Improved health Training Education in Malawian Nursing Schools Independent Mid Term Review

The Project
The Norwegian government is funding "Improved health training in Malawi" implemented by Norwegian Church Aid (NCA) in collaboration with CHAM (Christian Health Association of Malawi). The programme is a response to the health human resource crisis and includes improving and enhancing the physical infrastructure of the church owned Malawian health nursing training institutions, and building capacity of the same. The aim is to increase the number of qualified health personnel, particularly nursery and midwifery technicians (NMT) and improve the quality of health training education in Malawi. Norway has submitted NOK 86 mill. to this programme for the period 2005-2009.

Interesting Findings
The project adopts a unique model that aims at increasing student numbers and quality by providing infrastructure, nurse trainers and learning resources, and by improving networking and building tutors' capacity. In the circumstances the approach has worked well but whether it has already led to improvements in teaching quality is hard to say.

Infrastructure:
• In a relatively short time, a lot of progress has been made. Over 60 individual construction projects have been initiated at the 9 colleges by NCA since 2005 under this programme. The project has enabled a significant proportion of the facilities, identified in the CHAM led Needs Assessment of 2005, to be realised.
• The quality of the construction has generally been good. The awareness of long term sustainability and future maintenance, have resulted in a stock of buildings that should serve each college well for decades to come. Every attempt has been made by the design team to develop each college campus in a sensitive way with consideration for future expansion.
• At this Mid Term Review (MTR)it appears that the programme is on target to complete all the committed and remaining construction contracts within the project budget and timeframe, though the challenge remains for each college to source further funding to enable all the recommended facilities to be built on each campus and critical items such as furniture and specialist equipment to be provided.

Nursing education:
• Numbers of Nurse Midwife Technician students more than doubled between 2004 and 2008, and the main increases in workload have been shared among 4 colleges (out of 10) who have more than trebled student numbers. Numbers of graduates have also increased and will continue to increase and probably surpass targets initially set by the Ministry of Health (MOH).
• Numbers of tutors and (especially) clinical instructors have not kept pace with the increases in student numbers. This must surely have had a significant impact on the quality of NMT education, but such impact could not be assessed at this MTR in the absence of baseline information.
There are a number of lessons learnt from project design. The project was formulated as a pragmatic response to double capacity in nursing colleges within 5 years. While the objectives of the project were clearly defined in the project document, it was much less clear how such objectives would be pursued and what specific strategies and activities would be used. One of the implications of a very open (ambiguous) project design has been continued swift changes in the project approach.

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