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Malawi Health for all that never came |
HEALTH
A decade ago, the World Health Organisation declared: «Health for all by
the Year 2000».
This was a wonderful vision but an unfulfilled vision as
far as Malawi is concerned.
The fact is — the health situation of Malawi’s
people is far worse than before WHO‘s declaration
Health is one of the major priority areas of the Government under its policy of poverty reduction. Increased productivity can only be realised by a healthy nation.
However, the current situation as demonstrated by key statistics is appalling. Malaria, malnutrition, intestinal infections are endemic, whilst HIV/AIDS and Tuberculosis prevalence is extremely high. Maternal mortality is also very high due to: The high fertility rate; a large percentage of high-risk pregnancies; poor quality of obstetric services at all care-levels; an underdeveloped referral structure.
Statistics
According to the results of Malawi’s 1998 Integrated Household Survey Analysis, poverty is estimated to affect 64% of the total population (Malawi’s population is about 10 million). Other indicative statistics are: 54.8% of households and 43.7% of the country’s urban population are described as being «poor». The country is divided into three administrative regions namely South, Central and North. The Southern Region has the largest proportion of the poor at 48.3%, followed by the Central Region at 40.8%, the Northern Region at 10.8%. Per capita income is low, estimated at US $180. Life expectancy is one of the lowest in Africa and is estimated at 41 years. There are indications that life expectancy at birth is going down and one of the probable reasons for this could be the high HIV/AIDS prevalence.
High population density estimated at 105 persons per square kilometre, high illiteracy rate at 45%, and a high HIV/AIDS prevalence rate which is estimated to be affecting 15% of the population, make the situation appear much more gloomy. Nearly 60% of households face a food insecurity situation and 49% of children under five are stunted. Only 37% of Malawians have access to safe drinking water within a distance of less than 0.5km. Malawi is also faced with the problem of rapid environmental degradation and high unemployment. These statistics only compound the problem of health in Malawi.
Health services continue to decline
The general level of the quality of health services and internal efficiency continues to decline due to a number of factors. Key among these are: Chronic deficiencies in quantity and quality of technical and support personnel in all key cadres for health service delivery; inadequate and inconsistent supply of drugs and other medical supplies at all levels of the health delivery system; inadequate or lack of basic medical equipment; deterioration of the physical conditions of health facilities; and lack of basic amenities such as electricity and water.
Alick Phiri, a 27 year-old primary school teacher says: «Looking at it from the point of view of a local villager, Malawi’s health situation in Malawi is poor. It is below standard. There is lack of provision of safe water. Health facilities in the rural areas are there in name only. They are not functioning. There are no medicines. And even if medicines were to be provided, they would find their way to the street vendors».
Michael Kaiyatsa, a 25 year-old Pharmacy Attendant at Likuni Hospital run by the Catholic Diocese of Lilongwe says: «Malawi’s health policy is not poor-friendly. The health system is supposed to serve the needs of the people and the majority of the people in Malawi are poor. They cannot afford essential medicines like antibiotics, analgesics, etc. We are told health services are free to people in government hospitals. But what we are seeing is that there are no drugs in government hospitals. So patients are given prescriptions and are told to go and look for medicines in the commercial pharmacies and other private hospitals and private clinics. Due to high prices for the drugs in commercial pharmacies and private hospitals and clinics. People can’t get hold of medicines and are suffering as a result».
Hospital beds are filled with HIV/AIDS patients
The decline in the quality of health care has also been compounded by the HIV/AIDS pandemic, with related opportunistic diseases accounting for about 70% of in-patient admissions. These have significantly consumed available resources due to patients prolonged stay in hospitals and the complexity of medical care requirements. All these factors have greatly limited the range and quality of services provided.
Here are some HIV/AIDS-related statistics. More than one mission people in Malawi are HIV-positive. The United Nations reports that HIV/AIDS caused 70,000 deaths in 1999 alone, has created 400,000 orphans since the first case was noted in 1984, has reduced life expectancy from 47 years for a baby born in the mid-1980s, to 36 years for a baby born now, and has, at the present time, infected 16% of the adult population.
There is extreme overcrowding in all public hospitals in Malawi. Patients not only fill every bed, they sleep on the floor. Nurses are scarce. Only the most basic drugs are in stock. And sometimes, there is no doctor at night. For instance, at Lilongwe Central Hospital in Central Malawi, the situation in the children’s ward is pathetic. Go inside and what do you see? Patients having to sleep close together with more patients on the floor. The mattresses are bare, there are no sheets, no blankets, no pillows.
Malawi has an acute shortage of nurses. In an interview with The Nation newspaper, the Controller of Nursing Services, Lillian Ng’oma says: «There are very few nurses in the country. It will take us many years, maybe up to 50 years to have enough nurses in our hospitals». The Children’s Ward at Lilongwe Central Hospital is supposed to have 4 nurses on duty, but in most cases it has two and during weekends there is only one nurse on duty.
Currently, there are approximately 6,000 nurses in the country. About half this number are classified as civil servants and earn a salary that even officials in the health sector admit is meagre, considering the number of hours they work and the conditions under which they operate. Random interviews in Lilongwe indicated that most government nurses earn less than US $50 a month — which doesn’t encourage them to stay in the profession.
Private clinics
Private clinics and hospitals have been in existence for a long time but current practice leaves a lot to be desired. In some there are no toilets, no drug dispensing areas, and generally speaking, a lack of a clean environment. The licensing procedure is also questionable. The law stipulates that only doctors, clinical officers and medical assistants can operate private clinics. Nurses cannot operate private clinics themselves and can only register such establishments if they have a qualified medical assistant, clinical officer or doctor in a senior position.
While not many people have access to health institutions in the country, if you want to open and operate a private clinic then distance does not seem to matter. For instance, In the Likuni area in the Central District of Lilongwe, 9 km from Lilongwe, there are 4 health institutions. There is a referral hospital run by the Catholic Church and three private clinics within a distance of 2 km from each other. «Provision of health services is no longer a service but a business. By having the clinics close to each other, you introduce competition», a nurse working for a Government referral Central hospital in Lilongwe, who chose to remain anonymous said.
Private clinics are said to be well stocked with medical supplies which are not available in public hospitals. The danger is, patients are given more medicines than necessary because there’s money to be made! Sometimes people are provided with wrong drugs just to show that they (private clinics) are functioning. Poor staffing is part of the private clinics’ game. In many cases, only the owner of the clinic is qualified and the support staff is unqualified.
The way forward
The task of improving health services in Malawi seems daunting. The Government’s overall policy goal in the health sector is to ensure that all Malawians remain in good health. According to the National Health Plan (1999-2004), a number of policy measures and strategies have been formulated to achieve this goal. These measures include: Expanding the range and quality of health services focused on maternal health and children under the age of five years; increasing access to basic health care facilities and services; increasing, retaining and improving the quality of trained human resource and distributing them efficiently and equitably; providing quality health care services in all health facilities; strengthening, expanding and integrating relevant health services; strengthening collaboration and partnerships amongst the health sector; and increasing the availability and allocation of overall resources to the health sector.
However, despite the shift in resources from tertiary health care (central hospitals) to secondary (district hospitals) and primary (local health centres and clinics) levels, expenditure on tertiary levels remain high. In order to reduce the burden of tertiary care and to encourage the use of primary and secondary facilities, proposals have been made to introduce cost recovery measures in central hospitals.
But if Malawi’s economic situation doesn’t improve, how can it possibly solve its health care problem? The country is currently facing high inflation, high interest rates, unstable exchange rates, high unemployment, and a high unsustainable debt.The health structure needs a complete overhaul, complete restructuring, and corruption within the health service needs to be addressed urgently. And the Government’s health policy needs revamping.
But faced with a huge debt burden what chance is there for Malawi’s citizens to have better health?
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