Ellen Schell

Predictors of Workforce Retention Among Malawian Nurse Graduates of a Scholarship Program: A Mixed-Methods Study

Several non-remuneration strategies may help improve retention of public-sector nurses: availability of supplies, adequate housing, advancement opportunities, and a positive work environment. A scholarship program with close follow-up of graduates may also help improve retention. Several non-remuneration strategies may help improve retention of public-sector nurses: availability of supplies, adequate housing, advancement opportunities, and a positive work environment. A scholarship program with close follow-up of graduates may also help improve retention. ABSTRACT Background: Malawi faces critical health care worker shortages of both physicians and nurses. The Global AIDS Interfaith Alliance (GAIA) began a nursing scholarship program in Malawi that requires graduates to work in the public sector for 4–5 years following graduation. The main objective of this study was to identify job satisfaction and retention factors of scholarship recipients after graduation. Methods: We conducted a mixed-methods study consisting of 30 individual qualitative interviews and 56 quantitative surveys that evaluated job satisfaction, factors associated with retention, and impact of the GAIA Nursing Scholarship Program. Participants included GAIA scholarship recipients who had graduated. We used thematic analysis to analyze qualitative interviews. Kruskal-Wallis, Spearman correlation, and chi-squared tests were used to analyze survey data. Results: The majority of survey and interview participants indicated it was unlikely that they would leave the public sector (70% and 90%, respectively). Most interview and survey participants cited a lack of supplies, inadequate human resources, and high workload as major challenges to their work. Poor working relationships with management or coworkers was significantly correlated with consideration of changing jobs in the next 6 months (correlation coefficient −0.28, P < .05 and −0.36, P < .01, respectively). Low salaries, high workload, poor accommodations, and a lack of appreciation were the most common reasons given for considering leaving the public sector while job security, desire to pursue further education, and public service agreement were primary motivations for continuing to work in the public system. Participants felt supported by GAIA staff and expressed a desire to serve their communities in return by working in government-supported health facilities. Conclusions: Despite the many challenges faced by public-sector nurses, low-income countries such as Malawi can employ non-remuneration strategies to retain nurses in the public sector, including adequate housing, availability of supplies, advancement opportunities, and positive work environments. Scholarship programs with close follow-up of graduates may also help increase retention.

How Community Trust Was Gained by an NGO in Malawi, Central Africa, to Mitigate the Impact of HIV/AIDS

Trust is valuable social capital that is essential for effective partnerships to improve a community’s health. Yet, how to establish trust in culturally diverse communities is elusive for many researchers, practitioners, and agencies. The purpose of this qualitative study was to obtain perspectives of individuals working for a nongovernmental organization (NGO) about gaining community trust in Malawi in order to mitigate the impact of HIV/AIDS. Twenty-six interviews were conducted over 12 months. Content analysis revealed the relationship between NGO staff and the community is crucial to gaining community trust. Gender, social context, and religious factors influence the establishment of trust within the relationship, but NGO assumptions about the community can erode community trust. Nurses and other health professionals working with the NGOs can help create conditions to build trust in an ethically and culturally sensitive manner whereby communities can develop processes to address their own health concerns.

Building the nursing workforce in Malawi.

Helping a developing African country solve its nursing shortage.

Cracking the code: getting men tested in rural Africa.

The emphasis on women in the African AIDS epidemic has left men behind [1]. Although HIV disproportionately affects women in this context [2], they are more likely than men to come into contact with the healthcare system because of child bearing and rearing, and thus more likely to receive early HIV diagnosis and treatment, improving their treatment outcomes. In Malawi, the Option Bþ treatment policy has made dramatic gains for pregnant and breastfeeding women and their infants. Men do not have the same contact with and encouragement from the healthcare system; they get into care later and are disproportionately represented among AIDS deaths [3]. The ambitious UNAIDS 90–90–90 targets will not be met without concerted efforts to engage men [4].

Characterizing Pediatric Non–Malarial Fever and Identifying the At-Risk Child in Rural Malawi:

Objective. To characterize children with non–malarial fever at risk of nonrecovery or worsening in rural Malawi. Methods. This is a subgroup analysis of patients ≤14 years of age from a prospective cohort study in non–malarial fever subjects (temperature ≥37.5°C, or fever within 48 hours, and malaria negative) in southern Malawi cared for at a mobile clinic during the 2016 dry (August to September) or wet (November to December) season. Data collection included chart review and questionnaires; 14-day follow-up was conducted. We conducted univariate descriptive statistics on cohort characteristics, bivariate analyses to examine associations between characteristics and outcomes, and multivariate logistic regressions to explore factors associated with nonrecovery. Results. A total of 2893 patients were screened, 401 were enrolled, 286 of these were children, and 280 children completed follow-up. Eighty-seven percent reported symptom resolution, 12.9% reported no improvement, and there were no deaths or hospitalizations. No improvement was associated with dry season presentation (42.6% vs 75.0%, P < .0003), >2 days of symptoms (51.6% vs 72.2%, P = .03), and food insecurity (62.3% vs 86.1%, P = .007). Dry season subjects had a 4.35 times greater likelihood of nonimprovement (95% confidence interval [CI] = 1.96-11.11). Household food insecurity and being >2 hours from a permanent clinic were associated with no improvement (adjusted odds ratio [AOR] = 4.61, 95% CI = 1.81-14.29; and AOR = 2.38, 95% CI = 1.11-5.36, respectively). Conclusion. Outcomes were generally excellent in this rural, outpatient pediatric cohort, though risk factors for nonrecovery included food insecurity, access to a standing clinic, and seasonality. Ideally, this study will inform clinic- and policy-level changes aimed at ameliorating the modifiable risk factors in Malawi and throughout rural Africa.

How can male rates of HIV testing be increased? Recommendations from a mixed methods study in southern Malawi

Background In southern Malawi, 12.8% of adults are HIV positive. Men are less likely to have been tested than women. We investigated mens HIV knowledge and the attitudes, influencers, facilitators and barriers affecting HIV testing. Methods We conducted an explanatory mixed-methods study with analysis of secondary quantitative data from 425 rural men collected in January 2014 (time 1) and April 2015 (time 2) and qualitative interviews with 50 men in September 2015. All respondents lived in villages receiving HIV education and testing. Results Quantitative data revealed that comprehensive HIV knowledge increased and was associated with having been tested by time 2. Educational level was positively associated with having been tested. Mens reasons for not getting tested were fear of learning their HIV status, fear of rejection by partners and wives and fear of discrimination. Wives influenced mens opinions about healthcare. The qualitative results demonstrated that men feared being seen at test sites and feared discrimination. Wives had the greatest reported influence on male testing. Men perceived services as female-oriented and stigmatizing. They preferred door-to-door testing. Conclusions Providers can improve uptake by increasing mens HIV knowledge, leveraging the influence of spouses and offering door-to-door testing with male health workers.