Royal College of Nurses Scotland joins Norwegian Malawian nursing partnership

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1 Royal College of Nurses Scotland joins Norwegian Malawian nursing partnership The Norwegian Nurses Organisation (NNO) has partnered with the National Nursing Association of Nurses and Midwives of Malawi (NONM). The main partnership goal is to strengthen the Malawi Nurses Organisation and support HIV infected and affected nurses and other health care workers. Since partnership began in 2005 the Malawi Nurses Organisation has grown to become the largest health profession organisation in Malawi, with over members. The people (and nurses) of Malawi face enormous health care challenges. Scotland has a long history of helping meet these needs. The Royal College of Nurses Scotland wants to help out and we welcome them as new partners in the ongoing Norwegian Malawian nursing partnership. NNO is the first nursing organisation (in recent history) to give a helping hand to its beleaguered sister organisation in Malawi. Collaboration began in Prior to this the Malawi Nurses Organisation (NONM) had less than 50 members. It was paralysed by the enormous challenges in the country: overwhelming medical problems; 17 % of the population infected with HIV/AIDS; a national economy largely dependent on foreign donors; and a massive exodus of nurses and other health care workers to greener pastures abroad. Since partnership commenced our sister organisation and colleagues in Malawi have worked tirelessly to rebuild their organisation, thereby placing them in a position where they can work to improve living and working conditions for nurses and also provide quality health care to the people of Malawi. Much has been accomplished in a short period of time. With financial support from NNO and Norad, NONM has rented and equipped offices, hired key personnel, and initiated a series of organisational changes aimed at transforming NONM into a vibrant, sustainable CSO (Civil Society Organisation). At its Annual General Meeting in November 2006 NONM adopted a new constitution enabling it to become a trade union. Previously, NONM functioned only as a professional Malawi nurses at Mzimba hospital in Northern Malawi. The nurse to the right (in blue uniform) is the District Nursing Officer, responsible for nursing services in one of the country s 31 districts. association without the legal right to negotiate salary and working conditions for its members. As a combined professional association and trade union NONM will now be responsible for professional issues and ollective bargaining for over nurses in Malawi, making it the largest health profession trade union in Malawi. In addition to the organisational changes mentioned above, activities are also being carried out to provide support to HIV-positive infected and affected nurses and other health care workers. Workshops providing updated information about symptoms, testing, counselling and treatment are being carried out. Local support groups are being formed and provided with seed money to start income generating activities, from which profits will be used to provide support to needy nurses or other health care workers.

2 A spirit of renewed hope and optimism has been created among many of the nurses. Other health care professionals are turning to NONM, hoping to find professional support. This latest development can position NONM as one of the leading health care worker organisations in Malawi. Enormous Challenges Malawi is plagued by serious health care challenges. Many professionals describe the situation as an Emergency Condition. Malawi has one of the highest maternal mortality rates in the world. The mortality rate for children under five years of age is also extreme. 17 % of the country s population is HIV-positive. An increasing incidence of resistant malaria and tuberculosis is noted. One million orphans places an enormous burden on health care services and the general population. Mother and child at Likoma Island Health Care Centre in Lake Malawi. The island s 10,000 inhabitants are serviced 24/7 by four nurses and one technical doctor. Emergency treatment on the mainland is only available through boat transport that comes once a week. A lack of qualified health care workers has seriously udermined the quality of health care services being provided. It is not unusual to find one nurse in charge of a ward with upwards of 100 patients, some requiring comprehensive care. In a country with 12 million inhabitants, some 200 medical doctors remain. The exodus of medical doctors from Malawi has been so extensive that some larger cities in the United Kingdom have more Malawian doctors working in them than those left in the entire country of Malawi. It is against this critcal backdrop that the Nurses Organisation of Malawi is striving to retain and empower their remaining nurses. It is critcal to work towards rebuilding a feeling of confidence and support among the nurses in Malawi. International conventions ensure freedom of movement for nurses and other health care workers. Attempting to put in place restrictions to prevent nurses from leaving the country will ultimately fail. The sole recourse to retaining nurses is by implementing a series of positive interventions aimed at encouraging them to remain. A national strategic plan for nurse recruitment and retention should be considered. Such a plan should address key issues: Appropriate number of nurses, with proper skill mix Appropriate number of student nurses Public Health Nursing Career progression scheme, with clinical specialist plan Salary Structure Scheme, including Terms & Conditions Safe Working Environment

3 Recruitment, Retention and International Exchange Plan Loan & Mortgage Scheme National health care authorities, the National Organisation of Nurses and Midwives of Malawi, other Malawian health care workers and international partners should join forces in developing middle to long-term strategic interventions with workable solutions to turn around the current Emergency Situation. The National Nurses Organisation of Nurses and Midwives of Malawi must be a main collaborative partner with government officials and international partners in the formulation of such a plan. It is within this complicated setting that the Norwegian Nurses Organisation (NNO) has been allowed to play a key role, in partnership with the NONM. NNO is therefore pleased to welcome the Royal College of Nurses Scotland on board as a new partner. Royal College of Nurses Scotland NNO has been working with the Malawian nurses for over two years. Much has been accomplished in a short period of time, but even more remains to be done. A new sense of hope and optimism has been kindled among many of the nurses. But with so many challenges facing them, there is a need for additional international partners. The Royal College of Nurses (RCN) contacted the Norwegian Nurses Organisation last year, looking to provide some support to our colleagues in Malawi. RCN has a long history of international collaboration, but never before in Malawi. Scotland has a long history of contact with and support to Malawi, dating back to the mid 1800 s when Scottish doctors/missionaries brought the Holy Bible and basic health care services to the country. RCN, with its 30,000 members, is keen on helping out in Malawi and wishes to add their support to the current Norwegian Malawian nursing partnership. Scottish colleagues together with Malawian children on Likoma Island.

4 Joint Visit Representatives from both the Norwegian and Scottish Nursing Organisations visited Malawi in a joint visit January 13 th to 23 rd. The main purpose was to introduce Scottish colleagues to our Malawian partners and to give them insight into conditions in Malawi, both general and health care related. During this 10-day visit our Scottish colleagues took part in a HIV/AIDS workshop, arranged by NONM with financial support from NNO, met with key people in the Ministry of Health, visited several health care institutions and travelled north in the country to visit district services. The high point of the visit was a five-hour boat ride crossing Lake Malawi to visit nurses and other health care workers on the tiny Likoma Island. This joint visit gave everyone enough time to get to know one other, to discuss conditions and challenges, to develop a common understanding and to lay a foundation for future cooperation. The RCN representatives returned to Scotland with a clearer vision of the role they might play in helping our colleagues in Malawi. Their immediate task will be to garner support for activities in Malawi and to spread information to their members, so that they can effectively join the Norwegian Malawian nursing partnership. The Road Ahead March 13 th will witness a return visit by Norwegian and Malawian nursing representatives to Edinburgh, Scotland. The main purpose will be to meet with representatives of the Scottish Royal College of Nurses, attend a gathering of Scottish nurses and learn more about the Scottish health care system, especially relating to their work with HIV/AIDS. This visit will be one more step towards an effective three-country partnership in Malawi. It is also of interest to note that the Norwegian Nurses Organisation, as part of its strategic support to nurses in Malawi, has helped secure financial support for nurses from the Malawi National AIDS Commission. This support enables the Malawi Nurses Organisation to arrange additional HIV/AIDS workshops. The International Council of Nurses (ICN) is also actively involved in Malawi. Several Mobile Book Libraries have been donated to the nurses of Malawi. ICN has also brokered a contract with an American company (Proctor & Gamble) providing funds to run a Safe Water Project providing clean water to 700 orphans at four orphanages and 500 community health nurses. NNO s representative (leaning on car) together with Scottish and Malawian colleagues prior to their journey to northern areas of Malawi.

5 These positive developments have taken place since the start of the Norwegian - Malawian partnership. And although NNO s efforts have been important, it is nonetheless the tireless efforts of our Malawian colleagues that have proven decisive in creating these victories. The road ahead is long and full of obstacles. This spirit of renewed hope and optimism among our Malawian colleagues augers well for future developments. The Norwegian Nurses Organisation is committed to a long-term partnership, realizing the scope of the challenges facing our Malawian colleagues. Continued support from Norad and the Norwegian Embassy in Malawi is vital. We are pleased to welcome the nurses of Scotland along as new members of this exciting partnership.