- Malawi is a small landlocked country in south east Africa. Population of approx 12 million, 50% under 15 years of age. 1 million orphans due to prevalence of HIV/AIDS.
- 10th poorest country in the world. (World Health Org).
- 80% of Malawians are subsistence farmers living in rural areas.
- 57% of rural population have access to safe water. Less than 30% have access to latrines (Water Aid 2007)
Malawi is in southeast central Africa bordered by Tanzania to the north, Zambia to the west and Mozambique to the east. Lake Malawi, the 3rd largest fresh water lake in Africa, occupies approximately one fifth of the land mass. The capital city, Lilongwe is in central Malawi and has a population of approximately 400,000.
Malawi ranks among the world's most densely populated and least developed countries . The economy is predominately agricultural. Agriculture accounts for more than one-third of GDP and 90% of export revenues. The performance of the tobacco sector is key to short-term growth as tobacco accounts for more than half of exports. The economy depends on extensive support from The World Bank, the IMF and donations from individual nations.
Formerly the British Protectorate of Nyasaland, Malawi achieved independence in 1964. It became a democratic multiparty system in 1995 when Dr Bakili Mulusi was elected. In 2004 Bingu wa Mutharika came to power in the general election under the United Democratic Front (UDF).
The government faces many challenges, including developing a market economy, improving educational facilities, facing up to environmental problems, dealing with the rapidly growing problem of HIV/AIDS, and satisfying foreign donors that fiscal discipline is being tightened. In 2005, President MUTHARIKA championed an anticorruption campaign.
Since 2005 President MUTHARIKA'S government has exhibited improved financial discipline under the guidance of Finance Minister Goodall GONDWE and signed a three year Poverty Reduction and Growth Facility worth $56 million with the IMF. Improved relations with the IMF lead other international donors to resume aid as well.
As president, MUTHARIKA has overseen substantial economic improvement but Population growth, increasing pressure on agricultural lands, corruption, and the spread of HIV/AIDS pose major problems for Malawi.
Malawi is well organized to deal with food crises but over one fifth of the population are not yet able to meet minimum daily food needs. Great support is needed for the Government in making key agricultural markets work for the poor: much improvement is needed for provision of basic services (including health and HIV and AIDS education, social protection and water development).
14% of population BETWEEN 15 TO 49 YEARS OLD IS HIV positive. Life expectancy 39 yrs (W.H.O)
FACTORS contributing to spread of HIV transmission
Increased number of marriages without knowing HIV status.
Lack of community awareness and involvement in HIV prevention & mitigation
Inadequate resources for HIV prevention & mitigation
HIV infected mothers transmitting to their children during pregnancy, labour , delivery & lactation
Increased premarital & extra marital sex
Harmful cultural practises
Deliveries by unskilled personnel
The number of people on Antiretroviral therapy, which effectively delays the onset of AIDS in people living with HIV, has greatly increased. In 2003 a national strategy was launched to prevent mother to child transmission of HIV (PMTCT). Under this 5 year AIDS treatment plan, access to the drug nevirapene has significantly reduced the chances of pregnant women passing the infection to their new born child.
However there are still thousands of people in need of these drugs who are not receiving them. Distribution is hampered by the low number of health care workers available to administer them and there is an urgent need for more training of healthcare personnel , particularly in the rural areas. Lack of transport means many people cannot reach the clinics and rural hospitals and this remains a major problem.
SHORTAGE OF MEDICAL PERSONNEL
1 doctor for every 100,000 people, the lowest figure for any country covered by the UN’s Human Development report.
Rural Hospitals & Health Centres have no surgeons and no doctors. They have nurses, Medical Assistants and Clinical Officers.
District Hospitals may have 1 doctor carrying out basic surgery.
A qualified nurse earns approx £35.00 pm. A doctor £150.00 pm.
The College of Medicine in the Republic of Malawi: Feb 15 2007
Malawi has a critical human resources problem, particularly in the health sector. There is a severe shortage of doctors: there are only a few medical specialists. The College of Medicine , COM, is the only medical school and was founded in 1991. For senior staff it depends heavily on expatriates.
The government run hospital system in Malawi is designed in a three-tiered network of interlocking medical facilities. The third tier is a large network of rural hospitals woven throughout the country. They serve as the first line of defense in the war against disease. Their services are free and they are often the only medical facility that many village people will see in their lifetimes. Most medical cases enter the system through the rural hospital nearest their home.
There are almost no doctors and few nurses at any of the rural hospitals. Although many facilities have antiquated surgical equipment, there are no surgeons on staff to carry out even minor surgery, so these units remain out of service. Supplies to the rural hospitals are often not available.
The overall system is designed to fill the needs of the top tier first, then to the second tier and finally to the rural hospitals on the third tier. The problem comes when there are only enough supplies for the top tier, and few for the other levels. When this happens the third tier receives no supplies at all. This can mean between supply shipments, a typical rural hospital may have nothing on its shelves, not even a band-aid or an aspirin. When its supplies run out the word spreads quickly through the catchment area, and the village people stop coming to the hospitals. Births, deaths and other illnesses are handled in the villages and disease spreads without any safeguards.
According to the government plan when a medical case is too critical for the rural hospital to handle, the system calls for the patient to be transferred to the district hospital. These facilities are centrally located in each of Malawi’s 27 districts. This plan calls for the district hospitals to perform more involved surgery and handle the more difficult cases, but there are no surgeons, no doctors and few nurses even at the district level. Here, as with the situation at the rural level, the supplies run short. The system that is designed to feed from the top fails when there is not enough medicine or resources for even the top tier of the medical establishment.
The top tier is designed for patients to be referred to facilities that have more advanced technology, resources, medicine and medical personnel. Also when problems cannot be resolved at either of the two lower levels. These top tier hospitals are in the major urban areas. However, as with the other two tiers the shortage of supplies and medical personnel is overwhelming and fails to fill the needs. Few nurses and fewer doctors are even at the top tier in order to assist with a growing influx of HIV/AIDS, tuberculosis, malaria, childbirth, accident cases and a multitude of other medical needs for a nation of 12,000,000 people. Even at the top tier, as with the other two, the equipment is broken and in need of repair or even non-existent, the medical staff personnel works long hours with little protection from exposure to disease, and the supplies and medicines that are required to save lives are often not available.
For the entire nation and for all three tiers of medical care there are registered less than 100 doctors and 3,000 nurses. The problem is compounded with the fact that nearly half of the graduating doctors and nurses from the Malawi Medical School system leave the country to practice.
Clinical officers (COs).
Human Resources for Health 14 June 2007
“Clinical Officers perform much of major surgery in Malawi, in the absence of medical officers , doctors and surgeons. They perform most emergency gynaecological surgical interventions such as caesarean sections, subtotal and total hysterectomies, repair of uterine rupture and tubal ligation.etc. They constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians.
Maternal & infant deaths:
1,120 mothers and 4,200 babies die for every 100,000 live births: 44% of all deliveries are outside healthcare facilities. (Malawi Health Foundation Consortium 2007). In the UK the figure is 5.1 per 100,000 (mothers)
Even among developing countries, Malawi has one of the highest death rates during childbirth. Recent Figures from the Malawi Demographic and Health Survey show that 1,120 mothers and 4,200 babies die for every 100,000 live births. Furthermore nearly half of all deliveries occur outside of healthcare facilities, making it difficult to provide timely and effective treatment when complications occur.
In March 2006. the Health Foundation launched a three year programme dedicated to improving the quality of healthcare for mothers and babies in Malawi.
The programme has two strands. The first involves improving standards of maternity care inside hospitals. The second is to provide support directly to village communities, empowering and educating local people to improve care for pregnant women and newborn babies.
Adult literacy: 63% : males 79%: females 52% : 20% of children from ages 6-13 are out of school. (University of Malawi 2006)
The quality of education needs to be raised at all levels. Class sizes of over 100 pupils are normal; enrolment rates have risen but completion rates are one of the worst in Africa. Gender disparity is marked at secondary and tertiary levels. Many children, who are either orphaned or whose parents are HIV positive and too sick to work in the fields, drop out of school in order to take care of their siblings and work on the family land to provide food.
Education statistics in Malawi are grim. In 1994, the Government of Malawi (GOM) abolished school fees for primary education, resulting in an increase in primary school enrollment from 1.9 million pupils to 3.2 million and an average pupil-teacher ratio of 72. High repetition and dropout rates (17% and 22%, respectively), low completion rates (60% of primary students drop out before completing grade 8) and poor overall school quality (80% cannot meet reading and math minimal standards) illustrate the severity of the educational crisis. 22% of primary school teachers have little or no formal training. HIV/AIDS has significantly contributed to a 6% annual teacher attrition rate, exacerbating the shortage of trained teachers. The literacy rate is 63%.
In 19 African countries, the ratio of children completing primary school is 50% or lower, meaning that at least every second child does not complete primary school
- A very high percentage of primary pupils in Malawi drop out of school without attaining functional literacy skills. After six months in Standard One, the majority of learners still cannot read or write even one word. This is partly due to many primary school teachers having only rudimentary training, coupled with the average primary class exceeding one hundred students. There are not enough girls attending secondary and tertiary education.
www.fco.gov.uk Foreign and Commonwealth Office
www.who.int/en/ World Health Organization