End of NONM/NNO Project Evaluation Report

Background

A Needs assessment survey among nurses, midwives and other health personnel groups in Malawi in 2005, provided sufficient evidence to conclude that Malawian nurses, midwives and other health personnel groups needed updated information about HIV/AIDS, in order to adequately treat patients and avoid infection, both at the workplace and in their social life.

Those already infected were in need of care and support, and needed to be enabled in order to live positively and maintain their professional careers for as long as possible. At that time, the National Association of Nurses of Malawi (NANM) was a small association with only 50 members, who had little influence. With this as a backdrop, a project called “Caring for HIV-positive care-givers and strengthening of NANM” was initiated. The project was running from 2006 through 2011.

Purpose/objective

The main objective of the study was to:

• Assess the impact of the project interventions to gauge the extent to which it managed to meet the intended bench marks
• Conduct a SWOT analysis of NONM to feed into the next phase of the project
• To propose recommendations for the way forward

Methodology

The study used both primary and secondary data. The primary data was collected through key informant interviews and focus group discussions. Stratified sampling was used to identify respondents. Two health facilities were selected in each of the six districts from the 5 health zones of Malawi, in line with the Ministry of Health’s (MoH’s) classification. Of the total facilities visited, one belonged to the Christian Health Association of Malawi (CHAM).

A total of 200 nurses, midwives and student nurses took part in the evaluation. In addition, key informant interviews and focus group discussions were held with student members from the Malawi College of Health Sciences (Blantyre and Zomba campuses). Key informant interviews with key stakeholders in NONM were also conducted. Among others, interviews were held with the National AIDS Commission (NAC), the Ministry of Health (MoH), and the Malawi Congress of Trade Unions (MCTU).

Secondary data was collected through desk review of NONM reports and other forms of documentation.

Key findings

• The association NANM transformed into the organisation NONM in 2008, as a result of being granted trade union status
• NONM has had a steady increase in its membership base, from 50 in 2005 to 6634 in 2009
• Respondents are reporting that NONM lobby and advocacy interventions have enhanced professionalism, and improved their welfare, such as:
  - Re-introduction of tuition scholarships to student nurses after government withdrew this
  - NONM provides legal advice to members for free
  - NONM provides support such as funeral ceremony expenses to members Introduction of Hepatitis B vaccine after NONM had heavily lobbied for that
  - Wellness centre providing support to nurses, midwives and nurse students
  -NONM creates a unity among nurses and midwives 
• Still respondents report that there is more emphasis on the rights of patients than the rights of nurses and midwives in the facilities
• Care of caregivers project and development of support groups for nurses and midwives (support groups in the rural health facilities lagging behind) – 56 support groups are actively implementing support initiatives
• Lack of clarity/inadequate consultation and information flow on some processes such as selection of award recipients and feedback on some critical work being undertaken by NONM on behalf of its members
• Flow of communication between the NONM secretariat and its members is weak
• Support groups are open to all staff at an institution which means increased number of beneficiaries
• Weak financial skills in some of the support groups
• Inadequate monitoring and supervision of chapter work which results into laxity by chapter members and which could otherwise assist NONM respond to needs in a timely manner;
• Weak financial resource base for chapter work;
• Difficult relationship between NONM and the Nurses and Midwives Council of Malawi, and even the nursing department in the Ministry of Health.

The SWOT analysis is described on page 17-18 in the report.

Recommendations

• NONM should consider scaling up to rural health facilities and the hard –to-reach districts for equity, ensuring knowledge gaps are minimized; clarity on reason for existence for NONM, its programming and respective processes is enhanced; and pertinent feedback provided in a timely manner.
• NONM should endeavor to intensify their resource mobilization efforts so that they are able to provide meaningful seed money for pertinent initiatives, and to replicate the project in a number of areas while providing comprehensive care to those in need.
• NONM should consider advocating for/facilitating a part time upgrading program for nurse/midwife technicians, and for a just grading system and fair remuneration packages.
• To address the disparities and misunderstandings on workers’ rights between employers and the nurses, NONM should partner with the Ministry of Labor; the Ministry of Labor could play a facilitative role towards bringing together the Ministry of Health and senior management members of health facilities to trainings on workers’ rights. This approach has worked with some unions.
• NONM, in partnership with other stakeholders, should lobby for justice in the way the Nurses and Midwives Council of Malawi handles disciplinary issues.
• NONM should lobby the MoH to put in place welfare policies that are non-discriminatory in nature.
• NONM should continue lobbying and advocating for allocation of more resources in the national budget towards training of nurses and midwives to address the problem of high nurse-to-patient ratio
• NONM Secretariat should work towards addressing the relationship it has with Nurses and Midwives Council. This will help remove the confusion/fear that some nurses have regarding their welfare bearing in mind that the government and not NONM is their employer.

Comments from the organisation, if any

To work on the recommendations given in the end of project evaluation, a new agreement with Norad, NNO and NONM came to place in a project running from 2012-2015 (“Phase 2: Organisational Strengthening and Sustainability Project”).