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*24510$aClosing the Gap: Sufficient, Competent and Motivated Nurses and Midwives in Malawi 2019 to 2023$bNorad Collected Review
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*520  $aThe National Organization of Nurses and Midwives in Malawi (NOMN) has been supported by sustained investments from both Norad and the Norwegian Nurses Organization (NNO) since 2006. Now, NONM is the fastest growing union in Malawi (Danish Trade Union, Malawi Labour Market Survey 2022). The End-Term Evaluation examines progress towards the programme’s goal of “sufficient, competent and motivated nurses capable of addressing the population’s current and emerging health needs.” Despite natural disasters, political unrest, the Covid-19 pandemic, and the deteriorating macroeconomic environment, NONM is on track to meeting virtually all the targets in the results framework. Targets for membership, continued professional development and gender equality have all been exceeded. With dedicated and high-quality technical support from NNO, NONM has become an increasingly effective advocate and watchdog. NONM lobbied government to hire more nurses under the Global Fund and PEPFAR grants. It advocated for the provision of personal protective equipment (PPE) and increased risk allowances during the Covid-19 Pandemic. NONM has also been a passionate defender of nurses’ rights, never failing to speak out when nurses were subjected to harassment and violence. NONM is trusted by its membership of more than 6,500 nurses. As a representative organization, grounded at the grassroots level with sound systems of governance, NONM has the legitimacy to speak for nurses and patients and promote accountability. NONM therefore has an important role in protecting rights in the health sector and beyond. Despite the partnership’s commitment to disability inclusion and NONM’s capacity in inclusive health communication, targets for disability inclusion were not met in full. However, disability inclusion is an ambitious agenda that will require sustained investment in health, education, social welfare and governance in the medium term. The NNO/NONM partnership and advocacy efforts have contributed to higher level impacts within the health sector and society. With the recruitment of an additional 2,697 nurses’ vacancy rates have fallen contributing to improvements in care. With the investments in continued professional development (CPD), nurses are better able to respond to needs in sexual and reproductive health. Young female nurses are empowered and motivated to seek leadership positions and there has been steady progress in advancing gender equality. NONM is a trusted partner trying to promote evidence-based decision making and committed to better resource allocation in the health sector. Despite the progress, the gains are fragile. Malawi’s nurses remain underpaid and under-valued. The human resource constraint remains acute. While nurses are working double and triple shifts in an effort to make ends meet, 3,000 qualified nurses are unemployed. As the macroeconomic environment deteriorates and debt service obligations increase, the Malawi government cannot absorb more nurses within the public sector. Increasingly, the government is struggling to pay salaries for existing workers. Accelerating climate change suggests that there will be more disasters and pandemics in the future. The health sector is struggling to cope with the current needs. It is not prepared for future pandemics or disasters. This is not a lack of knowledge or political will, it is a lack of resources. We advance the following high-level recommendations to the Norwegian and Malawian audience: 1. Sustain the partnership between NNO and NONM. It is cost-effective and delivering impressive results. 2. NONM should decentralize membership recruitment to the shop stewards and strengthen decentralized structures. 3. NONM should continue to invest in strengthening systems for financial management and monitoring and evaluation. It should continue to innovate in its training programmes and CPD. 4. NONM should continue to strengthen its credibility as a trusted partner for the Ministry of Health, participate in all Technical Working Groups, and continue to protect nurses’ rights and speak out against violence. 5. Norad and NNO should increase funding for investments in disability inclusion and gender equality through a dedicated new programme. 6. There is need to move beyond disciplinary silos. Improving health outcomes, advancing gender equality and disability inclusion will require greater cross-sectoral collaboration. 7. Norad should increase funding to credible civil society organizations in Malawi including NONM who represent the needs of nurses who are the backbone of the health sector, and others who represent people living with disabilities. They have expertise that could be used to scale up the disability inclusion agenda in Malawi
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