Observation (CEACR) - adoptée 2025, publiée 114ème session CIT (2026)

Convention (n° 149) sur le personnel infirmier, 1977 - Malawi (Ratification: 1986)

Article 2 of the Convention. National policy concerning nursing services and nursing personnel. Consultation. The Government reports that the high disease burden continues to impact the country, citing the COVID-19 pandemic and the cholera outbreak from 2022 to 2023, which resulted in 58,979 cases and 1,768 deaths as of 5 August 2023. The Government also reports improvements in certain health indicators, such as a maternal mortality ratio of 349 per 100,000 live births, a neo-natal mortality ratio of 19 per 1,000 live births, and an infant mortality rate of 29 per 1,000 live births for 2019/2020. The Government further highlights the transition from the expired Health Sector Strategic Plan (HSSP) II (2017–22) to HSSP III (2023–30), which aims to guide the delivery of comprehensive, high-quality nursing and midwifery services for all Malawians. According to information available from the Ministry of Health of Malawi, several key reforms are being implemented to improve healthcare as part of HSSP III. These include transitioning to integrated care platforms, upgrading urban health centres, and enhancing equipment management. They aim to match workforce supply with demand, improve performance management, and develop a unified training system. Efforts are also focused on coordinating supply chains, scaling up electronic health records, and enhancing governance with unified planning and budgeting. Additionally, strategic purchasing of health services is being introduced. These reforms are designed to boost the efficiency, quality, and accessibility of healthcare services in Malawi. The Government further refers to a report titled Nursing and Midwifery Policy dated June 2018. The Committee notes that, according to information from UNICEF (2020), the country’s nursing sector was facing critical challenges which collectively impact the quality and accessibility of healthcare services in Malawi. An important challenge is the severe shortage of nurses, with a nurse-to-population ratio of about 1:2300. This shortage leads to high patient loads and directly impacts care quality. Limited training opportunities and poor retention rates worsen the workforce crisis, as many health workers seek better opportunities abroad. Additionally, the presence of parallel information systems and poor performance of routine health information systems hinder effective healthcare delivery. Underinvestment in the sector affects the availability of essential resources and infrastructure. The Committee considers that addressing these issues requires comprehensive strategies, including better training programmes, improved working conditions, and enhanced health information systems, in line with the policy vision promoted by the Convention. In the absence of the previously requested information in this respect, the Committee once again urges the Government to provide detailed, up-to-date data on the concrete measures taken under the National Health Policy, the Health Sector Strategic Plan II (2017–22) and its successor, phase III (2023–30), the Nursing and Midwifery Policy, and the Malawi German Health Programme. The Committee also requests information on the practical impact of these measures in delivering the quantity and quality of nursing care needed to achieve the highest possible health standards for the population. Specifically, the Government is asked to clarify whether it has periodically monitored and evaluated the implementation of these various strategic initiatives at the end of their respective terms to ensure that lessons learned are integrated into future policy iterations. Additionally, the Committee requests detailed information on the implementation and impact of measures aimed at improving employment conditions, career prospects, and remuneration for nursing personnel, with the goal of attracting and retaining professionals in the field.

The Committee is raising other matters in a request addressed directly to the Government.