Spotlight on Global Health Initiative Plus Countries: Malawi

Spotlight on Global Health Initiative Plus Countries: Malawi

The Global Health Initiative (GHI) and its approach of integrating health programs with HIV & AIDS, malaria, tuberculosis, maternal, newborn, and child health, nutrition, and family planning and reproductive health is in line with the current approaches and health priorities of the Government of Malawi.

Malawi, with a population of slightly over 13 million people, has 83% of its people living in the rural hard to reach, underserved areas. The biggest health challenge facing the country is access to basic health services by the rural population. The problem of access to health services is multifaceted. For instance, family planning services are mostly facility-based, contributing to a low Contraceptive Prevalence Rate of 28% and high unmet family planning need of 28% (Malawi Demographic and Health Survey, 2004).

However, there is also a critical shortage of trained health service providers and availability of contraceptives is a logistical nightmare in Malawi. Making a routine mix of all contraceptives accessible to women of reproductive age regularly in rural communities can avert unwanted pregnancies and maternal deaths, and reduce high total fertility rate and infant mortality rate. Rural people walk long distances to seek health services, sometimes only to return without a service due to shortage of health personnel and stock-out of supplies.

Policies have allowed for task shifting (a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers) to be piloted in a limited number of districts where communities can access limited but essential health services within their communities using non-medical staff. The Health Surveillance Assistants, who are the lowest group of health workers, and Community-Based Distribution Agents, who are selected by community leaders and trained using protocols developed by the Ministry of Health, are helping provide services in rural area.

Integrating community-based health activities has helped us reach the rural masses with critical health services such as: selected maternal and child health, family planning, HIV testing and counseling, and tuberculosis screening services at the community level.

Further, the Government of Malawi has also shown the commitment to improve the health of its population through making more resources available through the Sector-Wide Approach (bringing together donors, the government and other stakeholders to focus on the operating procedures instead of specific services). The Government is providing its staff to train non-medical community based personnel and advocating for increased budget allocation to the health sector. Through such initiatives, Malawi has made strides in reducing maternal mortality rate from 1120 in 2000 to 984/100,000 in 2004 and 807 in 2006. Infant mortality rate has decreased from 133 to 72 per 1000 live births in 2004 and HIV prevalence from 14% to 12%.

These integrated community-based health initiatives provided by non-medical staff and volunteers have proved successful and significantly contribute to achieving Millennium Development Goal targets. This approach provides a continuum of care from community to health facility level.

However, the Government of Malawi has not been able to scale-up the initiatives to the entire country due to financial constraints.  The GHI support in Malawi is seen as coming at the right time when there is a strong Government commitment and the communities’ willingness to participate in improving the health and well-being of Malawians living in the hard to reach underserved rural communities.

Mexon Nyirongo is Chief of Party for the USAID-funded Community-Based Family Planning and HIV/AIDS Services Project in Malawi managed by MSH.