwawa safe for pregnant women and newborns.
Safe Motherhood coordinator Nyson Sekani explains: “Chikwawa district experiences many challenges regarding maternal and neonatal health.
“Among others, we have high vacancy and turnover rates, so we need to know where the gaps are and continue to recruit and mentor our teams for the benefit of women and children in our care.”
While Kamwela is still excited about the fruits of the staff audit, the government has already approved the second round of proposed recruitments.
He says: “We are thankful that UNICEF supported this staff review done in June 2022 though the approved staff was recruited in February this year.
“With a vacancy rate of about 40%, we still need more support to advertise the vacancies approved, interview eligible applicants, and keep beefing up our staff for better health outcomes. We need all necessary staff at work to reduce maternal and newborn deaths further,” he says.