THET

Malawi

malawi Health services in Malawi are delivered both by the government and the Christian Health Association of Malawi (CHAM), which provides 37% of the total health services and serves as a liaison between the churches and government health authorities.

The health system is decentralised with different District Health Offices being in charge of the distribution of resources within their districts.
The main health challenges are the high level of HIV (14.1% prevalence), high infant mortality rates (125 per 1,000 live births) and a chronic shortage of health workers (0.02 doctors and 0.60 nurses per 1,000 people).
There are four central (referral) hospitals located in Mzuzu, Lilongwe, Blantyre and Zomba which support the smaller District Hospitals.

The Health Sector Wide Approach (SWAp) joint programme of work, of which DFID is a key partner, aims to coordinate donor efforts towards sustained improvements in quality and access to health systems. In 2004 an emergency human resource programme was initiated to start the scaling up of training of health workers and support plans to improve retention. The Malawi government has developed an Essential Health Package which highlights priority areas.

THET in Malawi
Links are long-term institutional partnerships between NHS Trusts, UK academic and research institutions and their counterparts overseas. THET works to help broker and support the development of Links that respond to the needs and demands of local health institutions. THET’s work in Malawi started in 1999 through involvement with two Links: the Middlesborough-Lilongwe Link and Zomba Mental Hospital-Harrogate Link. THET supported the work of these Links through a grant from the National Lottery and helped the development of a number of wider programmes through the Links. Through involvement with the College of Medicine, THET was instrumental in re-establishing the Orthopaedic Clinical Officer training programme in 1998.

How THET is helping
THET encourages Links to focus on work that supports the implementation of Malawi’s national and district plans – particularly human resource development plans. To further enhance the support and coordination for Links in Malawi THET currently has a part-time Link Coordinator based in Lilongwe.

As well as supporting Health Links we support a number of projects in the country to strengthen health services. We also liaise with the Scottish Government, which is supporting much work in Malawi.

There are ten Links registered on THET’s database although one of these, the Scotland-Malawi Partnership, is itself composed of many initiatives (for details of the Links see www.thet.org.uk and select Malawi in the Links Search section). THET supports these Links through advice, networking and occasional funding programmes. In March and November 2008 meetings were held for Links in Malawi, to discuss how Links with UK partners could be utilized to feed into existing needs. In April 2008 a meeting was held for their UK counterparts in Glasgow, to enable Links to network and to see how their work can be aligned more effectively with the national strategy. Links in Malawi tend to focus their work within three main areas – trauma and surgery, maternal and child health, mental health and epilepsy.

What has been achieved

Encouraged partners in the UK and Malawi to think strategically about how to align work with national priorities and to respond to existing training needs.
Supported the training of 72 Orthopaedic Clinical Officers (OCOs). Now based at the Central and District Hospitals they are making a massive contribution to the care of trauma patients around Malawi – a country with only two orthopaedic surgeons. Without them, patients with any bone or cartilage injuries would have to be referred to the Central hospitals.
Helped establish epilepsy clinics at the four Central hospitals which now treat almost 2,000 patients a year. THET has also helped raise awareness of epilepsy in Malawi. Supported doctors and clinical officers from the Central Hospitals to train health workers at a district level on a short trauma course so that they are better prepared in emergencies.
Supported the evaluation of Links’ work.

Further programme has included:

Strengthening Health Services for People with Epilepsy (2007-2008) – This project aims to increase awareness of and access to treatment for epilepsy by supporting the decentralisation of epilepsy services in Malawi. The project supports local nurses, trained through a Link, to share knowledge with health workers at the central and district hospitals. Workshops focus on how to diagnose and treat patients with epilepsy, so that patients receive better local treatment. Why epilepsy? The prevalence of epilepsy is often high in developing countries as a result of greater exposure to risk factors such as trauma, birth problems and malaria. Although a common condition, it remains very stigmatised and often hidden. Children with the condition may be expelled from school and segregated within the family. Nationally epilepsy is a low priority within a tight health budget. However, it is an area in which there is great need, and so by working with committed nurses and clinical officers in Malawi THET has been able to help raise the profile of epilepsy in the country and ensure that many people with epilepsy can access affordable and appropriate treatment.

Strengthening Trauma and Emergency Services (2007-2008) – Malawi has a very high rate of road traffic accidents. THET is supporting the work of doctors and clinical officer who are training other frontline health workers in basic trauma and life support skills to ensure that they are fully equipped to respond in such emergencies. In the period between April and September 2007 five courses took place, which provided training for 87 health workers. The cost of training each health worker is less than £14 per person trained. Once trained these medical assistants, clinical officers, nurses and doctors have the skills necessary to ensure that a patient stabilises so they have a better chance of survival.