National Organisation of Nurses and Midwives of Malawi

Background

The Norwegian Nurses Organisation (NNO) has collaborated with the National Organisation of Nurses and Midwives of Malawi with funding from Norad since 2006 (at that time National Association of Nurses and Midwives). From 2006-2011 a project called “Caring for HIV-positive care-givers and strengthening of NANM” was implemented. Following that, a new project was initiated, namely the “Phase 2: Organisational Strengthening and Sustainability Project”. This report is a midterm review of that project.

Purpose/objective

The objective of the evaluation is to do a mid-term evaluation of the project in order to inform the second half of the project

Methodology

The study employed descriptive cross sectional design using mixed research methods. Quantitative data were obtained from members who responded to a structured questionnaire to give their perception and impression on sustainability and strengthening of the secretariat and leadership. Qualitative data were obtained from staff members and management who responded to a key informant interview guide. Quantitative data were cleaned and entered in SPSS for analysis. Descriptive statistics were generated to obtain measures of central tendency and dispersion on numeric variables and frequencies and percentages on categorical variables. Qualitative data were thematically analysed and used for triangulation. 176 members of NONM participated.

Key findings

• NONM has had a steady growth – with 50 members in 2006 to 6634 members in 2009 – to 9640 members in 2013.
• NONM has provided assistance to sick nurses (of which some have been referred to health facilities outside Malawi)
• NONM has provided legal assistance to some of its members
• A majority of respondents see NONM’s role in industrial dispute as satisfactory and helpful
• The ‘care for caregivers-program’ is a motivating factor for nurses and midwives to become and to stay as members
• NONM has engaged in a lot of training activities:
  - More than 100 shop stewards were trained in trade union issues, labour laws and related acts
  - More than 200 members from management teams were trained
  - More than 1300 health care workers and their spouses received information about HIV/Aids
  - 30 young female nurses received training in leadership, skills and knowledge
  - 15 media personnel were trained in NONM activities to better cover this in media
• Respondents reported they were dissatisfied with the membership fee
• More than 30% of the respondents reported to be dissatisfied with the provision of scholarship for career advancement
• A majority of respondents have not encouraged non-members to become members
• NONM has taken important steps in the direction of generating income – with offices for rent and a restaurant. However still the main source of income is from partners
• It is reported that there still is a poor relationship between NONM and Nurses and Midwives Council of Malawi (NMCM).

Recommendations

1. Members recommended NONM to distance itself from partisan politics; decentralize its offices to rural areas; introduce a program to look after retired nurses and orphans to nurses; provide sponsorship to students using its own resources; and scale up training.
2. NONM leadership and secretariat should improve on a number of aspects that its members expect. Much as NONM is rated highly to be playing a useful role in championing welfare of its members, satisfaction levels indicate that the gap between expectation and what is done remains wide. Additionally, as a representative of its members, NONM leadership should desist from partisan politics considering the membership may align to different political groups. This is important for a strengthened union.
3. The office complex and restaurant are inadequate to help NONM become self-sustaining (even though they provide foundation to move towards sustainability). NONM should look into other aspects of income generating activities that would help meet operational cost and offer competitive package to staff to improve retention.
4. NONM should capitalize on its professional membership and work with Doctors Association of Malawi to mobilize resources for establishing a state of the art clinic which will be generating substantial revenue to finance operational costs as well as serve their membership better.
5. NONM should recruit a business development officer or enhance the terms of reference for marketing officer so that the officer plans for high return investment areas and provide technical analysis for viability. Meaningful sustainability will be achieved when NONM can meet all its operating cost (salaries, utilities, loans to members and staff) without eating up on donor funds. That will make NONM even more attractive to donors who will only fund project cost.
6. NONM should review its role in provision of legal backing to its members whenever they have lawsuits before the Nurses and Midwives Council of Malawi (NMCM) to ensure that they are not seen encouraging mediocrity and recklessness amongst nurses and midwives. In as much as NONM is a union, the need for a cordial working relationship with MoH and NMCM cannot be overemphasized if their lobby and advocacy efforts for the welfare of nurses are to bear fruits.