Direct Request (CEACR) - adopted 2025, published 114th ILC session (2026)

Nursing Personnel Convention, 1977 (No. 149) - Malawi (Ratification: 1986)

Community health nursing. The Government reports progress in reducing the vacancy rate for nursing and midwifery personnel from 63 per cent in 2018 to 50 per cent in 2022, with the current rate standing at 52 per cent. A functional review conducted in 2020 established 15,000 posts for nursing and midwifery personnel, including specialists at the bedside. However, the impact of this review is yet to be assessed, as its implementation began in July 2023 for central hospitals. The Government also highlights that specialized nursing and midwifery courses at Kamuzu University of Health Sciences have helped fill existing specialized vacancies. Under the decentralization policy, priority is given to individuals with nursing and midwifery skills when deploying leaders at the district or council level, with 93.1 per cent of these leaders possessing such skills, including 18.5 per cent who are specialists in midwifery and reproductive health. The Committee notes the Government’s ongoing efforts to develop and review nursing and midwifery standards to ensure quality care, alongside periodic assessments of care provision and staffing data to inform evidence-based recruitment decisions. Additionally, the Ministry of Health is developing specific conditions of service for healthcare workers to attract more professionals to the field. The Committee requests the Government to provide detailed updated information on the effective implementation, monitoring and impact of the measures adopted in the framework of the National Community Health Strategy 2017–22 (now covering also the relevant period of phase III for 2023–2030) and the 2018 Nursing and Midwifery Policy with regard to nursing services and nursing personnel, including nurses, midwives and community health workers.

Mental health nurses. The Committee notes that the Government’s recent functional review has created posts for senior psychiatric nurses at the referral Mental Health Hospital (Zomba), and this has been replicated in the local councils for mental health and psychiatric nurses. The Government indicates that the database for the Nurses and Midwives Council of Malawi (NCMC) has 217 psychiatric nurse technicians, out of which 107 are below 60 years and 50 psychiatric and mental health nursing officers are all below 60 years. The Committee requests the Government to keep providing updated detailed information on the measures taken or envisaged to ensure the quantity and quality of mental health nursing care necessary for attaining the highest possible level of health for the population.

Article 2(2)(a) and (3). Nursing education and training. The Government indicates that Continuous Professional Development (CPD) is a prerequisite to performance appraisal and renewal of licenses to practice at Nurses and Midwives Council. The Government indicates that there is a CPD platform for all healthcare workers, including nurses and midwives, which is managed by the Quality Management Directorate (QMD). The Committee notes that the platform is still being upgraded so that the lessons uploaded are more interactive. The Government reports that the Ministry of Health, in collaboration with the Nurses and Midwives Council and other stakeholders, carry out accreditation and monitoring and supervision of teaching institutions to ensure quality nursing and midwifery education. The Government further reports that there is continuous capacity-building of teaching staff in both teaching institutions and hospitals on emerging issues in health, followed by periodic reviews of syllabi and curricula to incorporate emerging trends in health. The Government highlights that the participation of nursing and midwifery staff in professional associations such as the East Central and Southern African College of Nursing and Midwifery (ESCACONM), the International Council of Nurses (ICN) and the International Confederation of Midwives (ICM) contribute to enhancing performance and career development. The Committee requests the Government to keep providing updated detailed information on the nature, implementation, monitoring and impact of the measures adopted to ensure that nursing personnel, including midwives, are provided with quality education and training appropriate to the exercise of their functions as well as to their professional career development.

Article 5(2). Determination of conditions of employment and work. The Committee notes with concern that the Government once more indicates that the collective bargaining agreement for the nursing sector has still not been concluded. The Government indicates, however, that three collective bargaining agreements are being prepared with the Ministry of Health, the private hospital owners, and the Christian Health Association of Malawi. The Committee reiterates its requests to the Government to continue to provide information on the status of the collective bargaining process and progress made in this regard, as well as to transmit a copy of any collective agreements concluded for the nursing sector.

Article 7. Occupational safety and health. The Committee notes that the provision of personal protective equipment (PPE) was constantly available with the help of the Government’s partners during the COVID-19 pandemic to all healthcare workers, including nurses and midwives. The Committee notes that during the time of the pandemic, duty rosters were modified to limit the number of hours of exposure by dividing them into teams, starting with a 4-hour shift when the pandemic was at its peak and then slowly increasing to a 6-hour shift in busy health facilities. The Government indicates that in order to ensure safety, the Ministry of Health has provided cholera, hepatitis B, and COVID-19 vaccines to all health workers, including nurses and midwives. The Government further explains that to ensure that healthcare workers, including nurses and midwives, are taken care of when they are sick or affected, the Ministry of Health developed a Care of Carer Policy (2020) to be disseminated in central and district hospitals. The Committee requests the Government to continue to provide detailed updated information on the safety measures being taken or that are envisaged with a view to protecting the health and well-being of nurses in performing their duties.

Part V of the report form. Application in practice. The Committee notes that, according to the WHO Global Health Observatory, the total number of nursing and midwifery personnel in Malawi increased from 7,957 in 2018 to 13,564 in 2020. The Committee notes that, when reporting the number of health workers per cadre per facility, the Government reported that the total number amounted to 5,388 health workers. The Committee notes the information provided by the Government on the number of health workers per cadre per facility by age group, the number of health workers per cadre by sex, and the institutions that provide healthcare services in terms of student enrolment. The Committee reiterates its observation that personnel shortage in the healthcare sector places a heavy burden on those nursing and midwifery professionals who are in employment. The Committee reiterates its requests to the Government to provide updated detailed information on the application of the Convention in practice, including statistical data disaggregated by sex, age and region concerning the ratio of nursing personnel to the population; the number of persons enrolled in nursing schools; the number of female and male nurses who enter and leave the profession each year; the organization and the operation of all institutions which provide healthcare services; as well as official studies, surveys and reports addressing health workforce issues in the Malawi health sector.